Comparative epidemiology and resistance trends of common urinary pathogens

Abstract

Introduction. Urinary tract infections (UTIs) are some of the most common infections in human medicine, affecting a large patient population (around 150 million cases/year) to various extents, irrespective of age and gender. The principal cause of UTIs (>80%) are uropathogenic Escherichia coli and Klebsiella species both in the community and nosocomial settings. The assessment of local data on the prevalence and resistance is essential to evaluate trends over time and to make adjustments on the empirical treatment protocol. Aim of the study. Assessment of epidemiology and resistance trends of most common urinary pathogens in order to create a hospital-specific antibiogram and practical recommendation on first chose antibiotics for empirical and prevention treatment.Materials and methods.. A retrospective record review of data collected from laboratory results of 1299 patients admitted to the Urology Department of Republican Clinical Hospital between April 2019 and October 2019 was done. The outcome of interest was the antibiotic susceptibility of bacterial isolates from the patient’s urine probes, before or after planned surgery. Pathogens the selection was done according to the highest incidence observed: Escherichia Coli, Klebsiella pneumonia, Proteus Mirabilis and Pseudomonas aeruginosa. The isolates were analyzed for susceptibility and resistance to 4 antimicrobial groups (Cephalosporins, Carbapenems, Fluoroquinolones, Aminoglycosides) and 3 miscellaneous agents (Nitrofurantoin, Fosfomycin trometamol, Trimethoprim-sulfamethoxazole). Results. A total of 221 (17%) isolates from urines, of 4 selected bacteria were analyzed: Escherichia Coli (43.43%), Klebsiella pneumonia (33,48%), Proteus Mirabilis (12.66%) and Pseudomonas aeruginosa (5.88%). According to received data, the highest susceptibility for Escherichia Coli, Klebsiella pneumonia and Proteus Mirabilis it was for Fosfomycin with 92.7%, 63.51% and 89.28 respectively. Pseudomonas aeruginosa sensitivity it was highest for Amikacin followed by Carbapenems and Cefalosporins with 76.92%, 61.53% and 53.84% respectively. Klebsiella pneumonia was found with the lowest susceptibility to Cephalosporins (29.72%), Fluoroquinolones (27.02%) and Nitrofurantoin (18.91%) – those antibiotics that are most commonly used as prophylaxis and empirical treatment. If we consider the general impact of Amikacin on selected bacteria, we see that almost 75% of all isolates are sensitive to it. Conclusions. Statistically significant increases in resistance to commonly used antibiotics were observed. In this respect, we consider that the choice of empiric antibiotic therapy should be selected based on local susceptibility profiles. The choice of antimicrobial drugs should be reconsidered when it comes to prevention or empiric treatment, as most commonly used groups of antibiotics are no more effective. From this specific study, we can conclude that Amikacin and Fosfomycin trometamol should be considered as first chose antibiotics for empirical and prevention treatment.