Antibiotic resistance in UTIs among elderly residents of long-term care facilities.

INTRODUCTION

Urinary tract infection (UTI) is among the most common infections in long-term care facilities worldwide and is a leading driver of antimicrobial use. Increasing antimicrobial resistance (AMR), particularly among multidrug-resistant gram-negative organisms, presents major clinical and public health challenges in this vulnerable population.

AREAS COVERED: A comprehensive literature search and narrative review of studies published between 2010 and March 2026 were conducted using PubMed and international surveillance databases. Current knowledge regarding AMR in UTIs in long-term care residents is summarized.

EXPERT OPINION: UTIs account for 15-30% of infections and 25-50% of antibiotic prescriptions in long-term care facilities globally. Resistance rates among Escherichia coli isolates are high worldwide: trimethoprim-sulfamethoxazole (30-70%), fluoroquinolones (25-60%), and third-generation cephalosporins (15-40%). Extended-spectrum β-lactamase prevalence ranges from 10-50%, depending on the region. Carbapenem-resistant Enterobacterales are increasingly reported in long-term care settings. Risk factors include prior antibiotic exposure, indwelling catheter use, functional impairment, recent hospitalization, and polypharmacy. Inappropriate treatment of asymptomatic bacteriuria significantly contributes to AMR. Implementation of antimicrobial stewardship programs, catheter minimization strategies, infection and prevention control, and improved diagnostic criteria is critical to mitigating resistance and improving resident outcomes.