{"paper_id":"0058c835-ba7b-4afa-a4ff-5afe6714b7fc","body_text":"Uropathogenic Profiles and Antibiotic Resistance in Gynaecological Cases: A Microbial Surveillance Study from Northeast India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Uropathogenic Profiles and Antibiotic Resistance in Gynaecological Cases: A Microbial Surveillance Study from Northeast India Julie Bania, Vishal Chakraborty, Archita Limboo, Ritusmita Deori, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7519847/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background: Urinary tract infection (UTI) is one of the most common bacterial infections in women worldwide. This study explored bacterial diversity, risk factors, and MDR status of UTIs in gynecologic patients. Result A total of 896 subjects were included, of whom 278 (37.6%) were diagnosed as UTI-positive using standard microbiological protocols. Midstream clean-catch urine samples were also collected and tested for antimicrobial susceptibility as recommended by the CLSI. Significant associations were found between UTI prevalence and several risk factors, including age 18–39 years (OR: 2.14, p < 0.001), women with a previous history of UTI (OR: 7.81, p < 0.001), hypertension (OR: 2.75, p < 0.001), previous antibiotic use (OR: 2.99, p < 0.001), and during pregnancy (OR: 1.96, p < 0.001) respectively. The most prevalent pathogens were Escherichia coli (62.5%) and Klebsiella pneumoniae (16.9%). According to sensitivity patterns, Gentamicin, Ertapenem, Amikacin, and Fosfomycin for Gram-negative bacteria, and Tigecycline and Nitrofurantoin for Gram-positive pathogens, are recommended as treatment options for UTIs. Conclusion These findings emphasize the urgent need for localized antibiotic stewardship programs, routine surveillance for resistance, microbiological diagnostic support in gynecological care, and infection control measures. Responsible antibiotic use and infection control are critical strategies to prevent the spread of MDR. Health sciences/Diseases Health sciences/Medical research Biological sciences/Microbiology Health sciences/Urology Urinary tract infections (UTIs) Northeast India Uropathogenic Antibiotic Resistance Gynaecological Infections Urinary tract infection Pathogens Figures Figure 1 Figure 2 1. Introduction Urinary tract infections (UTIs) represent one of the most common bacterial infections affecting women worldwide, while leading to substantial morbidity and healthcare costs [ 1 ]. Globally, the estimated incidence of UTIs is 150 million cases, resulting in around 0.26 million deaths and leading to at slightest $ 6 billion in health care costs per annum [ 1 , 2 , 3 ]. The more frequent prevalence rate for UTI shows women experience it 50-fold higher among the 20–50 years age group [ 4 ]. The number of UTI cases worldwide increased rather intensely from just about 252.2 million in 1990 to over 404.6 million in 2019 [ 5 ]. UTIs can lead to several serious complications, including the presence of protein in the urine (proteinuria), elevated blood pressure (hypertension), and kidney impairment due to reduced renal function [ 2 ]. Urinary tract infections are broadly classified into two categories: uncomplicated and complicated [ 6 , 7 ]. Uncomplicated UTIs occur in individuals with no underlying structural or functional abnormalities of the urinary tract, and they are most commonly observed in otherwise healthy individuals. These infections are further divided into lower UTIs (cystitis), which affect the bladder, and upper UTIs (pyelonephritis), which involve the kidneys [ 7 – 10 ]. In contrast, complicated UTIs are associated with conditions that compromise the host's urinary system or defence mechanisms. These conditions may include urinary obstructions, neurogenic bladder disorders, immunosuppression, chronic kidney disease, renal transplantation, pregnancy, and the presence of foreign bodies such as kidney stones, indwelling catheters, or other drainage devices, to mention a few [ 11 , 12 ]. Such factors not only increase susceptibility to infection but also complicate treatment outcomes. The global rise of antibiotic-resistant bacteria poses a severe threat to healthcare systems worldwide and is a major contributor to the increasing incidence of UTIs [ 13 , 14 ]. The standard clinical approach to managing urinary tract infections (UTIs) relies heavily on antibiotic therapy. However, the effectiveness of this strategy is steadily declining due to the escalating prevalence of antimicrobial resistance among UTI pathogens. Moreover, the extensive and often indiscriminate use of antibiotics for these infections further accelerates the emergence of resistant bacterial strains, complicating treatment outcomes and posing a significant public health challenge [ 12 – 15 ]. Accumulating evidence suggests that the primary etiological agent responsible for both uncomplicated and complicated UTIs is uropathogenic Escherichia coli (UPEC) [ 7 ]. In cases of uncomplicated UTIs, UPEC is most frequently isolated, followed by other pathogens such as Klebsiella pneumoniae , Staphylococcus saprophyticus , Enterococcus faecalis , Group B Streptococcus (GBS) , Proteus mirabilis , Pseudomonas aeruginosa , Staphylococcus aureus , and Candida species, to name a few [ 6 , 16 , 17 ]. For complicated UTIs, the spectrum of causative agents expands, with UPEC remaining the most common pathogen, followed by Enterococcus species, K. pneumoniae , Candida spp., S. aureus , P. mirabilis , P. aeruginosa , and GBS [ 10 , 18 – 21 ]. India has experienced a significant surge in antibiotic resistance among uropathogenic Escherichia coli (UPEC) over the past decade, with resistance patterns emerging across multiple antibiotic classes. These include penicillins, cephalosporins, aminoglycosides, quinolones/fluoroquinolones, and sulfonamides [ 22 – 25 ]. However, notable variations exist in resistance profiles, both within and between different regions of the country 22–26 . The increasing prevalence of multidrug-resistant (MDR) UPEC strains exhibiting resistance mechanisms such as extended-spectrum β-lactamase (ESBL) production, metallo-β-lactamase (MBL) production, and AmpC β-lactamase production has become a major concern in the last few years [ 27 – 30 ]. The Northeast region of India poses a unique context for UTI research due to its diverse population, varied healthcare access, and limited prior data [ 31 ]. Understanding the local bacterial pathogens, AMR patterns, and clinical impacts in Northeast Indian states is crucial for guiding effective management. To date, there are only a few reports that highlight the identification and characterization of the pathogenic strains associated with the UTIs in Northeast India. In Manipur, a study at RIMS Imphal (2007) found E. coli in 72.8% of culture-positive UTIs, followed by Klebsiella spp. (14.4%), with other organisms like Pseudomonas and Proteus accounting for a smaller fraction, [ 32 ]. In 2012, a study from Silchar Medical College, Assam, found E. coli in 33.3% of isolates, with significant contributions from Staphylococcus aureus (22.2%) and Klebsiella pneumoniae (11.1%) [ 33 ]. However, unlike some other regions of India, Northeast India does not yet have a robust, continuous surveillance network focused on UTIs. Data from several NE states are nearly absent from the literature, pointing to a surveillance gap. The novelty of our study is to focus on a susceptible patient among the younger patient population from the northeast region with distinct geographical and demographic characteristics. In addition, the accuracy and repeatability of our findings were also guaranteed due to the use of strong microbiological techniques and CLSI guidelines. To the best of our knowledge, this is one of the early comprehensive studies from Northeast India investigating the correlation between drug resistance, diversity of uropathogens among younger women. 2. Materials and Methods 2.1 Study Design and Setting A cross-sectional study was conducted from April 2024 to March 2025 at the department of microbiology, Pratiksha Hospital, Guwahati, Assam, in collaboration with the department of medical laboratory technology, The Assam Royal Global University, Guwahati. The study aims to evaluate the bacterial diversity and antibiotic resistance patterns of uropathogens in gynaecological cases in Northeast India. The involved female patients exhibited urinary tract infection (UTI) symptoms in gynaecology inpatient gynaecological units, outpatient departments, and maternity wards. The private medical facility operates as a referral centre to offer specialized treatment for patients coming from Northeast India's urban and rural areas. The study examined 896 women who received UTI diagnoses through clinical symptoms, including dysuria, increased urinary frequency, urgency, suprapubic discomfort, or fever. The study excluded patients with kidney diseases, immunosuppressed conditions, or recent antibiotic usage to maintain clear microbial results during resistance evaluation (Fig. 1 ). 2.2 Sample Collection and Processing The Midstream clean-catch urine samples (5–10 mL) were collected in sterile, wide-mouthed, screw-capped containers from non-catheterized patients (Fig. 1 ). Daisceptic urine collection from catheterized patients started with cleansing catheter ports using 70% alcohol, followed by drying the area before using a sterile syringe for aspiration. Samples underwent proper labelling before their instant transportation to the microbiology laboratory for laboratory examination. If immediate processing of the specimen was not feasible, the sample underwent cold storage at 4°C for no longer than 2 hours to stop microorganisms from multiplying [ 29 ]. 2.3 Inclusion and Exclusion Criteria Patients with confirmed urinary tract infections (UTIs) were included based on culture-positive urine samples. The study enrolled community-based UTI patients with documented age, gender, previous history, and symptoms such as dysuria, frequent urination, and cloudy or bloody urine with a strong odour. UTI confirmation was established through significant bacterial growth. Exclusion criteria included negative cultures, fungal infections, paediatric cases, and contaminated samples (Fig. 1 ). 2.4 Isolation and Identification of Bacterial Uropathogen The collected urine samples were cultured on MacConkey and Blood agar (HiMedia, Mumbai, India) using the semi-quantitative streak plate method and incubated aerobically at 37°C for 18–24 hours. We then evaluated bacterial growth and counted the colony-forming units (CFU). We specified significant bacteriuria as having ≥ 10⁵ CFU/mL for midstream urine and ≥ 10³ CFU/mL for catheterized urine, following standard microbiological guidelines. The presumptive identification of bacteria depended on their appearance in culture media, microscopic observation, and Gram-staining results. To confirm accurate species identification, selected isolates were analysed using the VITEK 2 automated system (BioMérieux, France) [ 34 ]. 