Burden of antibiotic resistance in urinary isolates: a retrospective cross-sectional study from a tertiary center in Far-Western Nepal.

BACKGROUND: Antibiotic resistance poses a severe public health challenge, particularly in resource-limited settings where data scarcity undermines local infection prevention strategies. This study provides the first comprehensive surveillance of urinary antibiotic resistance from the Far-Western region of Nepal in over a decade, highlighting patterns relevant to antimicrobial stewardship and infection control. METHODS: A retrospective cross-sectional study was conducted using urine culture records collected between April 2024-March 2025. Laboratory data on bacterial isolates and antibiotic susceptibility were extracted from microbiology database, exported to Microsoft® Excel 2021, entries with missing data removed, cleaned for duplicates, verified for completeness, and de-identified. Organism identification and susceptibility testing were done following CLSI guidelines and Multidrug-resistant (MDR) and extensively drug-resistant (XDR) were identified as per the international standard definition. Data were stratified by age, organism, and antibiotic class (WHO AWaRe classification) to assess trends and inform empirical treatment strategies. RESULTS: Total 3,155 cultures were processed, among which 754 (23.9%) were positive. Escherichia coli (41.6%) and Klebsiella spp. (22.1%) were the most common uropathogens. MDR and XDR rates were 27.9% and 67.5%, respectively, with XDR prevalence increasing with patient age-peaking at 81.4% in those over 65. Alarmingly high resistance was observed against commonly used oral antibiotics (> 80% for ampicillin, cefixime, and ciprofloxacin), limiting outpatient treatment options. WHO Watch and Reserve group antibiotics such as meropenem and colistin remained comparatively effective. High XDR rates in nosocomial organisms like Pseudomonas aeruginosa and Proteus spp. were noticed. CONCLUSION: This study highlights the burden and evolving pattern of antibiotic resistance with high XDR rates in an area with limited resources and a lack of prior surveillance data. These findings reinforce the need for escalating antimicrobial stewardship, strengthening surveillance systems in the region, while also contributing to national infection control strategies. CLINICAL TRIAL NUMBER: Not applicable.