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Published on: March 3, 2023
Uropathogenic distribution and antibiotic resistance patterns according to multidrug-resistant bacteria colonization
Ju Hyeon Kim1, Jae Hyun Lee, Young-Joo Sim
1Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan, Korea.
Abstract:
Urinary tract infections (UTI) are common in patients with stroke. The colonization of multidrug-resistant organisms (MDR) has recently become a global issue, and infection with MDR is associated with a poorer prognosis. This study aimed to investigate the uropathogenic distribution in stroke patients according to MDR colonization and investigate the infection risk and antibiotic resistance of each uropathogen to help determine initial antibiotic treatment. This study is a retrospective study conducted on patients who underwent inpatient treatment for stroke at Kosin University Gospel Hospital in 2019 to 2021. The participants were classified into Group VRE if vancomycin-resistant Enterococcus (VRE) colonization was confirmed, Group CRE if carbapenem-resistant Enterobacteriaceae (CRE) colonization was confirmed, and Group Negative if no MDR colonization was confirmed. Urine culture was performed if symptomatic UTI was suspected. Uropathogenic distribution, antibiotic resistance patterns were assessed by one-way analysis of variance, independent t-test, and Pearson chi-square test. And the infection risk factors for each uropathogen were assessed by multinomial logistic regression analysis. Six hundred thirty-three participants were enrolled. The mean age of all participants was 69.77 ± 14.91, with 305 males and 328 females, including 344 hemorrhagic strokes and 289 ischemic strokes. No growth in urine culture was the most common finding (n = 281), followed by Escherichia coli (E.coli) (n = 141), and Enterococcus spp. (n = 80). Group Negative had significantly more cases of no growth in urine culture than Group VRE (Odds ratio [OR], 11.698; 95% confidence interval [CI], 3.566-38.375; P < .001) and than Group CRE (OR, 11.381; 95% CI, 2.665-48.611; P < .001). Group VRE had significantly more E.coli (OR, 2.905; 95% CI, 1.505-5.618; P = .001), and more Enterococcus (OR, 4.550; 95% CI, 2.253-9.187; P < .001) than Group Negative. There was no statistical difference in antibiotic resistance according to MDR colonization in E coli, but for Enterococcus spp., Group VRE and CRE showed significantly more resistance to numerous antibiotics than Group Negative. MDR colonization increases the risk of UTI and is associated with greater antibiotic resistance. For appropriate administration of antibiotics in UTI, continuous monitoring of the latest trends in uropathogenic distribution is required, and clinicians should pay more attention to the use of initial empirical antibiotics in patients with MDR colonization.
Insights
Multidrug-resistant organism (MDR) colonization in stroke patients significantly increases the risk of urinary tract infections (UTI). MDR-colonized patients also exhibit greater antibiotic resistance, necessitating careful antibiotic selection.
Area of Science:
- Infectious Diseases
- Neurology
- Clinical Microbiology
Background:
- Urinary tract infections (UTIs) are a common complication in stroke patients.
- The increasing prevalence of multidrug-resistant organisms (MDR) poses a significant global health challenge, particularly in vulnerable populations like stroke survivors.
- MDR infections are linked to poorer patient outcomes and increased treatment complexity.
Purpose of the Study:
- To investigate the distribution of uropathogens in stroke patients based on MDR colonization status.
- To assess the infection risk and antibiotic resistance patterns of specific uropathogens in relation to MDR colonization.
- To inform initial antibiotic treatment strategies for UTIs in stroke patients.
Main Methods:
- Retrospective study of stroke patients treated between 2019-2021.
- Classification of patients into groups based on colonization: vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), or no MDR (Group Negative).
- Analysis of urine cultures, uropathogenic distribution, antibiotic resistance, and infection risk factors using statistical methods including logistic regression.
Main Results:
- Escherichia coli (E.coli) and Enterococcus spp. were the most common uropathogens identified.
- Patients with VRE or CRE colonization had a significantly higher risk of E.coli and Enterococcus spp. infections compared to the Group Negative.
- While E.coli resistance patterns did not differ significantly by MDR status, Enterococcus spp. showed markedly increased resistance to multiple antibiotics in VRE and CRE groups.
Conclusions:
- MDR colonization is a significant risk factor for developing UTIs in stroke patients.
- MDR colonization is associated with increased antibiotic resistance, particularly in Enterococcus spp.
- Continuous monitoring of uropathogen trends and careful consideration of empirical antibiotic choices in MDR-colonized patients are crucial for effective UTI management.