2.5 Antimicrobial Susceptibility Testing (AST) AST profiles of the bacterial isolates were performed for each bacterium identified using the standard Kirby-Bauer disk diffusion method on Mueller-Hinton Agar (MHA) HiMedia, Mumbai, India ) according to the Clinical and Laboratory Standards Institute (CLSI) 2018 guidelines to prepare the suspension, we took 3 to 5 colonies from a pure culture using an inoculation loop. The colonies were then emulsified in nutrient broth and mixed gently. This process was continued until the turbidity of the suspension matched 0.5 McFarland. Antibiotic drugs and concentrations were included to determine the antibiogram of the strains per gram. A set of 19 antibiotic discs was selected based on the CLSI recommendations and regional antibiotic usage for gram-negative bacteria. The antibiotics tested included Ampicillin (10 µg), Gentamicin (30 µg), Ciprofloxacin (20 µg), Nitrofurantoin (30 µg), Trimethoprim / Sulfamethoxazole (30 µg), Ticarcillin (30 µg), Piperacillin/Tazobactam (30 µg), cefalotin (30 µg), cefoxitin (30 µg), cefixime (30 µg), ceftazidime (30 µg), ceftriaxone (30 µg), Ertapenem (30 µg), Amikacin (30 µg), Nalidixic Acid (30 µg), Norfloxacin (30 µg), ofloxacin (30 µg), Fosfomycin (30 µg) and 20 antibiotic drugs were selected for gram positive bacteria such as Ampicillin (30 µg), (30 µg), Amoxicillin/Clavulanic acid (30 µg), Benzylpenicillin (30 µg), Oxacillin (30 µg), Gentamicin (30 µg), Ciprofloxacin (30 µg), Levofloxacin (30 µg), Nitrofurantoin (30 µg), Doxycycline (30 µg), Vancomycin (20 µg), Tigecycline (30 µg), Nitrofurantoin (30 µg), Trimethoprim / Sulfamethoxazole (30 µg), Piperacillin/Tazobactam (30 µg), cefoxitin (30 µg), cefixime (30 µg), ceftriaxone (30 µg) Amikacin (30 µg), Piperacillin-tazobactam (30 µg) Penicillin (30 µg). The plates were incubated at 37°C for 18–24 h, and the diameters of the inhibition zones were measured using calipers. The isolates were classified as susceptible (S), intermediate (I), or resistant (R) according to the CLSI 2018 guidelines [ 29 , 35 ]. Quality Control Assessment All the bacterial species identification and susceptibility pattern assessment were confirmed with the help of standard reference strains obtained from the American Type Culture Collection (ATCC) used for quality control. The Escherichia coli (ATCC 25922), Klebsiella pneumoniae (ATCC 700603), Pseudomonas aeruginosa (ATCC 27853), Proteus mirabilis (ATCC 29906) for gram-negative bacteria, and Staphylococcus saprophyticus (ATCC BA750), Staphylococcus aureus ( ATCC 29213), and Enterococcus faecalis (ATCC 29212) gram-positive bacteria were used as reference strains. These strains were confirmed by clinical isolates to determine the performance of the VITEK 2 system for both detection and antimicrobial susceptibility testing. All test results for control strains were required to fall within established quality control ranges as recommended by the Clinical and Laboratory Standards Institute (CLSI) guidelines to ensure reliability and accuracy of the results [ 36 , 37 ]. 2.6 Ethical Statement The present study was approved by the Institutional Ethical Committee (IEC) at The Assam Royal Global University, Guwahati. Written informed consent was obtained from all participants through designed questionnaires and personal interviews 2.7 Statistical Analysis The study employed descriptive statistics to report data results in percentages alongside tables for presentation. All UTI patient data associated with demographic characteristics, UTI status were employed using the chi-square test or Fisher's exact test. Univariate analysis was done by calculating odds ratios (ORs) along with 95% confidence intervals (CIs) to determine relationships between different variables and instances of infection. Results demonstrated statistical significance with a p-value at or below 0.05 and non-significance using p-values exceeding 0.05. All the accumulating data were performed using Microsoft Excel (Ver. 2013), MedCalc (Ver. 19.3), and SPSS software version 20.0 (SPSS Inc., Chicago, IL, USA). 3. Results 3.1 Association of Sociodemographic and Clinical Risk Factors with UTI Prevalence Among Women in Northeast India Out of the 896 urine samples collected from women with suspected urinary tract infections (UTIs) in Northeast India, 435 (48.55%) were culture positive. After excluding samples without significant bacterial growth, 278 cases were included for further microbiological and sociodemographic analysis presented in (Figure. 1). The patients’ age ranged from 14 to 89 years, with a mean age of 38 ± 16.68 years. (Table 1) outlines the associations between various sociodemographic and clinical factors with UTI positivity. The prevalence of UTIs was significantly higher among women aged 18–39 years (59.71%), with an odds ratio (OR) of 2.14 (95% CI: 1.38–3.32; p < 0.001), indicating that this age group was over twice as likely to develop UTIs compared to those aged 60 and above. The 40–59 years group also had elevated prevalence (27.69%) but did not reach statistical significance (p = 0.22). Marital status showed no significant association with UTI prevalence, although unmarried women (36.69%) and married women (54.31%) constituted the majority of UTI-positive cases. Likewise, education level (literate vs. illiterate; p = 0.98) and place of residence (urban/semi-urban vs. rural; p = 0.23) did not significantly influence UTI risk, even though 68.70% of UTI-positive cases resided in urban or semi-urban areas. Similarly, dietary habits (vegetarian vs. non-vegetarian) were not significantly associated with UTI prevalence (p = 0.39), despite the predominance of non-vegetarian subjects among both UTI-positive (88.48%) and UTI-negative (86.33%) groups. Several clinical risk factors were found to be statistically significant. A history of previous UTI episodes was strongly associated with current infection (14.74% vs. 2.16%; OR = 7.81, 95% CI: 3.84–15.85; p < 0.001), suggesting a nearly eight-fold increased risk. Similarly, hypertension emerged as a significant risk factor, with 21.22% of UTI-positive women diagnosed with the condition, compared to 8.89% in the UTI-negative group (OR = 2.75; p < 0.001). Prior antibiotic use also correlated significantly with UTI prevalence (26.25% vs. 10.62%; OR = 2.99; p < 0.001), indicating that prior exposure may predispose women to infection, potentially due to antibiotic resistance. Pregnancy was another strong correlate, with 85.61% of UTI-positive patients being pregnant, showing a significant association (OR = 1.96; p < 0.001) compared to non-pregnant individuals. Interestingly, a high proportion of both UTI-positive (94.60%) and UTI-negative (92.84%) women reported experiencing a burning sensation during urination; however, the difference was not statistically significant (p = 0.34). This finding suggests that, despite urinary discomfort being a commonly reported clinical symptom, its presence alone does not reliably indicate the status of a urinary tract infection. Collectively, these findings indicate that younger age, prior UTI history, hypertension, pregnancy, and prior antibiotic usage are key predictors of UTI among women in this Northeast Indian cohort in present (Table 1). 3.2 Microbial Spectrum of Uropathogens Isolated from Gynaecological Patients Among the 278 culture-positive urine samples obtained from women with clinically suspected urinary tract infections (UTIs), the microbial profile revealed a striking predominance of Gram-negative bacteria. Escherichia coli emerged as the most frequently isolated uropathogen, accounting for 62.58% (n = 174) of the total isolates, thereby reaffirming its established role as the leading etiological agent of community-acquired UTIs in women. Klebsiella pneumoniae was identified as the second most common Gram-negative isolate, representing 16.90% (n =47), followed by Pseudomonas aeruginosa (1.79%, n = 5) and Proteus mirabilis (2.87%, n = 8). Together, these Gram-negative organisms comprised a significant majority of the uropathogenic burden. Gram-positive bacteria constituted a smaller but clinically relevant proportion of the isolates. Among them, Enterococcus faecalis was the most prominent, detected in 8.27% (n = 23) of cases. Staphylococcus aureus and Staphylococcus saprophyticus were isolated in 4.31% (n = 12) and 3.23% (n = 9) of samples, respectively. The distribution pattern, illustrated in (Figure 2), highlights the microbial diversity of uropathogens encountered in gynaecological patients admitted to Pratiksha Hospital and emphasizes the dominance of Gram-negative bacilli in the regional UTI landscape. 3.3 . Age-Specific Distribution of Uropathogens Among Women with UTIs The comparative distribution of uropathogens across two age groups: women below 40 years old and those aged 40 years or older, who tested positive for 278 UTIs, revealed that E. coli was the most frequently identified pathogen in both age groups, but it was significantly more prevalent in younger women (Table 2). Specifically, E. coli was isolated in 65.66% (n = 109) of cases in the group under 40, compared to 58.03% (n = 65) in women aged 40 and older. This difference was statistically significant (p = 0.008), indicating a greater susceptibility to E. coli-mediated urinary tract infections (UTIs) among younger women. Klebsiella pneumoniae , the second most commonly isolated Gram-negative bacterium, showed similar prevalence across age groups—16.86% in women under 40 and 16.96% in those aged 40 and above, with no significant statistical association (p=0.87). Other Gram-negative pathogens, such as Pseudomonas aeruginosa and Proteus mirabilis , were relatively rare in both groups. P. aeruginosa was slightly more common in older women (2.67%) than in younger ones (1.20%), while Proteus mirabilis exhibited a low but uniform prevalence in both age categories (3.01% vs. 2.67%). Among the Gram-positive bacteria, Enterococcus faecalis was more frequently isolated from women aged 40 years and older (9.82%) than from those below 40 (7.22%), although this association was not statistically significant (p= 0.34). Similarly, Staphylococcus aureus showed nearly equal prevalence in both age groups (4.21% vs. 4.46%; p = 0.26). Notably, Staphylococcus saprophyticus exhibited a higher prevalence among older women (5.35%) compared to the younger group (1.80%), but this difference was not statistically significant. Overall, the data reaffirm E. coli as the leading uropathogen with a distinct age-related pattern favouring younger women. 3.4. Multidrug Resistance Profiles of Uropathogens Isolated from Gynaecological Patients To investigate the antimicrobial resistance patterns among Gram-positive and Gram-negative uropathogens, a high prevalence of multidrug resistance (MDR) among the bacteria is prevalent. Escherichia coli (E. coli) demonstrated the highest resistance among Gram-negative bacteria, with 56 (32.18%) of the isolates showing (≥R5) multidrug resistance to antibiotics, followed by 67 (38.50%) isolates that confirmed (R4) antibiotics resistance. The MDR profile of Klebsiella pneumoniae isolates showed significant results, as 51.06% of them exhibited resistance to (≥R5) antibiotics. The five Pseudomonas aeruginosa isolates exhibited full resistance against five different antibiotics. Gram-positive bacteria showed Staphylococcus aureus to have the strongest resistance among them, since 9 out of 12 (75%) isolates demonstrated resistance to (≥R5) antibiotics. The bacterial strain Enterococcus faecalis demonstrated five or more antibiotic-resistant properties through 11 (47.82%) clinical isolates. The antibiotic resistance level of Staphylococcus saprophyticus was moderate, based on two (22.22%) isolates showing resistance to (≥R5) antibiotics. 