Prevalence and outcomes of Urinary tract infections caused by Enterobacterales resistant to third-generation cephalosporins in the Emergency Department: results from UTILY cohort, a prospective multicentre study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-05-09 DOI:10.1007/s15010-025-02547-3

Caterina Monari, Lorenzo Onorato, Alessandro Cornelli, Margherita Macera, Enrico Allegorico, Andrea Ferraro, Carmine Nasta, Maria Teresa Florio, Kim Russo, Piero Bianco, Vita Dora Iula, Fabio Giuliano Numis, Giovanna Guiotto, Mauro Giordano, Rosa Raucci, Ferdinando Dello Vicario, Rodolfo Nasti, Evaluna Perez Guillen, Nicola Coppola

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引用次数: 0

Abstract

Introduction: In accordance with the spread of drug-resistant bacteria worldwide, an increase in the prevalence of Antimicrobial Resistance (AMR) among pathogens causing urinary tract infections (UTIs) has been described globally. The aim of this study was to describe the prevalence and outcome of UTIs caused by third-generation cephalosporin-resistant (3GC-R) Enterobacterales in a prospective cohort of patients admitted to Emergency Department (ED).

Materials and methods: We conducted an observational prospective multicentre study, involving 7 healthcare facilities, enrolling all consecutive adult patients admitted to ED with a microbiologically confirmed diagnosis of UTIs caused by Enterobacterales. The primary outcomes were the prevalence of UTIs caused by 3GC-R Enterobacterales, and 30-day mortality.

Results: During the study period, we included 288 patients with urinary tract infection: 41.7% of subjects were males, median age was 72 years (IQR 56-81). The most frequently isolated pathogen was Escherichia coli (70.5%); 35.9% of all pathogens isolated were non-susceptible to 3GC. At multivariate logistic regression analysis, admission to a hospital (OR 3.31, 95% CI 1.41-7.75, p = 0.006) or a long-term care facility (OR 4.87, 95% CI 1.16-20.36, p = 0.03) in the previous three months was independently associated with isolation of a 3GC-R pathogen. Regarding the clinical outcomes, 22 out of 217 (10.1%) patients completing follow-up died at 30 days. At multivariate analysis 7-day clinical response was the only variable associated with 30-day mortality (OR 0.11, 95% CI 0.04-0.36, p < 0.001).

Conclusions: In our study, 35.9% of pathogens isolated in urine cultures of patients with community-acquired UTIs were non-susceptible to 3GC. In the ED, the knowledge of local epidemiology and of risk factors for antimicrobial resistance is of paramount importance for choosing the right empiric therapy and setting up local guidelines.

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急诊科对第三代头孢菌素耐药肠杆菌引起的尿路感染的患病率和结局：来自UTILY队列的结果，一项前瞻性多中心研究

导言：随着耐药细菌在世界范围内的传播，引起尿路感染（uti）的病原体中抗菌素耐药性（AMR）的流行率在全球范围内有所增加。本研究的目的是描述在急诊科（ED）住院的前瞻性队列患者中由第三代头孢菌素耐药（3GC-R）肠杆菌引起的尿路感染的患病率和结局。材料和方法：我们进行了一项观察性前瞻性多中心研究，涉及7家医疗机构，纳入了所有连续入院的经微生物学证实诊断为肠杆菌引起的尿路感染的ED成年患者。主要结局是3GC-R肠杆菌引起的uti患病率和30天死亡率。结果：研究期间纳入尿路感染患者288例，41.7%为男性，中位年龄72岁（IQR 56 ~ 81）。检出最多的病原菌为大肠杆菌（70.5%）；35.9%的病原菌对3GC不敏感。在多变量logistic回归分析中，前三个月住院（OR 3.31, 95% CI 1.41-7.75, p = 0.006）或长期护理机构（OR 4.87, 95% CI 1.16-20.36, p = 0.03）与3GC-R病原体的分离独立相关。关于临床结果，217例完成随访的患者中有22例（10.1%）在30天内死亡。在多变量分析中，7天的临床反应是与30天死亡率相关的唯一变量（OR 0.11, 95% CI 0.04-0.36, p）。结论：在我们的研究中，从社区获得性尿路感染患者的尿液培养中分离出的35.9%的病原体对3GC不敏感。在急诊室，了解当地流行病学和抗微生物药物耐药性的危险因素对于选择正确的经验性治疗和制定当地指南至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.