Multidrug-Resistant (MDR) Urinary Tract Infections Associated with Gut Microbiota in CoV and Non-CoV Patients in a Urological Clinic during the Pandemic: A Single Center Experience

Abstract

The aim of the study was to compare the profile of COVID-19 (CoV)-infected patients with non-COVID-19 (non-CoV) patients who presented with a multidrug-resistant urinary tract infection (MDR UTI) associated with gut microbiota, as well as analyze the risk factors for their occurrence, the types of bacteria involved, and their spectrum of sensitivity. Methods: We conducted a case–control study on patients admitted to the urology clinic of the “Parhon” Teaching Hospital in Iasi, Romania, between March 2020 and August 2022. The study group consisted of 22 CoV patients with MDR urinary infections associated with gut microbiota. For the control group, 66 non-CoV patients who developed MDR urinary infections associated with gut microbiota were selected. Electronic medical records were analyzed to determine demographics, characteristics, and risk factors. The types of urinary tract bacteria involved in the occurrence of MDR urinary infections and their sensitivity spectrum were also analyzed. Results: Patients in both groups studied were over 60 years of age, with no differences in gender, environment of origin, and rate of comorbidities. Patients in the CoV group had a higher percentage of urosepsis (54.5% versus 21.2%, p < 0.05) and more hospitalization days (9.27 versus 6.09, p < 0.05). Regarding risk factors, the two groups had similar percentages of previous urologic interventions (95.45% versus 96.97%, p > 0.05), antibiotic therapy (77.3% versus 87.9%, p > 0.05), and the presence of permanent urinary catheters (77.27% versus 84.85%, p > 0.05). Escherichia coli (31.8% versus 42.4%, p > 0.05), Klebsiella spp. (22.7% versus 34.8%, p > 0.05), and Pseudomonas aeruginosa (27.3% versus 9.1%, p > 0.05) were the most common urinary tract bacteria found in the etiology of MDR urinary infections in CoV and non-CoV patients. A high percentage of the involved MDR urinary tract bacteria were resistant to quinolones (71.4–76.2% versus 80.3–82%, p > 0.05) and cephalosporins (61.9–81% versus 63.9–83.6%, p > 0.05), both in CoV and non-CoV patients. Conclusions: Patients with urological interventions who remain on indwelling urinary catheters are at an increased risk of developing MDR urinary infections associated with gut microbiota resistant to quinolones and cephalosporins. Patients with MDR UTIs who have CoV-associated symptoms seem to have a higher rate of urosepsis and a longer hospitalization length.

Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic

“…Regarding MDR infections, we found a lower percentage of them compared with other studies, which is probably explained by the lower incidence of possible risk factors (age, presence of urinary catheters, multiple hospitalizations, etc.). Although the group with sepsis had a higher statistically significant percentage of MDR UTIs compared with the non-sepsis group, this incidence is lower than in other reports [35]. The fact that we could not objectify any germs in urine culture in 25% of the cases, can also be explained by the fact that antibiotic treatment was initiated in many cases in other hospitals from which patients were transferred.…”

Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following Double-J Catheter Insertion

“…Reflux pyelonephritis can be a serious complication that can quickly lead to urosepsis in the absence of adequate antibiotic treatment [30]. However, as in other studies [28,31], the incidence of symptoms associated with double-J catheters in our study was much lower than the nearly 80% reported in other studies [13,25]. We did not find, as reported in other studies [32], that multiple ESWL sessions are required in patients with double-J stents to achieve the same effect as in patients without stents.…”

“…The administration of multiple ESWL sessions prolongs the time to achieve stone-free status and thus increases the risk of reflux, pyelonephritis, and double-J syndrome, as emphasized in other studies [13,[27][28][29]. Reflux pyelonephritis can be a serious complication that can quickly lead to urosepsis in the absence of adequate antibiotic treatment [30].…”

Urinary Tract Infections with Carbapenem-Resistant Klebsiella pneumoniae in a Urology Clinic—A Case-Control Study

“…With regard to potential risk factors, we analyzed the presence of urinary catheters at the time of diagnosis, a recognized factor for increasing the incidence of MDR UTI [53], such as urethral catheters, double-J ureteral catheters, percutaneous nephrostomy catheters, cystostomy catheters, and percutaneous ureterostomy catheters. Regarding the presence of urinary catheters, we analyzed patients with catheters inserted earlier than one month ago and over one month separately in the two groups, knowing that the presence of catheters is a risk factor for bacterial colonization and the subsequent occurrence of infections.…”