3.5. Multidrug Resistance Pattern Among Gram-negative Uropathogenic Bacteria The Multidrug resistance pattern (MDR) of gram-negative uropathogens isolated from women with urinary tract infections (UTIs) is represented in (Table 4). Out of the 234 gram-negative bacteria were isolates including Escherichia coli (E. coli) was the predominant pathogen (n=174), followed by Klebsiella pneumoniae (n=47), Proteus mirabilis (n=5), and Pseudomonas aeruginosa (n=8). Whereas E. coli had a high resistance to Norfloxacin (84.27%), nalidixic acid (76.43%), ampicillin (63.21%), cefalotin (63.21%), and ciprofloxacin (61.5%). However, high level of susceptibility was recorded for Fosfomycin (91.37 %), Amikacin (84.48%), Gentamicin (83.90 %), Ertapenem (85.63%), cefoxitin (72.49%) and Piperacillin/Tazobactam (65.52%) respectively with higher level of MDR, suggesting their continued effectiveness for treating complicated UTIs caused by E. coli . In the context of Klebsiella pneumoniae strain (N= 47) isolates, resistance was similar to E. coli , with high-level resistance observed against Cefalotin (68.08%), Ampicillin (51.06%), and Nalidixic Acid (59.57%). Moreover, the resistance to third-generation cephalosporins such as Cefixime (48.93%) and Ceftriaxone (42.55%) was significant. On the contrary, the pathogen remained mostly susceptible to Amikacin (89.36%), Fosfomycin (85.10 %), and Gentamicin, Ertapenem (80.85%), highlighting the potential role of these agents in managing multidrug-resistant strains. On the other hand, lower resistance was observed for amikacin (8.51%) and ertapenem (6.38%), which were among the most effective drugs against this species. The high susceptibility to piperacillin/tazobactam (78.72%) and amoxicillin-clavulanic acid (51.06%) highlights their potential use in empirical therapy, though susceptibility testing remains critical. Pseudomonas aeruginosa (N=5) isolates, though limited in number, showed moderate susceptibility to most tested antibiotics, including 80% susceptibility to Ampicillin, Gentamicin, Piperacillin/Tazobactam, and Cefoxitin. However, this species also demonstrated high resistance to Nalidixic Acid (80%) and Ceftriaxone (80%), aligning with its intrinsic multidrug resistance mechanisms. While Proteus mirabilis strain (N=8) displayed high susceptibility pattern to amikacin and Fosfomycin (100%), ceftriaxone and ertapenem (87.5%), suggesting these as potential treatment options. However, the resistance to ampicillin (37.5%) and nitrofurantoin (62.5%) was noteworthy. Nitrofurantoin, although widely effective in UTIs, is known to have reduced activity against Proteus species. 3.6. Multidrug Resistance Pattern Among Gram-Positive Uropathogenic Bacteria The multidrug resistance (MDR) patterns and antimicrobial susceptibility profiles of Gram-positive uropathogens isolated from women with urinary tract infections (UTIs) indicate that a total of 44 Gram-positive isolates were identified in this cohort, comprising Staphylococcus aureus (n = 12), Staphylococcus saprophyticus (n = 9), and Enterococcus faecalis (n = 23) (Table 5). Among the Staphylococcus aureus isolates, high resistance rates were observed against commonly used β-lactam antibiotics, with 75% of the isolates resistant to ceftriaxone, 66.66% to penicillin, and 58.33% to cefoxitin, indicating a significant burden of methicillin-resistant S. aureus (MRSA) strains in the population studied. Despite this, the susceptibility of several antibiotics remained relatively high: 75% of the isolates were sensitive to both amikacin and vancomycin, while 66.66% retained susceptibility to nitrofurantoin and tigecycline, highlighting their potential for treating resistant infections. Staphylococcus saprophyticus displayed complete (100%) resistance to ampicillin and benzylpenicillin, aligning with its known resistance to β-lactam agents. However, this pathogen was fully susceptible to gentamicin, vancomycin, and tigecycline, and demonstrated 88.88% susceptibility to nitrofurantoin, doxycycline, and amoxicillin/clavulanic acid. These findings suggest that while first-line β-lactams may be ineffective, alternative agents such as nitrofurantoin and glycopeptides remain highly effective for managing infections caused by this species. Enterococcus faecalis exhibited a distinct resistance pattern, with the highest resistance noted against ciprofloxacin, cefixime, and penicillin (each 60.86%), followed by gentamicin and ceftriaxone (both 56.52%). Nonetheless, the isolates showed excellent susceptibility to nitrofurantoin (91.30%), tigecycline (82.60%), and ampicillin (78.26%). Additionally, vancomycin and piperacillin/tazobactam retained moderate effectiveness, with 69.56% of the isolates susceptible to each. Thus, the results reveal a high prevalence of multidrug resistance among Gram-positive uropathogens, particularly in S. aureus and E. faecalis (Table 5). However, the data also reinforce the continued efficacy of specific antibiotics, such as nitrofurantoin, tigecycline, amikacin, and vancomycin, which may be considered in empirical therapy in light of regional resistance trends. 4. Discussion Unsectioned Paragraphs Urinary tract infections (UTIs) remain a significant health problem, primarily affecting women with gynecological conditions 38 . The present study provides an extensive microbiological and epidemiological assessment of urinary tract infections (UTIs) among women in Northeast India, highlighting key sociodemographic determinants, microbial distribution patterns, and alarming antimicrobial resistance trends. A significant finding was the higher prevalence of UTIs among women aged 18–39 years (Table 1), with a two-fold increase in risk compared to those aged ≥60 years ( p < 0.001). This trend aligns with prior studies reporting increased susceptibility among sexually active premenopausal women due to anatomical and hormonal factors [39]. Other clinical risk factors, including prior UTI history, hypertension, pregnancy, and recent antibiotic usage, also showed significant associations with infection [40]. Our findings further indicate that women aged 18–39 years have a significantly higher likelihood of developing UTIs compared to those groups aged ≥60 years (OR: 2.14; p < 0.001). This aligns with previous studies that reported higher UTI incidence in younger women, particularly those of reproductive age, likely due to sexual activity, hormonal factors, and anatomical predisposition [41]. Considerably, women with a previous history of UTIs had a significantly increased risk of present UTI ( p < 0.001) [42]. The robust association supports the present study, demonstrating that recurrent UTI is a main risk factor due to reasons like partial treatment, determination of uropathogens, and possible host-related immunological responses [43]. Furthermore, we have also demonstrated that hypertension also emerged as a significant associate ( p < 0.001) (Table 1), proposing a potential relationship between systemic inflammation, compromised immunity, and increased susceptibility to infection [44]. Previous studies suggested that UTIs diagnosed through bacteriuria tests in pregnant women lead to higher risks of hypertension in pregnancy [45]. Interestingly, we also observed that pregnancy showed a strong association with UTI positivity, with 85.61% of UTI-positive cases occurring in pregnant individuals (Table 1). Also, the prior antibiotic use was significantly associated with higher UTI prevalence ( p < 0.001), potentially due to disruption of the normal microbiota and development of antimicrobial resistance, which is increasingly recognised in UTI pathogenesis [46 ] . Microbiological analysis (Table 2) revealed Escherichia coli as the most prevalent pathogen, isolated in 62.5% of cases, while Klebsiella pneumoniae , Enterococcus faecalis , and Staphylococcus aureus were other notable isolates. This result corroborates the similar pattern of E. coli being the most common uropathogen, which has been significantly reported in previous findings in both India and worldwide [47-50]. We also observed the distribution of uropathogens among various age groups. Previous reports suggest that Gram-negative bacteria, particularly Escherichia coli , were responsible for most urinary tract infections in the lower age group [51, 52]. We also observed a statistically significantly higher rate of E. coli infections among < 40 years, thus suggesting hormonal and sexual elements play a role in this observation (Table 2). Interestingly, the near-equal prevalence of Klebsiella pneumoniae across age groups was observed, which implies its role as a consistent secondary pathogen, likely independent of age-related physiological changes (Table 2). Multidrug resistance pattern was widespread (Table 3), with more than 38% of E. coli and 51% of K. pneumoniae isolates showing resistance to five or more antibiotics (≥R5). We observed a significant variation among the MDR-pathogens, with E. coli emerging as the most common uropathogen, showing high resistance to ampicillin (63.21%), ciprofloxacin (61.50%), and amoxicillin/clavulanic acid (32.76%), respectively (Table 3). Klebsiella pneumoniae showed high resistance to ampicillin (51.06%), ticarcillin (46.80%), and ceftriaxone (42.55%), respectively (Table 4). Interestingly, E. coli exhibits significant susceptibility to gentamicin (83.90%) and nitrofurantoin (69.54%), while Klebsiella pneumoniae showed susceptibility to piperacillin/tazobactam (78.72%) and ertapenem (80.85%), supporting their use in resistant infections, consistent with previous findings [53, 54]. In contrast, Pseudomonas aeruginosa exhibited strong resistance to several antibiotics, with broad resistance to ampicillin and piperacillin/tazobactam. However, the bacteria demonstrated sensitivity to both amikacin (84.48%) and ertapenem (80.85%), suggesting these agents may be effective in treating P. aeruginosa UTIs in this population group. like previous findings [55, 56] . Furthermore, the susceptibility of Proteus mirabilis to Amikacin (100%), Fosfomycin (100 %), Ertapenem (87%), and Gentamicin (75 %), respectively, was high, while resistance to ampicillin (37.5%) and Nitrofurantoin (62.5%) was observed. correspondingly reported by Miranda EJ et al and Maraki S et al, and Chen CY et al, [57, 58]. Thus, the results indicate the promising use of certain antibiotics, which may be used to counter the Gram-negative MDR strains in UTI management. Similarly, exploring the antimicrobial resistance patterns in Gram-positive uropathogens in UTI patients revealed that Enterococcus faecalis showed outstanding resistance to ciprofloxacin (60.86%) and gentamicin (56.52%) (Table 5). These findings support previous observations of resistance mechanisms in Enterococcus spp [59, 60]. Moderate resistance against ampicillin and oxacillin β-lactam antibiotics existed in Staphylococcus aureus and S. saprophyticus bacteria in alignment with national reports of methicillin-resistant strains (MRSA) affecting community-acquired UTIs [ 61, 62] . Staphylococcus aureus isolates displayed moderate resistance to commonly used antibiotics like ampicillin (66 %) and ceftriaxone (75 %), supporting previous reports of methicillin-resistant strains in urinary infections [63, 64]. Alarmingly, 58.33% of S. aureus isolates were resistant to cefoxitin, indicating a high prevalence of methicillin resistance, similar to trends observed in other Indian and Asian cohorts [65, 66 ]. Staphylococcus saprophyticus , though a less frequent pathogen, showed 100% susceptibility to Gentamicin, nitrofurantoin, vancomycin, and tigecycline, reaffirming their utility in empirical therapy similar to earlier studies [67]. Collectively, our findings not only corroborate global AMR trends but also emphasize the unique burden faced by Northeast Indian populations due to microbial diversity, patient comorbidities, and other lifestyle factors. Integrating molecular typing and resistance gene profiling in future studies could further elucidate the regional epidemiology and guide targeted interventions. We anticipate that our results will provide useful information for clinicians, microbiologists, and public health authorities. Through emphasising geographical variation in microbial epidemiology and resistance challenges, our study generates an important understanding for creating tailored empirical treatment guidelines and antimicrobial stewardship initiatives. In the future, evidence-based analytics such as these will be important for enhancing patient outcomes, lowering healthcare costs, and arresting the advance of AMR. 5. Conclusion The present study underscores a pressing public health concern posed by urinary tract infections among gynecological patients in Northeast India, with Escherichia coli and Klebsiella pneumoniae emerging as the predominant uropathogens. This study offers a comprehensive evaluation of urinary tract infections (UTIs) among women with gynaecological concerns in Northeast India, uncovering key sociodemographic and clinical factors associated with infection prevalence. The data reveal that women aged 18–39 years are at significantly higher risk, particularly those with prior UTI episodes, hypertension, pregnancy, or recent antibiotic exposure. Among the culture-positive samples, Escherichia coli emerged as the dominant uropathogen, followed by Klebsiella pneumoniae and Staphylococcus aureus , all demonstrating high levels of multidrug resistance (MDR). Notably, while resistance to commonly prescribed antibiotics was widespread, agents such as gentamicin, nitrofurantoin, amikacin, ertapenem, and tigecycline retained high efficacy, suggesting their potential as empirical options in this region. These findings highlight the urgent need for localized antibiotic regimens, regular antimicrobial surveillance, and risk-based patient stratification to ensure better clinical outcomes and reduce the regional AMR burden. Declarations Conflict of Interest The authors declare no competing interests 7. Author Contributions Conceptualization, RK, AD and JB.; Methodology, RK, AD and JB ; Data Curation, JB, VC, AL, RD, RK; Writing Original Draft Preparation, R.K, A.D., A.B.; Writing—JB, VC, AL, RD, RK; 8. ACKNOWLEDGEMENTS The authors are grateful to The Assam Royal Global University for Seed Money Grant [RGU/Ch(Acad)/07/Biotechnology (22)] to RK and [RGU/Ch(Acad)/07/Biochem.