Burden of gram-positive bacteria from urinary tract infection: A four-year retrospective study in a tertiary health setting in southern Saudi Arabia

Abstract

Background Antibiotic resistance is a worldwide problem causing significant health-related and economic losses. Gram-positive causes of urinary tract infections (UTIs) are usually underestimated or overlooked by physicians. Aim To examine the prevalence of antibiotic resistance among major gram-positive bacteria from UTIs in a tertiary care health hospital in southern Saudi Arabia. Method A cross-sectional retrospective study was done in a tertiary health setting in southern Saudi Arabia between 2019 and 2022, to identify the major gram-positive bacteria and antibiotic resistance. Data were collected from the hospital records and was analyzed using the SPSS statistical package. Results The most common gram-positive species were Enterococcus faecalis (44.7%), Staphylococcus aureus (15.1%), and Enterococcus faecium (12.9%), beta-hemolytic streptococci (8.4%), and methicillin-resistant Staphylococcus aureus (MRSA) (1.8%). The 1540 isolates showed an overall susceptibility of 71.0%, compared to a resistance of 29.0%. The most resistance was among Enterococcus faecium (54.5%), Enterococcus gallinarum (42.4%), Enterococcus faecalis (34.3%), and MRSA (27.2%). The most common resistance was to erythromycin (75.7%), followed by cefotaxime (73.9%), tetracycline (70.5%), ciprofloxacin (54.3%), and Synercid (53.6%). The prediction model indicates an increase in the prevalence of resistance in MRSA and, to a lesser extent, with E. faecalis, E. faecium, and beta-hemolytic streptococci. Conclusions Enterococcus faecalis was the predominant gram-positive species, surpassing Staphylococcus aureus. Almost remarkable resistance was observed to most of the antibiotics that are frequently used in the study area, mainly erythromycin, cefotaxime, and tetracycline. Performing continuous monitoring of drug susceptibility may help with the empirical treatment of bacterial agents in the region.