COMPARISON OF ANTIMICROBIAL RESISTANCE PATTERN BETWEEN COMPLICATED AND UNCOMPLICATED URINARY TRACT INFECTIONS

Abstract

Objective: To determine the antibiotic resistance pattern of patients attending with UTI and to compare antimicrobial resistance pattern between complicated and uncomplicated UTI. Background: Urinary Tract Infection (UTI) is one of the most common bacterial infections seen in clinical practice worldwide every year, with about 150 million people getting infected. Multidrug resistant uropathogens have considerably complicated empirical antibiotic therapy especially in lower middle-income countries like Pakistan where antibiotics are used in irrational manner. There is limited data available on the antimicrobial resistance pattern of complicated and uncomplicated UTIs in Balochistan which restricts the clinicians to work towards locally adapted empirical antibiogram. Place and Duration of Study: Department of Medicine / Urology OPD, Sandeman Provincial Hospital and Bolan Medical College, Quetta from  April 12, 2026 to  July 13, 2026. Methodology: The method used was a cross-sectional analytical study with non-probability consecutive sampling of 203 cases of patients who had UTI aged 18, with a urine culture of ≥50,000 CFU/mL and with clinical symptoms. There was an operational definition for complicated vs uncomplicated UTI. Urine culture was performed and antibiotic susceptibility testing using the disc diffusion method was carried out for 20 antibiotics. The chi-square / Fischer exact test was used for comparisons of the resistance frequencies among groups. The raw data were analysed by SPSS 24.0. Results: The mean age was 38.2 ± 14.6 years with female predominance (68.5%). Complicated UTI was identified in 44.3% (90/203) and uncomplicated UTI in 55.7% (113/203) of patients. The most frequently reported pathogen was Escherichia coli (58.6%). Significant differences were found between complicated and uncomplicated UTI for ampicillin (82.2% vs 70.8%), ciprofloxacin (68.9% vs 54.0%), ceftriaxone (63.3% vs 48.7%), co-trimoxazole (74.4% vs 62.8%) and nitrofurantoin (32.2% vs 20.4%) (all p<0.05). Nitrofurantoin and amikacin had the lowest resistance rates for both groups. Conclusion: More complicated UTIs actually show significantly higher antimicrobial resistance rates compared to all uncomplicated UTIs for multiple antibiotic classes. Ampicillin and co-trimoxazole are no longer useful as empirical agents in either group. Nitrofurantoin and amikacin are still relatively active and should still be considered as a priority in local guideline for empirical treatment. To guide rational antibiotic prescribing at the local level continuous antibiotic surveillance is necessary in Quetta.