(19)] to AD. 9. Funding The authors declare that no financial support was received for the conduct of this research. This study did not receive any funding from governmental, non-governmental, commercial, academic, or institutional sources. However, limited funds from the university seed money grants from RGU were utilized. 10. Institutional Review Board Statement The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of The Assam Royal Global University 11. Data Availability Statement Data availability : The data generated and analyzed during this study can be provided by the corresponding author upon reasonable request 12. Informed consent statement Written informed consent was obtained from all participants through designed questionnaires and personal interviews. References Wang J, Lei S, Liang L. 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02:37:35\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":143039,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eFlow chart of the study\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7519847/v1/31f1f163e72cafb376088b51.jpg\"},{\"id\":93728958,\"identity\":\"2f4843ab-07aa-4516-a07b-bae52caefe88\",\"added_by\":\"auto\",\"created_at\":\"2025-10-17 02:13:35\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":68437,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePrevalence of bacteria identified in urine samples among gynaecological cases with urinary tract infections.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7519847/v1/1a7712a60665cc5c1d6e62b4.jpg\"},{\"id\":93732774,\"identity\":\"bb5e9537-9111-49d8-b1bc-80a012a4f5ef\",\"added_by\":\"auto\",\"created_at\":\"2025-10-17 02:37:40\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1119195,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7519847/v1/c11645ec-dc84-4515-858b-9e6337e5937e.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Uropathogenic Profiles and Antibiotic Resistance in Gynaecological Cases: A Microbial Surveillance Study from Northeast India\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eUrinary tract infections (UTIs) represent one of the most common bacterial infections affecting women worldwide, while leading to substantial morbidity and healthcare costs [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Globally, the estimated incidence of UTIs is 150\\u0026nbsp;million cases, resulting in around 0.26\\u0026nbsp;million deaths and leading to at slightest \\u003cspan\\u003e$\\u003c/span\\u003e6\\u0026nbsp;billion in health care costs per annum [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. The more frequent prevalence rate for UTI shows women experience it 50-fold higher among the 20\\u0026ndash;50 years age group [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. The number of UTI cases worldwide increased rather intensely from just about 252.2\\u0026nbsp;million in 1990 to over 404.6\\u0026nbsp;million in 2019 [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. UTIs can lead to several serious complications, including the presence of protein in the urine (proteinuria), elevated blood pressure (hypertension), and kidney impairment due to reduced renal function [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eUrinary tract infections are broadly classified into two categories: uncomplicated and complicated [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Uncomplicated UTIs occur in individuals with no underlying structural or functional abnormalities of the urinary tract, and they are most commonly observed in otherwise healthy individuals. These infections are further divided into lower UTIs (cystitis), which affect the bladder, and upper UTIs (pyelonephritis), which involve the kidneys [\\u003cspan additionalcitationids=\\\"CR8 CR9\\\" citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn contrast, complicated UTIs are associated with conditions that compromise the host's urinary system or defence mechanisms. These conditions may include urinary obstructions, neurogenic bladder disorders, immunosuppression, chronic kidney disease, renal transplantation, pregnancy, and the presence of foreign bodies such as kidney stones, indwelling catheters, or other drainage devices, to mention a few [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Such factors not only increase susceptibility to infection but also complicate treatment outcomes.\\u003c/p\\u003e\\u003cp\\u003eThe global rise of antibiotic-resistant bacteria poses a severe threat to healthcare systems worldwide and is a major contributor to the increasing incidence of UTIs [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. The standard clinical approach to managing urinary tract infections (UTIs) relies heavily on antibiotic therapy. However, the effectiveness of this strategy is steadily declining due to the escalating prevalence of antimicrobial resistance among UTI pathogens. Moreover, the extensive and often indiscriminate use of antibiotics for these infections further accelerates the emergence of resistant bacterial strains, complicating treatment outcomes and posing a significant public health challenge [\\u003cspan additionalcitationids=\\\"CR13 CR14\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAccumulating evidence suggests that the primary etiological agent responsible for both uncomplicated and complicated UTIs is uropathogenic \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e (UPEC) [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. In cases of uncomplicated UTIs, UPEC is most frequently isolated, followed by other pathogens such as \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e, \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e, \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e, \\u003cem\\u003eGroup B Streptococcus (GBS)\\u003c/em\\u003e, \\u003cem\\u003eProteus mirabilis\\u003c/em\\u003e, \\u003cem\\u003ePseudomonas aeruginosa\\u003c/em\\u003e, \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e, and \\u003cem\\u003eCandida\\u003c/em\\u003e species, to name a few [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. For complicated UTIs, the spectrum of causative agents expands, with UPEC remaining the most common pathogen, followed by \\u003cem\\u003eEnterococcus\\u003c/em\\u003e species, \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e, \\u003cem\\u003eCandida spp., S. aureus\\u003c/em\\u003e, \\u003cem\\u003eP. mirabilis\\u003c/em\\u003e, \\u003cem\\u003eP. aeruginosa\\u003c/em\\u003e, and GBS [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR19 CR20\\\" citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIndia has experienced a significant surge in antibiotic resistance among uropathogenic \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e (UPEC) over the past decade, with resistance patterns emerging across multiple antibiotic classes. These include penicillins, cephalosporins, aminoglycosides, quinolones/fluoroquinolones, and sulfonamides [\\u003cspan additionalcitationids=\\\"CR23 CR24\\\" citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. However, notable variations exist in resistance profiles, both within and between different regions of the country \\u003csup\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e22\\u0026ndash;26\\u003c/span\\u003e\\u003c/sup\\u003e. The increasing prevalence of multidrug-resistant (MDR) UPEC strains exhibiting resistance mechanisms such as extended-spectrum β-lactamase (ESBL) production, metallo-β-lactamase (MBL) production, and AmpC β-lactamase production has become a major concern in the last few years [\\u003cspan additionalcitationids=\\\"CR28 CR29\\\" citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe Northeast region of India poses a unique context for UTI research due to its diverse population, varied healthcare access, and limited prior data [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. Understanding the local bacterial pathogens, AMR patterns, and clinical impacts in Northeast Indian states is crucial for guiding effective management. To date, there are only a few reports that highlight the identification and characterization of the pathogenic strains associated with the UTIs in Northeast India. In Manipur, a study at RIMS Imphal (2007) found E. coli in 72.8% of culture-positive UTIs, followed by Klebsiella spp. (14.4%), with other organisms like Pseudomonas and Proteus accounting for a smaller fraction, [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. In 2012, a study from Silchar Medical College, Assam, found E. coli in 33.3% of isolates, with significant contributions from \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e (22.2%) and \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e (11.1%) [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. However, unlike some other regions of India, Northeast India does not yet have a robust, continuous surveillance network focused on UTIs. Data from several NE states are nearly absent from the literature, pointing to a surveillance gap.\\u003c/p\\u003e\\u003cp\\u003eThe novelty of our study is to focus on a susceptible patient among the younger patient population from the northeast region with distinct geographical and demographic characteristics. In addition, the accuracy and repeatability of our findings were also guaranteed due to the use of strong microbiological techniques and CLSI guidelines. To the best of our knowledge, this is one of the early comprehensive studies from Northeast India investigating the correlation between drug resistance, diversity of uropathogens among younger women.\\u003c/p\\u003e\"},{\"header\":\"2. Materials and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.1 Study Design and Setting\\u003c/h2\\u003e\\u003cp\\u003eA cross-sectional study was conducted from April 2024 to March 2025 at the department of microbiology, Pratiksha Hospital, Guwahati, Assam, in collaboration with the department of medical laboratory technology, The Assam Royal Global University, Guwahati. The study aims to evaluate the bacterial diversity and antibiotic resistance patterns of uropathogens in gynaecological cases in Northeast India. The involved female patients exhibited urinary tract infection (UTI) symptoms in gynaecology inpatient gynaecological units, outpatient departments, and maternity wards. The private medical facility operates as a referral centre to offer specialized treatment for patients coming from Northeast India's urban and rural areas. The study examined 896 women who received UTI diagnoses through clinical symptoms, including dysuria, increased urinary frequency, urgency, suprapubic discomfort, or fever. The study excluded patients with kidney diseases, immunosuppressed conditions, or recent antibiotic usage to maintain clear microbial results during resistance evaluation (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.2 Sample Collection and Processing\\u003c/h2\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eThe Midstream clean-catch urine samples (5\\u0026ndash;10 mL) were collected in sterile, wide-mouthed, screw-capped containers from non-catheterized patients (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Daisceptic urine collection from catheterized patients started with cleansing catheter ports using 70% alcohol, followed by drying the area before using a sterile syringe for aspiration. Samples underwent proper labelling before their instant transportation to the microbiology laboratory for laboratory examination. If immediate processing of the specimen was not feasible, the sample underwent cold storage at 4\\u0026deg;C for no longer than 2 hours to stop microorganisms from multiplying [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e].