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

Abstract

The ageing of the population—especially in developed countries—has brought on many societal challenges and has significantly contributed to the burden on healthcare infrastructures worldwide. Elderly persons (aged ≥ 65 years) are at higher risk for developing UTIs, due to a range of intrinsic and extrinsic risk factors, and they often delay seeking treatment. A retrospective observational study was performed regarding the epidemiology and resistance of UTIs in elderly patients. Identification of the isolates was carried out using VITEK 2 ID/AST and MALDI-TOF mass spectrometry. Antibiotic resistance in these isolates was assessed based on EUCAST guidelines, and were grouped into the WHO AWaRe (Access, Watch, Reserve) classification of antimicrobials. During the 10-year study period, n = 4214 (421.4 ± 118.7/year) and n = 4952 (495.2 ± 274.6) laboratory-confirmed UTIs were recorded in inpatients and outpatients, respectively. The causative agents showed differentiation among outpatients and inpatients: Escherichia coli (48.14% vs. 25.65%; p = 0.001), Enterococcus spp. (20.15% vs. 21.52%; p > 0.05), Klebsiella spp. (16.28% vs. 16.26%; p > 0.05), Pseudomonas spp. (4.40%vs. 13.36%; p = 0.001); Proteus-Providencia-Morganella group (4.56% vs. 10.96%; p = 0.001); Candida spp. (0.53% vs. 5.98%; p = 0.001); Citrobacter-Enterobacter-Serratia group (1.90% vs. 2.71%; p < 0.05). Significantly higher resistance rates were observed in inpatient isolates for many Access and Watch antibiotics compared to isolates of outpatient origin; in addition, resistance rates were higher in these uropathogens compared to the previously recorded rates in the region. More care should be taken for the diagnosis and treatment of UTIs affecting elderly patients, as they represent a particularly vulnerable patient population.

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

“…Even though Proteus spp. is usually associated with hospital-acquired UTIs [21], with higher resistance rates to carbapenems [40,41], we identified up to 97% susceptibility to meropenem, similar to other Romanian research [16]; however, we must interpret these results with caution, due to the relatively small number of Proteus spp. isolates.…”

Xanthogranulomatous Pyelonephritis Caused by Stenotrophomonas maltophilia—The First Case Report and Brief Review

“…Rarely, the urinary tract appears to be responsible as the primary source. A recent study conducted by Gajdács et al in Hungary that analyzed a 10 year period, including more than 9000 urine positive cultures, collected from both outpatients and inpatients, reported only 11 cases of S. maltophilia [19]. It is supplementary proof to attest to the rarity of our case.…”

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

“…The diagnosis and treatment of UTI varied across different age groups (Chu and Lowder, 2018), e.g., young women with UTI were different from women older than 65 years who were at higher risk for developing UTIs due to a range of intrinsic and extrinsic risk factors (Gajdács et al, 2021), and the antibiotic choices for treating UTI were different between pediatric and adult patients. To the best of our knowledge, few studies have systematically compared the UTI etiological profiles and antimicrobial resistance patterns for patients of different ages.…”