Antimicrobial Susceptibility Patterns and Proportion of Multidrug-Resistant Uropathogens in a Remote Tertiary Hospital in Bhutan: A Cross-Sectional Study.

BACKGROUND AND AIMS: A surge in antimicrobial resistance and multidrug-resistant organisms among uropathogens have complicated its management over time. It is imperative to examine epidemiology and local antimicrobial susceptibility patterns to promote evidence-based management. This study aimed to evaluate the antimicrobial susceptibility patterns of uropathogens and proportion of multidrug-resistant organisms at a remote tertiary hospital in Bhutan.

METHODS

A cross-sectional study was conducted in the Microbiology Laboratory of a remote tertiary hospital in Bhutan, by retrospectively reviewing medical records of patients who underwent urine culture and sensitivity testing from January 1 to December 31, 2025. All culture - positive (≥ 105 CFU/mL) samples were included in the study. Data were collected using a structured proforma and analyzed using SPSS version 23.

RESULTS

A total of 1867 urine samples were analyzed, of which 19.9% were culture positive. Culture positivity was more common in female (85.8%), and older than 40 years (55%). Gram-negative bacteria constituted the majority (98.4%), with E. coli (80.6%) being the most frequently isolated pathogen, followed by Klebsiella pneumoniae (15.6%). E. coli demonstrated high sensitivity to Access group-gentamicin (81.1%) and Watch group-Imipenem (84.2%). Nearly two-fifths of the uropathogen isolates were multidrug-resistant (39.2%), and a few isolates were carbapenem-resistant organism (8.2%). Multidrug-resistant uropathogens were significantly reported from hospitalized patients (77.4% vs 22.6%, p < 0.001). On multivariable analysis, inpatient status was the only independent predictor of multidrug-resistant organisam isolation (aOR 2.4, 95% CI 1.34-4.37, p = 0.003).

CONCLUSION

Most of the culture positive were caused by Gram-negative bacteria-E. coli demonstrating high susceptibility to gentamicin. Multidrug-resistant organisms were prevalent in nearly two-fifths of the isolates. These findings provide baseline data to guide empirical therapy and support antimicrobial stewardship program.