{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T14:22:44Z","timestamp":1792765364861,"version":"4.5.0"},"reference-count":43,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Urinary tract infections (UTIs) represent one of the most frequent bacterial infections worldwide, with Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) as the predominant uropathogens. The emergence of extended-spectrum \u03b2-lactamase (ESBL)-producing Enterobacterales has severely limited treatment options, making regional surveillance crucial. This study aimed to determine the prevalence of uropathogens, assess antimicrobial resistance patterns, and evaluate the burden of ESBL-producing organisms among patients presenting with suspected UTIs in a tertiary care hospital in Riyadh. We conducted a retrospective analysis of 19,556 urine cultures from a tertiary care hospital in Riyadh, Saudi Arabia, between January and December 2024. Of these, 2629 (13.4%) cultures showed significant bacterial growth, predominantly in females (83.2%) and in the 16\u201330 year age group. E. coli accounted for 65.9% of isolates, followed by K. pneumoniae (16.8%). ESBL production was detected in 28.5% of E. coli and Klebsiella isolates. ESBL producers exhibited complete resistance to third-generation cephalosporins and \u03b2-lactam\/\u03b2-lactamase inhibitor combinations, whereas carbapenems, aminoglycosides, and fosfomycin maintained high efficacy. Resistance to ciprofloxacin and co-trimoxazole was widespread in both ESBL and non-ESBL isolates. Additionally, vancomycin-resistant enterococci (7%), methicillin-resistant Staphylococcus aureus (2%), and carbapenem-resistant Enterobacterales (0.9%) were found. These findings highlight the escalating burden of ESBL-associated UTIs and underscore the urgent need for strengthened antimicrobial stewardship, continuous surveillance, and optimized empirical therapy to mitigate the impact of multidrug-resistant uropathogens in clinical practice.<\/jats:p>","DOI":"10.3390\/pathogens14121254","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:17:36Z","timestamp":1765185456000},"page":"1254","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Epidemiology and Antimicrobial Resistance of Uropathogens in a Tertiary Care Center in Riyadh, Saudi Arabia: A One-Year Retrospective Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8975-0205","authenticated-orcid":false,"given":"Fizza","family":"Khalid","sequence":"first","affiliation":[{"name":"Department of Microbiology, MDLab Dr. Sulaiman Al Habib Medical Group, Riyadh 11325, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael Jumah","family":"Aljohani","sequence":"additional","affiliation":[{"name":"Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh 14255, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeel","family":"Akram","sequence":"additional","affiliation":[{"name":"Department of Molecular and Genetics, MDLab Dr. Sulaiman Al Habib Medical Group, Riyadh 11325, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Bukhari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, Dr. Sulaiman Al Habib Medical Group, Riyadh 14212, Saudi Arabia"},{"name":"Internal Medicine Department, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6641-4044","authenticated-orcid":false,"given":"Osamah T.","family":"Khojah","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia"},{"name":"Laboratory Department, Chief Medical Officer Office, Dr. Sulaiman Al Habib Medical Group, Riyadh 11643, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary tract infections: Epidemiology, mechanisms of infection and treatment options","volume":"13","author":"Walker","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1310\/sci2503-228","article-title":"Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection","volume":"25","author":"Hreha","year":"2019","journal-title":"Top. Spinal Cord. Inj. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1756287219832172","DOI":"10.1177\/1756287219832172","article-title":"An introduction to the epidemiology and burden of urinary tract infections","volume":"11","author":"Medina","year":"2019","journal-title":"Ther. Adv. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.eururo.2024.03.035","article-title":"European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines","volume":"86","author":"Kranz","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"403","DOI":"10.33073\/pjm-2019-048","article-title":"Antibiotic Resistance Among Uropathogenic Escherichia coli","volume":"68","author":"KOT","year":"2019","journal-title":"Pol. J. Microbiol."},{"key":"ref_6","first-page":"e280922209238","article-title":"Resistance Pattern in Mostly Gram-negative Bacteria Causing Urinary Tract Infections","volume":"22","author":"Alotaibi","year":"2022","journal-title":"Infect. Disord.-Drug Targets"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1007\/s40121-023-00799-w","article-title":"A Narrative Review of Healthcare-Associated Gram-Negative Infections Among Pediatric Patients in Middle Eastern Countries","volume":"12","author":"Alghounaim","year":"2023","journal-title":"Infect. Dis. