Revisiting the frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections

• Autor(a) principal: Silva, Andreia Cristina Miguel da
• Data de Publicação: 2021
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10773/30669
• topic: Urinary tract infection; Community adquired infections; Uropathogens; Antimicrobials; Antimicrobial resistance

Urinary tract infections (UTI) are one of the most common infectious diseases at both community and hospital levels. The continue misuse of antimicrobials is leading to an increase in bacterial resistance, which is a worldwide problem. The objective of this work was to study the incidence and pattern of antimicrobial resistance of the main bacteria responsible for urinary tract infections in the community of central and northern Portugal and establish an appropriate empirical treatment. The studied urine samples were collected in Avelab – Laboratório Médico de Análises Clínicas, in outpatients, over a period of 5 years (2015-2019). Of the 106019 samples analysed, 15439 had urinary infection. Urinary infections were more frequent in females (79.6%) than in males (20.4%), and the most affected patients were the elderly (56.9%), being responsible for more than half of the samples with infection. Escherichia coli (70,1%) was the most frequent uropathogen, followed by Klebsiella pneumoniae (8,9%), Proteus mirabilis (5,5%), and Enterococcus faecalis (3,2%). The bacteria responsible for UTI varied according to the patient’s gender, with the greatest differences being observed for E. faecalis and P. aeruginosa, these being more prevalent in men. In general, there was an increase in bacterial resistance as the age of patients increased. Generally, Gram-negative bacteria proved to be more resistant than Gram-positive bacteria. Although E coli was the most responsible uropathogen for UTI, it was among the most susceptible. Comparing our results with results from 10 years ago, there was generally an increase in resistance for some antimicrobials and bacteria. Based on the antibiotics recommended for the treatment of uncomplicated UTIs by the European Association of Urology, first-line antibiotics (nitrofurantoin and fosfomycin) and alternative cephalosporin antibiotics, namely cefotaxime and cefuroxime, can be considered appropriate for the empirical treatment of community-acquired urinary infections in the area studied. Trimethoprim-sulfamethoxazole, amoxicillin-clavulanic acid, and ciprofloxacin should not be prescribed empirically for the region studied.