\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.3 Inclusion and Exclusion Criteria\\u003c/h2\\u003e\\u003cp\\u003ePatients with confirmed urinary tract infections (UTIs) were included based on culture-positive urine samples. The study enrolled community-based UTI patients with documented age, gender, previous history, and symptoms such as dysuria, frequent urination, and cloudy or bloody urine with a strong odour. UTI confirmation was established through significant bacterial growth. Exclusion criteria included negative cultures, fungal infections, paediatric cases, and contaminated samples (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.4 Isolation and Identification of Bacterial Uropathogen\\u003c/h2\\u003e\\u003cp\\u003eThe collected urine samples were cultured on MacConkey and Blood agar (HiMedia, Mumbai, India) using the semi-quantitative streak plate method and incubated aerobically at 37\\u0026deg;C for 18\\u0026ndash;24 hours. We then evaluated bacterial growth and counted the colony-forming units (CFU). We specified significant bacteriuria as having\\u0026thinsp;\\u0026ge;\\u0026thinsp;10⁵ CFU/mL for midstream urine and \\u0026ge;\\u0026thinsp;10\\u0026sup3; CFU/mL for catheterized urine, following standard microbiological guidelines. The presumptive identification of bacteria depended on their appearance in culture media, microscopic observation, and Gram-staining results. To confirm accurate species identification, selected isolates were analysed using the VITEK 2 automated system (BioM\\u0026eacute;rieux, France) [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e].\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.5 Antimicrobial Susceptibility Testing (AST)\\u003c/h2\\u003e\\u003cp\\u003e AST profiles of the bacterial isolates were performed for each bacterium identified using the standard Kirby-Bauer disk diffusion method on Mueller-Hinton Agar (MHA) HiMedia, Mumbai, India ) according to the Clinical and Laboratory Standards Institute (CLSI) 2018 guidelines to prepare the suspension, we took 3 to 5 colonies from a pure culture using an inoculation loop. The colonies were then emulsified in nutrient broth and mixed gently. This process was continued until the turbidity of the suspension matched 0.5 McFarland. Antibiotic drugs and concentrations were included to determine the antibiogram of the strains per gram. A set of 19 antibiotic discs was selected based on the CLSI recommendations and regional antibiotic usage for gram-negative bacteria. The antibiotics tested included Ampicillin (10 \\u0026micro;g), Gentamicin (30 \\u0026micro;g), Ciprofloxacin (20 \\u0026micro;g), Nitrofurantoin (30 \\u0026micro;g), Trimethoprim / Sulfamethoxazole (30 \\u0026micro;g), Ticarcillin (30 \\u0026micro;g), Piperacillin/Tazobactam (30 \\u0026micro;g), cefalotin (30 \\u0026micro;g), cefoxitin (30 \\u0026micro;g), cefixime (30 \\u0026micro;g), ceftazidime (30 \\u0026micro;g), ceftriaxone (30 \\u0026micro;g), Ertapenem (30 \\u0026micro;g), Amikacin (30 \\u0026micro;g), Nalidixic Acid (30 \\u0026micro;g), Norfloxacin (30 \\u0026micro;g), ofloxacin (30 \\u0026micro;g), Fosfomycin (30 \\u0026micro;g) and 20 antibiotic drugs were selected for gram positive bacteria such as Ampicillin (30 \\u0026micro;g), (30 \\u0026micro;g), Amoxicillin/Clavulanic acid (30 \\u0026micro;g), Benzylpenicillin (30 \\u0026micro;g), Oxacillin (30 \\u0026micro;g), Gentamicin (30 \\u0026micro;g), Ciprofloxacin (30 \\u0026micro;g), Levofloxacin (30 \\u0026micro;g), Nitrofurantoin (30 \\u0026micro;g), Doxycycline (30 \\u0026micro;g), Vancomycin (20 \\u0026micro;g), Tigecycline (30 \\u0026micro;g), Nitrofurantoin (30 \\u0026micro;g), Trimethoprim / Sulfamethoxazole (30 \\u0026micro;g), Piperacillin/Tazobactam (30 \\u0026micro;g), cefoxitin (30 \\u0026micro;g), cefixime (30 \\u0026micro;g), ceftriaxone (30 \\u0026micro;g) Amikacin (30 \\u0026micro;g), Piperacillin-tazobactam (30 \\u0026micro;g) Penicillin (30 \\u0026micro;g). The plates were incubated at 37\\u0026deg;C for 18\\u0026ndash;24 h, and the diameters of the inhibition zones were measured using calipers. The isolates were classified as susceptible (S), intermediate (I), or resistant (R) according to the CLSI 2018 guidelines [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eQuality Control Assessment\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eAll the bacterial species identification and susceptibility pattern assessment were confirmed with the help of standard reference strains obtained from the American Type Culture Collection (ATCC) used for quality control. The \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e (ATCC 25922), \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e (ATCC 700603), \\u003cem\\u003ePseudomonas aeruginosa\\u003c/em\\u003e (ATCC 27853), \\u003cem\\u003eProteus mirabilis\\u003c/em\\u003e (ATCC 29906) for gram-negative bacteria, and \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e (ATCC BA750), \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e\\u003cb\\u003e(\\u003c/b\\u003eATCC 29213), and \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e (ATCC 29212) gram-positive bacteria were used as reference strains. These strains were confirmed by clinical isolates to determine the performance of the VITEK 2 system for both detection and antimicrobial susceptibility testing. All test results for control strains were required to fall within established quality control ranges as recommended by the Clinical and Laboratory Standards Institute (CLSI) guidelines to ensure reliability and accuracy of the results [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e].\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.6 Ethical Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe present study was approved by the Institutional Ethical Committee (IEC) at The Assam Royal Global University, Guwahati. Written informed consent was obtained from all participants through designed questionnaires and personal interviews\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.7 Statistical Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study employed descriptive statistics to report data results in percentages alongside tables for presentation. All \\u0026nbsp;UTI patient data associated with demographic characteristics, UTI status were employed using the chi-square test or Fisher\\u0026apos;s exact test. Univariate analysis was done by calculating odds ratios (ORs) along with 95% confidence intervals (CIs) to determine relationships between different variables and instances of infection. \\u0026nbsp;Results demonstrated statistical significance with a p-value at or below 0.05 and non-significance using p-values exceeding 0.05. All the accumulating data were performed using Microsoft Excel (Ver. 2013), MedCalc (Ver. 19.3), and SPSS software version 20.0 (SPSS Inc., Chicago, IL, USA).\\u003c/p\\u003e\"},{\"header\":\"3.\\tResults\",\"content\":\"\\u003cp\\u003e3.1 \\u003cstrong\\u003eAssociation of Sociodemographic and Clinical Risk Factors with UTI Prevalence Among Women in Northeast India\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOut of the 896 urine samples collected from women with suspected urinary tract infections (UTIs) in Northeast India, 435 (48.55%) were culture positive. After excluding samples without significant bacterial growth, 278 cases were included for further microbiological and sociodemographic analysis presented in (Figure. 1). The patients\\u0026rsquo; age ranged from 14 to 89 years, with a mean age of 38 \\u0026plusmn; 16.68 years. (Table 1) outlines the associations between various sociodemographic and clinical factors with UTI positivity. The prevalence of UTIs was significantly higher among women aged 18\\u0026ndash;39 years (59.71%), with an odds ratio (OR) of 2.14 (95% CI: 1.38\\u0026ndash;3.32; p \\u0026lt; 0.001), indicating that this age group was over twice as likely to develop UTIs compared to those aged 60 and above. The 40\\u0026ndash;59 years group also had elevated prevalence (27.69%) but did not reach statistical significance (p = 0.22).\\u003c/p\\u003e\\n\\u003cp\\u003eMarital status showed no significant association with UTI prevalence, although unmarried women (36.69%) and married women (54.31%) constituted the majority of UTI-positive cases. Likewise, education level (literate vs. illiterate; p = 0.98) and place of residence (urban/semi-urban vs. rural; p = 0.23) did not significantly influence UTI risk, even though 68.70% of UTI-positive cases resided in urban or semi-urban areas. Similarly, dietary habits (vegetarian vs. non-vegetarian) were not significantly associated with UTI prevalence (p = 0.39), despite the predominance of non-vegetarian subjects among both UTI-positive (88.48%) and UTI-negative (86.33%) groups.\\u003c/p\\u003e\\n\\u003cp\\u003eSeveral clinical risk factors were found to be statistically significant. A history of previous UTI episodes was strongly associated with current infection (14.74% vs. 2.16%; OR = 7.81, 95% CI: 3.84\\u0026ndash;15.85; p \\u0026lt; 0.001), suggesting a nearly eight-fold increased risk. Similarly, hypertension emerged as a significant risk factor, with 21.22% of UTI-positive women diagnosed with the condition, compared to 8.89% in the UTI-negative group (OR = 2.75; p \\u0026lt; 0.001). Prior antibiotic use also correlated significantly with UTI prevalence (26.25% vs. 10.62%; OR = 2.99; p \\u0026lt; 0.001), indicating that prior exposure may predispose women to infection, potentially due to antibiotic resistance. Pregnancy was another strong correlate, with 85.61% of UTI-positive patients being pregnant, showing a significant association (OR = 1.96; p \\u0026lt; 0.001) compared to non-pregnant individuals. Interestingly, a high proportion of both UTI-positive (94.60%) and UTI-negative (92.84%) women reported experiencing a burning sensation during urination; however, the difference was not statistically significant (p = 0.34). This finding suggests that, despite urinary discomfort being a commonly reported clinical symptom, its presence alone does not reliably indicate the status of a urinary tract infection.\\u003c/p\\u003e\\n\\u003cp\\u003eCollectively, these findings indicate that younger age, prior UTI history, hypertension, pregnancy, and prior antibiotic usage are key predictors of UTI among women in this Northeast Indian cohort in present (Table 1).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.2\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp;\\u003cstrong\\u003eMicrobial Spectrum of Uropathogens Isolated from Gynaecological Patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAmong the 278 culture-positive urine samples obtained from women with clinically suspected urinary tract infections (UTIs), the microbial profile revealed a striking predominance of Gram-negative bacteria. \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e emerged as the most frequently isolated uropathogen, accounting for 62.58% (n = 174) of the total isolates, thereby reaffirming its established role as the leading etiological agent of community-acquired UTIs in women.