Prevalence and antimicrobial resistance patterns of urinary tract infections at the university hospital center in Marrakech Morocco (2020–2024): a retrospective study

Abstract Objective To determine the prevalence, epidemiological and microbiological characteristics of urinary tract infections (UTIs), and to assess antimicrobial resistance (AMR) trends at the University Hospital Center Mohammed VI, Marrakech, over a five-year period. Methods A retrospective cross-sectional study was conducted from January 2020 to December 2024. All urine specimens processed at the microbiology laboratory were reviewed. Duplicate isolates were excluded, and only the first positive isolate per patient per infectious episode was retained. Bacterial identification was performed using MALDI-TOF MS, and antimicrobial susceptibility testing was carried out using disk diffusion and the BD Phoenix ® automated system. For consistency, AST results were rechecked and interpreted according to a single harmonized CA-SFM/EUCAST 2025 guideline version. Temporal trends in resistance were assessed using beta-regression models, with annual changes expressed as percentage-point variation per year and p -values adjusted using the Benjamini-Hochberg false discovery rate procedure. Results Of 62,788 urine specimens, 8,231 were culture-positive 13.1%. Prevalence rose from 11.5% in 2020 to 14.9% in 2022, then stabilized at 12–13% in 2023–2024. Women accounted for 59.6% of cases, and patients ≥ 60 years were the most affected. Escherichia coli was the leading uropathogens 47.9%, followed by Klebsiella pneumoniae 16.7% and Enterococcus spp. 4.6%. Significant increases in resistance were observed for several clinically important antimicrobials. Amoxicillin-clavulanate resistance increased significantly in both E. coli (+ 6.00% points/year; 95% CI: 2.83–8.82; FDR- p < 0.001) and K. pneumoniae (+ 5.21% points/year; 95% CI: 2.08–8.03; FDR- p = 0.002). Ceftriaxone and piperacillin-tazobactam resistance increased significantly in E. coli , while carbapenem resistance increased significantly in both species. Fluoroquinolone resistance also showed significant upward trends in E. coli and K. pneumoniae . Among aminoglycosides, amikacin resistance increased significantly in both species, whereas gentamicin resistance increased significantly only in E. coli . No significant temporal trend was observed for trimethoprim-sulfamethoxazole resistance in either species. Conclusion UTIs remain common, with E. coli and K. pneumoniae showing increasing resistance trends, particularly against β-lactams, fluoroquinolones, carbapenems and aminoglycosides. These findings underscore the importance of ongoing surveillance and support the implementation of antimicrobial stewardship strategies.