Exploring Urinary Pathogens and Antibiotic Resistance Profiles in Male and Female Patients from the South Italy A Cross-Sectional Study in Apulia
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Abstract
Introduction
Urinary tract infections (UTIs) are among the most common infectious diseases, with a significantly higher incidence in females than in males.
Escherichia coli remains the predominant causative agent. AMR is a global health threat.
The Global Leaders Group on AMR estimates that without a stronger response, global life expectancy will be 1.8 years lower than otherwise due to AMR by 2035 (1).
One in six laboratory-confirmed bacterial infections responsible for the most common infections in 2023 were found to be resistant to antibiotic treatment (23).
Numerous studies have documented widespread antimicrobial resistance among uropathogens, raising global concerns—particularly regarding the increasing prevalence of multidrug-resistant (MDR) strains (2).
Methodology
This cross-sectional study was conducted between April 2024 and December 2024 using a non-probability purposive sampling method. Informed consent was obtained from all participants.
They were collected from participants with suspected urinary tract infections who were urged by their general practice doctors to go to the laboratory for analysis.
Data were collected from the culture and antibiotic susceptibility reports of the enrolled patients and systematically entered into WinGla database. The results were analyzed and presented using both percentages and absolute values to ensure clarity and comprehensiveness.
Results
Out of 691 participants, 127 were positive. UTIs were more prevalent in females than in males. E. coli and Cocci + KESC group (Klebsiella, Enterobacter, Serratia and Citrobacter) were the most frequently isolated pathogens.
Antibiotic susceptibility testing revealed notable sensitivity to agents such as Ceftriaxone, Ciprofloxacin, Levofloxacin and Aztreonam, whereas high levels of resistance were observed against amoxicillin-clavulanateand nitrofurantoin. These findings underscore the importance of gender-specific pathogen distribution and resistance patterns in guiding targeted therapy.
Conclusion
This study highlights the growing challenge of antibiotic resistance in Apulian patients with UTIs.
The highest resistance rates for all pathogens detected were observed for amoxicillin-clavulanate and Nitrofurantoin (2 of the 3 empirical treatments suggested by “The WHO AWaRe antibiotic book”); in contrast, Ceftriaxone, Ciprofloxacin, Levofloxacin and Aztreonam exhibited considerable efficacy; the oral powder of Fosfomycin, at its maximum dose, can often be used versus Escherichia coli, probably thanks to its high concentration in urinary tract.
These findings emphasize the urgent need for alternative therapeutic strategies and robust antimicrobial stewardship to address the escalating threat of resistance.
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References
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THE WHO AWARE (ACCESS, WATCH, RESERVE) ANTIBIOTIC BOOK. GENEVA: WORLD HEALTH ORGANIZATION; 2022. LICENCE: CC BY-NC-SA 3.0 IGO
GLOBAL ANTIBIOTIC RESISTANCE SURVEILLANCE REPORT 2025 - WHO GLOBAL ANTIMICROBIAL RESISTANCE AND USE SURVEILLANCE SYSTEM (GLASS) OCTOBER 2025 GENEVA - ISBN 978-92-4-011633-7 (ELECTRONIC VERSION)