Динаміка антибіотикорезистентності Escherichia coli при інфекціях сечовивідних шляхів: 20-річний аналіз та перспективи подолання

The objective: to investigate the dynamics of antimicrobial susceptibility changes in Escherichia coli (E. coli) from upper and lower urinary tract (UT) and assess the current level of antibiotic resistance for optimization of UT infection (UTI) therapy. Materials and methods. Archival material from microbiological studies from 2004 to 2024 was analyzed based on examination data from 7,230 patients with inflammation of the upper and lower UT. Of these patients, causative agents were identified in 2,686 (37.15%); and E. coli was isolated from 1,535 (57.14%) of these patients, and its antibiotic susceptibility profile was established. Susceptibility determination was performed using the disc-diffusion method according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) and CLSI (Clinical and Laboratory Standards Institute) recommendations. Statistical data processing was performed using Microsoft Excel 2019. Results. E. coli remained the dominant UTI pathogen throughout the observation period (45% of all isolated microorganisms), but its relative proportion decreased slightly from 56% in 2004 to 50% in 2024 (χ2 = 9.8, p < 0.01). Meanwhile, the proportion of Klebsiella pneumoniae significantly increased from 4% in 2004 to 25% in 2024 (χ2 = 156.4, p < 0.001). Among E. coli strains, 69.9% were susceptible to antibiotics, 22.7% were resistant, and 7.4% were intermediate. Resistance increased from 26.1% in 2004 to 38% in 2020 (χ2 = 32.7, p < 0.001), with a decrease to 15.1% in 2024 (χ2 = 89.2, p < 0.001). The highest resistance was observed to tetracyclines (49%), β-lactam antibiotics (30.4%), and fluoroquinolones (28.1%). Aminoglycosides maintained the highest efficacy (resistance 20.4%). Among cephalosporins, ceftizoxime was most effective (resistance 8%, susceptibility 90.7%), while cephalexin was least effective (resistance 33.3%, susceptibility 48.9%). Conclusions. The study revealed an alarming trend of increasing E. coli resistance to major antibiotic classes, especially II–III generation cephalosporins. These data justify the need for continuous monitoring of UTI pathogen susceptibility, development of new antibiotic therapy strategies, and implementation of alternative treatment methods to overcome antibiotic resistance.