OBJECTIVE: To assess the epidemiology of antimicrobial resistance among community-residing persons with spinal cord injury (SCI). DESIGN: Retrospective analysis of existing data. SETTING: Data were obtained from persons with SCI attending clinic for annual examinations. PARTICIPANTS: Two hundred eighty-seven SCI outpatients. INTERVENTION: None. MAIN OUTCOME MEASURE: Occurrence of bacteriuria with gram-negative organisms demonstrating resistance to antimicrobial agents in 2 or more classes. RESULTS: There were 706 gram-negative isolates from 444 urine specimens. Resistance to drugs in 2 or more classes occurred in 33% of bacterial isolates, but did not significantly increase in frequency among those injured for longer periods or more severely. Significantly higher rates of multidrug-resistant bacteria occurred in specimens from males, younger age group (< or =45 yrs), and persons with indwelling and condom catheters. CONCLUSIONS: Antimicrobial resistance in outpatients with SCI is common and is related to widespread use of specific drugs, type of bladder management, and other host factors.