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Dashti, A.A., and Jadaon, M.M. (2025). Extended-Spectrum Beta-Lactamases (ESBLs) Gene Mutations in Kuwait: How Much Do We Know? Not Much!. Bacteria, 4.","DOI":"10.20944\/preprints202502.0727.v1"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Alghamdi, S.A.A., Mir, S.S., Alghamdi, F.S., Al Banghali, M.A.M.M.A., and Almalki, S.S.R. (2023). Evaluation of Extended-Spectrum Beta-Lactamase Resistance in Uropathogenic Escherichia coli Isolates from Urinary Tract Infection Patients in Al-Baha, Saudi Arabia. Microorganisms, 11.","DOI":"10.3390\/microorganisms11122820"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.jiph.2019.12.001","article-title":"ESBL expression and antibiotic resistance patterns in a hospital in Saudi Arabia: Do healthcare staff have the whole picture?","volume":"13","author":"Aldrazi","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"275","DOI":"10.12669\/pjms.41.1.3379","article-title":"Emergence of Extended spectrum \u03b2-lactamase (ESBL) and carbapenemase producing Escherichia coli (E. coli) in mid-stream urine cultures of patients presenting in outpatient department of tertiary care hospital with uncomplicated cystitis (2016-2022): A retrospective analysis of Laboratory data","volume":"41","author":"Shafquat","year":"2025","journal-title":"Pak. J. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"386","DOI":"10.30699\/ijp.2021.521669.2556","article-title":"Molecular Characterization of Antibiotic Resistance Associated with TEM and CTX-M ESBL in Uropathogenic E. coli Strains Isolated from Outpatients","volume":"16","author":"Farzi","year":"2021","journal-title":"Iran. J. Pathol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vance, M.K., Cretella, D.A., Ward, L.M., Vijayvargiya, P., Garrigos, Z.E., and Wingler, M.J.B. (2023). Risk Factors for Bloodstream Infections Due to ESBL-Producing Escherichia coli, Klebsiella spp., and Proteus mirabilis. Pharmacy, 11.","DOI":"10.3390\/pharmacy11020074"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1093\/jac\/dkx146","article-title":"Global epidemiology of CTX-M \u03b2-lactamases: Temporal and geographical shifts in genotype","volume":"72","author":"Bevan","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"dlac113","DOI":"10.1093\/jacamr\/dlac113","article-title":"Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy","volume":"4","author":"Labi","year":"2022","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1128\/CMR.00068-15","article-title":"Fosfomycin","volume":"29","author":"Falagas","year":"2016","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/cid\/ciw243","article-title":"Ceftazidime\/Avibactam and Ceftolozane\/Tazobactam: Second-generation \u03b2-Lactam\/\u03b2-Lactamase Inhibitor Combinations","volume":"63","author":"Bonomo","year":"2016","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_18","first-page":"e35140","article-title":"Isolation of Staphylococcus aureus Urinary Tract Infections at a Community-Based Healthcare Center in Riyadh","volume":"15","author":"Alshomrani","year":"2023","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wingler, M.J., Patel, N.R., King, S.T., Wagner, J.L., Barber, K.E., and Stover, K.R. (2021). Linezolid for the Treatment of Urinary Tract Infections Caused by Vancomycin-Resistant Enterococci. Pharmacy, 9.","DOI":"10.3390\/pharmacy9040175"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"He, Y., Zhao, J., Wang, L., Han, C., Yan, R., Zhu, P., Qian, T., Yu, S., Zhu, X., and He, W. (2025). Epidemiological trends and predictions of urinary tract infections in the global burden of disease study 2021. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-89240-5"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Almutawif, Y.A., and Eid, H.M.A. (2023). Prevalence and antimicrobial susceptibility pattern of bacterial uropathogens among adult patients in Madinah, Saudi Arabia. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08578-1"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2147\/IDR.S299846","article-title":"Antimicrobial Surveillance for Bacterial Uropathogens in Ha\u2019il, Saudi Arabia: A Five-Year Multicenter Retrospective Study","volume":"14","author":"Bazaid","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mohapatra, S., Panigrahy, R., Tak, V., V., S., K. C., S., Chaudhuri, S., Pundir, S., Kocher, D., Gautam, H., and Sood, S. (2022). Prevalence and resistance pattern of uropathogens from community settings of different regions: An experience from India. Access Microbiol., 4.","DOI":"10.1099\/acmi.0.000321"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Folliero, V., Caputo, P., Della Rocca, M.T., Chianese, A., Galdiero, M., Iovene, M.R., Hay, C., Franci, G., and Galdiero, M. (2020). Prevalence and Antimicrobial Susceptibility Patterns of Bacterial Pathogens in Urinary Tract Infections in University Hospital of Campania \u201cLuigi Vanvitelli\u201d between 2017 and 2018. Antibiotics, 9.","DOI":"10.3390\/antibiotics9050215"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Odoki, M., Almustapha Aliero, A., Tibyangye, J., Nyabayo Maniga, J., Wampande, E., Drago Kato, C., Agwu, E., and Bazira, J. (2019). Prevalence of Bacterial Urinary Tract Infections and Associated Factors among Patients Attending Hospitals in Bushenyi District, Uganda. Int. J. Microbiol., 2019.","DOI":"10.1155\/2019\/4246780"},{"key":"ref_26","first-page":"40","article-title":"Urinary tract infection in women","volume":"20","author":"Czajkowski","year":"2021","journal-title":"Prz. Menopauzalny"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/1756287218814382","article-title":"Risk factors and predisposing conditions for urinary tract infection","volume":"11","author":"Storme","year":"2019","journal-title":"Ther. Adv. