Applying international urinary tract infection guidelines in Poland: epidemiologic insights from southern Poland

Urinary tract infections (UTIs) are a common condition and represent the second most prevalent infectious illness globally.

This study aimed to determine the species‑specific share in positive cultures of UTIs in both inpatients and outpatients, and to assess the applicability of recent UTI treatment guidelines in patients from Silesia, southern Poland.

This retrospective multicenter study analyzed 85 485 urine samples collected in Poland (2022-2023) from inpatients (n = 52 294) and outpatients (n = 33 191) with suspected UTIs. The study participants were grouped into 3 categories: premenopausal women, postmenopausal women, and men. Antibiotics were classified according to the World Health Organization Access, Watch, Reserve framework.

The study showed low antibiotic susceptibility. The potential risk of empirically available therapy ineffectiveness was between 26.7% and 44.6%, depending on in- or outpatient status. In the inpatients, susceptibility of Escherichia coli to cotrimoxazole was 73%, and to cephalosporins at least 86.9% in premenopausal women, and about 76.6% in men and postmenopausal women. Susceptibility of Klebsiella pneumoniae exceeded 80% only in the case of cefoperazone / sulbactam (86.3%), but was below 60% for other drugs. Outpatient E. coli isolates showed 91.9% susceptibility to nitrofurantoin, but most other Access group agents fell below 60%, except for gentamicin (92%). Resistance was frequent: extended‑spectrum β‑lactamases occurred in 12.8% of the outpatients and 32.9% of the inpatients, Enterobacterales and high‑level aminoglycoside resistance in 56.5% of the inpatients with Enterococcus faecalis and 63.7% of E. faecium.

Due to a high potential risk of ineffective empirical therapy based on current guidelines, its applicability to clinical practice should be further evaluated using more locally derived data.