Microbiology and Drug Resistance of Pathogens in Patients Hospitalized at the Nephrology Department in the South of Poland.

A retrospective study was conducted among 498 patients with urinary tract infections (UTI) referred to our department from January 2013 to December 2015. This study was performed to evaluate the etiology of UTI and the antibiotic susceptibility profile of Escherichia coli ( E. coli ) as the main etiological factor in different age groups. Urine samples were examined using standard microbiological methods. Three hundred sixty-three samples (72.9%) were identified as E. coli , of which 29 (8.0%) can produce extended-spectrum ß-lactamases (ESBL). E. coli was highly sensitive to imipenem (100.0%), gentamicin (91.0%), nitrofurantoin (89.4%), amikacin (88.2%), piperacillin/ tazobactam (87.0%) and cephalosporins (79.7-89.5%). Low sensitivity was found in relation to fluoroquinolones (60.3-70.4%). E. coli was least sensitive to ampicillin (30.2%) and amoxicillin/clavulanic acid (49.9%). We observed a significant fall in susceptibility level to piperacillin/tazobactam (68.4% vs. 88.8%; p = 0.017), amikacin (61.1% vs. 90.7%; p = 0.001), gentamicin (70.0% vs. 93.2%; p = 0.002), cefalexin (41.2% vs. 83.3%; p < 0.001), cefotaxime (63.6% vs. 89.4%; p = 0.002), ceftazidime (61.9% vs. 85.6%; p = 0.008), cefepime (73.7% vs. 91.1%; p = 0.025), ciprofloxacin (54.1% vs. 72.2%; p = 0.024) and norfloxacin (40.5% vs. 62.5%; p = 0.011) among patients with catheter-associated UTI (CAUTI) compared to those with non-CAUTI. A similar susceptibility profile was observed between different age groups. In the longevity, E. coli showed a higher sensitivity to cephalosporins than in the young-old group. E. coli susceptibility to fluoroquinolones was low, which excludes them as a first-line drug in our department. Nitrofurantoin may be used as an alternative drug to carbapenems. Monitoring of susceptibility pattern is of great importance.A retrospective study was conducted among 498 patients with urinary tract infections (UTI) referred to our department from January 2013 to December 2015. This study was performed to evaluate the etiology of UTI and the antibiotic susceptibility profile of Escherichia coli (E. coli) as the main etiological factor in different age groups. Urine samples were examined using standard microbiological methods. Three hundred sixty-three samples (72.9%) were identified as E. coli, of which 29 (8.0%) can produce extended-spectrum ß-lactamases (ESBL). E. coli was highly sensitive to imipenem (100.0%), gentamicin (91.0%), nitrofurantoin (89.4%), amikacin (88.2%), piperacillin/ tazobactam (87.0%) and cephalosporins (79.7­89.5%). Low sensitivity was found in relation to fluoroquinolones (60.3­70.4%). E. coli was least sensitive to ampicillin (30.2%) and amoxicillin/clavulanic acid (49.9%). We observed a significant fall in susceptibility level to piperacillin/tazobactam (68.4% vs. 88.8%; p = 0.017), amikacin (61.1% vs. 90.7%; p = 0.001), gentamicin (70.0% vs. 93.2%; p = 0.002), cefalexin (41.2% vs. 83.3%; p < 0.001), cefotaxime (63.6% vs. 89.4%; p = 0.002), ceftazidime (61.9% vs. 85.6%; p = 0.008), cefepime (73.7% vs. 91.1%; p = 0.025), ciprofloxacin (54.1% vs. 72.2%; p = 0.024) and norfloxacin (40.5% vs. 62.5%; p = 0.011) among patients with catheter-associated UTI (CAUTI) compared to those with non-CAUTI. A similar susceptibility profile was observed between different age groups. In the longevity, E. coli showed a higher sensitivity to cephalosporins than in the young-old group. E. coli susceptibility to fluoroquinolones was low, which excludes them as a first-line drug in our department. Nitrofurantoin may be used as an alternative drug to carbapenems. Monitoring of susceptibility pattern is of great importance.

