Urinary Tract Infections Caused by Extended-Spectrum Beta-Lactamase-Producing and Carbapenem-Resistant Enterobacterales in Saudi Arabia: Impact of Catheterization

<i>Background and Objectives</i>: Catheter-associated urinary tract infections (CAUTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing and carbapenem-resistant Enterobacterales (CRE) significantly contribute to global rates of UTI. This study aimed to compare the prevalence and trends of ESBL-producing Enterobacterales and CRE in patients with CAUTIs and non-CAUTIs. <i>Materials and Methods</i>: A retrospective review of 4262 UTI-positive urine cultures was conducted at King Fahad Hospital of the University, Al Khobar, Saudi Arabia (January 2022-November 2023). Demographic, clinical, and microbiological data were obtained from hospital records. Antimicrobial susceptibility was tested using the Vitek^® System; ESBL and CRE were identified using Ezy MIC™ strips and Xpert^® Carba-R assay, respectively. <i>Results</i>: ESBL-producing Enterobacterales accounted for 11.3% of cases; CRE comprised 1.8%. ESBL was significantly more prevalent in non-catheterized patients and those in emergency care. CRE was significantly associated with catheterized patients and inpatient settings. <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> were the predominant ESBL-producing and CRE isolates, respectively. <i>bla-OXA-48</i> was the most frequently detected carbapenemase gene (66.7%). ESBL was prevalent in younger, non-catheterized females, suggesting increasing community transmission. Conversely, CRE were primarily observed in older, catheterized inpatients, emphasizing the role of invasive devices in resistance spread. <i>Conclusions</i>: These findings highlight the importance of targeted infection control and early catheter removal to mitigate resistance trends.