Multidrug resistance and mortality in patients with hospitalacquired urinary tract infections in Islamic Republic of Iran.

Abstract

Background: Hospital-acquired urinary tract infections are a frequent complication in intensive care units. They are increasingly being associated with multidrug-resistance, especially in low-resource settings.

Aim: To assess the uropathogenic and antimicrobial resistance patterns and identify patient-related factors associated with multidrug resistance and mortality among patients with hospital-acquired urinary tract infections in Tehran, Islamic Republic of Iran.

Methods: We analysed secondary data on all patients aged ≥ 18 years who had hospital-acquired urinary tract infections and were admitted to intensive care units of 45 public and private hospitals in Tehran, Islamic Republic of Iran, between 2022 and 2024. We examined the associations between the demographic and clinical variables using prevalence ratios and the outcomes of interest using relative risks. P ≤ 0.05 was considered statistically significant.

Results: Of the 2467 patients, 60% were catheterised. A bacterial pathogen was isolated from 77% and Candida spp. from 23%. The most common pathogens were Escherichia coli (26%), Klebsiella spp. (22%) and Candida spp. (23%). Seventy-two percent of 1590 patients assessed exhibited multidrug resistance. Males, catheterised patients and patients with extended catheter use (> 8 days) had higher prevalence of multidrug resistance. Overall mortality rate was 42% and mortality was highest among patients with prolonged catheter use (57%), those admitted in public hospitals (51%) and those infected with Candida spp (60%).

Conclusion: The alarmingly high prevalence of multidrug resistance and high mortality rate among patients with hospital-acquired urinary tract infections indicate the need to enhance infection prevention and control practices in Iranian hospitals, and to significantly improve antibiotic susceptibility testing and antimicrobial resistance surveillance.