ESCALATING and consistently high levels of antimicrobial resistance among urology inpatients have been revealed in a new study from a Turkish tertiary care centre covering a six-year period. The findings highlight the urgent need for more stringent antimicrobial stewardship and regular reassessment of empirical therapy in urological practice.
The retrospective analysis examined 1,092 adult urology inpatients treated for urinary tract infections between 2015 and 2020, each with confirmed positive urine or blood cultures. The cohort was predominantly male (71%), reflecting the case mix typical of a tertiary urology department.
Escherichia coli emerged as the leading pathogen in both urine (33.9%) and blood cultures (41%), aligning with global data on the microbiology of complicated urinary infections. Enterococcus species were the second most common isolates in urine cultures (21.4%), an important consideration given their intrinsic resistance patterns.
Antibiotic Resistance Rising Alongside Carbapenem Use
The study tracked institutional antibiotic prescribing behaviour over time, revealing a major shift toward broader-spectrum treatments. Cephalosporins and carbapenems were the most commonly prescribed agents. Notably, carbapenem use increased markedly, reaching 52% of prescriptions by 2020, a trend the authors describe as concerning due to the risk of driving further resistance.
Resistance levels were notably high across the study population, with ESBL-producing organisms accounting for 44% of all isolates, multidrug-resistant (MDR) strains comprising 29%, and extensively drug-resistant (XDR) bacteria making up a further 4%, underscoring the significant antimicrobial challenge faced in urology inpatients.
A key finding was the strong association between prior antibiotic exposure and subsequent infection with MDR organisms. Patients who had received antibiotics previously were 61% more likely to harbour MDR pathogens (p=0.002).
The authors emphasise that these patterns reflect a dynamic relationship between prescribing practices and resistance development. Periodic shifts in antibiotic preferences, particularly escalating carbapenem use, appear to correspond with resistance trends observed in the patient population.
Antibiotic Resistance in Urology: A Growing Clinical Challenge
The study concludes that urology inpatients represent a high-risk group for antimicrobial resistance, demanding vigilant surveillance, robust stewardship interventions, and the regular updating of empirical therapy protocols. Such measures, the researchers argue, will be essential for preserving antibiotic efficacy and improving patient outcomes in an era of rapidly evolving resistance.
Reference
Cicek M et al. Annual changes of antimicrobial resistance and antibiotic preference in urology inpatient group; a tertiary hospital experience. BMC Urol. 2025. Doi: 10.1186/s12894-025-02007-y
