Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia

Abstract

Introduction: Surveillance of antimicrobial resistance is essential in establishing treatment guidelines for urinary tract infections. The aim of this pilot study was to analyse resistance rates of pathogens, across different demographics and determine whether adjustments in empiric therapy should be considered for different age and gender groups. Methodology: A 5-year retrospective study included 256 patients hospitalised, under the initial diagnosis of Fever of Unknown Origin who were then subsequently diagnosed with a urinary tract infection at the Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia. Patients were evaluated using demographic, clinical, and antimicrobial resistance data with appropriate statistical analysis including ANOVA significance testing, univariate, and multivariate analysis. Results: Resistance rates were above the threshold of 20% for the majority of the antimicrobials tested, the only exception being carbapenems. Amikacin, cefepime, and norfloxacin were agents that could be effectively used as empiric therapy in younger adults with resistance rates of 4.2, 8.0, and 10.0%, respectively. Moderate resistance rates of 17.4% for amikacin and 19.1% for cefepime were observed in the age group 35-64 years. High resistance rates were observed for all antimicrobials among patients 65 years and over. Among male patients, resistance rates to most antimicrobials were high. In female patients, amikacin and cefepime had resistance rates less than 20%. Younger age presented as a negative risk factor for infection by a multi-drug resistant pathogen. Conclusion: Age and gender demonstrated to be significant factors for determining proper empiric therapy; large-scale studies from Serbia are needed to solidify these findings.

Antibiotic resistance pattern of Escherichia coli isolates from outpatients with urinary tract infections in Somalia

“…Despite the fact that the statistics were not significant between marital status and gender with UTI, yet high percentages of married respondents (n = 70/101, 69.3%) and females (n = 57/91, 62.6%) were in UTI positive group. These were also reported in other studies [14,15].…”

“…The majority of the respondents of the study were females 91 (71.1%) in comparison to males, which were 37 (28.9%). Showing considerable differences in the prevalence of UTI among outpatient visiting hospital setting, this agrees with a study from Nigeria, which showed that the prevalence of UTI was very high in females attending hospitals for UTI cases 111 (74%) compared to males 39 (26%) [14,15] as well as study conducted in Iran reported high proportion of UTI among outpatients were females (85.2%) [4]. These results indicated that females were prone to UTI as these were attributed to the nature of urogenital tract of the females; it is proximity to the anus and also lacking the bacteriostatic nature of prostatic secretions of male [14,15,20].…”

Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study

“…Data analysis considered the timing of infection and LOS for the duration of the infection, adjusted for patient comorbidity upon admission to avoid possible overestimation of the effect of resistance, [57][58][59] and controlled for various potential confounding demographic and clinical factors.…”

Comparison of Antimicrobial Susceptibilities of Escherichia coli Isolated From Urinary Cultures of Different Patient Groups: A University Hospital Experience

“…Gerek toplum kaynaklı gerekse hastane kaynaklı ÜSİ'de ilk sırada yer alan etken Escherichia coli'dir (2,3). İdrar kültüründe üreyen patojenin tanımlanması ve antibiyotik duyarlılık testlerinin sonuçlanması için belli bir süreye ihtiyaç duyulması nedeniyle, ÜSİ'de sıklıkla ampirik antibiyotik tedavisi başlanmaktadır (4,5). Uygun olmayan ampirik tedavi, antibiyotiklerin değiştirilmesine neden olmakta; bu da zaman kaybına, hastanede yatış sürelerinin uzamasına, antibiyotik direncinin gelişmesine ve maliyet artışına yol açmaktadır (4)(5)(6).…”

“…İdrar kültüründe üreyen patojenin tanımlanması ve antibiyotik duyarlılık testlerinin sonuçlanması için belli bir süreye ihtiyaç duyulması nedeniyle, ÜSİ'de sıklıkla ampirik antibiyotik tedavisi başlanmaktadır (4,5). Uygun olmayan ampirik tedavi, antibiyotiklerin değiştirilmesine neden olmakta; bu da zaman kaybına, hastanede yatış sürelerinin uzamasına, antibiyotik direncinin gelişmesine ve maliyet artışına yol açmaktadır (4)(5)(6). ÜSİ'de en sık saptanan etkenin ülkemizdeki antibiyotik duyarlılık profiliyle ilgili bilgiler, ampirik tedavide kullanılacak antibiyotiklerin seçiminde yol gösterici olmaktadır (1,2,4).…”