Microbiology and drug resistance of pathogens in patients hospitalized at the nephrology department in the south of Poland
A retrospective study was conducted among 498 patients with urinary tract infections (UTI) referred to our department from January 2013 to December 2015. This study was performed to evaluate the etiology of UTI and the antibiotic susceptibility profile of Escherichia coli (E.coli) as the main etiological factor in different age groups. Urine samples were examined using standard microbiological methods. Three hundred sixty-three samples (72.9%) were identified as E.coli, of which 29 (8.0%) can produce extended-spectrum β-lactamases (ESBL). E.coli was highly sensitive to imipenem (100.0%), gentamicin (91.0%), nitrofurantoin (89.4%), amikacin (88.2%), piperacillin/tazobactam (87.0%) and cephalosporins (79.7–89.5%). Low sensitivity was found in relation to fluoroquinolones (60.3–70.4%). E.coli was least sensitive to ampicillin (30.2%) and amoxicillin/clavulanic acid (49.9%). We observed a significant fall in susceptibility level to piperacillin/tazobactam (68.4% vs. 88.8%; p=0.017), amikacin (61.1% vs. 90.7%; p=0.001), gentamicin (70.0% vs. 93.2%; p=0.002), cefalexin (41.2% vs. 83.3%; p<0.001), cefotaxime (63.6% vs. 89.4%; p=0.002), ceftazidime (61.9% vs. 85.6%; p=0.008), cefepime (73.7% vs. 91.1%; p=0.025), ciprofloxacin (54.1% vs. 72.2%; p=0.024) and norfloxacin (40.5% vs. 62.5%; p=0.011) among patients with catheter-associated UTI (CAUTI) compared to those with non-CAUTI. A similar susceptibility profile was observed between different age groups. In the longevity, E.coli showed a higher sensitivity to cephalosporins than in the young-old group. E.coli susceptibility to fluoroquinolones was low, which excludes them as a first-line drug in our department. Nitrofurantoin may be used as an alternative drug to carbapenems. Monitoring of susceptibility pattern is of great importance.
- Nephrology and Dialysis Centre, Department of Internal Medicine, Regional St Lukas Hospital, Tarnow, Poland
- Nephrology and Dialysis Centre, Department of Internal Medicine, Regional St Lukas Hospital, Tarnow, Poland
- State Higher Vocational School, Tarnow, Poland
- Chair and Department of Nephrology, Jagiellonian University, Krakow, Poland
- Abejew AA, Denboba AA, Mekonnen AG. 2014. Prevalence and antibiotic resistance pattern of urinary tract bacterial infections in Dessie area, North-East Ethiopia. BMC Res Notes. 7(1):687.
- Abou-Dobara MI, Deyab MA, Elsawy EM, Mohamed HH. 2010. Antibiotic susceptibility and genotype patterns of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from urinary tract infected patients. Pol J Microbiol. 59(3):207–212.
- Albu S, Voidazan S, Bilca D, Badiu M, Truţă A, Ciorea M, Ichim A, Luca D, Moldovan G. 2018. Bacteriuria and asymptomatic infection in chronic patients with indwelling urinary catheter: the incidence of ESBL bacteria. Medicine. 97(33):e11796.
- Alpay Y, Aykın N, Korkmaz P, Güldüren HM, Çevik Çağlan F. 2018. Urinary tract infections in the geriatric patients. Pak J Med Sci. 34(1):67–72.
- Baraboutis IG, Tsagalou EP, Lepinski JL, Papakonstantinou I, Papastamopoulos V, Skoutelis AT, Johnson S. 2010. Primary Staphylococcus aureus urinary tract infection: the role of undetected hematogenous seeding of the urinary tract. Eur J Clin Microbiol Infect Dis. 29(9):1095–1101.
- Bradford PA. 2001. Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 14(4):933–951.
- Daoud Z, Salem Sokhn E, Masri K, Matar GM, Doron S. 2015. Escherichia coli isolated from urinary tract infections of Lebanese patients between 2005 and 2012: epidemiology and profiles of resistance. Front Med (Lausanne). 2:26.
- Esposito S, Emmi V, Mennini FS, Montorsi F, Sganga G, Leone S. 2011. Management and prevention of catheter-associated urinary tract infections: current opinions and clinical practice. (in Italian). Infez Med. 19(2):74–90.
