Abstract
Background and objectives: Urinary tract infections (UTIs) are the third most common infections in humans, representing a significant factor of morbidity, both among outpatients and inpatients. The pathogenic role of Citrobacter, Enterobacter, and Serratia species (CES bacteria) has been described in UTIs. CES bacteria present a therapeutic challenge due to the various intrinsic and acquired resistance mechanisms they possess. Materials and Methods: The aim of this study was to assess and compare the resistance trends and epidemiology of CES pathogens in UTIs (RECESUTI) in inpatients and outpatients during a 10-year study period. To evaluate the resistance trends of isolated strains, several antibiotics were chosen as indicator drugs based on local utilization data. 578 CES isolates were obtained from inpatients and 554 from outpatients, representing 2.57 ± 0.41% of all positive urine samples for outpatients and 3.02 ± 0.40% for inpatients. E. cloacae was the most prevalent species. Results: The ratio of resistant strains to most of the indicator drugs was higher in the inpatient group and lower in the second half of the study period. ESBL-producing isolates were detected in 0–9.75% from outpatient and 0–29.09% from inpatient samples. Conclusions: Resistance developments of CES bacteria, coupled with their intrinsic non-susceptibility to several antibiotics, severely limits the number of therapeutic alternatives, especially for outpatients.
Highlights
Urinary tract infections (UTIs) are the third most prevalent type of infections in human medicine worldwide, following respiratory and gastrointestinal infections, while in Europe, UTIs are the second most prevalent type of infections in humans [1,2]
UTIs are most commonly caused by members of the Enterobacterales order, several bacteria, which were previously isolated infrequently have emerged as increasingly relevant pathogens in UTIs, both in community and nosocomial settings [1,2,3,4,5,6]
This study presents the epidemiological trends and resistance levels of Citrobacter/Enterobacter/Serratia associated with of urinary tract infections (UTIs) in Hungary over a long surveillance period (10 years), demonstrating the gradient of change in the resistance levels regarding various antibiotics
Summary
Urinary tract infections (UTIs) are the third most prevalent type of infections in human medicine worldwide, following respiratory and gastrointestinal infections, while in Europe, UTIs are the second most prevalent type of infections in humans [1,2]. Hospital acquired UTIs are the most common healthcare associated infections (i.e., nosocomial infections). They account for 25–50% of nosocomial infections overall, representing a serious economic and public health issue for healthcare institutions [1,2,4]. Urinary tract infections (UTIs) are the third most common infections in humans, representing a significant factor of morbidity, both among outpatients and inpatients. The pathogenic role of Citrobacter, Enterobacter, and Serratia species (CES bacteria) has been described in UTIs. CES bacteria present a therapeutic challenge due to the various intrinsic and acquired resistance mechanisms they possess. Results: The ratio of resistant strains to most of the indicator drugs was higher in the inpatient group and lower in the second half of the study period. Conclusions: Resistance developments of CES bacteria, coupled with their intrinsic non-susceptibility to several antibiotics, severely limits the number of therapeutic alternatives, especially for outpatients
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