Background. Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The objective of our study was to describe antimicrobial patterns of resistance and identify risk factors associated with MDR uropathogens. Methods. We conducted a cross-sectional study in 296 patients with community-acquired UTI who underwent clinical and microbiologic analysis, and clinical associations to MDR uropathogens were investigated. Findings. Microbiological analysis included E. coli (55%), ESBL-E. coli (26%), Enterococcus (6%), Klebsiella (5%), and others (8%). Higher frequencies of MDR bacteria were found among ESBL-E. coli, with resistance to ampicillin (100%), ceftriaxone (96%), gentamicin (57%), ciprofloxacin (89%), and TMP/SMX (53%). However, they were sensitive to fosfomycin (6.6%), nitrofurantoin (1.3%), and carbapenems (0%). Fosfomycin MIC90 for ESBL-E. coli was 5.78 μg/mL. The only clinical variable with significant association to ESBL producers was the presence of comorbidities: hypertension and type 2 diabetes mellitus with an OR (95%CI) of and , respectively. Conclusions. In the majority of cases, resistance rates to commonly prescribed antimicrobials in UTIs were high, except for fosfomycin, nitrofurantoin, and carbapenems. To provide appropriate treatment, both the identification of risk factors and the uropathogen would be important. An active surveillance in UTIs in the community is required since the proportion of ESBL producers is increasing.

中文翻译：

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社区获得性尿路感染中高抗菌素耐药性的临床意义。

背景。尿路感染 (UTI) 每年在全世界影响多达 1.5 亿人，主要由大肠杆菌（大肠杆菌）和克雷伯氏菌引起。耐多药 (MDR) 细菌的出现和传播正在增加，是对人类健康的最大威胁之一。我们研究的目的是描述耐药性的抗菌模式并确定与 MDR 尿路病原体相关的风险因素。方法。我们对 296 名社区获得性 UTI 患者进行了一项横断面研究，这些患者接受了临床和微生物学分析，并调查了与 MDR 尿路病原体的临床关联。调查结果。包括微生物分析大肠杆菌(55%)、ESBL-大肠杆菌(26%)、肠球菌(6%)、克雷伯氏菌(5%) 和其他 (8%)。在 ESBL-大肠杆菌中发现 MDR 细菌的频率较高，对氨苄青霉素 (100%)、头孢曲松 (96%)、庆大霉素 (57%)、环丙沙星 (89%) 和 TMP/SMX (53%) 耐药。然而，它们对磷霉素（6.6%）、呋喃妥因（1.3%）和碳青霉烯类（0%）敏感。ESBL-大肠杆菌的磷霉素 MIC90 为5.78  μ g/mL。与 ESBL 生产者显着相关的唯一临床变量是合并症：高血压和 2 型糖尿病的 OR (95%CI)和，分别。结论。在大多数情况下，除了磷霉素、呋喃妥因和碳青霉烯类药物外，尿路感染中对常用抗菌药物的耐药率很高。为了提供适当的治疗，危险因素和尿路病原体的识别都很重要。由于 ESBL 生产者的比例正在增加，因此需要对社区 UTI 进行积极监测。