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Article

Epidemiological and Clinical Characteristics Associated with Antimicrobial-Resistant Urinary Tract Infections in Outpatient and Inpatient Settings: A Retrospective Study from Northwestern Mexico

by
Jose Monroy-Higuera
1,
Uriel A. Angulo-Zamudio
2,*,
Nidia Leon-Sicairos
2,3,
Hector Flores-Villaseñor
2,4,
Jorge Velazquez-Roman
2,
Ernesto Ruiz-Trejo
5,
Julio Medina-Serrano
6,
Francisco Castro-Apodaca
7,
Gabriela Tapia-Pastrana
8 and
Adrian Canizalez-Roman
2,7,*
1
Programa de Doctorado, Posgrado Integral en Biotecnología, Faculatad de Ciencias Quimico-Biologicas, Universidad Autonoma de Sinaloa, Culiacan 80030, Sinaloa, Mexico
2
School of Medicine, Autonomous University of Sinaloa, Culiacan 80019, Sinaloa, Mexico
3
Pediatric Hospital of Sinaloa, Culiacan 80200, Sinaloa, Mexico
4
The Sinaloa State Public Health Laboratory, Secretariat of Health, Culiacan 80058, Sinaloa, Mexico
5
IMSS Hospital General Regional 1, Culiacan 80230, Sinaloa, Mexico
6
Coordinación de Investigación en Salud, Delegacion Instituto Mexicano del Seguro Social, Culiacan 80220, Sinaloa, Mexico
7
The Women’s Hospital, Secretariat of Health, Culiacan 80020, Sinaloa, Mexico
8
Laboratorio de Investigación Biomédica, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca 71256, Mexico
*
Authors to whom correspondence should be addressed.
Pathogens 2026, 15(1), 92; https://doi.org/10.3390/pathogens15010092
Submission received: 10 December 2025 / Revised: 31 December 2025 / Accepted: 8 January 2026 / Published: 14 January 2026
(This article belongs to the Special Issue New Insights into Antibiotic-Resistant Pathogens Within the One Health Framework: Epidemiology, Mechanisms and Strategies for Eradication)
Versions Notes

Abstract

Antimicrobial resistance in urinary tract infections (UTIs) poses a critical public health challenge, yet comparative data between outpatient and inpatient settings remain limited, particularly in Latin America. This study characterized the epidemiology, microbiology, and resistance patterns of UTIs in northwestern Mexico. A retrospective analysis of 1041 patients with UTI (May–November 2024) was conducted. Microorganism identification and antimicrobial susceptibility were determined using the MicroScan WalkAway system in accordance with CLSI guidelines. Results: Outpatients accounted for 80.5% of cases and inpatients for 19.4%, with a 3.1% mortality rate. Escherichia coli predominated (62.9%), with a significant association with outpatients (p = 0.02), whereas Enterobacter cloacae, Acinetobacter spp., Candida tropicalis, and C. albicans were associated with inpatients (p < 0.05). Pediatric patients exhibited distinctive microbiological profiles: Pseudomonas aeruginosa (9.7% vs. 2.1%, p = 0.032), Enterococcus faecalis (33.3% vs. 16.2%, p = 0.001), and Staphylococcus epidermidis (26.6% vs. 6.5%, p = 0.027) were significantly more prevalent than in adults. Multidrug resistance (MDR) was detected in 27.1% of isolates, and extensive drug resistance (XDR) in 3.2%. XDR was associated with Gram-positive bacteria (12.2% vs. 1.4%, p < 0.001). Carbapenem-resistant Enterobacteriaceae (CRE) were identified in 0.9% (7/772) of cases, with 42.9% occurring in outpatients. Hospitalization (OR: 2.01; 95% CI: 1.43–2.83), surgical services (OR: 1.41; 95% CI: 1.02–1.97), and recent surgery (OR: 2.37; 95% CI: 1.04–5.39) were independent predictors of MDR/XDR infections. Conclusions: These findings demonstrate the emergence of CRE within the community and distinctive pediatric resistance patterns, underscoring the need for tailored antimicrobial stewardship strategies in this region.
Keywords: urinary tract infection; outpatients; inpatients; E. coli; antimicrobial resistance; carbapenem resistance urinary tract infection; outpatients; inpatients; E. coli; antimicrobial resistance; carbapenem resistance

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MDPI and ACS Style

Monroy-Higuera, J.; Angulo-Zamudio, U.A.; Leon-Sicairos, N.; Flores-Villaseñor, H.; Velazquez-Roman, J.; Ruiz-Trejo, E.; Medina-Serrano, J.; Castro-Apodaca, F.; Tapia-Pastrana, G.; Canizalez-Roman, A. Epidemiological and Clinical Characteristics Associated with Antimicrobial-Resistant Urinary Tract Infections in Outpatient and Inpatient Settings: A Retrospective Study from Northwestern Mexico. Pathogens 2026, 15, 92. https://doi.org/10.3390/pathogens15010092

AMA Style

Monroy-Higuera J, Angulo-Zamudio UA, Leon-Sicairos N, Flores-Villaseñor H, Velazquez-Roman J, Ruiz-Trejo E, Medina-Serrano J, Castro-Apodaca F, Tapia-Pastrana G, Canizalez-Roman A. Epidemiological and Clinical Characteristics Associated with Antimicrobial-Resistant Urinary Tract Infections in Outpatient and Inpatient Settings: A Retrospective Study from Northwestern Mexico. Pathogens. 2026; 15(1):92. https://doi.org/10.3390/pathogens15010092

Chicago/Turabian Style

Monroy-Higuera, Jose, Uriel A. Angulo-Zamudio, Nidia Leon-Sicairos, Hector Flores-Villaseñor, Jorge Velazquez-Roman, Ernesto Ruiz-Trejo, Julio Medina-Serrano, Francisco Castro-Apodaca, Gabriela Tapia-Pastrana, and Adrian Canizalez-Roman. 2026. "Epidemiological and Clinical Characteristics Associated with Antimicrobial-Resistant Urinary Tract Infections in Outpatient and Inpatient Settings: A Retrospective Study from Northwestern Mexico" Pathogens 15, no. 1: 92. https://doi.org/10.3390/pathogens15010092

APA Style

Monroy-Higuera, J., Angulo-Zamudio, U. A., Leon-Sicairos, N., Flores-Villaseñor, H., Velazquez-Roman, J., Ruiz-Trejo, E., Medina-Serrano, J., Castro-Apodaca, F., Tapia-Pastrana, G., & Canizalez-Roman, A. (2026). Epidemiological and Clinical Characteristics Associated with Antimicrobial-Resistant Urinary Tract Infections in Outpatient and Inpatient Settings: A Retrospective Study from Northwestern Mexico. Pathogens, 15(1), 92. https://doi.org/10.3390/pathogens15010092

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