Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance

Abstract

Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.

Chronic Kidney Disease—An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections

“…At the same time, CKD seems to be a risk factor for infections caused by antibiotic-resistant pathogens, but most of the published studies are focused on the risk of MDROs infections in ESKD undergoing dialysis [ 34 , 35 ], with a limited number of studies regarding association of early stages of CKD with antimicrobial resistance. To note that the proportion of CKD patients among hospitalized patients with UTIs varies across studies from 21.47% [ 10 ] to 28.6% [ 36 ], accounting for 42.4% in our study.…”

“…However, in the multivariate analysis, only CKD, age over 65 and presence of indwelling urinary catheters were associated with overall AMR in hospitalized patients with UTIs. Previous studies also reported an increased risk of UTIs with antibiotic-resistant strains in long-term nursing home residents, elderly [ 10 , 17 ], indwelling urinary catheters [ 10 ], urinary incontinence [ 10 ] and recurrent UTIs [ 17 ].…”

“…Regarding non-infectious complications in hospitalized patients with UTIs, namely AKI, in a European cohort of 489 CKD patients, the reported rate of AKI in patients hospitalized for UTIs was 73.6%, the mean length of hospital-stay (days) 13.2 ± 18.5 [ 26 ] compared to a 34.9% incidence of AKI and 8.33 ± 5.82 days mean length of stay in our group. Other studies reported AKI incidence in hospitalized patients ranging from 45.4% [ 10 ] to 75.2% in a kidney transplant cohort [ 39 ]. To mention that our group included patients with many comorbidities and risk factors for AKI, both related and non-related to UTIs.…”

“…It is generally accepted that CKD is a risk factor for complicated UTIs [ 8 , 9 ] and the clinical evolution and outcomes of UTIs in this specific population are influenced by higher levels of comorbidity, impaired immunity in people with CKD, and equally important, by the increasing prevalence of UTIs with antibiotic-resistant uropathogens [ 10 , 11 ].…”

Hospital Urinary Tract Infections in Healthcare Units on the Example of Mazovian Specialist Hospital Ltd

“…Urinary-catheter-related infection is one of the more common nosocomial infections and has been studied by many authors ( Foxman, 2002 ; Flores-Mireles et al., 2015 ; Eliakim-Raz et al., 2019 ; Garcia-Bustos et al., 2021 ). Infections affect both the upper and lower urinary tract ( Gharbi et al., 2019 ).…”