{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:36:09Z","timestamp":1791855369801,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:00:00Z","timestamp":1768003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Urinary tract infections (UTIs) represent a major cause of morbidity among adult women, with a disproportionate burden among postmenopausal patients. Limited data exist from Eastern Europe regarding pathogen distribution, antimicrobial resistance, and treatment patterns in hospitalized women. We conducted a retrospective cohort study of 948 adult female patients hospitalized with symptomatic UTIs between January 2021 and December 2023 in a Romanian multidisciplinary hospital. Demographic, clinical, and microbiological parameters were analyzed. Pathogen identification was performed by MALDI-TOF MS, and antimicrobial susceptibility testing followed EUCAST 2024 standards. Empiric treatment strategies and subsequent therapy modifications were assessed. Postmenopausal women accounted for 78.4% of cases and exhibited higher rates of recurrent UTIs, frailty, diabetes, urinary catheterization, and prior antibiotic exposure. Escherichia coli remained the predominant pathogen (52.6%), followed by Klebsiella spp. (18.4%) and Enterococcus spp. (12.1%). ESBL-producing organisms were found in 21.4% of E. coli and 38.7% of Klebsiella isolates. Pathogen distribution differed by age: younger women had a higher proportion of E. coli, whereas postmenopausal women showed a relative increase in opportunistic\/healthcare-associated pathogens, particularly Klebsiella spp. and Enterococcus spp., consistent with higher catheter exposure and comorbidity burden. Carbapenem resistance was rare but present in a small subset of Klebsiella isolates with phenotypes compatible with OXA-48-like carbapenemase production. Empiric therapy most frequently included ceftriaxone or fluoroquinolones, but 27.8% of regimens required adjustment after susceptibility results. Independent predictors of prolonged hospitalization included age &gt; 65 years, recurrent UTI, MDR infection, urinary catheterization, and delayed targeted therapy. UTIs among hospitalized adult women\u2014especially postmenopausal patients\u2014are strongly influenced by comorbidity burden and antimicrobial resistance. Local resistance patterns highlight the need for evidence-based empiric treatment and rapid therapy optimization. Strengthening stewardship and preventive interventions in elderly women is essential.<\/jats:p>","DOI":"10.3390\/microorganisms14010157","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:30:34Z","timestamp":1768203034000},"page":"157","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictors of Multidrug-Resistant Urinary Tract Infections in Women: A Large Retrospective Cohort Study in a Romanian University Hospital"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8818-9539","authenticated-orcid":false,"given":"Corina-Ioana","family":"Anton","sequence":"first","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd., 050474 Bucharest, Romania"},{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"},{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2508-2551","authenticated-orcid":false,"given":"Cristian Sorin","family":"Sima","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"},{"name":"Department of Urology, \u201cProf. Dr. Theodor Burghele\u201d Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0218tefan","family":"Ion","sequence":"additional","affiliation":[{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"},{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7632-5328","authenticated-orcid":false,"given":"Viorel","family":"Jinga","sequence":"additional","affiliation":[{"name":"Department of Urology, \u201cProf. Dr. Theodor Burghele\u201d Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania"},{"name":"Medical Sciences Section, Academy of Romanian Scientists, 050085 Bucharest, Romania"},{"name":"Department of Urology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: A systematic analysis with forecasts to 2050","volume":"404","author":"Naghavi","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.cmi.2021.11.025","article-title":"European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine)","volume":"28","author":"Paul","year":"2022","journal-title":"Clin. 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