What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe

Abstract

(1) Background: The evolution of bacterial resistance to antibiotics is one of the factors that make infectious pathology an extremely dynamic field, also inducing a significant burden on public health systems; therefore, continuous updates on the bacterial resistance to antibiotics and their particular regional patterns is crucial for the adequate approach of various infectious diseases. (2) Methods: We retrospectively analyzed 354 patients with Enterobacterales urinary tract infections (UTIs), determined their antibiotic resistance pattern, thus aiming to correlate them with the outcome and other specific markers of poor prognosis. (3) Results: The most frequent causative agent was Escherichia coli, representing 64.6% of all UTIs. We identified 154 patients resistant to multiple antibiotic classes, of which 126 were multidrug-resistant (MDR), 17 were extensive drug-resistant (XDR) and 11 were pandrug-resistant (PDR). Moreover, 25 isolates were resistant to carbapenems (CRE), 25 were difficult-to-treat (DTR), and 84 were extended-spectrum cephalosporin-resistant (ESC), with only 95 isolates susceptible to all tested antibiotics. Mortality ranged from 1% for UTIs caused by isolates susceptible to all tested antibiotics, to 24% for the ones caused by DTR or CRE isolates. Other significant risk factors associated with mortality were: prolonged hospital stay (p = 0.0001), Charlson comorbidity index ≥ 3 (p = 0.02), urinary catheterization (p = 0.001), associated respiratory pathologies (p = 0.004), obesity (p = 0.047), a history of previous hospitalizations (p = 0.007), inappropriate empiric antibiotic regimen (p = 0.001), or hyper inflammatory status (p = 0.006). Basically, we observed that a multiple regression model comprising urinary catheterization, inappropriate empiric anti-biotherapy, obesity, and respiratory comorbidities exhibits the best correlation with mortality rate in patients with UTI (R = 0.347, R2 = 0.12). (4) Conclusions: By focusing on the novel resistance patterns, our study provides complementary evidence concerning the resistance profiles found in an Eastern European region, as well as their prognostic implications in patients with UTI.

Epidemiology of Community Origin of major multidrug-resistant ESKAPE uropathogens in a paediatric population in South-East Gabon

“…1A). Male gender has already been described as a likely risk factor in the occurrence of MDR UTIs [20]. In the previously cited study, the authors showed that female gender was a protective factor in the occurrence of antibioticresistant UTIs, which does not support the results of the present study.…”

“…Resistance phenotypes have been classi ed into seven categories: Multi-drug Resistant (MDR), Extensive Drug Resistant (XDR), Pandrug-resistant (PDR), Usual Drug Resistance (UDR), Di cult-to-Treat Resistance (DTR), Extended-spectrum cephalosporin-resistant (ESC), Carbapenem-resistant Enterobacterales (CRE). These different categories of resistance have been de ned in several previous studies [10,19,20].…”

Analysis of Etiology of Community-Acquired and Nosocomial Urinary Tract Infections and Antibiotic Resistance of Isolated Strains: Results of a 3-Year Surveillance (2020–2022) at the Pediatric Teaching Hospital in Warsaw

“…Our results differ slightly from those of Miftode et al, who obtained MDR rates among E. coli , Klebsiella spp., and Proteus spp. of 60.3, 18.2, and 15.8%, respectively [ 23 ]. Our study detected half as many MDR E. coli strains (30%), but more MDR Klebsiella spp.…”

Two Newly Isolated Enterobacter-Specific Bacteriophages: Biological Properties and Stability Studies

“…Related genes that have increasingly been found in clinical strains are, among others, bla KPC−2 , as well as bla NDM , and the presence of efflux pumps is also important [ 25 , 27 , 28 ]. Recent studies describing Enterobacter -induced UTIs indicate the involvement of extensive drug resistant (XDR), multidrug resistant (MDR), as well as carbapenem-resistant Enterobacterales (CRE) strains in the pathogenesis of infection in hospitalized patients in Eastern Europe [ 29 ].…”