[Urinary tract infections in adults].

Review of urinary tract infections in adults including etiology, pathogenesis, classification and the most important therapeutic recommendations. Urinary tract infections are still a common clinical problem occurring more often in sexually active women, pregnancy, elderly , after catherization of a urinary bladder and urological surgery as well as in the co-existence of diabetes or nephrolithiasis. Due to the anatomical differences, women suffer more often than men. The main etiological factor is Escherichia coli, even though it plays a lesser role in the complicated infections, than in non-complicated ones. Apart from that, the infections may also be caused by atypical microbes, viruses and fungi. Relapses as well as reinfections are typical features of urinary tract infections and in some cases prolonged infections can spread from lower to upper urinary tract contributing to pyelonephritis, urosepsis or even death. These long-term infections can progress in a hidden, insidious, oligosymptomatic or asymptomatic manner leading to irreversible, progressive deterioration of renal function. They can also mask other diseases such as tuberculosis or neoplasms of the urinary tract, which leads to the delayed diagnosis and treatment. Diagnosis and treatment of urinary tract infections is a complex problem, often requiring specialized procedures as well as hospitalization. The choice of a therapy is determined by the type of infection, general condition, age and coexisting diseases. Rapid diagnosis and implementation of proper pharmacotherapy may shorten the time of treatment and hospitalization, preventing serious complications and reinfections.

[Community-acquired urinary tract infections in the internal and nephrology ward: etiology and selected risk factors].

Background: Community-acquired urinary tract infections (UTI) are one of the most common types of infections. In some cases they become a cause of hospitalization and various, sometimes serious complications. Objectives: The aim of this study was to analyze community-acquired UTI in patients hospitalized in the internal nephrology ward, taking into account causative pathogens, gender, age as well as selected risk factors. Material and methods: The retrospective study analyzed patients hospitalized in the ward from 1 January 2013 till 31 December 2015 (4512 people, 2452 women and 2060 men). During this period 425 patients aged 18 to 101 years (the average age 74.5) were diagnosed with community-acquired UTI. Population was divided into four age groups (I: 18-45, II: 46-65, III: 66-80, IV ≥81). The independence test χ2 with odds ratio (OR) and 95% confidence intervals (CI) were used to analyze statistically possible relationships between pathogens, age groups, gender and selected risk factors. Results: 425 cases of community- -acquired UTI were diagnosed that accounted for 9,4% of all hospitalized patients. An increased number of diagnosed infections occurred in the subsequent age groups (I-24, II-56, III-161, IV-184). Infections were more frequent in women (63.8%) than men (36.2%). E. coli was the main etiological factor ­ 74.8% (84.1% in women and 58,4% in men). The contribution of other pathogens was significantly smaller: K. pneumoniae-6.6%, P. mirabilis-5.6%, E. cloacae-3.5%, E. faecalis-1.9%, St. aureus-1.6% and others-3.5%. There was no statistically significant relationship between age groups and the type of bacteria (p>0.05). It was shown that E. coli was a more common causative agent in women (p=0.0001) than in men while P. mirabilis and E. cloacae were more common in men (p=0.0084 and p=0.002 respectively). The most common risk factor in both genders was diabetes mellitus (39.3%). Additionally the presence of catheter in the bladder (p<0.0001), stasis/hydronephrosis (p=0.0067) and cancers of the genitourinary tract (p<0.0001) were significantly more common in men. Conclusions: E. coli was the most common etiologic agent of community-acquired UTI. Its contribution was significantly smaller in males than in females. The incidence of UTI was the highest in young women and elderly people. Diabetes mellitus was the most common, underlying risk factor of infections. The presence of catheter in the bladder, stasis/hydronephrosis and cancers of the genitourinary tract were significantly more frequent in men with community- acquired UTI.