Miftode Ionela-Larisa, Pasare Maria-Antoanela, Miftode Radu-Stefan, Nastase Eduard, Plesca Claudia Elena, Lunca Catalina, Miftode Egidia-Gabriela, Timpau Amalia-Stefana, Iancu Luminita Smaranda, Dorneanu Olivia Simona
Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania.
St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.
Antibiotics (Basel). 2022 Apr 20;11(5):548. doi: 10.3390/antibiotics11050548.
(1) Background: The evolution of bacterial resistance to antibiotics is one of the factors that make infectious pathology an extremely dynamic field, also inducing a significant burden on public health systems; therefore, continuous updates on the bacterial resistance to antibiotics and their particular regional patterns is crucial for the adequate approach of various infectious diseases. (2) Methods: We retrospectively analyzed 354 patients with urinary tract infections (UTIs), determined their antibiotic resistance pattern, thus aiming to correlate them with the outcome and other specific markers of poor prognosis. (3) Results: The most frequent causative agent was , representing 64.6% of all UTIs. We identified 154 patients resistant to multiple antibiotic classes, of which 126 were multidrug-resistant (MDR), 17 were extensive drug-resistant (XDR) and 11 were pandrug-resistant (PDR). Moreover, 25 isolates were resistant to carbapenems (CRE), 25 were difficult-to-treat (DTR), and 84 were extended-spectrum cephalosporin-resistant (ESC), with only 95 isolates susceptible to all tested antibiotics. Mortality ranged from 1% for UTIs caused by isolates susceptible to all tested antibiotics, to 24% for the ones caused by DTR or CRE isolates. Other significant risk factors associated with mortality were: prolonged hospital stay ( = 0.0001), Charlson comorbidity index ≥ 3 ( = 0.02), urinary catheterization ( = 0.001), associated respiratory pathologies ( = 0.004), obesity ( = 0.047), a history of previous hospitalizations ( = 0.007), inappropriate empiric antibiotic regimen ( = 0.001), or hyper inflammatory status ( = 0.006). Basically, we observed that a multiple regression model comprising urinary catheterization, inappropriate empiric anti-biotherapy, obesity, and respiratory comorbidities exhibits the best correlation with mortality rate in patients with UTI (R = 0.347, R = 0.12). (4) Conclusions: By focusing on the novel resistance patterns, our study provides complementary evidence concerning the resistance profiles found in an Eastern European region, as well as their prognostic implications in patients with UTI.
（1）背景：细菌对抗生素的耐药性演变是使感染性病理学成为一个极具动态性领域的因素之一，也给公共卫生系统带来了巨大负担；因此，持续更新细菌对抗生素的耐药性及其特定的区域模式对于妥善应对各种传染病至关重要。（2）方法：我们回顾性分析了354例尿路感染（UTI）患者，确定了他们的抗生素耐药模式，旨在将其与预后及其他不良预后的特定标志物相关联。（3）结果：最常见的病原体是 ，占所有UTI的64.6%。我们确定了154例对多种抗生素类别耐药的患者，其中126例为多重耐药（MDR），17例为广泛耐药（XDR），11例为全耐药（PDR）。此外，25株分离菌对碳青霉烯类耐药（CRE），25株为难治性（DTR），84株对超广谱头孢菌素耐药（ESC），只有95株分离菌对所有测试抗生素敏感。死亡率从对所有测试抗生素敏感的分离菌引起的UTI的1%，到DTR或CRE分离菌引起的UTI的24%不等。与死亡率相关的其他显著风险因素包括：住院时间延长（P = 0.0001）、查尔森合并症指数≥3（P = 0.02）、导尿（P = 0.001）、相关呼吸道疾病（P = 0.004）、肥胖（P = 0.047）、既往住院史（P = 0.007）、经验性抗生素治疗方案不当（P = 0.001）或高炎症状态（P = 0.006）。基本上，我们观察到一个包含导尿、经验性抗微生物治疗不当、肥胖和呼吸道合并症的多元回归模型与UTI患者的死亡率具有最佳相关性（R = 0.347，R² = 0.12）。（4）结论：通过关注新的耐药模式，我们的研究提供了有关东欧地区发现的耐药谱及其对UTI患者预后影响的补充证据。
