{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:10:28Z","timestamp":1790194228582,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Medicine Fo\u010da","award":["01-3-36"],"award-info":[{"award-number":["01-3-36"]}]},{"name":"Faculty of Medicine Fo\u010da","award":["01-3-353"],"award-info":[{"award-number":["01-3-353"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Urinary tract infections, as one of the most common infectious diseases, contribute substantially to the global healthcare burden, particularly due to the rising prevalence of resistant bacterial strains such as Klebsiella pneumoniae. Background\/Objectives: The aim was to investigate the prevalence of urinary tract infection pathogens among hospitalized patients at Saint Apostol Luka Hospital in Doboj during the period 2021\u20132023. Methods: This retrospective cross-sectional study was conducted at Saint Apostol Luka Hospital, Doboj, Republic of Srpska, Bosnia and Herzegovina. Data from the Department of Microbiology were analyzed for the period 2021\u20132023, including patients with positive urine cultures (\u2265103 CFU\/mL) of a single uropathogen. Bacterial identification and susceptibility testing were performed according to EUCAST standards, and statistical analysis was carried out using SPSS v24. Results: Escherichia coli was the most frequent isolate (29.2%), followed by Klebsiella spp. (24.2%) and Enterococcus spp. (19.8%). A significant rise in K. pneumoniae prevalence and resistance to multiple antibiotics\u2014including \u03b2-lactams, carbapenems, aminoglycosides, and colistin\u2014was observed during the study period. Conclusions: This study revealed that E. coli and Klebsiella spp. were the leading uropathogens, with notable differences in distribution by sex, age, and hospital department. A marked rise in multidrug resistance, particularly among K. pneumoniae, was observed across the study period. These findings underscore the urgent need for continuous surveillance and stronger antimicrobial stewardship to curb resistance trends.<\/jats:p>","DOI":"10.3390\/antibiotics14121234","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:21:43Z","timestamp":1765182103000},"page":"1234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Rising Prevalence of Multidrug-Resistant Klebsiella spp. in Urinary Tract Infections: A Study from Doboj Hospital"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-4352","authenticated-orcid":false,"given":"Dragana","family":"Drakul","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"},{"name":"Centre for Biomedical Research, Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3794-2539","authenticated-orcid":false,"given":"Bojan","family":"Joksimovi\u0107","sequence":"additional","affiliation":[{"name":"Centre for Biomedical Research, Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"},{"name":"Department of Preclinical Subjects (Pathophisiology), Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1741-0025","authenticated-orcid":false,"given":"Ana V.","family":"Pej\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radica","family":"\u017divkovi\u0107-Zari\u0107","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sini\u0161a","family":"Mari\u0107","sequence":"additional","affiliation":[{"name":"Bolnica \u201cSveti Apostol Luka\u201d, 74000 Doboj, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2985-4523","authenticated-orcid":false,"given":"Biljana","family":"Mijovi\u0107","sequence":"additional","affiliation":[{"name":"Dapartment of Epidemiology, Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Ivanovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragana","family":"Erbez","sequence":"additional","affiliation":[{"name":"Bolnica \u201cSveti Apostol Luka\u201d, 74000 Doboj, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5745-8448","authenticated-orcid":false,"given":"Dragana","family":"Sokolovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"},{"name":"Centre for Biomedical Research, Faculty of Medicine Fo\u010da, University of East Sarajevo, 73300 Fo\u010da, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5106","DOI":"10.1128\/IAI.00376-06","article-title":"Uropathogenic Escherichia coli induces extrinsic and intrinsic cascades to initiate urothelial apoptosis","volume":"74","author":"Klumpp","year":"2006","journal-title":"Infect. Immun."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3309","DOI":"10.1128\/IAI.00470-13","article-title":"Immunization with the yersiniabactin receptor, FyuA, protects against pyelonephritis in a murine model of urinary tract infection","volume":"81","author":"Brumbaugh","year":"2013","journal-title":"Infect. Immun."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5s","DOI":"10.1016\/S0002-9343(02)01054-9","article-title":"Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs","volume":"113","author":"Foxman","year":"2002","journal-title":"Am. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1038\/nrurol.2010.190","article-title":"The epidemiology of urinary tract infection","volume":"7","author":"Foxman","year":"2010","journal-title":"Nat. Rev. