Community and healthcare-associated UTIs: antimicrobial resistance patterns in a Tunisian emergency-intensive care unit.

IF 1.3 4区医学 Q4 INFECTIOUS DISEASES

Journal of Infection in Developing Countries Pub Date : 2026-07-31 DOI:10.3855/jidc.21837

Manel Ennaceur, Sofien Bouzazi, Sonia Chouaieb

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Abstract

Introduction: Urinary tract infections (UTIs) are a leading cause of antibiotic use globally, with rising antimicrobial resistance (AMR) complicating management-particularly in healthcare settings.

Methodology: This cross-sectional study compared community-acquired (CA-UTI) and healthcare-associated UTIs (HA-UTI) at the Habib Thameur Hospital's emergency-intensive care unit in Tunis during 2022-2023.

Results: Out of a total of 4,474 urine samples, 446 (10%) were culture-positive. The patients were predominantly elderly (73.3% were ≥ 60 years). More females had CA-UTI (M:F = 0.57) than HA-UTI (M:F = 0.78). Escherichia coli was the main pathogen causing both CA-UTI (57.4%) and HA-UTI (44.6%), while Klebsiella pneumoniae was the more common pathogen in HA-UTI (26.1% vs. 23.3%). Gram-negative bacteria accounted for 90.6% of isolates. Among the K. pneumoniae isolates, resistance to imipenem was significantly higher among HA-UTI isolates (29.2% vs. 5.9%; p = 0.02). Among the E. coli isolates, resistance to nitrofurantoin was significantly higher among HA-UTI isolates (3.7% vs. 12.5%; p = 0.01). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were detected in 8.5% of isolates (mostly E. coli and K. pneumoniae), and carbapenem-resistant Enterobacteriaceae (CRE) in 8.7% (predominantly K. pneumoniae in HA-UTI). CRE showed near-complete β-lactam resistance and high non-β-lactam resistance in HA-UTI.

Conclusions: Rising UTI rates and alarming AMR trends, particularly in HA-UTIs, highlight the need for enhanced antibiotic stewardship and tailored empirical therapy. The predominance of multidrug-resistant strains underscores the urgency for infection control measures in Tunisian healthcare settings.

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社区和卫生保健相关的尿路感染：突尼斯紧急重症监护病房的抗微生物药物耐药性模式

导言：尿路感染（uti）是全球抗生素使用的主要原因，抗菌素耐药性（AMR）上升使管理复杂化，特别是在医疗保健机构。方法：这项横断面研究比较了2022-2023年突尼斯Habib Thameur医院急诊重症监护室的社区获得性（CA-UTI）和医疗保健相关的uti （HA-UTI）。结果：4474份尿样中，培养阳性446份（10%）。患者以老年人为主（73.3%≥60岁）。女性CA-UTI发生率（M:F = 0.57）高于HA-UTI （M:F = 0.78）。CA-UTI和HA-UTI的主要病原菌均为大肠杆菌（57.4%）和HA-UTI (44.6%)， HA-UTI的主要病原菌为肺炎克雷伯菌（26.1%比23.3%）。革兰氏阴性菌占90.6%。在肺炎克雷伯菌分离株中，HA-UTI分离株对亚胺培南的耐药性显著高于HA-UTI分离株（29.2% vs. 5.9%, p = 0.02）。大肠杆菌中HA-UTI分离株对呋喃妥因的耐药性显著高于HA-UTI分离株（3.7% vs. 12.5%, p = 0.01）。产广谱β-内酰胺酶（ESBL）的肠杆菌科（以大肠杆菌和肺炎克雷伯菌为主）占8.5%，耐碳青霉烯类肠杆菌科（CRE）占8.7% （HA-UTI中以肺炎克雷伯菌为主）。在HA-UTI中，CRE表现出接近完全的β-内酰胺抗性和高度的非β-内酰胺抗性。结论：尿路感染发生率的上升和令人担忧的抗生素耐药性趋势，特别是在ha -UTI中，突出了加强抗生素管理和量身定制经验治疗的必要性。耐多药菌株的优势突出了突尼斯卫生保健机构采取感染控制措施的紧迫性。

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

Journal of Infection in Developing Countries INFECTIOUS DISEASES-

CiteScore

3.70

自引率

5.30%

发文量

239

审稿时长

4-8 weeks

期刊介绍： The Journal of Infection in Developing Countries (JIDC) is an international journal, intended for the publication of scientific articles from Developing Countries by scientists from Developing Countries. JIDC is an independent, on-line publication with an international editorial board. JIDC is open access with no cost to view or download articles and reasonable cost for publication of research artcles, making JIDC easily availiable to scientists from resource restricted regions.