Management of complicated urinary tract infections in a referral center in Mexico

Area of Science:

• Infectious Diseases
• Urology
• Microbiology

Background:

• Urinary tract infections (UTIs) are common, with complicated UTIs (CUTIs) showing poorer treatment response.
• Escherichia coli (E. coli) is the predominant pathogen in CUTIs.
• Mexico faces significant antibiotic resistance, including high rates for ciprofloxacin, trimethoprim/sulfamethoxazole, and cephalosporins, alongside a notable prevalence of ESBL E. coli.

Purpose of the Study:

• To characterize the clinical management of patients diagnosed with CUTIs.
• To document the clinical progression and microbiological findings, identifying common pathogens and their resistance patterns.
• To analyze factors associated with CUTI development and treatment outcomes.

Main Methods:

• Retrospective review of clinical records for patients hospitalized with CUTIs between January 2012 and July 2013.
• Analysis of demographic data, clinical presentations, causative microorganisms, antibiotic susceptibility, treatment modalities, and mortality rates.

Main Results:

• E. coli was the most frequent pathogen (83%), with a high prevalence of ESBL-producing strains (71.4%).
• Antibiotic resistance was substantial: 89.7% for quinolones, 64.7% for cephalosporins, and 60.3% for trimethoprim.
• Recent antibiotic use (95.3%) and obstructive uropathy (73.4%) were key associated factors. Minimally invasive treatments were used in 40.5% of cases.

Conclusions:

• High prevalence of ESBL-producing pathogens and over 50% resistance to first-line antibiotics necessitate a reevaluation of antibiotic strategies in Mexico.
• Minimally invasive treatments are fundamental for managing complicated infections, though nephrectomy retains a role in specific cases.
• Wide-spectrum antimicrobial therapy and minimally invasive approaches are standard for CUTIs, highlighting the need for updated antibiotic stewardship.