Predictive factors for multidrug-resistant gram-negative bacteria among hospitalised patients with complicated urinary tract infections
Open Access
- 14 September 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in Antimicrobial Resistance & Infection Control
- Vol. 7 (1), 111
- https://doi.org/10.1186/s13756-018-0401-6
Abstract
Patients with complicated urinary tract infections (cUTIs) frequently receive broad-spectrum antibiotics. We aimed to determine the prevalence and predictive factors of multidrug-resistant gram-negative bacteria in patients with cUTI. This is a multicenter, retrospective cohort study in south and eastern Europe, Turkey and Israel including consecutive patients with cUTIs hospitalised between January 2013 and December 2014. Multidrug-resistance was defined as non-susceptibility to at least one agent in three or more antimicrobial categories. A mixed-effects logistic regression model was used to determine predictive factors of multidrug-resistant gram-negative bacteria cUTI. From 948 patients and 1074 microbiological isolates, Escherichia coli was the most frequent microorganism (559/1074), showing a 14.5% multidrug-resistance rate. Klebsiella pneumoniae was second (168/1074) and exhibited the highest multidrug-resistance rate (54.2%), followed by Pseudomonas aeruginosa (97/1074) with a 38.1% multidrug-resistance rate. Predictors of multidrug-resistant gram-negative bacteria were male gender (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.20–2.29), acquisition of cUTI in a medical care facility (OR, 2.59; 95%CI, 1.80–3.71), presence of indwelling urinary catheter (OR, 1.44; 95%CI, 0.99–2.10), having had urinary tract infection within the previous year (OR, 1.89; 95%CI, 1.28–2.79) and antibiotic treatment within the previous 30 days (OR, 1.68; 95%CI, 1.13–2.50). The current high rate of multidrug-resistant gram-negative bacteria infections among hospitalised patients with cUTIs in the studied area is alarming. Our predictive model could be useful to avoid inappropriate antibiotic treatment and implement antibiotic stewardship policies that enhance the use of carbapenem-sparing regimens in patients at low risk of multidrug-resistance.Keywords
Funding Information
- Innovative Medicines Initiative Joint Undertaking (115523 | 115620 | 115737)
This publication has 27 references indexed in Scilit:
- A Targeted Infection Prevention Intervention in Nursing Home Residents With Indwelling DevicesJAMA Internal Medicine, 2015
- Emerging Issues in Gram-Negative Bacterial ResistanceMayo Clinic Proceedings, 2015
- Antimicrobial Susceptibility of Inpatient Urinary Tract Isolates of Gram-Negative Bacilli in the United States: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART) Program: 2009−2011Clinical Therapeutics, 2013
- Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistanceClinical Microbiology & Infection, 2012
- Consensus review of the epidemiology and appropriate antimicrobial therapy of complicated urinary tract infections in Asia-Pacific regionJournal of Infection, 2011
- Antimicrobial Resistance in Urinary Tract Pathogens in Canada from 2007 to 2009: CANWARD Surveillance StudyAntimicrobial Agents and Chemotherapy, 2011
- Management of Complicated Urinary Tract Infections in the Era of Antimicrobial ResistancePostgraduate Medicine, 2010
- Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteriaJournal of Antimicrobial Chemotherapy, 2010
- Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studiesBMJ, 2007
- Antibacterial resistance worldwide: causes, challenges and responsesNature Medicine, 2004