Search Results (595)

Pathogens that have developed resistance to antibiotics pose a threat to public health. The primary goal in preventing foodborne infections is to inhibit the growth of and, subsequently, eliminate antibiotic-resistant pathogens at every stage from production to consumption. Escherichia coli, which has acquired resistance to most known antibiotics, is frequently found in chicken meat. In many countries, due to unregulated antibiotic use in poultry farming, poor hygiene in slaughterhouses, or cross-contamination, extended-spectrum beta-lactamase (ESBL)-producing E. coli has been identified as the causative agent in poultry-associated food poisoning. The need for more effective antimicrobial agents against this pathogen, which is resistant to existing antibiotics, has led to increased attention being paid to postbiotics produced by lactic acid bacteria, particularly bacteriocins. This study aimed to determine the antimicrobial effects of postbiotics obtained from kefir-derived Lactiplantibacillus plantarum and Lactococcus lactis against ESBL-positive E. coli. To achieve this, E. coli strains were isolated from raw chicken meat samples collected from the market using culture-based methods, and their antimicrobial resistance profiles were determined using the disk diffusion method. The ESBL positivity of the isolates was assessed using the double-disk synergy test. The antimicrobial activities of the postbiotics against the identified ESBL-positive E. coli strains were tested using the macro-dilution method to determine minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values. ESBL-positive E. coli was detected in 48% of raw chicken meat samples. The antimicrobial effects of postbiotics were examined by disk diffusion, and postbiotics produced by 18 Lb. plantarum strains and 20 Lc. lactis strains showed strong antimicrobial activity. Significant differences in the antimicrobial effects of postbiotics were observed between the two species. Lb. plantarum postbiotics exhibited both bacteriostatic (concentration 60%) and bactericidal (concentration 80%) effects on ESBL-positive E. coli strains, whereas Lc. lactis postbiotics showed only bacteriostatic effects (80% concentration). Postbiotics derived from probiotic bacteria offer promising effects against multidrug-resistant E. coli due to their heat resistance, activity across different pH values, strong antimicrobial effects, affordability, and ease of production. Full article

Background and Objectives: Acute and obstructive pyelonephritis (AOP) management, despite advancements in diagnostic imaging and antimicrobial therapy, is characterized by delayed recognition and increasing antimicrobial resistance. This review aimed to summarize current evidence regarding the clinical characteristics, microbiological spectrum, biomarkers, and imaging findings associated with AOP. Materials and Methods: A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251162736). Literature searches were performed across the PubMed, Scopus, and Web of Science databases for articles published between January 2014 and 31 March 2025 using the term “acute obstructive pyelonephritis”. Inclusion criteria comprised original full-text English-language studies, published in the last 10 years and conducted in adults, reporting clinical, laboratory, microbiological, and imaging characteristics. Exclusion criteria are letters to the editor, expert opinions, case reports, conference or meeting abstracts, reviews, and redundant publications; having unclear or incomplete data; and being performed on cell cultures or on mammals. The quality of included studies was assessed using the Newcastle–Ottawa Scale. Results: Twenty-three studies met the inclusion criteria. AOP predominantly affected elderly patients with comorbidities, especially diabetes mellitus and urinary tract obstruction. Predictors of septic shock included thrombocytopenia, hypoalbuminemia, elevated procalcitonin (>1.12 µg/L), presepsin, and a neutrophil-to-lymphocyte ratio ≥ 8.7. Escherichia coli remained the leading pathogen (60–95%) with extended-spectrum β-lactamase (ESBL) rates between 20 and 70%, followed by Klebsiella pneumoniae. CT demonstrated 71–100% sensitivity for detecting obstructive complications, confirming its superiority over ultrasound, while MRI provided comparable diagnostic accuracy in selected cases. Source control through double-J stenting or percutaneous drainage significantly improved survival. Conclusions: AOP requires prompt recognition and early decompression to prevent sepsis-related mortality. Biomarkers such as procalcitonin, presepsin, and neutrophil to lymphocyte ratio enhance risk stratification, while CT remains the gold-standard imaging modality. The increasing prevalence of ESBL-producing pathogens underscores the need for antimicrobial stewardship and individualized therapeutic strategies guided by local resistance data. Full article

