Urinary Tract Infection Etiological Profiles and Antibiotic Resistance Patterns Varied Among Different Age Categories: A Retrospective Study From a Tertiary General Hospital During a 12-Year Period

Abstract

BackgroundUrinary tract infections (UTIs) are among the most common infections worldwide. With continuing trends of antibiotic resistance, the etiological distribution and antibiotic susceptibility surveillance are of great importance for empirical antimicrobial therapy. The risk factors and clinical circumstances of UTI among different age categories varied; thus, the pathogens and antimicrobial susceptibilities of UTI may also change with age. The aim of this study was to compare the etiological profiles and antibiotic resistance patterns of UTIs sorted by different age categories from a tertiary general hospital during a 12-year period.MethodsAll positive urine culture results from non-repetitive UTI patients in our hospital from January 2009 to December 2020 were collected retrospectively. The microbial distribution and antibiotic resistance rates were analyzed by WHONET 5.6 software. The etiological profiles sorted by different age categories (newborn, pediatric, adult, and geriatric) and antibiotic resistance rates of the top five pathogens were analyzed.ResultsA total of 13,308 non-repetitive UTI patients were included in our study. Enterococcus faecium was dominant in newborn (45%, n = 105), and replaced by Escherichia coli in pediatric (34%, n = 362), adult (43%, n = 3,416), and geriatric (40%, n = 1,617), respectively. The etiological profiles of different age categories were divergent, sorted by genders (male and female) and ward types (outpatient, inpatient, ICU, and emergency). E. coli, Klebsiella pneumoniae, Enterococcus faecalis, E. faecium, and Pseudomonas aeruginosa were the top five pathogens in all age categories. The resistance rates of cefoperazone–sulbactam and piperacillin–tazobactam in E. coli were low in all age categories. The resistance rates of other cephalosporins, carbapenems, and fluoroqinolones in K. pneumoniae were higher in geriatric patients overall. E. faecium was more resistant than E. faecalis in all age categories. Multidrug resistance increased with age, which was more serious in geriatric patients.ConclusionThe UTI etiological profiles and antibiotic resistance patterns varied among different age categories, especially in pediatric and geriatric patients; thus, a different antibiotic therapy for various age categories should be considered when initiating empirical antimicrobial therapies.

Bacterial profile and antibiotic susceptibility pattern of uropathogens causing urinary tract infection in the eastern part of Northern India

“…The most common gram-negative bacteria isolated from samples in our investigation was E. coli (55.0%). These findings are consistent with those of several other published studies where the prevalence of E. coli was 97.0, 92.6, 74.0, 55.0, 49.3, 43.5, 41.9, and 40.0% (Arora et al, 2016;Odoki et al, 2019;Chen et al, 2020;Daoud et al, 2020;Ali et al, 2022;Huang et al, 2022;Jagadeesan et al, 2022;Komagamine et al, 2022). In our study, 10.3389/fmicb.2022.965053…”

“…The inappropriate and indiscriminate use of broad-spectrum antibiotics and prolonged hospital stay are key etiological factors associated with MDR infections ( Prestinaci et al, 2015 ). In our study, 40.4% of E. coli produced ESBLs, whereas other publications reported 25.2%; 35.7, 46.0, and 52–67% ( Gharavi et al, 2021 ; Huang et al, 2022 ; Naushad et al, 2022 ; Sadeghi et al, 2022 ). ESBL producers hydrolyze and eliminate the majority of broad-spectrum beta-lactam antibiotics, increasing morbidity and mortality ( Mahmud et al, 2020 ).…”

“…In our study, 96.0% of the pathogens were MDR, compared to 91.3% in Nepal, 85.5% in Somaliland, 83.0% in Haryana, 45.1% in Tunisia, and 42.6% in China (Ben Ayed et al, 2019;Huang et al, 2022;Malik et al, 2021;Shilpakar et al, 2021;Ali et al, 2022). The inappropriate and indiscriminate use of broad-spectrum antibiotics and prolonged hospital stay are key etiological factors associated with MDR infections (Prestinaci et al, 2015).…”

Global and Regional Burden of Bacterial Antimicrobial Resistance in Urinary Tract Infections in 2019

“…Escherichia coli and Klebsiella pneumoniae dominated the deaths attributed to and associated with AMR in UTI. This result was consistent with the results reported in other studies [ 10 , 19 , 20 ]. When considering the antibiotic classes of drug, fluoroquinolones, carbapenems, third-generation cephalosporins, aminopenicillin, β-lactam or β-lactamase inhibitors, and trimethoprim/sulfamethoxazole were the most common antibiotics causing death.…”

“…Additionally, socioeconomic level, such as infrastructure construction and government supervision, might influence AMR [ 19 ]. For example, in addition to the relatively low UTI burden [ 9 ], the other reasons for the lowest bacterial AMR burden in UTI in sub-Saharan African might include the scarcity of laboratory infrastructure resulting in the lack of adequate quality of data [ 20 ] and insufficient government regulations resulting in the easy acquisition of antibiotics without prescription [ 21 ] or counterfeited medications [ 22 ]. As the patterns and drivers of bacterial AMR differ among regions, local data provide useful information for policy-making, and special tailored strategies should be developed considering local socioeconomic factors.…”