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1365-2362.2008.01986.x","article-title":"Mechanisms and consequences of bladder cell invasion by uropathogenic Escherichia coli","volume":"38","author":"Dhakal","year":"2008","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Seifu, W.D., and Gebissa, A.D. (2018). Prevalence and antibiotic susceptibility of Uropathogens from cases of urinary tract infections (UTI) in Shashemene referral hospital, Ethiopia. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-017-2911-x"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sujith, S., Solomon, A.P., and Rayappan, J.B.B. (2024). Comprehensive insights into UTIs: From pathophysiology to precision diagnosis and management. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1402941"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3001","DOI":"10.1093\/jac\/dks298","article-title":"Sales of veterinary antibacterial agents in nine European countries during 2005-09: Trends and patterns","volume":"67","author":"Grave","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"96","DOI":"10.5173\/ceju.2015.01.474","article-title":"Urinary tract infections and Candida albicans","volume":"68","author":"Behzadi","year":"2015","journal-title":"Cent. Eur. J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Delcaru, C., Alexandru, I., Podgoreanu, P., Grosu, M., Stavropoulos, E., Chifiriuc, M.C., and Lazar, V. (2016). Microbial Biofilms in Urinary Tract Infections and Prostatitis: Etiology, Pathogenicity, and Combating strategies. Pathogens, 5.","DOI":"10.3390\/pathogens5040065"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/S1473-3099(09)70054-4","article-title":"The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria","volume":"9","author":"Nordmann","year":"2009","journal-title":"Lancet Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1590\/0037-8682-0021-2014","article-title":"Investigation of class 1 integrons in Klebsiella pneumoniae clinical and microbiota isolates belonging to different phylogenetic groups in Recife, State of Pernambuco","volume":"47","author":"Lima","year":"2014","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Borcan, A.M., Rotaru, E., Radu, G., Costea, E.L., Borcan, C.A., Olariu, M.-C., and Simoiu, M. (2025). Resistance Trends in Klebsiella pneumoniae Strains Isolated from Bloodstream Infections in a Tertiary Care Hospital over a Period of 7 Years. Microorganisms, 13.","DOI":"10.3390\/microorganisms13112451"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Shein, A.M.S., Hongsing, P., Abe, S., Luk-In, S., Ragupathi, N.K.D., Wannigama, D.L., and Chatsuwan, T. (2021). Will There Ever Be Cure for Chronic, Life-Changing Colistin-Resistant Klebsiella pneumoniae in Urinary Tract Infection?. Front. Med., 8.","DOI":"10.3389\/fmed.2021.806849"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"341","DOI":"10.3390\/antibiotics3030341","article-title":"Uncomplicated Urinary Tract Infections and Antibiotic Resistance-Epidemiological and Mechanistic Aspects","volume":"3","author":"Wiedemann","year":"2014","journal-title":"Antibiotics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s10096-024-04835-6","article-title":"Epidemiology and antimicrobial resistance patterns of bacterial meningitis among hospitalized patients at a tertiary care hospital in Saudi Arabia: A six-year retrospective study","volume":"43","author":"Alhazmi","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Li, S., Yu, S., Peng, M., Qin, J., Xu, C., Qian, J., He, M., and Zhou, P. (2021). Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: A retrospective analysis of 135 cases. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06325-y"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9965334","DOI":"10.1155\/2022\/9965334","article-title":"Transdermal Administration of Volatile Oil from Citrus aurantium-Rhizoma Atractylodis Macrocephalae Alleviates Constipation in Rats by Altering Host Metabolome and Intestinal Microbiota Composition","volume":"2022","author":"Wang","year":"2022","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Mare\u0219, C., Petca, R.-C., Popescu, R.-I., Petca, A., Mul\u021bescu, R., Bulai, C.A., Ene, C.V., Geavlete, P.A., Geavlete, B.F., and Jinga, V. (2024). Update on Urinary Tract Infection Antibiotic Resistance-A Retrospective Study in Females in Conjunction with Clinical Data. Life, 14.","DOI":"10.3390\/life14010106"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Jitpratoom, P., and Boonyasiri, A. (2023). Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke. BMC Neurol., 23.","DOI":"10.1186\/s12883-023-03296-2"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/668770","article-title":"Antimicrobial-resistant pathogens associated with healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009\u20132010","volume":"34","author":"Sievert","year":"2013","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Isikgoz Tasbakan, M., Durusoy, R., Pullukcu, H., Sipahi, O.R., and Ulusoy, S. (2013). Hospital-acquired urinary tract infection point prevalence in Turkey: Differences in risk factors among patient groups. Ann. Clin. Microbiol. Antimicrob., 12.","DOI":"10.1186\/1476-0711-12-31"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1056\/NEJMoa1306801","article-title":"Multistate point-prevalence survey of health care-associated infections","volume":"370","author":"Magill","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"349597","DOI":"10.1100\/2012\/349597","article-title":"Gender and age-dependent etiology of community-acquired urinary tract infections","volume":"2012","author":"Magliano","year":"2012","journal-title":"Sci. World J."