Introduction: The rising incidence of antimicrobial resistance is a major source of concern, particularly in the absence of new antimicrobial agents. This infection arises when microorganisms (predominantly bacteria) infiltrate and multiply within the urinary tract. Aim: To we present the changing antibiotic sensitivity patterns of urinary pathogens over the past five years (2019-2023) in a hospital located on the northeast coast of Tamil Nadu, India. Materials and Methods: This retrospective study was performed at the Department of Microbiology, Chettinad Hospital and Research Institute, Tamil Nadu, India, from January 2019 to October 2023. Out of 39,592 urine samples, 9,940 samples with bacterial growth were included in the study, considering only those with positive bacterial growth. Exclusion criteria included samples with no bacterial growth, samples from patients who had received antibiotics before sample collection, and duplicate samples. The demographic parameters considered were age, gender and co-morbidities. Bacterial identification was performed using conventional microbiological methods, including Gram staining, catalase testing, oxidase testing and biochemical tests. Antibiotic resistance testing was conducted using the Kirby-Bauer disk diffusion technique, following the protocols established by the Clinical and Laboratory Standards Institute (CLSI). Statistical analysis was performed using the Chi-square test, with a p-value under <0.05 regarded as statistically significant. Results: The study processed 39,592 urine samples, from which 9,940 (25.1%) pathogens were isolated. Escherichia coli (4,406; 44%) and Klebsiella pneumoniae (1,730; 17%) were the most common Gram-Negative Bacteria (GNB), while Enterococcus spp. (1,305; 13%) dominated among Gram-Positive Cocci (GPC). Notably, the efficacy of Amikacin (AK) against E. coli, Citrobacter koseri and Pseudomonas aeruginosa has declined over the last five years, as has the penicillin class of antibiotics, such as penicillin against Staphylococcus aureus. However, certain antibiotic classes like cephalosporins, aminoglycosides, Cotrimoxazole (COT), and Ciprofloxacin (CIP) exhibited improved efficacy against GNB. COT and Clindamycin (CD) also demonstrated notable effectiveness against Staphylococcus aureus, highlighting evolving antibiotic susceptibility patterns. Conclusion: From 2019 to 2023, there was a noticeable decrease in the efficacy of amikacin against E. coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, as well as a decrease in penicillin effectiveness against S. aureus. However, Imipenem (IMP), Meropenem (MRP), and Gentamicin (GEN) remained effective against GNB. Oxazolidinones, glycopeptides and sulfonamide antibiotics showed positive efficacy against GPC, highlig
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