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e was identified as the second most common Gram-negative isolate, representing 16.90% (n =47), followed by \\u003cem\\u003ePseudomonas aeruginosa\\u003c/em\\u003e (1.79%, n = 5) and \\u003cem\\u003eProteus mirabilis\\u003c/em\\u003e (2.87%, n = 8). Together, these Gram-negative organisms comprised a significant majority of the uropathogenic burden. Gram-positive bacteria constituted a smaller but clinically relevant proportion of the isolates. Among them, \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e was the most prominent, detected in 8.27% (n = 23) of cases. \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e and \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e were isolated in 4.31% (n = 12) and 3.23% (n = 9) of samples, respectively. The distribution pattern, illustrated in (Figure 2), highlights the microbial diversity of uropathogens encountered in gynaecological patients admitted to Pratiksha Hospital and emphasizes the dominance of Gram-negative bacilli in the regional UTI landscape.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.3\\u003c/strong\\u003e. \\u003cstrong\\u003eAge-Specific Distribution of Uropathogens Among Women with UTIs\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe comparative distribution of uropathogens across two age groups: women below 40 years old and those aged 40 years or older, who tested positive for 278 UTIs, revealed that \\u003cem\\u003eE. coli\\u003c/em\\u003e was the most frequently identified pathogen in both age groups, but it was significantly more prevalent in younger women (Table 2). Specifically, \\u003cem\\u003eE. coli\\u003c/em\\u003e was isolated in 65.66% (n = 109) of cases in the group under 40, compared to 58.03% (n = 65) in women aged 40 and older. This difference was statistically significant (p = 0.008), indicating a greater susceptibility to E. coli-mediated urinary tract infections (UTIs) among younger women. \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e, the second most commonly isolated Gram-negative bacterium, showed similar prevalence across age groups\\u0026mdash;16.86% in women under 40 and 16.96% in those aged 40 and above, with no significant statistical association (p=0.87). Other Gram-negative pathogens, such as \\u003cem\\u003ePseudomonas aeruginosa\\u003c/em\\u003e and \\u003cem\\u003eProteus mirabilis\\u003c/em\\u003e, were relatively rare in both groups. \\u003cem\\u003eP. aeruginosa\\u003c/em\\u003e was slightly more common in older women (2.67%) than in younger ones (1.20%), while \\u003cem\\u003eProteus mirabilis\\u003c/em\\u003e exhibited a low but uniform prevalence in both age categories (3.01% vs. 2.67%).\\u003c/p\\u003e\\n\\u003cp\\u003eAmong the Gram-positive bacteria, \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e was more frequently isolated from women aged 40 years and older (9.82%) than from those below 40 (7.22%), although this association was not statistically significant (p= 0.34). Similarly, \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e showed nearly equal prevalence in both age groups (4.21% vs. 4.46%; p = 0.26). Notably, \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e exhibited a higher prevalence among older women (5.35%) compared to the younger group (1.80%), but this difference was not statistically significant. Overall, the data reaffirm E. coli as the leading uropathogen with a distinct age-related pattern favouring younger women.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.4.\\u003c/strong\\u003e \\u003cstrong\\u003eMultidrug Resistance Profiles of Uropathogens Isolated from Gynaecological Patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTo investigate the antimicrobial resistance patterns among Gram-positive and Gram-negative uropathogens, a high prevalence of multidrug resistance (MDR) among the bacteria is prevalent. \\u0026nbsp;\\u003cem\\u003eEscherichia coli\\u003c/em\\u003e \\u003cem\\u003e(E. coli)\\u003c/em\\u003e demonstrated the highest resistance among Gram-negative bacteria, with 56 (32.18%) of the isolates showing (\\u0026ge;R5) multidrug resistance to antibiotics, followed by 67 (38.50%) isolates that confirmed (R4) antibiotics resistance. The MDR profile of \\u003cem\\u003eKlebsiella pneumoniae\\u0026nbsp;\\u003c/em\\u003eisolates showed significant results, as 51.06% of them exhibited resistance to (\\u0026ge;R5) antibiotics. The five \\u003cem\\u003ePseudomonas aeruginosa\\u003c/em\\u003e isolates exhibited full resistance against five different antibiotics. Gram-positive bacteria showed \\u003cem\\u003eStaphylococcus aureus\\u0026nbsp;\\u003c/em\\u003eto have the strongest resistance among them, since 9 out of 12 (75%) isolates demonstrated resistance to (\\u0026ge;R5) antibiotics. The bacterial strain \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e demonstrated five or more antibiotic-resistant properties through 11 (47.82%) clinical isolates. The antibiotic resistance level of \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e was moderate, based on two (22.22%) isolates showing resistance to (\\u0026ge;R5) antibiotics.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.5. Multidrug Resistance Pattern Among Gram-negative Uropathogenic Bacteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe Multidrug resistance pattern (MDR)\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eof gram-negative uropathogens isolated from women with urinary tract infections (UTIs) is represented in (Table 4). Out of the 234 gram-negative bacteria were isolates including \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e (E. coli) was the predominant pathogen (n=174), followed by \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e (n=47), \\u003cem\\u003eProteus mirabilis\\u003c/em\\u003e (n=5), and \\u003cem\\u003ePseudomonas aeruginosa\\u003c/em\\u003e (n=8). Whereas \\u003cem\\u003eE. coli\\u003c/em\\u003e had a high resistance to Norfloxacin (84.27%), nalidixic acid (76.43%), ampicillin (63.21%), cefalotin (63.21%), and ciprofloxacin (61.5%). However, high level of susceptibility was recorded for Fosfomycin (91.37 %), Amikacin (84.48%), Gentamicin (83.90 %), Ertapenem (85.63%), cefoxitin (72.49%) and Piperacillin/Tazobactam (65.52%) respectively with higher level of MDR, suggesting their continued effectiveness for treating complicated UTIs caused by \\u003cem\\u003eE. coli\\u003c/em\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eIn the context of \\u003cem\\u003eKlebsiella pneumoniae\\u0026nbsp;\\u003c/em\\u003estrain (N= 47) isolates, resistance was similar to E.\\u003cem\\u003ecoli\\u003c/em\\u003e, with high-level resistance observed against Cefalotin (68.08%), Ampicillin (51.06%), and Nalidixic Acid (59.57%). Moreover, the resistance to third-generation cephalosporins such as Cefixime (48.93%) and Ceftriaxone (42.55%) was significant. On the contrary, the pathogen remained mostly susceptible to Amikacin (89.36%), Fosfomycin (85.10 %), and Gentamicin, Ertapenem (80.85%), highlighting the potential role of these agents in managing multidrug-resistant strains. On the other hand, lower resistance was observed for amikacin (8.51%) and ertapenem (6.38%), which were among the most effective drugs against this species. The high susceptibility to piperacillin/tazobactam (78.72%) and amoxicillin-clavulanic acid (51.06%) highlights their potential use in empirical therapy, though susceptibility testing remains critical.\\u0026nbsp;\\u003cem\\u003ePseudomonas aeruginosa (N=5)\\u0026nbsp;\\u003c/em\\u003eisolates, though limited in number, showed moderate susceptibility to most tested antibiotics, including 80% susceptibility to Ampicillin, Gentamicin, Piperacillin/Tazobactam, and Cefoxitin. However, this species also demonstrated high resistance to Nalidixic Acid (80%) and Ceftriaxone (80%), aligning with its intrinsic multidrug resistance mechanisms. \\u0026nbsp; While\\u0026nbsp;\\u003cem\\u003eProteus mirabilis strain\\u0026nbsp;\\u003c/em\\u003e (N=8) displayed high susceptibility pattern to amikacin and Fosfomycin (100%), ceftriaxone and ertapenem (87.5%), suggesting these as potential treatment options. However, the resistance to ampicillin (37.5%) and nitrofurantoin (62.5%) was noteworthy. Nitrofurantoin, although widely effective in UTIs, is known to have reduced activity against Proteus species.\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.6. Multidrug Resistance Pattern Among Gram-Positive Uropathogenic Bacteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe multidrug resistance (MDR) patterns and antimicrobial susceptibility profiles of Gram-positive uropathogens isolated from women with urinary tract infections (UTIs) indicate that a total of 44 Gram-positive isolates were identified in this cohort, comprising \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e (n = 12), \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e (n = 9), and \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e (n = 23) (Table 5). Among the \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e isolates, high resistance rates were observed against commonly used \\u0026beta;-lactam antibiotics, with 75% of the isolates resistant to ceftriaxone, 66.66% to penicillin, and 58.33% to cefoxitin, indicating a significant burden of methicillin-resistant \\u003cem\\u003eS. aureus\\u003c/em\\u003e (MRSA) strains in the population studied. Despite this, the susceptibility of several antibiotics remained relatively high: 75% of the isolates were sensitive to both amikacin and vancomycin, while 66.66% retained susceptibility to nitrofurantoin and tigecycline, highlighting their potential for treating resistant infections.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e displayed complete (100%) resistance to ampicillin and benzylpenicillin, aligning with its known resistance to \\u0026beta;-lactam agents. However, this pathogen was fully susceptible to gentamicin, vancomycin, and tigecycline, and demonstrated 88.88% susceptibility to nitrofurantoin, doxycycline, and amoxicillin/clavulanic acid. These findings suggest that while first-line \\u0026beta;-lactams may be ineffective, alternative agents such as nitrofurantoin and glycopeptides remain highly effective for managing infections caused by this species.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e exhibited a distinct resistance pattern, with the highest resistance noted against ciprofloxacin, cefixime, and penicillin (each 60.86%), followed by gentamicin and ceftriaxone (both 56.52%). Nonetheless, the isolates showed excellent susceptibility to nitrofurantoin (91.30%), tigecycline (82.60%), and ampicillin (78.26%). Additionally, vancomycin and piperacillin/tazobactam retained moderate effectiveness, with 69.56% of the isolates susceptible to each. Thus, the results reveal a high prevalence of multidrug resistance among Gram-positive uropathogens, particularly in \\u003cem\\u003eS. aureus\\u003c/em\\u003e and \\u003cem\\u003eE. faecalis\\u003c/em\\u003e (Table 5). However, the data also reinforce the continued efficacy of specific antibiotics, such as nitrofurantoin, tigecycline, amikacin, and vancomycin, which may be considered in empirical therapy in light of regional resistance trends.\\u003c/p\\u003e\"},{\"header\":\"4.\\tDiscussion Unsectioned Paragraphs\",\"content\":\"\\u003cp\\u003eUrinary tract infections (UTIs) remain a significant health problem, primarily affecting women with gynecological conditions \\u003cu\\u003e\\u003csup\\u003e38\\u003c/sup\\u003e\\u003c/u\\u003e. The present study provides an extensive microbiological and epidemiological assessment of urinary tract infections (UTIs) among women in Northeast India, highlighting key sociodemographic determinants, microbial distribution patterns, and alarming antimicrobial resistance trends. A significant finding was the higher prevalence of UTIs among women aged 18\\u0026ndash;39 years (Table 1), with a two-fold increase in risk compared to those aged \\u0026ge;60 years ( p \\u0026lt; 0.001). This trend aligns with prior studies reporting increased susceptibility among sexually active premenopausal women due to anatomical and hormonal factors [39]. Other clinical risk factors, including prior UTI history, hypertension, pregnancy, and recent antibiotic usage, also showed significant associations with infection [40].