- ECDC. 2015. European surveillance of healthcare-associated infections in intensive care units: HAI-Net ICU protocol, version 1.02 [Internet]. Stockholm (Sweden): European Centre for Disease Prevention and Control; [cited 2018 May 21]. Available from http://ecdc.europa.eu/en/publications/publications/healthcare-associatedinfections-hai-icu-protocol.pdf
- Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A. 2009. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis. 13(2):140–144.
- Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. 2015. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 13(5):269–284.
- Galindo-Méndez M. 2018. Molecular characterization and antimicrobial susceptibility pattern of extended-spectrum β-lactamaseproducing Escherichia coli as cause of community acquired urinary tract infection. (in Spanish). Rev Chilena Infectol. 35(1): 29–35.
- Gardner A, Mitchell B, Beckingham W, Fasugba O. 2014. A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals. BMJ Open. 4(7):e005099.
- Giles M, Watts W, O’Brien A, Berenger S, Paul M, McNeil K, Bantawa K. 2015. Does our bundle stack up! Innovative nurse-led changes for preventing catheter-associated urinary tract infection (CAUTI). Healthc Infect. 20(2):62–71.
- Grabe M, Bishop MC, Bjerklund-Johansen TE. Botto H, Çek M, Lobel B, Naber KG, Palou J, Tenke P, Wagenlehner F. 2009. Guidelines on Urological Infections. Arnhem (The Netherlands): European Association of Urology.
- Guneysel O, Onur O, Erdede M, Denizbasi A. 2009. Trimethoprim/sulfamethoxazole resistance in urinary tract infections. J Emerg Med. 36(4):338–341.
- Holecki M, Duława J, Hryniewicz W, Imiela J, Klinger M, Pawlik K, Wanke-Rytt M. 2015. Recommendations for diagnosis, treatment and prevention of urinary tract infections in adults. Warsaw (Poland): Ministry of Health.
- Hollingsworth JM, Rogers MAM, Krein SL, Hickner A, Kuhn L, Cheng A, Chang R, Saint S. 2013. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med. 159(6):401–410.
- Jacobsen SM, Stickler DJ, Mobley HLT, Shirtliff ME. 2008. Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis. Clin Microbiol Rev. 21(1): 26–59.
- Kalal BS, Nagaraj S. 2016. Urinary tract infections: a retrospective, descriptive study of causative organisms and antimicrobial pattern of samples received for culture, from a tertiary care setting. Germs. 6(4):132–138.
- Kidwai SS, Nageen A, Ghaznavi S, Bashir F, Ara J. 2017. Antibiotic susceptibility in commonly isolated pathogens from urinary tract infection in a cohort of subjects from low socioeconomic strata. Pak J Med Sci. 33(2):254–259.
- Kim B, Pai H, Choi WS, Kim Y, Kweon KT, Kim HA, Ryu SY, Wie S, Kim J. 2017. Current status of indwelling urinary catheter utilization and catheter-associated urinary tract infection throughout hospital wards in Korea: A multicenter prospective observational study. PLoS One. 12(10):e0185369.
- Krygiel R, Stachowiak M, Sylwestrzak I, Grzesiowski P. 2012. Urinary tract infection in patients with urinary catheter during 3 years retrospective study. (in Polish). Zakażenia. 12(1):128–134.
- Li X, Chen Y, Gao W, Ye H, Shen Z, Wen Z, Wei J. 2017. A 6-year study of complicated urinary tract infections in southern China: prevalence, antibiotic resistance, clinical and economic outcomes. Ther Clin Risk Manag. 13:1479–1487.
- Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, Pegues DA, Pettis AM, Saint S, Yokoe DS. 2014. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: update 2014. Infect Control Hosp Epidemiol. 35(05):464–479.
- Michno M, Sydor A, Pelczar A. 2016. Community-acquired urinary tract infections in the internal and nephrology ward: etiology and selected risk factors. (in Polish). Przegl Lek. 73(11):824–829.
- Moryl M, Torzewska A, Jałmuzna P, Rózalski A. 2013. Analysis of Proteus mirabilis distribution in multi-species biofilms on urinary catheters and determination of bacteria resistance to antimicrobial agents. Pol J Microbiol. 62(4):377–384.