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Whelan, S., Lucey, B., and Finn, K. (2023). Uropathogenic Escherichia coli (UPEC)-Associated Urinary Tract Infections: The Molecular Basis for Challenges to Effective Treatment. Microorganisms, 11.","DOI":"10.3390\/microorganisms11092169"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Al-Zahrani, J., Al Dossari, K., Gabr, A.H., Ahmed, A., Al Shahrani, S.A., and Al-Ghamdi, S. (2019). Antimicrobial resistance patterns of Uropathogens isolated from adult women with acute uncomplicated cystitis. BMC Microbiol., 19.","DOI":"10.1186\/s12866-019-1612-6"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Muteeb, G., Rehman, M.T., Shahwan, M., and Aatif, M. (2023). Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals, 16.","DOI":"10.20944\/preprints202306.1921.v1"},{"key":"ref_31","first-page":"111589","article-title":"Extended-spectrum beta-lactamase-producing bacteria in a tertiary care hospital in Madrid: Epidemiology, risk factors and antimicrobial susceptibility patterns","volume":"5","author":"Garcia","year":"2012","journal-title":"Emerg. Health Threat. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13756-018-0309-1","article-title":"Prevalence of extended-spectrum-\u03b2-lactamase-producing Enterobacteriaceae: First systematic meta-analysis report from Pakistan","volume":"7","author":"Abrar","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_33","unstructured":"(2025, November 27). Frontiers|Prevalence and Genetic Characterization of Clinically Relevant Extended-Spectrum \u03b2-Lactamase-Producing Enterobacterales in the Gulf Cooperation Council Countries. Available online: https:\/\/www.frontiersin.org\/journals\/antibiotics\/articles\/10.3389\/frabi.2023.1177954\/full?utm_source=chatgpt.com."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Alyamani, E.J., Khiyami, A.M., Booq, R.Y., Majrashi, M.A., Bahwerth, F.S., and Rechkina, E. (2017). The occurrence of ESBL-producing Escherichia coli carrying aminoglycoside resistance genes in urinary tract infections in Saudi Arabia. Ann. Clin. Microbiol. Antimicrob., 16.","DOI":"10.1186\/s12941-016-0177-6"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3855\/jidc.9517","article-title":"Antimicrobial susceptibility of microorganisms causing Urinary Tract Infections in Saudi Arabia","volume":"12","author":"Balkhi","year":"2018","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_36","first-page":"1178633720909798","article-title":"Extended-Spectrum \u03b2-Lactamase-Producing Escherichia coli and Klebsiella Species in Pediatric Patients Visiting International Friendship Children\u2019s Hospital, Kathmandu, Nepal","volume":"13","author":"Kayastha","year":"2020","journal-title":"Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Alqasim, A., Abu Jaffal, A., and Alyousef, A.A. (2018). Prevalence of Multidrug Resistance and Extended-Spectrum \u03b2-Lactamase Carriage of Clinical Uropathogenic Escherichia coli Isolates in Riyadh, Saudi Arabia. Int. J. Microbiol., 2018.","DOI":"10.1155\/2018\/3026851"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Abalkhail, A., AlYami, A.S., Alrashedi, S.F., Almushayqih, K.M., Alslamah, T., Alsalamah, Y.A., and Elbehiry, A. (2022). The Prevalence of Multidrug-Resistant Escherichia coli Producing ESBL among Male and Female Patients with Urinary Tract Infections in Riyadh Region, Saudi Arabia. Healthcare, 10.","DOI":"10.3390\/healthcare10091778"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"78","DOI":"10.15171\/jrip.2019.15","article-title":"Prevalence and antibiotic resistance pattern of extended spectrum beta lactamase producing Escherichia coli isolated from urinary tract infection","volume":"8","author":"Rajabnia","year":"2018","journal-title":"J. Ren. Inj. Prev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.2147\/IDR.S160720","article-title":"The prevalence of plasmid-mediated quinolone resistance and ESBL-production in Enterobacteriaceae isolated from urinary tract infections","volume":"11","author":"Azargun","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1093\/infdis\/jiw282","article-title":"The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace","volume":"215","author":"Logan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e00079-17","DOI":"10.1128\/CMR.00079-17","article-title":"Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae","volume":"31","author":"Machuca","year":"2018","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2147\/IDR.S54125","article-title":"Vancomycin-resistant enterococcal infections: Epidemiology, clinical manifestations, and optimal management","volume":"8","author":"Crank","year":"2015","journal-title":"Infect. Drug Resist."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/12\/1254\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:34:23Z","timestamp":1765186463000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/12\/1254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":43,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["pathogens14121254"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14121254","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}