\\u003c/p\\u003e\\n\\u003cp\\u003eOur findings further indicate that women aged 18\\u0026ndash;39 years have a significantly higher likelihood of developing UTIs compared to those groups aged \\u0026ge;60 years (OR: 2.14; p \\u0026lt; 0.001). This aligns with previous studies that reported higher UTI incidence in younger women, particularly those of reproductive age, likely due to sexual activity, hormonal factors, and anatomical predisposition [41].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eConsiderably, women with a previous history of UTIs had a significantly increased risk of present UTI ( \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.001) [42]. The robust association supports the present study, demonstrating that recurrent UTI is a main risk factor due to reasons like partial treatment, determination of uropathogens, and possible host-related immunological responses [43]. Furthermore, we have also demonstrated that hypertension also emerged as a significant associate (\\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.001) (Table 1), proposing a potential relationship between systemic inflammation, compromised immunity, and increased susceptibility to infection [44]. Previous studies suggested that UTIs diagnosed through bacteriuria tests in pregnant women lead to higher risks of hypertension in pregnancy [45]. \\u0026nbsp;Interestingly, we also observed that pregnancy showed a strong association with UTI positivity, with 85.61% of UTI-positive cases occurring in pregnant individuals (Table 1). Also, the prior antibiotic use was significantly associated with higher UTI prevalence ( \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.001), potentially due to disruption of the normal microbiota and development of antimicrobial resistance, which is increasingly recognised in UTI pathogenesis [46\\u003cu\\u003e]\\u003c/u\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eMicrobiological analysis (Table 2) revealed \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e as the most prevalent pathogen, isolated in 62.5% of cases, while \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e, \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e, and \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e were other notable isolates. This result corroborates the similar pattern of \\u003cem\\u003eE. coli\\u003c/em\\u003e being the most common uropathogen, which has been significantly reported in previous findings in both India and worldwide [47-50]. We also observed the distribution of uropathogens among various age groups. Previous reports suggest that Gram-negative bacteria, particularly \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e, were responsible for most urinary tract infections in the lower age group [51, 52]. We also observed a statistically significantly higher rate of \\u003cem\\u003eE. coli\\u003c/em\\u003e infections among \\u0026lt; 40 years, thus suggesting hormonal and sexual elements play a role in this observation (Table 2). Interestingly, the near-equal prevalence of \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e across age groups was observed, which implies its role as a consistent secondary pathogen, likely independent of age-related physiological changes (Table 2).\\u003c/p\\u003e\\n\\u003cp\\u003eMultidrug resistance pattern was widespread (Table 3), with more than 38% of E. coli and 51% of K. pneumoniae isolates showing resistance to five or more antibiotics (\\u0026ge;R5). We observed a significant variation among the MDR-pathogens, with \\u003cem\\u003eE. coli\\u003c/em\\u003e emerging as the most common uropathogen, showing high resistance to ampicillin (63.21%), ciprofloxacin (61.50%), and amoxicillin/clavulanic acid (32.76%), respectively (Table 3). \\u0026nbsp; \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e showed high resistance to ampicillin (51.06%), ticarcillin (46.80%), and ceftriaxone (42.55%), respectively (Table 4). Interestingly, \\u003cem\\u003eE. coli exhibits significant susceptibility to gentamicin (83.90%) and nitrofurantoin (69.54%), while Klebsiella pneumoniae\\u003c/em\\u003e showed susceptibility to piperacillin/tazobactam (78.72%) and ertapenem (80.85%), supporting their use in resistant infections, consistent with previous findings [53, 54]. In contrast, \\u0026nbsp;\\u003cem\\u003ePseudomonas aeruginosa\\u003c/em\\u003e exhibited strong resistance to several antibiotics, with broad resistance to ampicillin and piperacillin/tazobactam. However, the bacteria demonstrated sensitivity to both amikacin (84.48%) and ertapenem (80.85%), suggesting these agents may be effective in treating P. \\u0026nbsp;aeruginosa UTIs in this population group. \\u0026nbsp;like previous findings [55, 56]\\u003cu\\u003e.\\u003c/u\\u003e Furthermore, the susceptibility of \\u003cem\\u003eProteus mirabilis\\u003c/em\\u003e to Amikacin (100%), Fosfomycin (100 %), Ertapenem (87%), and Gentamicin (75 %), respectively, was high, while resistance to ampicillin (37.5%) and Nitrofurantoin (62.5%) was observed. \\u0026nbsp;correspondingly reported by Miranda EJ et al and Maraki S et al, and\\u0026nbsp;Chen CY \\u0026nbsp;et al, [57, 58].\\u0026nbsp;Thus, the results indicate the promising use of certain antibiotics, which may be used to counter the Gram-negative MDR strains in UTI management.\\u003c/p\\u003e\\n\\u003cp\\u003eSimilarly, exploring the antimicrobial resistance patterns in Gram-positive uropathogens in UTI patients revealed that \\u003cem\\u003eEnterococcus faecalis\\u003c/em\\u003e showed outstanding resistance to ciprofloxacin (60.86%) and gentamicin (56.52%) (Table 5). These findings support previous observations of resistance mechanisms in Enterococcus spp [59, 60]. Moderate resistance against ampicillin and oxacillin \\u0026beta;-lactam antibiotics existed in \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e and \\u003cem\\u003eS. saprophyticus\\u003c/em\\u003e bacteria in alignment with national reports of methicillin-resistant strains (MRSA) affecting community-acquired UTIs [\\u003cu\\u003e61, 62]\\u003c/u\\u003e.\\u0026nbsp;\\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e isolates displayed moderate resistance to commonly used antibiotics like ampicillin (66 %) and ceftriaxone (75 %), supporting previous reports of methicillin-resistant strains in urinary infections \\u0026nbsp;[63, 64]. Alarmingly, 58.33% of \\u003cem\\u003eS. aureus\\u003c/em\\u003e isolates were resistant to cefoxitin, indicating a high prevalence of methicillin resistance, similar to trends observed in other Indian and Asian cohorts [65, 66\\u003cu\\u003e].\\u003c/u\\u003e \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e, though a less frequent pathogen, showed 100% susceptibility to Gentamicin, nitrofurantoin, vancomycin, and tigecycline, reaffirming their utility in empirical therapy similar to earlier studies [67].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eCollectively, our findings not only corroborate global AMR trends but also emphasize the unique burden faced by Northeast Indian populations due to microbial diversity, patient comorbidities, and other lifestyle factors. Integrating molecular typing and resistance gene profiling in future studies could further elucidate the regional epidemiology and guide targeted interventions. We anticipate that our results will provide useful information for clinicians, microbiologists, and public health authorities. Through emphasising geographical variation in microbial epidemiology and resistance challenges, our study generates an important understanding for creating tailored empirical treatment guidelines and antimicrobial stewardship initiatives. In the future, evidence-based analytics such as these will be important for enhancing patient outcomes, lowering healthcare costs, and arresting the advance of AMR.\\u003c/p\\u003e\"},{\"header\":\"5. Conclusion\",\"content\":\"\\u003cp\\u003eThe present study underscores a pressing public health concern posed by urinary tract infections among gynecological patients in Northeast India, with \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e \\u003cem\\u003eand Klebsiella pneumoniae\\u003c/em\\u003e emerging as the predominant uropathogens. This study offers a comprehensive evaluation of urinary tract infections (UTIs) among women with gynaecological concerns in Northeast India, uncovering key sociodemographic and clinical factors associated with infection prevalence. The data reveal that women aged 18\\u0026ndash;39 years are at significantly higher risk, particularly those with prior UTI episodes, hypertension, pregnancy, or recent antibiotic exposure. Among the culture-positive samples, \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e emerged as the dominant uropathogen, followed by \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e and \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e, all demonstrating high levels of multidrug resistance (MDR). Notably, while resistance to commonly prescribed antibiotics was widespread, agents such as gentamicin, nitrofurantoin, amikacin, ertapenem, and tigecycline retained high efficacy, suggesting their potential as empirical options in this region. These findings highlight the urgent need for localized antibiotic regimens, regular antimicrobial surveillance, and risk-based patient stratification to ensure better clinical outcomes and reduce the regional AMR burden.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eConflict of Interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests\\u003c/p\\u003e\\n\\u003cp\\u003e7. \\u003cstrong\\u003eAuthor Contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eConceptualization, RK, AD and JB.; Methodology, RK, AD and JB ; Data Curation, JB, VC, AL, RD, RK; Writing Original Draft Preparation, R.K, A.D., A.B.; Writing\\u0026mdash;JB, VC, AL, RD, RK; \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e8. ACKNOWLEDGEMENTS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors are grateful to The Assam Royal Global University for \\u0026nbsp;Seed Money Grant [RGU/Ch(Acad)/07/Biotechnology (22)] to RK and [RGU/Ch(Acad)/07/Biochem.(19)] to AD.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e9. Funding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that no financial support was received for the conduct of this research. This study did not receive any funding from governmental, non-governmental, commercial, academic, or institutional sources. However, limited funds from the university seed money grants from RGU were utilized.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e10.\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eInstitutional Review Board Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of The Assam Royal Global University\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e11. Data Availability Statement\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eData availability : The data generated and analyzed during this study can be provided by the corresponding author upon reasonable request\\u003c/p\\u003e\\n\\u003cp\\u003e12. \\u003cstrong\\u003eInformed consent statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWritten informed consent was obtained from all participants through designed questionnaires and personal interviews.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eWang J, Lei S, Liang L. Preparation of porous activated carbon from semi-coke by high temperature activation with KOH for the high-efficiency adsorption of aqueous Tetracycline. \\u003cem\\u003eAppl Surf Sci.\\u003c/em\\u003e 2020;530:147187.\\u003c/li\\u003e\\n\\u003cli\\u003eHe Y, Zhang X, Chen L, Zhou Y, Wang W, Gao H, et al. Epidemiological trends and predictions of urinary tract infections in the global burden of disease study 2021. \\u003cem\\u003eSci Rep.\\u003c/em\\u003e 2025;15:4702.