A comprehensive review on antimicrobial resistance in uropathogens isolated from ICU patients in the south-east Asian region

Hasan, Md Rakibul and Rogers, Whitney and Rahman, Saifur and Muna, Moryom Akter and Rabu, Kanij Fatema and Hassan, Sajid (2025) A comprehensive review on antimicrobial resistance in uropathogens isolated from ICU patients in the south-east Asian region. International Journal of Science and Research Archive, 14 (2). pp. 527-542. ISSN 2582-8185

Introduction: Urinary tract infections (UTIs) are a significant concern in intensive care units (ICUs) due to the high prevalence of indwelling urinary catheters and the compromised health status of patients. The South-East Asian region faces unique challenges in managing UTIs due to varying healthcare infrastructure, antibiotic resistance patterns, and pathogen profiles. This review aims to assess the burden of antimicrobial resistance (AMR) in uropathogens isolated from ICU patients in this region. Methods: This review was conducted as a content analysis, focusing on observational studies that reported on the prevalence and antimicrobial sensitivity of uropathogens in ICU patients in the South-East Asian region. Data were extracted from studies published between January 2020 and June 2023. The risk of bias was assessed using the tool developed by Hoy et al., and the quality of included studies was evaluated using the NIH quality assessment tool. Statistical analyses were performed using STATA 16.0. Results: A total of 50 studies met the inclusion criteria, providing data on 50,000 ICU patients. The pooled prevalence of UTIs was 25% (95% CI: 20%-30%). Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most commonly isolated uropathogens. High resistance rates were observed in Escherichia coli to ampicillin (70%) and ciprofloxacin (50%), and in Klebsiella pneumoniae to cephalosporins (60%) and carbapenems (40%). The heterogeneity among studies was moderate (I² = 60%). Discussion: The high prevalence of UTIs and significant resistance rates underscore the urgent need for effective infection control measures and antimicrobial stewardship programs. The variability in resistance rates suggests that local factors play a significant role in the emergence and spread of AMR. Conclusion: This review highlights the significant burden of AMR in uropathogens isolated from ICU patients in the South-East Asian region. Continuous surveillance and a multifaceted approach are essential for addressing this pressing issue.