PHARMACOLOGICAL MANAGEMENT OF RECURRENT URINARY TRACT INFECTION IN PALESTINIAN WOMEN: A RETROSPECTIVE STUDY

Abstract

Abstract

Background: Urinary tract infections (UTIs) are among the most common bacterial infections in women worldwide, with recurrent UTIs (rUTIs) creating major challenges for both clinical and public health. In Palestine, data on rUTIs and antimicrobial resistance (AMR) are still scarce. Objectives: This study aimed to describe the pharmacological management of recurrent urinary tract infection (RUTI) and determine the prevalence of rUTIs among Palestinian women, identify the factors that are associated with increased risk of recurrent episodes, characterize antimicrobial resistance patterns, and evaluate the impact of culture guided therapy on outcomes. Methods: This study was a retrospective cohort study was conducted across four hospitals in the urology department in southern West Bank in Palestine (2016–2025). Medical records of 380 women aged ≥18 years with UTI were reviewed. Demographic, clinical, microbiological, and treatment variables were extracted. rUTI was defined as ≥2 symptomatic episodes within six months or ≥3 within twelve months. Descriptive and inferential statistics, including logistic regression, were performed by SPSS. Results: The final analysis included 380 women diagnosed with UTI. The overall prevalence of rUTIs among Palestinian women was 27.4% (104/380). Older age (median 65 vs. 60 years, p = 0.015), diabetes mellitus (p = 0.004), asthma (p = 0.012), and prior UTI history (p < 0.001) were significantly associated with recurrence. Pregnancy was less frequent among rUTI cases (p < 0.001). The most dominant pathogen isolated from urine culture was Gram negative Escherichia coli (40.5%) and Klebsiella spp. (9.7%) as leading isolates. ESBL producing strains were common, diminishing the effectiveness of cephalosporin and fluoroquinolone. Empirical therapy was dominated by ceftriaxone (43.2%), while meropenem (23.9%) became most frequent after culture results. Culture guided therapy was significantly associated with a reduced recurrence rate (p < 0.05). Clinical resolution occurred in 93.4%, but reinfection (14.2%) and MDR history (28.9%) continue to pose significant challenges. Conclusion: rUTIs are prevalent among Palestinian women and represent a significant public health burden. rUTIs strongly associated with underlying comorbidities and resistant Gram negative pathogens. Improved outcomes observed with culture guided therapy, underscoring the need for a strengthened stewardship program and diagnostic infrastructure in resource limited settings to enhance UTI management in Palestinian healthcare practices.