Abstract
Urinary tract infections (UTIs) are prevalent bacterial infections globally and significantly contribute to both outpatient and inpatient antibiotic use. In the past five years (2020–2025), Pakistan has observed increasing rates of antimicrobial resistance (AMR) in uropathogens, notably Escherichia coli and Klebsiella spp., accompanied by frequent instances of multidrug resistance (MDR) and extended-spectrum β-lactamase (ESBL) production. This review consolidates findings from cross-sectional studies conducted in Pakistan, highlighting prevalence estimates, predominant uropathogens, antibiotic susceptibility profiles, trends in ESBL and carbapenem resistance, and implications for empirical therapy and stewardship. In various studies, E. coli was the predominant isolate, accounting for approximately 50–75% of cases. This bacterium exhibited consistently high resistance to ampicillin, trimethoprim-sulfamethoxazole, and fluoroquinolones. Conversely, nitrofurantoin, fosfomycin, and carbapenems demonstrated greater susceptibility; however, their availability and appropriateness for all outpatient settings are limited. The prevalence of ESBL-producing E. coli varied significantly by setting, frequently surpassing 20–30%, thereby complicating the selection of oral therapy options. The evidence highlights the necessity for region-specific antibiograms, enhanced laboratory surveillance, limitations on over-the-counter antibiotic availability, and the establishment of antimicrobial stewardship programs at both district and national levels to maintain effective UTI treatment.