Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011–2019

Abstract

Background While the resistance rates of commonly detected uropathogens are well described, those of less frequent Gram-negative uropathogenic bacteria have seldom been reported. The aim of this study was to examine the resistance rates of less frequent uropathogenic Gram-negatives in a population of patients treated in a Department of Urology of a tertiary referral centre in Central Europe over a period of 9 years. Methods Data on all positive urine samples from urological in- and out-patients were extracted form the Department of Clinical Microbiology database from 2011 to 2019. Numbers of susceptible and resistant isolates per year were calculated for these uropathogens: Acinetobacter spp. (n = 74), Citrobacter spp. (n = 60), Enterobacter spp. (n = 250), Morganella morganii (n = 194), Providencia spp. (n = 53), Serratia spp. (n = 82) and Stenotrophomonas maltophilia (n = 27). Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin and colistin. Results Penicillin derivatives have generally poor effect except piperacillin/tazobactam. Cefuroxime is not efficient unlike cefotaxime (except against Acinetobacter spp. and S. maltophilia). Susceptibility to fluoroquinolones is limited. Amikacin is somewhat more efficient than gentamicine but susceptibilities for both safely exceed 80%. Nitrofurantoin shows virtually no efficiency. Cotrimoxazole acts well against Citrobacter spp., Serratia spp. and it is the treatment of choice for S. maltophilia UTIs. Among carbapenems, ertapenem was less efficient than meropenem and imipenem except for S. maltophilia whose isolates were mostly not suceptible to any carbapenems. Conclusions Uropathogenic microorganisms covered in this report are noteworthy for their frequently multi-drug resistant phenotypes. Knowledge of resistance patterns helps clinicians choose the right empirical antibiotic treatment when the taxonomical assignment of the isolate is known but sensitivity results are pending.

Urinary Tract Infections in Elderly Patients: A 10-Year Study on Their Epidemiology and Antibiotic Resistance Based on the WHO Access, Watch, Reserve (AWaRe) Classification

“…generation cephalosporins, while resistance rates to III. generation cephalosporins, fluoroquinolones, aminoglycosides, carbapenems, nitrofurantoin and SXT were around 5-15%, 20%, 6-33.3%, 10%, 90% and 10-30%, respectively [10]. The increased diversity of urinary pathogens in patients with advanced age was further verified by the findings of Kot et al, noting the increasing importance of Enterococcus spp.…”

“…The number of available reports on the epidemiology of UTIs in the elderly is scarce. Hrbacek et al reported on the resistance of uncommon urinary isolates, mainly members of the CES (Citrobacter-Enterobacter-Serratia) and PPM (Proteus-Providencia-Morganella) groups, Acinetobacter and Pseudomonas [10]: the overall prevalence of these pathogens was 4.65% in a 9-year (2011-2019) study period, with male patients being disproportionally more affected (76.8%); the mean age of patients were 70.3 and 69.2 years for males and females. The majority (50-80%) of the surveyed isolates were resistant to aminopenicillins and I-II.…”

“…These microorganisms possess an advantageous mix of physiological adaptability and the relevant virulence factors (such as a polysaccharide capsule, urease enzyme, fimbriae, pili) to withstand the sheer forces and to thrive on the urinary epithelium [8]. Overall, Escherichia coli (or uropathogenic E. coli [UPEC]) is the most frequently isolated species in UTIs [9]; nevertheless, in hospitalized and/or immunosuppressed patients, non-conventional urinary pathogens are increasingly present [10,11]. The antimicrobial therapy of UTIs has become increasingly challenging, due to worrying developments in antimicrobial resistance (AMR) worldwide [12]; clinicians are often left with scarce therapeutic choices, as multidrug-resistant (MDR) bacteria are progressively more common in both community-associated and healthcare-associated UTIs [13].…”

Molecular Identification of Multi Drug-resistant Klebsiella pneumoniae Isolated from Neonates with Sepsis in Egypt

“…Due to resistance to penicillin derivatives and third generation cephalosporins, the use of these antibiotics in neonatal sepsis is limited, suggesting the use of a combination of antibiotics to overcome this resistance [21]. The combination of amikacin and cefotaxime, as well as piperacillin/tazobactam and cefotaxime, resulted in a significant increase in Klebsiella sensitivity, particularly with the amikacin combination [22]. The combination of amikacin and cephalosporins increases Klebsiella's sensitivity to third generation cephalosporins via a chelating mechanism similar to that of EDTA for magnesium and calcium, which are components of cell wall integrity, thereby facilitating the action of third generation cephalosporins [23,24].…”

Interplay between Phenotypic Resistance to Relevant Antibiotics in Gram-Negative Urinary Pathogens: A Data-Driven Analysis of 10 Years’ Worth of Antibiogram Data

“…or non-fermenters (Pseudomonas spp., Acinetobacter spp. ), are more commonly found as pathogens [26].…”