Background/Objectives: The expansion of intensive swine production in Córdoba, Argentina, underscores the need to assess the risks associated with antimicrobial (AM) use, whose extensive application has driven antimicrobial resistance, a major global threat within the One Health framework. This study aimed to characterize AM use practices and evaluate the epidemiological resistance profiles (non-wild-type phenotypes, NWT) of commensal Escherichia coli of fecal origin from swine farms, using epidemiological cut-off values (ECOFFs) as a surveillance criterion. Methods: An observational cross-sectional study was conducted in 19 farrow-to-finish farms in Córdoba during 2023. Information on AM use (prophylaxis, metaphylaxis, treatment) across production categories was collected. A total of 437 E. coli isolates were obtained from fecal samples, and minimum inhibitory concentrations (MICs) were determined for 10 AMs of critical importance for human and animal health. NWT phenotypes were classified according to EUCAST ECOFFs, and multidrug resistance (MDR) was assessed. Results: AM use was frequent and predominantly prophylactic (89.5% of farms), mainly through mass medication (66.3%), with macrolides and amoxicillin being the most commonly administered AMs. NWT proportions were extremely high (90–92%) for ampicillin, tetracyclines, and chloramphenicol and substantial for ciprofloxacin (50.6%), sulfamethoxazole (68.2%), and trimethoprim (44.9%). Extended-spectrum β-lactamase (ESBL)-producing phenotypes were detected. Alarmingly, 92% of isolates were classified as MDR E. coli, with homogeneous distribution across production categories. Conclusions: Findings reveal intensive and largely empirical AM use that has consolidated a stable intestinal resistome in the swine population. High MDR levels, even in categories with limited direct AM exposure or involving banned compounds, suggest that co-selection and horizontal gene transfer are key drivers of resistance. This scenario highlights the urgent need to strengthen integrated surveillance and promote prudent AM use strategies under the One Health approach to preserve therapeutic efficacy. Full article

Monitoring of antimicrobial resistance (AMR) in the environment is needed, but standardized methods are lacking. This study evaluated a cost-efficient, kit-based approach for detecting antibiotic-resistant Escherichia coli (AR-E. coli) and predicting multidrug-resistant E. coli (MDR-E. coli) in concentrated animal feeding operations (CAFO)-impacted surface waters in Tulare, California, and Clayton, Michigan. Eighteen Tulare and six Clayton samples were analyzed using modified IDEXX Colilert-18 kits with selective antibiotics. In Round 1 of the study, 702 isolates were tested against 12 antibiotics using disk diffusion to identify ideal additions. No and low resistance to AMP was seen at the unimpacted and less-impacted sites, respectively, while up to 34% of isolates at impacted sites were resistant to AMP. The percentage of isolates resistant to erythromycin was 16% or lower at less-impacted sites, but it ranged up to 64% at impacted sites. In Round 2, 1002 isolates (1704 total) were characterized to compare modified IDEXX results with culture-based results. Resistance to ampicillin (AMP-E. coli-col) detected by IDEXX strongly correlated with MDR prevalence in Clayton (R² = 0.71, p = 0.00197), while extended-spectrum beta-lactamase-producing E. coli (ESBL-E. coli-col) correlated with MDR prevalence in Tulare (R² = 0.70, p < 0.0001). This observation appears to be site-specific. Findings suggest both IDEXX- and culture-based methods can serve as AMR screening tools at CAFO-impacted sites. This work supports community-based monitoring and informs standardized approaches for tracking AMR in inland waters. Full article

