Antimicrobial Resistance in Urinary Tract Infections Among Patients with and Without Renal Comorbidities: A Retrospective Study from Al-Baha, Saudi Arabia

Urinary tract infections are among the most common bacterial infections worldwide, with increasing antimicrobial resistance posing a significant public health challenge. This study aimed to determine the demographic distribution, antimicrobial susceptibility patterns of uropathogens, and the clinical implications of UTIs in patients with renal comorbidities in the Al-Baha region of Saudi Arabia. A retrospective, cross-sectional study was conducted at King Fahad Hospital, Al-Baha, from January 2021 to September 2022. A total of 1126 culture-positive UTI cases were included. Patient demographics, uropathogen distribution, antimicrobial resistance profiles, and clinical characteristics were extracted from hospital records. Subgroup analysis was performed for 32 patients with renal comorbidities, including end-stage renal disease (ESRD), glomerulonephritis (GN), and kidney transplant recipients (KTs). Statistical analysis was performed using SPSS version 25. Most cases occurred in patients aged >70 years (43.2%) and females (68.29%). <i>Escherichia coli</i> (38.09%) and <i>Klebsiella pneumoniae</i> (14.02%) were the leading pathogens. High resistance to ampicillin (47-67%), cotrimoxazole (35-37%), and third-generation cephalosporins (34-47%) was observed, whereas carbapenems and aminoglycosides remained largely effective. Among the 32 patients with renal comorbidities, <i>E. coli</i> (43.8%), <i>Staphylococcus aureus</i> (25%), and <i>Enterococcus</i> spp. (18.8%) were the most common isolates. Dysuria (46.87%) and fever (31.25%) were the most frequent clinical presentations. Treatment regimens in this subgroup often required multidrug combinations, reflecting higher resistance burdens. Uropathogens in the Al-Baha region shows rising resistance to first-line antibiotics, with vulnerable populations such as patients with renal comorbidities experiencing distinct pathogen distributions and treatment challenges. Continuous surveillance, prudent antibiotic use, and targeted strategies for high-risk patients are essential to mitigate the impact of multidrug-resistant UTIs in Saudi Arabia.