Clinical characteristics, antimicrobial susceptibility patterns, and mortality predictors in patients with Pseudomonas aeruginosa urinary tract infection: A retrospective study

Background Pseudomonas aeruginosa ( P. aeruginosa ) is a leading cause of urinary tract infections (UTIs) in hospitalized patients, particularly those who are immunocompromised, catheterized, or have multiple comorbidities. Its intrinsic and acquired antimicrobial resistance mechanisms often complicate treatment and worsen outcomes. Data on P. aeruginosa UTIs from Palestinian healthcare settings remain scarce. Objectives To characterize the clinical features, antimicrobial resistance profiles, and independent predictors of mortality among patients with P. aeruginosa UTIs treated at An-Najah National University Hospital (NNUH), Nablus, Palestine. Design Retrospective study. Methods We conducted this study at NNUH (January 2022–December 2024) among patients with significant P. aeruginosa growth (>10 4 CFU/mL) on urine culture plus the presence of clinical indicators of UTI (Fever, dysuria, Flank Pain) across outpatient, inpatient, and ICU settings. The primary outcome was mortality, analyzed using univariate comparisons and multivariable logistic regression. Results Among 190 patients (median age 54 years [IQR 26–69]; 49.5% male), overall mortality was 11.6%. Resistance was highest for ciprofloxacin (31.5%) and lowest for ceftazidime–avibactam (11.1%). Ceftazidime–avibactam resistance rose significantly across care settings, from 0% in outpatients to 30.0% in ICU patients (p = 0.041). On multivariable analysis, immunocompromised status (OR 2.78, 95% CI 1.03–7.50; p = 0.043) and meropenem resistance (OR 2.99, 95% CI 1.03–8.75; p = 0.045) were independent predictors of mortality. Conclusion P. aeruginosa UTIs carry significant mortality in this Palestinian tertiary care cohort, driven by immunocompromised status and meropenem resistance. Fluoroquinolone and carbapenem resistance are prevalent, particularly in ICU patients, underscoring the need for targeted antibiotic stewardship and early risk recognition.