Urinary tract infections (UTIs) represent a major cause of morbidity among adult women, with a disproportionate burden among postmenopausal patients. Limited data exist from Eastern Europe regarding pathogen distribution, antimicrobial resistance, and treatment patterns in hospitalized women. We conducted a retrospective cohort study of 948 adult female patients hospitalized with symptomatic UTIs between January 2021 and December 2023 in a Romanian multidisciplinary hospital. Demographic, clinical, and microbiological parameters were analyzed. Pathogen identification was performed by MALDI-TOF MS, and antimicrobial susceptibility testing followed EUCAST 2024 standards. Empiric treatment strategies and subsequent therapy modifications were assessed. Postmenopausal women accounted for 78.4% of cases and exhibited higher rates of recurrent UTIs, frailty, diabetes, urinary catheterization, and prior antibiotic exposure. Escherichia coli remained the predominant pathogen (52.6%), followed by Klebsiella spp. (18.4%) and Enterococcus spp. (12.1%). ESBL-producing organisms were found in 21.4% of E. coli and 38.7% of Klebsiella isolates. Pathogen distribution differed by age: younger women had a higher proportion of E. coli, whereas postmenopausal women showed a relative increase in opportunistic/healthcare-associated pathogens, particularly Klebsiella spp. and Enterococcus spp., consistent with higher catheter exposure and comorbidity burden. Carbapenem resistance was rare but present in a small subset of Klebsiella isolates with phenotypes compatible with OXA-48-like carbapenemase production. Empiric therapy most frequently included ceftriaxone or fluoroquinolones, but 27.8% of regimens required adjustment after susceptibility results. Independent predictors of prolonged hospitalization included age > 65 years, recurrent UTI, MDR infection, urinary catheterization, and delayed targeted therapy. UTIs among hospitalized adult women—especially postmenopausal patients—are strongly influenced by comorbidity burden and antimicrobial resistance. Local resistance patterns highlight the need for evidence-based empiric treatment and rapid therapy optimization. Strengthening stewardship and preventive interventions in elderly women is essential. Full article

Background/Objectives: Antimicrobial resistance (AMR) in wildlife is an emerging public health concern due to the risk of zoonotic transmission, especially through the food chain, yet data on free-ranging animals remain scarce. This study examined the presence and patterns of AMR among bacteria isolated from hunted wild boars in the Campania region of Italy. Methods: Matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) was used to identify bacterial isolates from wild boar meat and carcass swabs to the species level, and the Kirby–Bauer disk diffusion test was applied to screen 205 isolates, spanning 20 bacterial genera, against a panel of clinically relevant antibiotics. Resistance metrics were analyzed at genus and antibiotic levels, and patterns were visualized using a hierarchically clustered heatmap. Results: Resistance was detected in 15 of the 20 genera, with full susceptibility observed in Acinetobacter, Arthrobacter, Glutamicibacter, Leclercia, and Rahnella. Overall, 67.3% (138/205) of the isolates showed resistance to at least one antibiotic, with 33.7% (69/205) classified as multidrug-resistant (MDR). Carbapenems retained the highest activity (≥95% susceptibility) among all genera tested, while amoxicillin/clavulanate (78.4%) and aztreonam (57.4%) exhibited the highest mean resistance. Among potential pathogens, Escherichia coli exhibited an extended-spectrum β-lactamase (ESBL)-like phenotype, with resistance to amoxicillin/clavulanate (67%), aztreonam (54%), and ceftazidime (47%) but preserved carbapenem susceptibility. Staphylococcus spp. showed pronounced resistance to linezolid (57%) and erythromycin (52%), whereas Pseudomonas isolates demonstrated elevated resistance to aztreonam and ceftazidime (57% each). Opportunistic pathogens such as Alcaligenes faecalis and Pantoea agglomerans showed peak resistance to ciprofloxacin and amoxicillin/clavulanate. Pathogens and opportunistic pathogens demonstrated higher mean resistance (>30%) than commensals (≤32%), but the difference in mean and median resistance levels was not statistically significant (Mann–Whitney’s U test, W = 4, p = 0.39). Conclusions: These findings highlight the widespread occurrence of AMR and MDR phenotypes, with clinically significant resistance patterns in wild-boar-associated bacteria, including non-pathogenic strains, highlighting their role in the amplification of AMR. Although the preservation of carbapenem susceptibility underscores their potential as last-line antibiotics, the high resistance to commonly used antibiotics raises concerns for zoonotic transmission. Surveillance of wildlife reservoirs therefore remains critical for integrated AMR control. Full article

