Antimicrobial resistance (AMR) is a growing global health crisis that severely threatens the effective treatment of infectious diseases, including urinary tract infections (UTIs). Between 2018 and 2023, UTIs accounted for over 1.8 million hospital admissions in the UK and are the most common bacterial infection encountered in general practice, placing a substantial burden on the health system

Despite the increasing prevalence of AMR, it is surprising to find a total lack of uropathogen-specific antibiograms within scientific literature which is up-to-date and readily available for clinicians and researchers, creating a critical knowledge gap, especially when formulating antibiotic prescribing practices and implementing targeted interventions to combat resistance.

This study presents the latest data on AMR prevalence in uropathogens isolated from clinical samples collected in both hospital and community settings in Berkshire, UK.

All positive urine samples collected from patients for Microscopy, Culture and Sensitivity (MC&S) between January 2023 and December 2023 were identified via the Infection Control Surveillance System (ICNet).

Uropathogens were identified using standard microbiological methods, and their susceptibility to commonly used antibiotics was determined through disk diffusion and the Uri-Plus plate-set susceptibility testing system. 

To ensure robust statistical analysis of cumulative percentage susceptibility rates, only bacterial species with a minimum of 30 isolates were included in the analysis, in accordance with Clinical and Laboratory Standards Institute guidelines. To further optimise the predictive value of the antibiogram for individual patient care, a standardised de-duplication process was implemented which removed repeat specimens obtained from the same patient within a 14-day period. 

Additionally, the data was stratified by sample location (community versus hospital).

A total of 20,785 positive urinary isolates were identified between January 1st, 2023 and December 31st, 2023, on which 181,408 antibiotic sensitivity tests were performed. The results are summarised in Figure 1.

Escherichia coli was the most frequently isolated pathogen (n=11,518), followed by Enterococcus spp (n=3754), Klebsiella spp (n=1987) and Proteus spp (n=1227). 

High levels of resistance were observed to Penicillins (Amoxicillin 44.2%, co-amoxiclav 13.3%) and Diaminopyrimidines (Trimethoprim 24.4%). Notably, resistance to aminoglycosides (Gentamicin 6.2%), fluoroquinolones (Ciprofloxacin 8.4%, Levofloxacin 3.8%), β-lactamase-resistant penicillins (Temocillin 1.1%) and carbapenems (Ertapenam 1.0%, Meropenam 0.8%) has remained low. 

Comparisons between hospital and community settings revealed higher resistance rates in hospital isolates in general (Figure 2).

This study provides the latest overview of AMR prevalence in uropathogens isolated in Berkshire, UK, incorporating a large sample size and employing robust filtering methods, including de-duplication and a minimum isolate threshold, to improve the accuracy and clinical relevance of the presented antibiogram. 

Notably, high resistance rates were observed to commonly prescribed first-line agents such as amoxicillin and trimethoprim, highlighting the need for careful consideration of local resistance patterns when selecting empirical therapy.

Consistent with global trends, Escherichia coli was the most prevalent uropathogen.  Higher resistance rates in hospital settings may reflect selection bias, as these patients are often more severely ill and harbour uropathogens resistant to standard community treatments. This difference may be further amplified by the fact that community urine cultures are often only performed on patients failing first-line therapy, potentially overrepresenting resistant uropathogens in the community data as well.

The latest data indicate a concerning rate of AMR among uropathogens in both hospital and community settings in Berkshire. This antibiogram provides a valuable resource for clinicians and researchers in optimising empirical antibiotic choices and for informing local infection control strategies. The availability of this up-to-date, local antibiogram fills a critical knowledge gap and will aid in the development of more effective, targeted interventions to combat the growing threat of AMR in UTIs.