Antimicrobial Susceptibility Trends in Uropathogens: A 6-Year Retrospective Study from Kerala, India

Introduction: Antimicrobial resistance (AMR) among uropathogens is a critical global public health challenge, potentially exacerbated by the COVID-19 pandemic. This study evaluates the pandemic’s impact on antimicrobial susceptibility trends among uropathogens at a tertiary care center in Kerala over six years (2018–2023). Methods: A retrospective analysis of 4,461 uropathogen isolates was conducted using data from laboratory records. Data were analyzed using IBM SPSS Statistics version 20, with Chi-square tests for associations. Results: Escherichia coli was the predominant pathogen (57.4%), followed by Klebsiella pneumoniae (14.3%) and Enterococcus spp. (6.0%). Other common isolates included Pseudomonas aeruginosa (4.2%) and Acinetobacter baumannii (3.3%), and fungi (6.8%). E. coli susceptibility to ampicillin increased significantly from 3.4% in 2018 to 13.9% in 2023 (P< 0.001), though overall resistance remained high; while susceptibility to cefoperazone-sulbactam and piperacillin-tazobactam declined (P< 0.001). K. pneumoniae susceptibility to cefoperazone-sulbactam decreased from 88.7% in 2018 to 73.0% in 2023 (P< 0.001). Enterococcus spp. susceptibility to nitrofurantoin declined from 91.0% in 2018 to 67.4% in 2023 (P = 0.017). A. baumannii showed increased ceftazidime susceptibility from 18.4% in 2018 to 56.0% in 2022, followed by a decline to 27.8% in 2023 (P = 0.015). P. aeruginosa exhibited increased susceptibility to gentamicin (57.6% to 77.2%; P = 0.012), ceftazidime (61.6% to 77.2%; P = 0.043), and fluoroquinolones (53.9% to 68.1%; P = 0.019) from 2018 to 2023. Conclusion: This study highlights dynamic shifts in antimicrobial susceptibility patterns among uropathogens, underscoring the need for continuous surveillance to guide empirical therapy and infection control strategies. Further research is warranted to explore contributing factors, including pandemic-related practices.