Rising antimicrobial resistance in urinary tract infections in Türkiye: an urgent need for update on regional treatment strategies and for enhanced antimicrobial stewardship efforts

Abstract

Türkiye ranks among the highest in antibiotic consumption within OECD countries and faces growing challenges from multidrug-resistant uropathogens. Nationwide, resistance-guided treatment data remain scarce. The main objective of this work is to provide a comprehensive nationwide data on antibiotic resistance patterns among uropathogens to guide treatment options in urinary tract infections (UTIs). Methods A multicenter, retrospective observational study was conducted between 2021 and 2023 across 11 centers from 8 provinces representing all major geographical regions of Türkiye. Uropathogens isolated from adult patients with UTIs were analyzed to assess temporal trends and regional variability in antimicrobial resistance. Results In outpatients, resistance to commonly used oral agents (amoxicillin–clavulanate, ciprofloxacin) frequently exceeded 30%, peaking above 60% in Eastern and Southeastern regions. Nitrofurantoin and fosfomycin consistently demonstrated low resistance nationwide, supporting their continued use for uncomplicated UTIs. Aminoglycosides, including amikacin, maintained low resistance rates across all regions, indicating potential for empirical use, though gradual year-on-year increases were observed. Multidrug and extensively drug-resistant isolates were most prevalent among elderly and inpatient populations. In inpatients, Klebsiella pneumoniae showed particularly high resistance, with the last-line agent ceftazidime–avibactam resistance exceeding 60% in some regions. Conclusion For the treatment of uncomplicated UTIs, nitrofurantoin and fosfomycin remain reliable options, while aminoglycosides may be considered for complicated UTIs with caution. Pregnant women and elderly patients require special consideration due to limited alternatives. In inpatient settings, aminoglycosides remain viable empirical choices for suspected MDR infections. Strengthening antimicrobial stewardship and surveillance is critical to improving UTI management and combating antibiotic resistance in Türkiye.