\\u003c/li\\u003e\\n\\u003cli\\u003eAmiri F, Najafi F, Roshanaei G, Khazaei S, Maleki F, Yousefi B, et al. Epidemiology of urinary tract infections in the Middle East and North Africa, 1990\\u0026ndash;2021. \\u003cem\\u003eTrop Med Health.\\u003c/em\\u003e 2025;53:16.\\u003c/li\\u003e\\n\\u003cli\\u003eMekonnen S, Zeleke G, Dagnew M, Mitiku B, Belay M, Bekele D, et al. Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. \\u003cem\\u003ePLoS ONE.\\u003c/em\\u003e 2023;18:e0283637.\\u003c/li\\u003e\\n\\u003cli\\u003eMohapatra S, Sahoo B, Das D, Padhy RN. 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Urinary tract infections: epidemiology, mechanisms of infection and treatment options. \\u003cem\\u003eNat Rev Microbiol.\\u003c/em\\u003e 2015;13:269\\u0026ndash;284.\\u003c/li\\u003e\\n\\u003cli\\u003eHooton TM. Uncomplicated urinary tract infection. \\u003cem\\u003eN Engl J Med.\\u003c/em\\u003e 2012;366:1028\\u0026ndash;1037.\\u003c/li\\u003e\\n\\u003cli\\u003eLichtenberger P, Hooton TM. Complicated urinary tract infections. \\u003cem\\u003eCurr Infect Dis Rep.\\u003c/em\\u003e 2008;10:499\\u0026ndash;504.\\u003c/li\\u003e\\n\\u003cli\\u003eLevison ME, Kaye D. Treatment of complicated urinary tract infections with an emphasis on drug-resistant Gram-negative uropathogens. Curr Infect Dis Rep. 2013;15:109\\u0026ndash;15.\\u003c/li\\u003e\\n\\u003cli\\u003eShaaban OA, Alzayani T, Al Khater H, Hasan RA, Mandeel QA, Alkhawaja SA, et al. Prevalence and resistance patterns of pediatric urinary tract infections in Bahrain. 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Frequency of drug-resistant bacterial isolates among pregnant women with UTI in maternity and children\\u0026apos;s hospital, Bisha, Saudi Arabia. \\u003cem\\u003eSci Rep\\u003c/em\\u003e. 2024;14:7397.\\u003c/li\\u003e\\n\\u003cli\\u003eSpanu T, Sanguinetti M, Ciccaglione D, D\\u0026rsquo;Inzeo T, Fiori B, Posteraro B, et al. Use of the VITEK 2 system for rapid identification of clinical isolates of Staphylococci from bloodstream infections. \\u003cem\\u003eJ Clin Microbiol\\u003c/em\\u003e. 2003;41:4259\\u0026ndash;4263.\\u003c/li\\u003e\\n\\u003cli\\u003eTaha AB. Bacterial etiology and antimicrobial resistance pattern of community-acquired urinary tract infection in older adults. \\u003cem\\u003eMed Microecol\\u003c/em\\u003e. 2024;22:100114.\\u003c/li\\u003e\\n\\u003cli\\u003eCzajkowski K, Broś-Konopielko M, Teliga-Czajkowska J. Urinary tract infection in women. \\u003cem\\u003ePrz Menopauzalny\\u003c/em\\u003e. 2021;20:40\\u0026ndash;47.\\u003c/li\\u003e\\n\\u003cli\\u003eRam\\u0026iacute;rez Sevilla C, G\\u0026oacute;mez Lanza E, Manzanera JL, Mart\\u0026iacute;n JAR, Sanz M\\u0026Aacute;B. Active immunoprophylaxis with Uromune\\u0026reg; decreases the recurrence of urinary tract infections at three and six months after treatment without relevant secondary effects. \\u003cem\\u003eBMC Infect Dis\\u003c/em\\u003e. 2019;19:901.\\u003c/li\\u003e\\n\\u003cli\\u003eWhelan S, Lucey B, Finn K. Uropathogenic \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e (UPEC)-associated urinary tract infections: the molecular basis for challenges to effective treatment. \\u003cem\\u003eMicroorganisms\\u003c/em\\u003e. 2023;11:2169.\\u003c/li\\u003e\\n\\u003cli\\u003eMedina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. \\u003cem\\u003eTher Adv Urol\\u003c/em\\u003e. 2019;11:1756287219832172.\\u003c/li\\u003e\\n\\u003cli\\u003eMarques LP, Flores JT, Junior OD, Rodrigues GB, de Medeiros Mour\\u0026atilde;o C, Moreira RM. Epidemiological and clinical aspects of urinary tract infection in community-dwelling elderly women. \\u003cem\\u003eBraz J Infect Dis\\u003c/em\\u003e. 2012;16:436\\u0026ndash;441.\\u003c/li\\u003e\\n\\u003cli\\u003eFlores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. \\u003cem\\u003eNat Rev Microbiol\\u003c/em\\u003e. 2015;13:269\\u0026ndash;284.\\u003c/li\\u003e\\n\\u003cli\\u003eChen Y, Li X, Zhao Y, Wang H, Zhang Y, Liu Y, et al. Association between systemic immunity-inflammation index and hypertension in US adults from NHANES 1999\\u0026ndash;2018. \\u003cem\\u003eSci Rep\\u003c/em\\u003e. 2024;14:5677.\\u003c/li\\u003e\\n\\u003cli\\u003eMarlina D, Wahyuni S, Prasetya IB, Putri R, Syah R. Association of bacteriuria with hypertension risk in pregnant women. \\u003cem\\u003eMed Sci Monit\\u003c/em\\u003e. 2025;31:e946167.\\u003c/li\\u003e\\n\\u003cli\\u003eJensen MLV, J\\u0026oslash;rgensen RL, Kessel L, Tvede M, Hjort U, Larsen AR, et al. Prior antibiotic use increases risk of urinary tract infections caused by resistant \\u003cem\\u003eEscherichia coli\\u003c/em\\u003e among elderly in primary care: a case-control study. \\u003cem\\u003eAntibiotics (Basel)\\u003c/em\\u003e. 2022;11:1382.\\u003c/li\\u003e\\n\\u003cli\\u003eRavishankar U, P S, Thayanidhi P. Antimicrobial resistance among uropathogens: Surveillance report from South India. \\u003cem\\u003eCureus\\u003c/em\\u003e. 2021;13:e12913.\\u003c/li\\u003e\\n\\u003cli\\u003eSorlozano A, Jimenez-Pacheco A, de Dios Luna J, Martinez-Gonzalez LJ, Lepe JA, Gutierrez-Fernandez J. Evolution of the resistance to antibiotics of bacteria involved in urinary tract infections: a 7-year surveillance study. \\u003cem\\u003eAm J Infect Control\\u003c/em\\u003e. 2014;42:1038\\u0026ndash;1040.\\u003c/li\\u003e\\n\\u003cli\\u003eEure TR, Ling ML, Kabbani S, Stone ND, McDonald LC, Jernigan JA, et al. Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013\\u0026ndash;2017. \\u003cem\\u003eInfect Control Hosp Epidemiol\\u003c/em\\u003e. 2020;12:1\\u0026ndash;6.\\u003c/li\\u003e\\n\\u003cli\\u003eSharma D, Preston SE, Hage R. 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Antibiotic resistance pattern of \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e with reference to MRSA isolates from pediatric patients. \\u003cem\\u003eFuture Sci OA\\u003c/em\\u003e. 2020;6:FSO464.\\u003c/li\\u003e\\n\\u003cli\\u003eGandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, et al. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008\\u0026ndash;2014. \\u003cem\\u003eInt J Infect Dis\\u003c/em\\u003e. 2016;50:75\\u0026ndash;82.\\u003c/li\\u003e\\n\\u003cli\\u003eOnanuga A, Awhowho GO. Antimicrobial resistance of \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e strains from patients with urinary tract infections in Yenagoa, Nigeria. \\u003cem\\u003eJ Pharm Bioallied Sci\\u003c/em\\u003e. 2012;4:226\\u0026ndash;230.\\u003c/li\\u003e\\n\\u003cli\\u003eGurung RR, Maharjan P, Chhetri GG. Antibiotic resistance pattern of \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e with reference to MRSA isolates from pediatric patients. \\u003cem\\u003eFuture Sci OA\\u003c/em\\u003e. 2020;6:FSO464.\\u003c/li\\u003e\\n\\u003cli\\u003eMehta VJ, Mehta SJ. Microbiological profile of abnormal vaginal discharge and its antimicrobial susceptibility pattern in a tertiary care hospital, Gujarat. \\u003cem\\u003eIndian J Microbiol Res\\u003c/em\\u003e. 2017;4:303\\u0026ndash;315.\\u003c/li\\u003e\\n\\u003cli\\u003eChen CJ, Huang YC. New epidemiology of \\u003cem\\u003eStaphylococcus aureus\\u003c/em\\u003e infection in Asia. \\u003cem\\u003eClin Microbiol Infect\\u003c/em\\u003e. 2014;20:605\\u0026ndash;623.\\u003c/li\\u003e\\n\\u003cli\\u003eChua KY, Chen SA, Ng YY, Tan TY. Antimicrobial resistance and its detection in \\u003cem\\u003eStaphylococcus saprophyticus\\u003c/em\\u003e urinary isolates. \\u003cem\\u003ePathology\\u003c/em\\u003e. 2023;55:1013\\u0026ndash;1016\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Urinary tract infections (UTIs), Northeast India, Uropathogenic, Antibiotic Resistance, Gynaecological Infections, Urinary tract infection, Pathogens\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7519847/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7519847/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground:\\u003c/h2\\u003e\\u003cp\\u003eUrinary tract infection (UTI) is one of the most common bacterial infections in women worldwide. This study explored bacterial diversity, risk factors, and MDR status of UTIs in gynecologic patients.\\u003c/p\\u003e\\u003ch2\\u003eResult\\u003c/h2\\u003e\\u003cp\\u003eA total of 896 subjects were included, of whom 278 (37.6%) were diagnosed as UTI-positive using standard microbiological protocols. Midstream clean-catch urine samples were also collected and tested for antimicrobial susceptibility as recommended by the CLSI. Significant associations were found between UTI prevalence and several risk factors, including age 18\\u0026ndash;39 years (OR: 2.14, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), women with a previous history of UTI (OR: 7.81, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), hypertension (OR: 2.75, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), previous antibiotic use (OR: 2.99, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and during pregnancy (OR: 1.96, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) respectively. The most prevalent pathogens were Escherichia coli (62.5%) and Klebsiella pneumoniae (16.9%). According to sensitivity patterns, Gentamicin, Ertapenem, Amikacin, and Fosfomycin for Gram-negative bacteria, and Tigecycline and Nitrofurantoin for Gram-positive pathogens, are recommended as treatment options for UTIs.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eThese findings emphasize the urgent need for localized antibiotic stewardship programs, routine surveillance for resistance, microbiological diagnostic support in gynecological care, and infection control measures. Responsible antibiotic use and infection control are critical strategies to prevent the spread of MDR.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Uropathogenic Profiles and Antibiotic Resistance in Gynaecological Cases: A Microbial Surveillance Study from Northeast India\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-17 02:13:30\",\"doi\":\"10.21203/rs.3.rs-7519847/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-01-19T17:56:29+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-17T06:44:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-14T14:31:51+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-09T06:58:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"135490963273658399825441394809334354082\",\"date\":\"2025-10-09T06:40:00+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"77401146050964139202458574909833108090\",\"date\":\"2025-10-07T08:45:46+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-06T17:15:14+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"102490807326909093984589993017066926947\",\"date\":\"2025-10-05T07:07:42+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"333179726575163284065063149562234236547\",\"date\":\"2025-10-04T06:47:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"248658791499338910686312919872078872572\",\"date\":\"2025-10-03T14:54:02+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-10-03T14:04:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-10-01T10:39:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-09-25T17:45:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-09-23T17:48:07+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Scientific Reports\",\"date\":\"2025-09-23T14:59:56+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"9615a7a5-5105-4977-8705-a6200ff74891\",\"owner\":[],\"postedDate\":\"October 17th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"in-revision\",\"subjectAreas\":[{\"id\":56285027,\"name\":\"Health sciences/Diseases\"},{\"id\":56285028,\"name\":\"Health sciences/Medical research\"},{\"id\":56285029,\"name\":\"Biological sciences/Microbiology\"},{\"id\":56285030,\"name\":\"Health sciences/Urology\"}],\"tags\":[],\"updatedAt\":\"2026-05-15T06:10:51+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-10-17 02:13:30\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7519847\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7519847\",\"identity\":\"rs-7519847\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}