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Trze\u015bniewska-Ofiara, Z., Mendrycka, M., Cudo, A., Szmulik, M., and Wo\u017aniak-Kosek, A. (2022). Hospital Urinary Tract Infections in Healthcare Units on the Example of Mazovian Specialist Hospital Ltd. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.891796"},{"key":"ref_26","unstructured":"World Health Organization (2022). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report, World Health Organization."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1017\/S0950268820003015","article-title":"Extended-spectrum beta-lactamase Escherichia coli and Klebsiella pneumoniae urinary tract infections","volume":"149","author":"Vachvanichsanong","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.7883\/yoken.JJID.2023.009","article-title":"Extensively Drug-Resistant Klebsiella pneumoniae Associated with Complicated Urinary Tract Infection in Northern India","volume":"77","author":"Kaza","year":"2024","journal-title":"Jpn J. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Neelambike Sumana, M., Maheshwarappa, Y.D., Kalyani, G., Mahale, R.P., Sowmya, G.S., Raghavendra Rao, M., Shankaregowda, R., Chitaragi, V.B., Deepashree, R., and Murthy, N.S. (2025). A retrospective study of the antimicrobial susceptibility patterns of Klebsiella pneumoniae isolated from urine samples over a decade in South India. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1553943"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Waterlow, N.R., Cooper, B.S., Robotham, J.V., and Knight, G.M. (2024). Antimicrobial resistance prevalence in bloodstream infection in 29 European countries by age and sex: An observational study. PLoS Med., 21.","DOI":"10.1371\/journal.pmed.1004301"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"613","DOI":"10.2147\/IDR.S499804","article-title":"Prevailing Antibiotic Resistance Patterns in Hospitalized Patients with Urinary Tract Infections in a Vietnamese Teaching Hospital (2014\u20132021)","volume":"18","author":"Le","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"475","DOI":"10.2147\/IDR.S295870","article-title":"Resistance Trends of Klebsiella pneumoniae Causing Urinary Tract Infections in Chongqing, 2011\u20132019","volume":"14","author":"Ding","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Clegg, S., and Murphy, C.N. (2016). Epidemiology and Virulence of Klebsiella pneumoniae. Microbiol. Spectr., 4.","DOI":"10.1128\/microbiolspec.UTI-0005-2012"},{"key":"ref_34","unstructured":"WHO (2024). Surveillance of Antimicrobial Resistance in Europe, 2023 Data: Executive Summary, European Centre for Disease Prevention and Control."},{"key":"ref_35","unstructured":"WHO (2025). Global Antibiotic Resistance Surveillance Report 2025. Global Antimicrobial Resistance and Use Surveillance System (GLASS), WHO."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1556\/030.2024.02230","article-title":"Carbapenem-resistant Klebsiella pneumoniae in the Balkans: Clonal distribution and associated resistance determinants","volume":"71","author":"Chatzidimitriou","year":"2024","journal-title":"Acta Microbiol. Immunol. Hung."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Karampatakis, T., Tsergouli, K., and Behzadi, P. (2023). Carbapenem-Resistant Klebsiella pneumoniae: Virulence Factors, Molecular Epidemiology and Latest Updates in Treatment Options. Antibiotics, 12.","DOI":"10.3390\/antibiotics12020234"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Dong, N., Yang, X., Chan, E.W., Zhang, R., and Chen, S. (2022). Klebsiella species: Taxonomy, hypervirulence and multidrug resistance. EBioMedicine, 79.","DOI":"10.1016\/j.ebiom.2022.103998"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Gentile, B., Grottola, A., Orlando, G., Serpini, G.F., Venturelli, C., Meschiari, M., Anselmo, A., Fillo, S., Fortunato, A., and Lista, F. (2020). A Retrospective Whole-Genome Sequencing Analysis of Carbapenem and Colistin-Resistant Klebsiella Pneumoniae Nosocomial Strains Isolated during an MDR Surveillance Program. Antibiotics, 9.","DOI":"10.3390\/antibiotics9050246"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/12\/1234\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:50:45Z","timestamp":1765183845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/12\/1234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,7]]},"references-count":39,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["antibiotics14121234"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14121234","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,7]]}}}