Summary
This study looked at the relationship between pathogen
spectrum and resistance and severity of urosepsis, and
whether these rates could be used as a representative of
urosepsis. The current study recruited patients from the 70
countries that are members of the Global Prevalence of
Infection in Urology (GPIU) who were admitted to urology
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Article of the Month
Antimicrobial resistance in urosepsis:
outcomes from the multinational,
multicenter global prevalence of
infections in urology (GPIU) study
2003-2013
EDITORIAL NOTES
Antibiotic Resistance of Healthcare-Acquired Urinary Tract
Infections Does Not Predict Resistance Rates of Urosepsis
Pathogens
By: Drs. Yasser A. Noureldin and Sero Andonian
wards.. The GPIU includes centres from Europe, Asia, Africa,
and South America. From 2003 to 2013, during November of
each year, each centre was assigned a single day to perform
urine and blood cultures with sensitivity testing for all
admitted patients to detect pathogens and their antimicrobial
resistance profiles. Bacterial resistance was checked for 10
antibiotics and 8 antibiotic combinations that are frequently
used in urology.
A total of 27,542 individuals were identified. Of those
included, 311 (76%) were from Europe, 66 (16.1%) were from
Asia, 21 (5.1%) were from Africa, and 10 (2.4%) were from the
United States. A total of 1,606 (5.8%) patients were
microbiologically diagnosed with healthcare-associated
urinary tract infections (HAUTIs), of whom 408 (25.4%) were
diagnosed with urosepsis. Simple sepsis was diagnosed in
77% of patients, and severe sepsis/septic shock was
diagnosed in 23% of patients. Urosepsis represented 1.5% of
the whole study population. Patients diagnosed with urosepsis
had a mean age of 63 ± 17 years, with a female to male ratio
of 3:7 and Charlson Comorbidity Index score of 2.48 ± 2.61.
Prior to the episode of urosepsis, a urinary catheter was
present in 287 (70%) cases at the time of diagnosis, urinary
tract obstruction was found in 234 (57%) cases, and
urolithiasis was found in 76 (20%) cases. Furthermore, an
intervention was reported in 324 (79%) cases.
Escherichia coli was the most frequent microbiologically
proven pathogen (43% of cases), followed by Enterococcus
species (11%), Pseudomonas aeruginosa (10%), and Klebsiella
species (10%). Furthermore, a high index of resistance to
commonly prescribed antibiotics was encountered, ranging
from 8% for imipenem to 62% for aminopenicillin/β-lactamase
inhibitors (BLIs). Multidrug resistance was identified in 45% of
Enterobacteriaceae and 21% of P. aeruginosa. Moreover, there
were significant geographical variations between Europe,Asia, Africa, and the Americas in terms of microbiological
resistance to ampicillin/BLIs (p=0.05), gentamicin (p=0.01),
and piperacillin/tazobactam plus gentamicin (p=0.03).
Furthermore, bacterial antimicrobial resistance rates were
significantly higher for urosepsis than other HAUTIs for
ampicillin/BLIs, levofloxacin, cefuroxime, cefotaxime,
ceftazidime plus gentamicin, ceftazidime plus ciprofloxacin,
and piperacillin/tazobactam plus ciprofloxacin (p |