- Muder RR, Brennen C, Rihs JD, Wagener MM, Obman A, Obman A, Stout JE, Yu VL. 2006. Isolation of Staphylococcus aureus from the urinary tract: association of isolation with symptomatic urinary tract infection and subsequent staphylococcal bacteremia. Clin Infect Dis. 42(1):46–50.
- Park JJ, Seo YB, Lee J. 2017. Antimicrobial susceptibilities of Enterobacteriaceae in community-acquired urinary tract infections during a 5-year period: a single hospital study in Korea. Infect Chemother. 49(3):184–193.
- Piechota H. 2016. Prevention of catheter-associated urinary tract infections. (in German). Aktuelle Urol. 47(3):220–228.
- Piljic D, PorobicJahic H, Piljic D, Ahmetagic S, Jahic R. 2013. Chateter-associated Urinary Tract Infections in Adults. Mater Sociomed. 25(3):182–186.
- Pobiega M, Wójkowska-Mach J, Chmielarczyk A, Romaniszyn D, Adamski P, Heczko PB, Gryglewska B, Grodzicki T. 2013. Molecular characterization and drug resistance of Escherichia coli strains isolated from long-term care facilities residents with urinary tract infections in Cracow, Poland. Med Sci Monit. 19:317–326.
- Pobiega M, Maciąg J, Chmielarczyk A, Romaniszyn D, Pomorska-Wesołowska M, Ziółkowski G, Heczko PB, Bulanda M, Wójkowska-Mach J. 2015. Molecular characterization of carbapenem-resistant Pseudomonas aeruginosa strains isolated from patients with urinary tract infections in Southern Poland. Diagn Microbiol Infect Dis. 83(3):295–297.
- Reis ACC, Santos SRS, Souza SC, Saldanha MG, Pitanga TN, Oliveira RR. 2016. Ciprofloxacin resistance pattern among bacteria isolated from patients with community-acquired urinary tract infection. Rev Inst Med Trop São Paulo. 58(0):53.
- Sacha P, Jakoniuk P, Wieczorek P, Żórawski M. 2007. Mechanisms of resistance to β-lactam antibiotics in Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Enterobacter cloacae isolates resistant to cefotaxime (in Polish). Nowiny Lekarskie. 76: 14–321.
- Saurel N, Pavese P, Boyer L, Vittoz JP, Decouchon C, Foroni L, Maurin M, François P, Stahl JP. 2006. Adequacy of antibiotic therapy to guidelines for urinary tract infection in hospital (in French). Med Mal Infect. 36(7):369–374.
- Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, Marchese A. 2009. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 34(5): 07–413.
- Stefaniuk E, Suchocka U, Bosacka K, Hryniewicz W. 2016. Etiology and antibiotic susceptibility of bacterial pathogens responsible for community-acquired urinary tract infections in Poland. Eur J Clin Microbiol Infect Dis. 35(8):1363–1369.
- Temiz E, Piskin N, Aydemir H, Oztoprak N, Akduman D, Celebi G, Kokturk F. 2012. Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units. Scand J Infect Dis. 44(5):344–349.
- Thirumala R, Ramaswamy M, Chawla S. 2010. Diagnosis and management of infectious complications in critically ill patients with cancer. Crit Care Clin. 26(1):59–91.
- UN. 2012. Population ageing and development: ten years after Madrid. New York (USA): United Nations; [cited 2018 May 21]. Available from http://www.un.org/esa/population/publications/popfacts/popfacts_2012-4.pdf
- Wang Y, Li H, Chen B. 2016. Pathogen distribution and drug resistance of nephrology patients with urinary tract infections. Saudi Pharm J.24(3):337–340.
- Zalewska-Piatek BM, Wilkanowicz SI, Piatek RJ, Kur JW. 2009. Biofilm formation as a virulence determinant of uropathogenic Escherichia coli Dr+ strains. Pol J Microbiol. 58(3):223–229.
- Zucconi A, Courjon J, Maruéjouls C, Saintpère F, Degand N, Pandiani L, Pradier C, Mondain V. 2018. Managing ESBL-producing Enterobacteriaceae-related urinary tract infection in primary care: a tool kit for general practitioners. Eur J Clin Microbiol Infect Dis. 37(5):983–986.