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Abstract
Background:Urinary Tract Infection (UTI) is a common cause of morbidity and mortality in older adults.Objective:To investigate antimicrobial resistance of uropathogenicEscherichia colifrom elderly patients in a General Hospital, Argentina.Method:During the period July 2011-July 2015, patients over 70 years old with urinary tract infections, without urinary catheters and with no antimicrobial therapy the previous week before sampling, were included. Phenotypic characterization was carried out.In vitroqualitative and quantitative antimicrobial resistances were investigated. Antimicrobials assayed: ampicillin, amoxicillin-clavulanate, cefazolin, cefuroxime, cefoxitin, cefotaxime, ceftazidime, cefepime, imipenem, ertapenem, gentamicin, nalidixic acid, ciprofloxacin, trimethoprim-sulfamethoxazole (TMS) and nitrofurantoin. Patients’ medical records were produced, and risk factors were analyzed by multivariate analysis.Results:768 bacterial isolates were identified asE. coli. Resistances to ampicillin (80.5%), nalidixic acid (61.7%), ciprofloxacin (42.8%), TMS (37.6%), amoxicillin-clavulanate (28.6%), cefazolin (21.6%), cefuroxime (20.7%), gentamicin (13.8%), cefotaxime (9.7%), ceftazidime (9.7%), cefepime (8.4%), cefoxitin (3.1%) and nitrofurantoin (2.3%) were observed. Resistance to carbapenems was not expressed. Production of extended spectrum β-lactamases was detected (7.6%) in community acquired (96%) and healthcare associated (4%) isolates. The independent risk factors for urinary infections produced by multi-resistantE. coliwere: diabetes mellitus, recurrent infections, hospitalization during the last year and exposure to β-lactams in the last 3 months.Conclusion:A high prevalence of resistance to β-lactams and to other antimicrobials was observed. Detection of antimicrobial multi-resistant isolates highlights the need of antimicrobial resistance surveillance in elderly patients with urinary tract infections.
Highlights
Urinary Tract Infections (UTI) can be defined as the existence of pathogen microorganisms in the urinary tract with symptoms
335/768 (43.6%) isolates were multi-resistant to antimicrobials, while 433/768 (56.4%) showed susceptibility or non-multiple resistance
Highest antimicrobial resistance prevalence frequencies were detected for β-lactams, followed by quinolones
Summary
Urinary Tract Infections (UTI) can be defined as the existence of pathogen microorganisms in the urinary tract with symptoms. Amongst UTI, bacterial etiology (80-90%) is the most frequent. Increased incidence of UTI in elderly patients is due to their immune status and the physiological and anatomical changes linked with aging. While urinary sepsis-associated deaths are globally low, in elderly patients with UTIs bacteremia, it can reach prevalence rates around 33% [3]. Escherichia coli is one of the bacterial agents with higher prevalence in community-acquired and health care associated urinary infections in elderly patients, followed by other Enterobacteriaceae such as Klebsiella spp., or Gram positive bacteria [4 - 7]. Urinary Tract Infection (UTI) is a common cause of morbidity and mortality in older adults
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