[Urinary tract infections in hospitalized patients: community and hospital acquired]

Urinary tract infections (UTIs) are among the most frequent infection in hospitalized patient, with a rising incidence of multidrug-resistant microorganisms (MDR) in recent decades. The main objective was to compare the clinical, microbiological, and antimicrobial resistance profiles of hospitalized patients with UTIs, differentiating between those admitted due to community-acquired UTIs and those who developed hospital-acquired UTIs, in two tertiary-care hospitals.

A retrospective cohort study was conducted between January 2022 and March 2023 in two hospitals in Córdoba, Argentina. Episodes of UTIs requiring hospitalization in patients aged >18 years were included, excluding pregnant women and asymptomatic bacteriuria.

A total of 719 UTI episodes were analyzed, occurring in 594 patients, of which 494 (68.7%) were community-acquired and 225 (31.3%) hospital-acquired. The mean age was 65±19.4 and 67±15 years, respectively. Urinary tract abnormalities (44.3% vs. 25.8%, p<0.001) and a history of solid-organ transplantation (13% vs. 5.8%, p=0.004) were more frequent in community-acquired infections. Escherichia coli was the predominant microorganism (63% vs. 41.3%, p<0.001), followed by Klebsiella pneumoniae. A total of 327 (45%) episodes were caused by MMR, significantly associated with previous urinary catheter use, recent antibiotic exposure, and recent hospitalization.

Most UTI episodes in hospitalized patients were community-acquired, while about one-third were hospital-acquired. E. coli was the predominant pathogen in both groups, though less frequent in hospital-acquired infections. A high proportion of MMR episodes was observed, associated with prior antimicrobial exposure, recent urinary instrumentation, and recent hospitalization.