Abstract
Background and Objective: Urinary tract infections (UTIs) are common in human medicine, affecting large patient populations worldwide. The principal cause of UTIs is uropathogenic Escherichia coli (UPEC) and Klebsiella, both in community and nosocomial settings. The assessment of local data on prevalence and resistance is essential to evaluate trends over time and to reflect on the national situation, compared to international data, using the methods of analytical epidemiology. Materials and Methods: The aim of this study was to assess resistance trends and epidemiology of UTIs caused by E. coli and Klebsiella species in inpatients and outpatients at a tertiary-care hospital in Hungary, using microbiological data. To evaluate resistance trends, several antibiotics were chosen as indicator drugs, based on local utilization data. Results: E. coli was the most prevalent isolate, representing 56.75 ± 4.86% for outpatients and 42.29 ± 2.94% for inpatients. For E. coli, the ratio of resistant strains for several antibiotics was significantly higher in the inpatient group, while in Klebsiella, similar trends were only observed for gentamicin. Extended-spectrum β-lactamase (ESBL)-producing isolates were detected in 4.33–9.15% and 23.22–34.22% from outpatient, 8.85–38.97% and 10.89–36.06% from inpatient samples for E. coli and Klebsiella, respectively. Conclusions: Resistance developments in common UTI pathogens (especially to fosfomycin, sulfamethoxazole-trimethoprim, fluoroquinolones, and 3rd generation cephalosporins), seriously curb therapeutic options, especially in outpatient settings.
Highlights
Urinary tract infections (UTIs) are some of the most common infections in human medicine, affecting a large patient population to various extents, irrespective of age and gender [1,2]
E. coli is described as the etiological agent in 60–90% of urinary tract infections, while Klebsiella species accounts for 3–20% of cases [3,11,12,13,14,15]
This study presents the epidemiological trends and resistance levels of E. coli and Klebsiella species, the main pathogens associated with urinary tract infections (UTIs) in Hungary, over a long surveillance period (10 years), mainly demonstrating an increasing tendency regarding the resistance levels to various antibiotics
Summary
Urinary tract infections (UTIs) are some of the most common infections in human medicine, affecting a large patient population (around 150 million cases/year) to various extents, irrespective of age and gender [1,2]. Both community-acquired (representing 10–30% of infections) and nosocomial. The principal cause of UTIs (>80%) are uropathogenic Escherichia coli (UPEC) and Klebsiella species (K. pneumoniae and K. oxytoca), both in the community and nosocomial settings. E. coli is described as the etiological agent in 60–90% of urinary tract infections, while Klebsiella species accounts for 3–20% of cases [3,11,12,13,14,15]. The assessment of local data on prevalence and resistance is essential to evaluate trends over time and to reflect on the national situation, compared to international data, using the methods of analytical epidemiology
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