Emerging patterns of resistance in a cohort of Greek patients with recurrent UTIs: a pilot study

Abstract

Bacterial urogenital infections caused by multi-drug resistant organisms (MDROs), are increasingly becoming a severe public health issue. The purpose of the present study was to examine the epidemiology of recurrent UTIs along with antimicrobial resistance patterns in a cohort of patients followed as outpatients at an Infectious Disease clinic of a tertiary care center in Greece. One hundred, sequential patients suffering from recurrent UTIs and coming for clinical evaluation, follow-up and treatment were examined; microbiological urine culture results were analyzed. Patients were separated into Group A: patients with ≥3 urogenital infections during the last study year, and Group B: patients with ≤2 urogenital infections. Furthermore, antimicrobial resistance patterns and presence of MDROs in relation to the number of urogenital infections during a three years period was evaluated. Group A had a mean of 4.3 ± 1.7 urogenital infections during the last year of the study, while patients in Group B 1.9 ± 0.3 infections over a three years period. An age cut-off of 30 years was critical for higher UTI rates. Escherichia Coli was the predominant isolated pathogen in 96.2% of the patients. Patients with diabetes mellitus had a 3 fold-higher risk for ≥3 UTIs. Resistance to colistin and imipenem was associated with a history of more than 2 episodes of UTIs but observed in a small number of patients with comorbidities. In this pilot study MDRO detection in patients suffering from recurrent UTIs emphasizes the need for continuous epidemiological surveillance in order to improve our understanding of the evolution of resistance in a common community infection as well as to implement successful prevention strategies.

Keywords:

• Urothelial infections
• Recurrent UTIs
• Drug resistance
• Levofloxacin
• MDR
• Risk factors

Acknowledgements

The authors would like to thank all study participants. The authors would also like to thank ATTIKON Hospital, from the National and Kapodistrian University of Athens for providing use of their laboratory facilities.

Disclosure statement

All authors report no conflict of interest.

Notes on contributors

Ioannis Moustakas, Medical Doctor, Department of Microbiology, “Aretaieion” General Hospital, National and Kapodistrian University of Athens, Athens; Greece, 11528- Clinical Microbiologist.

Georgios Dryllis, Medical Doctor/MSc/PhD, Department of First Internal Medicine Clinic, “Laikon” General Hospital, National and Kapodistrian University of Athens, Athens 11527- Hematologist.

Avraham Pouliakis, Statistical analyst/PhD, Second Department of Pathology, University General Hospital “ATTIKON”, School of Medicine, National and Kapodistrian University of Athens, Athens 12462-Statistical analyst.

Georgios Petrikos, Professor, School of Medicine, European University of Cyprus 22006-Professor of Internal Medicine and Infections.

Georgios Daikos, Professor, Department of First Internal Medicine Clinic, “Laikon” General Hospital, National and Kapodistrian University of Athens, Athens 11527-Professor of Internal Medicine and Infections.

Theodoros Pittaras, Assistant Professor, Department of Microbiology, “Aretaieion” General Hospital, National and Kapodistrian University of Athens, Athens; Greece, 11528- Clinical Microbiologist.

Panagiota Karasante, Medical Doctor, Panagia Grigorousa’, Neurology and Psychiatry Clinic 14122-Neurologist.

Konstantinos Karampotsis, Medical Doctor, King’s College Hospital of London, Pregenetic Counseling SE5 9RS-Gynaecologist.

Sotirios Tsiodras, Assistant Professor, Fourth Department of Internal Medicine, Division of Hematology, “ATTIKO” University Hospital, National and Kapodistrian University of Athens, Athens 12462- Assistant Professor of Internal Medicine and Infections.