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. 2025 Aug 1;20(8):e0328042.
doi: 10.1371/journal.pone.0328042. eCollection 2025.

Burden of gram-positive bacteria from urinary tract infection: A four-year retrospective study in a tertiary health setting in southern Saudi Arabia

Abdullah M Alkahtani  1 , Abdulah J Alqahtani  1 , Abdulaziz Alamri  2 , Mohammed Mushabab Assiry  3 , Mona Elfaki  1 , Yahya Mohammed Shabi  1 , Mohamed E Hamid  1
Affiliations

Burden of gram-positive bacteria from urinary tract infection: A four-year retrospective study in a tertiary health setting in southern Saudi Arabia

Abdullah M Alkahtani et al. PLoS One. .

Abstract

Background: Antibiotic resistance is a worldwide problem causing significant health-related and economic losses. Gram-positive causes of urinary tract infections (UTIs) are usually underestimated or overlooked by physicians.

Aim: To examine the prevalence of antibiotic resistance among major gram-positive bacteria from UTIs in a tertiary care health hospital in southern Saudi Arabia.

Method: A cross-sectional retrospective study was done in a tertiary health setting in southern Saudi Arabia between 2019 and 2022, to identify the major gram-positive bacteria and antibiotic resistance. Data were collected from the hospital records and was analyzed using the SPSS statistical package.

Results: The most common gram-positive species were Enterococcus faecalis (44.7%), Staphylococcus aureus (15.1%), and Enterococcus faecium (12.9%), beta-hemolytic streptococci (8.4%), and methicillin-resistant Staphylococcus aureus (MRSA) (1.8%). The 1540 isolates showed an overall susceptibility of 71.0%, compared to a resistance of 29.0%. The most resistance was among Enterococcus faecium (54.5%), Enterococcus gallinarum (42.4%), Enterococcus faecalis (34.3%), and MRSA (27.2%). The most common resistance was to erythromycin (75.7%), followed by cefotaxime (73.9%), tetracycline (70.5%), ciprofloxacin (54.3%), and Synercid (53.6%). The prediction model indicates an increase in the prevalence of resistance in MRSA and, to a lesser extent, with E. faecalis, E. faecium, and beta-hemolytic streptococci.

Conclusions: Enterococcus faecalis was the predominant gram-positive species, surpassing Staphylococcus aureus. Almost remarkable resistance was observed to most of the antibiotics that are frequently used in the study area, mainly erythromycin, cefotaxime, and tetracycline. Performing continuous monitoring of drug susceptibility may help with the empirical treatment of bacterial agents in the region.

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Conflict of interest statement

Authors declare that they have no conflict of interest.

Figures

Fig 1
Fig 1. Age-specific distribution of gram-positive bacteria that cause urinary tract infections in females and males. Bars represent the standard error.
Fig 2
Fig 2. Major gram-positive bacterial counts and their corresponding susceptibility and resistance numbers (S = sensitive and R = Resistant).
Fig 3
Fig 3. Resistance rate (%) of major gram-positive bacteria to commonly used antimicrobial agents for uncomplicated UTIs.
Fig 4
Fig 4. Overall resistance of the main gram-positive bacteria to antibiotics and orientation of the prediction lines.
See this image and copyright information in PMC

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