Rodrigues Francisco José Barbas, Coelho Patrícia, Mateus Sónia, Castelo-Branco Miguel
Sport Physical Activity and Health Research & Innovation Center (Sprint), Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal.
Faculty of Health Sciences, The University of Beira Interior, 6201-001 Covilha, Portugal.
Clin Pract. 2025 May 26;15(6):100. doi: 10.3390/clinpract15060100.
Urinary tract infections (UTIs) are a significant public health concern worldwide, yet longitudinal data from Portuguese hospital settings remain limited. This study aimed to characterize epidemiological trends, microbial etiology, antimicrobial resistance patterns, and associated risk factors of UTIs over a five-year period (2018-2022) in a central Portuguese hospital. In this retrospective observational study, 23,682 positive urine cultures were analyzed from specimens collected between January 2018 and December 2022. Data were extracted from the laboratory information system and included patient demographics, clinical service of origin, isolated microorganisms, resistance profiles, and annual antibiotic consumption (Defined Daily Dose (DDD) per 1000 patient-days). UTI prevalence was calculated as the proportion of positive cultures among all urine samples processed annually. The positivity rate increased from 18.7% in 2018 to 22.7% in 2022, with a peak in 2019. Women represented around 70% of cases throughout the study period. Most infections originated from inpatient wards, followed by emergency services. remained the leading pathogen (≈62%), followed by (≈14%) and (≈8%). Risk factors included catheterization (37.2%), prior UTI history (22.1%), and diabetes mellitus (18.5%). Longer hospital stays (>7 days) were associated with increased positivity. For , resistance ranged from 2% (amikacin) to 41% (ampicillin), with increasing resistance to ertapenem and fosfomycin and decreasing resistance to several key antibiotics. showed 4-36% resistance across antimicrobials, with notable increases for fosfomycin, meropenem, and cefuroxime axetil. Antibiotic usage trends reflected these patterns, with declining use of amikacin and rising use of cefuroxime axetil and meropenem. Over the five-year period, both UTI prevalence and resistance to critical antimicrobials increased, reinforcing the need to update empirical treatment guidelines. Identified risk factors may inform targeted prevention strategies. Ongoing surveillance and antimicrobial stewardship are crucial to mitigate the rising burden of UTIs and resistance.
尿路感染（UTIs）是全球重大的公共卫生问题，但葡萄牙医院环境下的纵向数据仍然有限。本研究旨在描述葡萄牙中部一家医院五年期间（2018 - 2022年）尿路感染的流行病学趋势、微生物病因、抗菌药物耐药模式及相关危险因素。在这项回顾性观察研究中，对2018年1月至2022年12月期间收集的标本中23682份阳性尿培养进行了分析。数据从实验室信息系统中提取，包括患者人口统计学信息、来源临床科室、分离出的微生物、耐药谱以及年度抗生素消耗量（每1000患者日的限定日剂量（DDD））。UTI患病率按每年处理的所有尿样中阳性培养的比例计算。阳性率从2018年的18.7%上升至2022年的22.7%，2019年达到峰值。在整个研究期间，女性约占病例的70%。大多数感染源自住院病房，其次是急诊服务。 仍然是主要病原体（约62%），其次是 （约14%）和 （约8%）。危险因素包括导尿（37.2%）、既往UTI病史（22.1%）和糖尿病（18.5%）。住院时间较长（>7天）与阳性率增加相关。对于 ，耐药率从2%（阿米卡星）到41%（氨苄西林）不等，对厄他培南和磷霉素的耐药性增加，对几种关键抗生素的耐药性降低。 显示对抗菌药物的耐药率为4 - 36%，磷霉素、美罗培南和头孢呋辛酯的耐药率显著增加。抗生素使用趋势反映了这些模式，阿米卡星的使用减少，头孢呋辛酯和美罗培南的使用增加。在五年期间，UTI患病率和对关键抗菌药物的耐药性均增加，这进一步表明需要更新经验性治疗指南。确定的危险因素可为针对性预防策略提供依据。持续监测和抗菌药物管理对于减轻UTI和耐药性不断上升的负担至关重要。
