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[Antimicrobial resistance of uropathogens in patients with acute obstructive pyelonephritis]
Yu L Naboka1,2, I A Gudima1,2, E V Mitusova1,2
1RostSMU of Minzdrav of Russia, Rostov on Don, Russia.
Insights
Acute obstructive pyelonephritis requires targeted antibiotic therapy. Carbapenems like ertapenem or meropenem are recommended initial treatments, while fluoroquinolones may be ineffective.
Area of Science:
- Urology
- Infectious Diseases
- Microbiology
Background:
- Acute pyelonephritis is a severe urinary tract infection with a high relapse rate.
- Standard antibiotic therapy may not prevent chronic progression.
- Understanding uropathogen antibiotic sensitivity is crucial for effective treatment.
Purpose of the Study:
- To investigate the spectrum of uropathogens in acute obstructive pyelonephritis.
- To determine the antibiotic sensitivity of these uropathogens.
- To guide rational antimicrobial therapy selection.
Main Methods:
- Bacteriological testing of urine samples from 72 patients with ureteral stones.
- Use of an extended set of culture media for pathogen detection.
- Antibiotic sensitivity testing against carbapenems, fluoroquinolones, cephalosporins, and penicillins.
Main Results:
- High detection rate (83.3%) of uropathogens with bacteriuria ≥ 10³ CFU/mL.
- Carbapenems (ertapenem, meropenem) recommended as initial empirical antibiotics.
- Fluoroquinolones showed inadequate effects in 15.0–67.0% of cases; cephalosporins and penicillins not recommended for initial therapy.
Conclusions:
- Rational antimicrobial therapy for acute obstructive pyelonephritis should prioritize carbapenems based on local antibiograms.
- Empirical use of fluoroquinolones, cephalosporins, and penicillins may be inadequate.
- Tailored antibiotic selection is essential to prevent treatment failure and relapses.
Relevance:
Acute pyelonephritis is known to be the most complicated and severe urinary tract infection occurring in all age groups and accounting for 14% of all kidney diseases. The generally recognized standard antibiotic therapy cannot completely prevent the progression of the disease to its chronic form after relief of its acute manifestations thus leading to a high incidence of relapses. The aim of our study was to investigate the spectrum of uropathogens and their antibiotic sensitivity in acute obstructive pyelonephritis.
Materials And Methods:
The study comprised 72 patients who underwent semi-rigid ureteroscopy and ultrasonic lithotripsy for ureteral stones. In all patients, bladder urine samples collected by a transurethral catheter were tested bacteriologically using an extended set of culture media within 3 hours after hospital admission. Antibiotics used in antibiotic sensitivity testing for all uropathogens, were grouped into 4 classes (carbapenems, fluoroquinolones, cephalosporins, penicillins). Etiotropic treatment was started upon the availability of the spectrum of microbial patterns, the level of bacteriuria and antibioticogram of uropathogens, 5-6 days after administering initial empirical antibiotic therapy.
Results:
The study patients had a high detection rate (83.3%) of canonical uropathogens in the bladder urine identified due to using an extended set of culture media, with a bacteriuria of more or equal 103 CFU/mL. Given the results of local antibiograms, a rational antimicrobial therapy should include carbapenems, namely ertapenem or meropenem as initial empirical antibiotics. Using fluoroquinolones as the first line treatment can lead to an inadequate effect in 15.0 to 67.0% of the cases. The findings of the antibiotic resistance testing of uropathogens to cephalosporins and semisynthetic penicillins showed that they should not be used as initial empirical antibiotic therapy for acute obstructive pyelonephritis in the given department of urology.
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