The indiscriminate and excessive use of antimicrobial agents in livestock production is a major driver of antimicrobial resistance (AMR), thereby posing a grave threat to global public health. Although several surveillance studies have documented antimicrobial resistance patterns of swine-derived E. coli in different regions of China, comprehensive investigations integrating multilocus sequence typing (MLST), resistance determinants, and virulence gene profiles have remained scarce for central China, particularly Hubei province, since 2018. This study investigated the prevalence of antibiotic resistance, and molecular epidemiology of E. coli isolated from swine farms in Hubei province, China, while simultaneously analyzing their clonal and genetic diversity. A total of 148 E. coli isolates were collected from porcine sources in central China, revealing distinct regional variations in genetic diversity. Multilocus sequence typing (MLST) analysis identified 38 sequence types (STs) distributed across 7 clonal complexes (CCs) and several unassigned clones. ST46 emerged as the predominant sequence type (19.6% prevalence), followed by ST23 and ST10. Antimicrobial susceptibility testing demonstrated 100% resistance to lincosamides and sulfonamides, with all isolates exhibiting multidrug resistance (MDR) to antimicrobial classes. Genetic characterization detected 16 resistance determinants, with individual isolates carrying 5–7 resistance genes on average. The resistance profile included seven β-lactamase genes: blaTEM (61.5%), blaCTX-M-1G (57.4%), blaDHA (46.6%), blaSHV (39.2%), blaCTX-M-9G (24.3%), blaOXA (13.5%), and blaCMY-2 (1.4%); and eight aminoglycoside-modifying enzyme genes, including polymyxin resistance gene mcr-1 (7.4%). Virulence factor screening through PCR detected nine associated genes, with EAST1, fyuA, STa, K88, STb, Irp2, and LT-1 present in 95.3% of isolates, while K99 and 987P were absent in all specimens. This investigation documents alarmingly high antimicrobial resistance rates in swine-derived E. coli populations while elucidating their genetic diversity. The findings suggest that intensive antibiotic use in porcine production systems has driven the evolution of extensively drug-resistant bacterial isolates. These results emphasize the urgent need to implement antimicrobial stewardship programs in livestock management to mitigate AMR proliferation. Full article

This pilot study investigated the presence of methicillin-resistant Staphylococcus aureus (MRSA) and third-generation cephalosporin-resistant (3GC-R) Enterobacterales in conventionally kept domestic pigs and their environment across four districts in Rwanda. A total of 114 swabs (nasal, rectal, manure, dust) from 29 farms were collected and processed to isolate resistant bacteria. Thirty-two 3GC-R Enterobacterales were detected. Escherichia coli predominantly harboring bla_CTX-M group 1 β-lactamase genes, alongside Klebsiella pneumoniae isolates, all displaying extended-spectrum β-lactamase (ESBL) phenotypes. Four MRSA isolates, all belonging to clonal complex 398 and SCCmec type IV, the typical livestock MRSA, were recovered from nasal and environmental samples. Multidrug resistance was frequently observed. The co-occurrence of β-lactamase genes, non-β-lactam resistance genes, and virulence factors such as fimH and loci associated with extraintestinal pathogenic and enteropathogenic E. coli. The detection of both MRSA and 3GC-R Enterobacterales in the present study indicates pigs and their farm environments as reservoirs of WHO priority pathogens in Rwanda, highlighting a potential public health risk in the context of extensive human–animal–environment interaction. These findings emphasize the urgent need for integrated One Health surveillance and comprehensive AMR control strategies addressing both animal and environmental reservoirs to support Rwanda’s National Action Plan on Antimicrobial Resistance. Full article

