Antibiotic resistant microorganisms and risk factors in community-acquired urinary tract infections

Objective: In our study, we aimed to determine the microorganisms growing in urine culture of the patients who were followed up in our hospital with the diagnosis of community-acquired urinary tract infection and their resistance profiles, to evaluate the risk factors in patients and to determine the appropriateness rates of our empirical treatments. Materials and Methods: Patients diagnosed with community acquired urinary tract infection (UTI) between February 2019 and February 2020 in Yıldırım Beyazıt University Medical Faculty and Ankara City Hospital Infectious Diseases and Clinical Microbiology Clinics, were included in the study for prospective analysis. Those with a history of hospitalization in the last six months and patients with urinary catheters were excluded. The clinical and demographic characteristics of the patients, microorganisms grown in urine cultures and their antibiotic susceptibility rates were examined. Clinical and demographic characteristics of the patients were compared between extended spectrum beta lactamase (ESBL) + and ESBL - or multi-drug resistance (MDR) + and MDR – groups. Empirical treatments and their success rates were evaluated. For the statistical analysis of the data, "Statistical Package for the Social Sciences (SPSS) Statistics Windows version 20.0" was used, p <0.05 was considered significant. Results: In our study, 68.7% (169/246) of the patients diagnosed with community acquired UTI were female and 31.3% (77/246) were male. 64.2% (158/246) of the patients were diagnosed with complicated UTI, 25.2% (62/246) as uncomplicated pyelonephritis, 10.6% (26/246) of them were diagnosed with cystitis. Escherichia coli 63.8% and Klebsiella spp. 24.4% were the most common microorganisms detected in the urine culture of the patients. The rate of MDR microorganism was 30.9%, while the rate of ESBL + microorganism was 46.6%. Agents with the highest resistance rates were ampicillin 77.2%, cefuroxime 49.6%, ceftriaxone 49%, TMP-SXT 48.9%. Male gender, presence of complicating factor, immunosuppression, history of kidney transplantation and history of antibiotic use were determined as significant risk factors for ESBL + microorganisms. When the risk factors for MDR + agent were evaluated, the history of antibiotic use and staying in the nursing home were found to be statistically significant. As independent risk factors for ESBL + agent; 'Male gender', 'immunosuppression' and 'history of antibiotic use' were detected. Risk factors for ESBL producing agents determined in the literature so far, were compared with ROC (Reciever Operator Characteristics) analysis between the patient groups in which ESBL-producing and non-producing microorganisms were isolated. Male gender, being ≥60 years of age, malignancy, immunosuppression, presence of urinary pathology, staying in nursing home, use of antibiotics and UTI history were included in the analysis as variables, ESBL-producing microorganisms were isolated less in patients with ≤2 variables, while in those with ≥ 3 variables ESBL-producing agents were isolated more. The most preferred agents in empirical treatment were ceftriaxone 41.1% and ertapenem 35.8%. In patients in whom ESBL + agent was isolated, appropriate empirical treatment rate was found to be significantly lower. There was no statistically significant difference in bacteremia rates and duration of treatment between the patient groups in which ESBL-producing and non-producing microorganisms were isolated (p = 0.853, p = 0.126). Conclusion: Resistance rates in our study are quite high compared to recent studies. Male gender, history of antibiotic use, immunosuppression have been identified as the independent risk factors for ESBL + microorganisms. The higher the number of risk factors detected in the patient, the higher the risk. It is the most important point to start the appropriate treatment as soon as possible, is to evaluate the patient's risk factors for resistant microorganism. Key Words: Community acquired, extenden spectrum beta lactamase, urinary tract infections, rısk factors of multidrug resistant microorganisms