Antimicrobial Resistance And Distribution Of Urinary Pathogens In Morocco: A Study From The Beni Mellal Regional Laboratory

Abstract

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and represent a significant public health concern due to their high prevalence, recurrence, and increasing antimicrobial resistance. The distribution of uropathogens and their resistance patterns varies geographically, highlighting the importance of local epidemiological data to guide empirical therapy. This study aimed to characterize the bacterial profile of UTIs and assess antimicrobial susceptibility patterns in the Béni Mellal region of Morocco. An analytical study was conducted on 800 urine samples collected from outpatients and hospitalized patients at the Regional Hospital Center of Béni Mellal. Only samples with significant bacteriuria (≥10⁵ CFU/mL) were included. Bacterial identification was performed using standard microbiological techniques, including Gram staining and the API 20E system. Antimicrobial susceptibility testing was carried out using the disk diffusion method in accordance with EUCAST/CLSI guidelines. Statistical analysis was performed using SPSS software, with a significance threshold set at p < 0.05. Out of 800 urine samples analyzed, 116 were positive for urinary tract infection, corresponding to a prevalence of 14.5%. A female predominance was observed (60.3% vs 39.7% in males), and the majority of cases occurred in elderly patients (63.8%), followed by adults (27.6%) and children (8.6%). Microbiological analysis revealed a clear predominance of Escherichia coli (74.14%), followed by Klebsiella pneumoniae (20.07%), while other pathogens such as Proteus mirabilis, Pseudomonas spp., and Staphylococcus spp. were less frequently isolated. Stratified analysis showed a significant association between E. coli infection and female sex (p = 0.034), as well as advanced age (p = 0.0012). Similarly, K. pneumoniae was significantly more prevalent among elderly patients (p < 0.0001). In addition, E. coli was more frequently isolated in outpatients compared to hospitalized patients (67.44% vs 32.57%; p = 0.030). Antimicrobial susceptibility testing revealed high resistance rates to commonly prescribed antibiotics, particularly amoxicillin (66%), ticarcillin (72%), and nalidixic acid (43%), along with notable resistance to ciprofloxacin and trimethoprim–sulfamethoxazole. In contrast, higher susceptibility rates were observed for mecillinam (82%), piperacillin–tazobactam (80%), and third-generation cephalosporins such as cefotaxime and cefoxitin (approximately 75%). This study confirms the predominance of Escherichia coli in UTIs and reveals alarming levels of antimicrobial resistance among uropathogens in the Béni Mellal region. These findings underscore the urgent need for continuous local surveillance and the rational use of antibiotics to optimize empirical treatment strategies and limit the spread of resistant strains. Keywords: AUrinary tract infections; uropathogens; antimicrobial resistance; antibiotic susceptibility.