Prevalence and outcomes of Urinary tract infections caused by Enterobacterales resistant to third-generation cephalosporins in the Emergency Department: results from UTILY cohort, a prospective multicentre study.

INTRODUCTION

In accordance with the spread of drug-resistant bacteria worldwide, an increase in the prevalence of Antimicrobial Resistance (AMR) among pathogens causing urinary tract infections (UTIs) has been described globally. The aim of this study was to describe the prevalence and outcome of UTIs caused by third-generation cephalosporin-resistant (3GC-R) Enterobacterales in a prospective cohort of patients admitted to Emergency Department (ED).

MATERIALS AND METHODS

We conducted an observational prospective multicentre study, involving 7 healthcare facilities, enrolling all consecutive adult patients admitted to ED with a microbiologically confirmed diagnosis of UTIs caused by Enterobacterales. The primary outcomes were the prevalence of UTIs caused by 3GC-R Enterobacterales, and 30-day mortality.

RESULTS

During the study period, we included 288 patients with urinary tract infection: 41.7% of subjects were males, median age was 72 years (IQR 56-81). The most frequently isolated pathogen was Escherichia coli (70.5%); 35.9% of all pathogens isolated were non-susceptible to 3GC. At multivariate logistic regression analysis, admission to a hospital (OR 3.31, 95% CI 1.41-7.75, p = 0.006) or a long-term care facility (OR 4.87, 95% CI 1.16-20.36, p = 0.03) in the previous three months was independently associated with isolation of a 3GC-R pathogen. Regarding the clinical outcomes, 22 out of 217 (10.1%) patients completing follow-up died at 30 days. At multivariate analysis 7-day clinical response was the only variable associated with 30-day mortality (OR 0.11, 95% CI 0.04-0.36, p < 0.001).

CONCLUSIONS

In our study, 35.9% of pathogens isolated in urine cultures of patients with community-acquired UTIs were non-susceptible to 3GC. In the ED, the knowledge of local epidemiology and of risk factors for antimicrobial resistance is of paramount importance for choosing the right empiric therapy and setting up local guidelines.