Background: Evidence on HAIs in Africa is fairly common. Objectives: The main objective was to identify the surveillance tools used for healthcare–associated infections (HAIs) in countries in the WHO African Region. Secondary objectives focused on the organization of surveillance, the pathogens involved, and the frequency of multidrug–resistant species. Inclusion and exclusion criteria: Observational or interventional studies on healthcare–associated infections in humans, published between January 2011 and December 2024, in French or English, were included. However, the following publications were not included: animal studies, healthcare–associated infections not related to healthcare, literature reviews, studies outside the period or geographical area, and studies in languages other than French or English. Sources of information and search date: The databases consulted were PubMed, Web of Science, EMBASE, Cochrane, African Index Medicus, Google Scholar, and AJOL. The search was conducted between January and March 2025. Risk of bias assessment: The risk of bias was assessed using a specific grid (eleven criteria), scored from one (low) to three (high). The studies were classified into three levels of methodological quality. The results of the bias assessment showed that the publications were excellent (strong and moderate) with a cumulative rate of 99.9%. Methods of synthesizing results: Data were extracted using a standardized grid and synthesized narratively. No meta–analysis was performed. Number of studies and characteristics: 95 studies were included, mostly cross–sectional studies (82.1%), cohorts (10.4%), and a few case reports. Most were from West Africa (60.0%), particularly Nigeria (16.8%) and South Africa (14.7%). Main results: • Most common pathogens: Staphylococcus aureus (53.7%), Escherichia coli (43.2%), Klebsiella pneumoniae (32.6%). • Resistance profile: ESBL (27.4%), MRSA (21.1%), multidrug resistance (13.7%). • Sources of HAIs: mainly exogenous (83.2%). • Laboratory methods: phenotypic (70.5%), genotypic or genomic rare (3.1%). • Scope of studies: local (96.8%), national (3.2%). Limitations of evidence: Risk of bias due to underreporting of HAIs, methodological heterogeneity, predominance of cross–sectional studies, low use of molecular methods, lack of modeling, and uneven geographical coverage. Overall interpretation and implications: surveillance of HAIs in Africa remains fragmented and poorly standardized. There is a need to strengthen national systems, integrate molecular methods, train professionals, and promote interventional research. The WHO GLASS program can serve as a framework for harmonizing surveillance. Full article

Urinary tract infections (UTIs) are common in children and are predominantly caused by uropathogenic Escherichia coli (UPEC). An increasing proportion of these strains produce extended-spectrum β-lactamases (ESBLs), which render β-lactam antibiotics ineffective. Interestingly, some patients with ESBL-producing UTIs improve clinically following treatment with antibiotics like cephalexin, despite demonstrated in vitro resistance. Working alongside and at times synergistically with antibiotics, host immune factors, such as the antimicrobial peptide cathelicidin (LL-37), contribute to bacterial clearance through direct killing and inhibition of biofilm formation. In this review, we summarize the current understanding of pediatric ESBL-producing UPEC infections and present selected in vitro and in vivo experimental data evaluating the combined effects of LL-37 and cephalexin on clinical isolates. Although no synergy was observed, ESBL-producing isolates demonstrated reduced bacterial burden in vivo compared to a non-ESBL UPEC strain. These findings suggest that host immune factors and environmental conditions may influence the fitness and virulence of drug-resistant UTI pathogens, warranting further investigation. Full article

