en Microbial pathogenesis Microbial pathogenesis Original article Original article <div style="text-align: justify;"><b><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">Introduction</span></span></span></b><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">: Antimicrobial resistance (AMR) among uropathogens is a critical global public health challenge, potentially exacerbated by the COVID-19 pandemic. This study evaluates the pandemic&rsquo;s impact on antimicrobial susceptibility trends among uropathogens at a tertiary care center in Kerala over six years (2018&ndash;2023). <b>Methods: </b>A retrospective analysis of 4,461 uropathogen isolates was conducted using data from laboratory records. Data were analyzed using IBM SPSS Statistics version 20, with Chi-square tests for associations. <b>Results: </b><i>Escherichia coli</i> was the predominant pathogen (57.4%), followed by <i>Klebsiella pneumoniae</i> (14.3%) and <i>Enterococcus</i> spp. (6.0%). Other common isolates included <i>Pseudomonas aeruginosa</i> (4.2%) and <i>Acinetobacter baumannii</i> (3.3%), and fungi (6.8%). <i>E. coli</i> susceptibility to ampicillin increased significantly from 3.4% in 2018 to 13.9% in 2023 (<i>P</i>< 0.001), though overall resistance remained high; while susceptibility to cefoperazone-sulbactam and piperacillin-tazobactam declined (<i>P</i>< 0.001). <i>K. pneumoniae</i> susceptibility to cefoperazone-sulbactam decreased from 88.7% in 2018 to 73.0% in 2023 (<i>P</i>< 0.001). <i>Enterococcus</i> spp. susceptibility to nitrofurantoin declined from 91.0% in 2018 to 67.4% in 2023 (<i>P</i> = 0.017). <i>A. baumannii</i> showed increased ceftazidime susceptibility from 18.4% in 2018 to 56.0% in 2022, followed by a decline to 27.8% in 2023 (<i>P</i> = 0.015). <i>P. aeruginosa</i> exhibited increased susceptibility to gentamicin (57.6% to 77.2%; <i>P</i> = 0.012), ceftazidime (61.6% to 77.2%; <i>P</i> = 0.043), and fluoroquinolones (53.9% to 68.1%; <i>P</i> = 0.019) from 2018 to 2023. <b>Conclusion: </b>This study highlights dynamic shifts in antimicrobial susceptibility patterns among uropathogens, underscoring the need for continuous surveillance to guide empirical therapy and infection control strategies. Further research is warranted to explore contributing factors, including pandemic-related practices.</span></span></span></div> Uropathogens, COVID-19, Antibiotic susceptibility, Drug resistance, Urinary tract infections, Kerala, India 147 155 http://jommid.pasteur.ac.ir/browse.php?a_code=A-10-607-1&slc_lang=en&sid=1 Sheeba Pookkottu Madom drsheebapm81@gmail.com 0000-0001-5960-2346 No Department of Microbiology, Government Medical College, Palakkad, Kerala, India Roshni K Jose rkjose4665@gmail.com 0000-0002-8048-5567 Yes Department of Microbiology, Government Medical College, Palakkad, Kerala, India Sreeram Balachandran dr.sreeramb84@gmail.com 0009-0008-8058-6625 No Department of General Medicine, Government Medical College, Palakkad, Kerala, India Deepak KS deepakks717@gmail.com No Department of Preventive and Social Medicine, Government Medical College, Palakkad, Kerala, India Anila A Mathews deepakanila11@gmail.com No Department of Microbiology, Government Medical College, Palakkad, Kerala, India