Abstract
Urinary tract infections (UTIs) are the third most common types of infection in human medicine worldwide. There is increasing appreciation for the pathogenic role of Gram-positive cocci (GPC) in UTIs, as they have a plethora of virulence factors, maintaining their pathogenicity and high affinity for the epithelial cells of the urinary tract. The study was carried out using microbiological data collected corresponding to the period between 2008 and 2017. Antimicrobial susceptibility testing was performed using the disk diffusion method and E-tests. The age range of patients affected from the outpatient and inpatient groups differed significantly (43 [range 0.7–99] vs. 68 [range 0.4–99] years; p = 0.008). 3962 GPCs were obtained from inpatient and 4358 from outpatient samples, corresponding to 20.5 ± 2.8% (range 17.5–26.8%) and 20.6 ± 2.6% (range 17.8–26.0%) of all positive urine samples (p > 0.05); in both groups, Enterococcus spp. were the most prevalent (outpatients: 79.6%; inpatients: 88.5%). High-level aminoglycoside resistance in enterococci was noted in 31.0–46.6% of cases. A pronounced increase in the number of MRSA was seen in the second half of the study period (0.6–1.9% vs. 9.8–11.6%; p = 0.038). The ratio of VRE isolates was 0.16%, no VISA/VRSA isolates were detected.
Highlights
Urinary tract infections (UTIs) are the third most common types of infection in human medicine worldwide
The most common pathogens in UTIs are the members of the Enterobacterales order (Gram-negative bacteria found in the gut, namely Escherichia coli, Klebsiella spp., pathogens of the CES group [Citrobacter-Enterobacter-Serratia], members of the Proteae tribe [Proteus-Providencia-Morganella]), other causative agents include Gram-positive cocci (Enterococcus spp., Streptococcus spp., Staphylococcus saprophyticus and S. aureus), non-fermenting Gram-negative bacteria (Pseudomonas spp. and Acinetobacter spp.), atypical microorganisms (Mycoplasma, Ureaplasma species) and yeasts (Candida spp.)[1,2,3,4,8,9,10,11]
The resulting selection pressure will fuel the “antibiotic resistance spiral”, i.e., the more pronounced use of last-resort antibiotics against drug resistant pathogens, which unavoidably leads to the emergence of resistant strains against the last resort agents[31,32,33]
Summary
Urinary tract infections (UTIs) are the third most common types of infection in human medicine worldwide. Urinary tract infections (UTIs; ranging from uncomplicated cystitis to severe pyelonephritis and nephrolithiasis) are the third most common types of infection in human medicine worldwide (after respiratory tract infections and infections of the alimentary tract), and the second most commonly occurring infections in developed countries, with 100–180 million cases/year[1,2,3] These infections affect outpatients and hospitalized patients to a significant extent (accounting for 25–50% of hospital-acquired infections overall), representing an important factor of morbidity, especially due to their recurring nature[1,4]. The aim of this study was to evaluate the resistance trends and epidemiology of Gram-positive cocci in the UTIs of inpatients and outpatients at the Albert Szent-Györgyi Clinical Center (Szeged, Hungary) retrospectively, during a 10-year study period
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