Background: There are many methods of identifying microbial resistance to therapeutic agents; however, they can generally be classified into two main categories: phenotypic and genotypic. The study aims to determine drug sensitivity and to analyze the correlation between the results obtained from cultures on commercial chromogenic media Brilliance^TM CRE (OXOID) and Brilliance^TM ESBL (OXOID) and the occurrence of specific resistance genes carbapenemase (IMP, NDM, VIM, KPC, OXA), ESBL β-lactamase (TEM, SHV, CTX-M), and AmpC (CMY, DHA), which will be used in drug sensitivity tests. Methods: The present study used bacteria, including Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli, obtained from patients hospitalized in military hospitals in Poland. All strains were plated on the commercial chromogenic media and subjected to antimicrobial susceptibility testing. Additionally, molecular assays detecting three main classes according to the mechanism of action, enzyme type carbapenemase (IMP, NDM, VIM, KPC, OXA), ESBL β-lactamase (TEM, SHV, CTX-M), and AmpC (CMY, DHA) were performed using the real-time PCR method. Results: The results of the studies indicate the presence of carbapenemases and ESBL genes. Among K. pneumoniae strains, the dominant gene was CTX-M-15 (88.89%), followed by the SHV (84.12%), NDM (46.03%), TEM (41.26%), KPC (34.92%), and OXA-48 (19.04%). In contrast, A. baumanii was dominated by carbapenemases from the OXA family (OXA-51 in 96.00% and OXA-24/40 in 84.00%). E. coli exhibits a high prevalence of CTX-M-15 (53.85%), TEM (46.15%), NDM (38.46%), and CMY-2 (30.77%). It was observed that the CTX-M-15 gene was commonly co-identified with SHV (n = 43). All tested strains grew on chromogenic Brilliance^TM CRE medium. In the case of Brilliance^TM ESBL medium, the genes determining the resistance mechanism were detected in 41.7% for A. baumannii, 53.8% for E. coli, and 100% for K. pneumoniae. Chromogenic media perfectly differentiate strains to species. A moderate positive correlation of the occurrence of the antibiotic resistance genes was observed for OXA-51 and OXA-24/40 genes, which were resistant to meropenem (rho = 0.45, p < 0.001). K-means cluster analysis performed on integrated genotype–phenotype data allowed for the identification of three distinct clusters characterized by distinct resistance gene profiles. These results demonstrate that selective agar media enable faster identification compared to other conventional techniques; however, the obtained results should be confirmed by other validated phenotypic methods, and, if possible, by a molecular assay. Full article

Background/Objectives: Antimicrobial resistance (AMR) threatens global public health. This systematic review and meta-analysis, as part of the “ENVIRE” project (interventions to control the dynamics of antimicrobial resistance from chickens through the environment), assesses the prevalence of phenotypic and genotypic resistance, including extended-spectrum beta-lactamases (ESBLs), AmpC beta-lactamases, carbapenemases, colistin, and fluoroquinolone resistance, in broiler chickens and their environment. Methods: The analysis covers the years 2002–2022, focusing on Escherichia (E.) coli, Klebsiella spp., Enterobacter spp., and Citrobacter spp. in fecal, meat, environmental, and other-than-feces samples from observational studies published in PubMed and Web of Science. Quality assessment was performed using the Alberta Heritage Foundation criteria. Results: Data from 170 studies, conducted in Europe, North Africa, and North America, were included. The most frequently studied resistance was to beta-lactam, with focus on ESBL-producing and AmpC beta-lactamase isolates. The pooled prevalence of ESBL-resistant E. coli observed in meat samples at 41% and in fecal samples at 38% demonstrated significant heterogeneity between the studies. The negative binomial regression analysis of prevalence data revealed significantly higher ESBL-producing E. coli rates in European meat samples compared to North African samples. Conclusions: This systematic review revealed substantial variation in prevalence and emphasizes the need for standardized surveillance systems and robust study designs. Full article

