Antibiotic Outcomes of Enterococcal Urinary Tract Infections: A Retrospective Analysis from Saudi Arabia and Oman

Enterococcus species are involved in urinary tract infections (UTIs), and they are known to be intrinsically resistant to certain antibiotics. We aimed to investigate the clinical characteristics and treatment outcomes of enterococcal UTIs in three hospitals in Saudi Arabia and Oman.

A retrospective cohort study was conducted on adults with clinically and microbiologically confirmed enterococcal UTI based on urinary symptoms and a urine culture of ≥100,000 CFU/mL, who received an antibiotic active against the pathogen. The primary endpoint was clinical cure. Secondary endpoints included microbiological cure, length of stay (LOS), in-hospital mortality, and recurrence.

E. faecalis and E. faecium were isolated from 188 (67.1%) and 92 (32.9%), respectively, of 280 included patients. Ampicillin/amoxicillin (25%) and vancomycin (22.1%) were the most-used antibiotics. Compared with E. faecium, E. faecalis was associated with higher clinical cure rates (75% vs. 57.6%; p = 0.003), lower in-hospital mortality (15.7% vs. 38.5%; p < 0.0001), and shorter LOS (12.5 vs. 25 days; p < 0.0001). No difference in recurrence was observed. Ciprofloxacin was associated with high odds of clinical cure (OR, 4.28; 95% CI, 1.18-15.56). Conversely, the recent cancer chemotherapy and growth of Enterococcus at another site were associated with lower odds of clinical cure. Urinary catheter removal was associated with lower recurrence odds (OR, 0.48; 95% CI, 0.24-0.98).

This study highlights the clinical challenges posed by enterococcal UTIs, particularly by E. faecium. Ciprofloxacin remains an effective option, particularly against E. faecalis. Patients with advanced age, critical illness, complicated infections, and liver disease, as well as patients on hemodialysis, require close monitoring to improve outcomes.