Bacterial species and antimicrobial resistance differ between catheter and non-catheter-associated urinary tract infections: Data from a national surveillance network

by Selleckchem | Apr 19 2023

Objective: To investigate clinically relevant microbiological characteristics of uropathogens and to compare patients with catheter-associated urinary tract infections (CAUTIs) to those with non-CAUTIs.

Methods: All urine cultures from the calendar year 2019 of the Swiss Centre for Antibiotic Resistance database were analyzed. Group differences in the proportions of bacterial species and antibiotic-resistant isolates from CAUTI and non-CAUTI samples were investigated.

Results: Data from 27,158 urine cultures met the inclusion criteria. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis together represented 70% and 85% of pathogens identified in CAUTI and non-CAUTI samples, respectively. Pseudomonas aeruginosa was significantly more often detected in CAUTI samples. The overall resistance rate for the empirically often-prescribed antibiotics ciprofloxacin (CIP), norfloxacin (NOR), and trimethoprim-sulfamethoxazole (TMP-SMX) was between 13% and 31%. Except for nitrofurantoin, E. coli from CAUTI samples were more often resistant (P ≤ .048) to all classes of antibiotics analyzed, including third-generation cephalosporines used as surrogate for extended-spectrum β-lactamase (ESBL). Significanty higher resistance proportions in CAUTI samples versus non-CAUTI samples were observed for CIP (P = .001) and NOR (P = .033) in K. pneumoniae, for NOR (P = .011) in P. mirabilis, and for cefepime (P = .015), and piperacillin-tazobactam (P = .043) in P. aeruginosa.

Conclusion: CAUTI pathogens were more often resistant to recommended empirical antibiotics than non-CAUTI pathogens. This finding emphasizes the need for urine sampling for culturing before initiating therapy for CAUTI and the importance of considering therapeutic alternatives.

Comments：

In this study, the authors analyzed urine cultures from the Swiss Centre for Antibiotic Resistance database to investigate the microbiological characteristics of uropathogens in patients with catheter-associated urinary tract infections (CAUTIs) compared to those with non-CAUTIs. They found that Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis were the most commonly identified pathogens in both CAUTI and non-CAUTI samples. However, Pseudomonas aeruginosa was significantly more often detected in CAUTI samples.

The study also found that CAUTI pathogens were more often resistant to recommended empirical antibiotics, including ciprofloxacin, norfloxacin, and trimethoprim-sulfamethoxazole, than non-CAUTI pathogens. For example, E. coli from CAUTI samples were more often resistant to all classes of antibiotics analyzed, including extended-spectrum β-lactamase (ESBL) antibiotics, except for nitrofurantoin. The authors also observed significantly higher resistance proportions in CAUTI samples compared to non-CAUTI samples for certain antibiotics in K. pneumoniae, P. mirabilis, and P. aeruginosa.

Based on these findings, the authors emphasize the need for urine sampling for culturing before initiating therapy for CAUTI and the importance of considering therapeutic alternatives. Clinicians should be aware of the differences in microbiological characteristics between CAUTI and non-CAUTI pathogens and choose appropriate antibiotics based on the results of urine culture and sensitivity testing. This can help to prevent the spread of antibiotic-resistant infections and improve patient outcomes.