Abstract

Manar Yousra*, Zarhloul Sami, Dadi Chaymae, Bighouab Youssef

ABSTRACT

Objectives: Urinary tract infections (UTIs) are among the most common bacterial infections in outpatient care. Given rising resistance rates, this study aims to describe the microbiological profile and antibiotic resistance of bacteria isolated from community-acquired UTIs in Rabat, specifically distinguishing patients with urinary catheters (complicated UTIs[9]). The goal is to address the lack of local data on antimicrobial resistance in the community setting. Methods: A retrospective study was conducted from December 2022 to September 2024 at the Maghreb Laboratory (Rabat). Urine culture results (cytobacteriological examination of urine) from 215 outpatients were analyzed, including a sub-analysis focused on the 27 catheterized patients. Only samples meeting strict criteria (presence of significant leukocyturia and positive bacteriuria ≥10³ CFU/mL) were included. Clinical and microbiological data (age, sex, catheterization status, isolated organism, antibiogram) were collected. Bacterial identification and antibiotic susceptibility testing were performed using standard protocols (inoculation on routine media, biochemical panels) and interpreted according to EUCAST/CA-SFM recommendations.[10] Resistance phenotypes (extended-spectrum beta-lactamases [ESBL], carbapenemases) were systematically screened for. Results are expressed as percentages and analyzed descriptively. Results: Of the 215 patients, 188 (87.4%) were not catheterized. Their mean age was 67 years, with a female predominance (76.6%). Among the isolated bacteria, 88.8% were Gram-negative bacilli (GNB) and 11.2% were Gram-positive cocci (GPC). *Escherichia coli* was the predominant organism (82% of total isolates), followed by *Klebsiella pneumoniae* (9.5%) and *Proteus mirabilis*. Gram-positive cocci (11.2%) consisted mainly of enterococci and staphylococci. High resistance to amoxicillin (66%) was observed in *E. coli*, along with moderate resistance to the amoxicillin-clavulanic acid combination (31%), fluoroquinolones (34%), and co-trimoxazole (36%). No cases of carbapenem resistance were detected. The ESBL rate reached 11%. *K. pneumoniae* exhibited intrinsic resistance to amoxicillin (100%) and remained relatively susceptible to amoxicillin-clavulanic acid (only 18.75% of strains resistant) and gentamicin (6.25%). In contrast, 25% of *K. pneumoniae* isolates were resistant to third-generation cephalosporins (3GC) and fluoroquinolones, 18.75% to carbapenems, and 43.75% to co-trimoxazole; 6.25% produced ESBLs. Among the 27 catheterized patients (mean age 78 years, 81.5% male), the bacterial spectrum was more diverse, including opportunistic nosocomial species (*Pseudomonas aeruginosa*, *Acinetobacter baumannii*). Their Enterobacteriaceae isolates exhibited very high resistance rates: ESBL production was confirmed in 31.6% of cases, carbapenemase production in 21.1%, and resistance rates approached 60% for fluoroquinolones and 42% for co-trimoxazole. Conclusion: This community-based study in Rabat confirms the predominance of *E. coli* in outpatient urinary tract infections but highlights a concerning rise in resistance to common antibiotics. The presence of multidrug-resistant *K. pneumoniae* clones in the community and the alarming rates observed in the patients studied underscore the urgent need to strengthen microbiological surveillance and update national treatment guidelines.[15] Measures promoting the prudent use of antibiotics in outpatient care must be intensified—in line with WHO warnings regarding antimicrobial resistance[3]—to preserve the efficacy of first-line treatments.