Antimicrobial resistance (AMR) among commensal Escherichia coli from poultry is a growing concern for food safety and public health. This study investigated AMR patterns in E. coli isolated from broiler neck skin at slaughter, comparing organic, antibiotic-free (ATB-free), and conventional production systems. A total of 375 samples were collected from two Italian slaughterhouses and tested by broth microdilution following EU protocols. E. coli was recovered from 358 samples, and 37.9% were presumptively positive for ESBL/AmpC-producing strains. Conventional broilers showed the highest resistance to ampicillin (73.8%), sulfonamides (72.5%), and fluoroquinolones (nalidixic acid, 62.5%; ciprofloxacin, 67.5%), while organic and ATB-free systems showed significantly lower levels. Intermediate resistance occurred for trimethoprim (21.4–47.9%) and tetracycline (36–54%), and low prevalence (<10%) was found for gentamicin, tigecycline, and third-generation cephalosporins. No relevant resistance was detected to colistin or carbapenems (≤1.2%). Total E. coli counts did not differ among systems, suggesting differences in resistant strain proportions rather than bacterial load. ATB-free flocks processed after conventional batches displayed higher resistance, indicating possible cross-contamination during slaughter. These results highlight the influence of farming practices and slaughterhouse hygiene on AMR dissemination, underscoring the need for integrated farm-to-slaughter control strategies. Full article

Uropathogenic Escherichia coli (UPEC) is the leading cause of urinary tract infections (UTIs) and a major contributor to the global antimicrobial resistance crisis. The increasing prevalence of multidrug-resistant (MDR) strains, including expanded-spectrum β-lactamases (ESBL) and carbapenemase-producing isolates, severely limits treatment options. This review provides an overview on the key molecular mechanisms of UPEC antibiotic resistance, such as enzymatic inactivation, target-site mutations, efflux pump activity, and biofilm formation. Beyond conventional antibiotics, special emphasis is placed on phytochemical strategies as promising alternatives. Flavonoids, alkaloids, terpenoids, and essential oils exhibit antibacterial, anti-adhesive, and antibiofilm properties. These natural bioactive compounds modulate motility, suppress fimbrial expression, inhibit quorum sensing, and enhance antibiotic efficacy, acting both as standalone agents and as adjuvants. Current in vitro and in vivo studies highlight the potential of plant-derived compounds and biologically based therapies to combat UPEC. However, challenges related to standardization, bioavailability, and clinical validation remain unresolved. Integrating molecular mechanistic insights with advanced phytochemical research may offers a sustainable and effective strategy for mitigating UPEC antibiotic resistance. Full article

Urinary tract infections (UTIs) represent one of the most frequent bacterial infections worldwide, with Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) as the predominant uropathogens. The emergence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales has severely limited treatment options, making regional surveillance crucial. This study aimed to determine the prevalence of uropathogens, assess antimicrobial resistance patterns, and evaluate the burden of ESBL-producing organisms among patients presenting with suspected UTIs in a tertiary care hospital in Riyadh. We conducted a retrospective analysis of 19,556 urine cultures from a tertiary care hospital in Riyadh, Saudi Arabia, between January and December 2024. Of these, 2629 (13.4%) cultures showed significant bacterial growth, predominantly in females (83.2%) and in the 16–30 year age group. E. coli accounted for 65.9% of isolates, followed by K. pneumoniae (16.8%). ESBL production was detected in 28.5% of E. coli and Klebsiella isolates. ESBL producers exhibited complete resistance to third-generation cephalosporins and β-lactam/β-lactamase inhibitor combinations, whereas carbapenems, aminoglycosides, and fosfomycin maintained high efficacy. Resistance to ciprofloxacin and co-trimoxazole was widespread in both ESBL and non-ESBL isolates. Additionally, vancomycin-resistant enterococci (7%), methicillin-resistant Staphylococcus aureus (2%), and carbapenem-resistant Enterobacterales (0.9%) were found. These findings highlight the escalating burden of ESBL-associated UTIs and underscore the urgent need for strengthened antimicrobial stewardship, continuous surveillance, and optimized empirical therapy to mitigate the impact of multidrug-resistant uropathogens in clinical practice. Full article