The Resistance Landscape of Uropathogens in a Romanian Tertiary Center: A 13-Month Single-Center Study with Focus on...

Area of Science:

• Clinical Microbiology and Infectious Diseases
• Antimicrobial Resistance (AMR) Epidemiology
• Public Health and Healthcare Policy

Background:

• Urinary tract infections (UTIs) are a major challenge in the context of the global antimicrobial resistance (AMR) crisis.
• Romania faces a significant AMR burden, yet detailed local data on urinary pathogens and their resistance profiles are limited.
• Understanding the resistance landscape is crucial for effective treatment and control strategies in tertiary healthcare settings.

Purpose of the Study:

• To characterize the comprehensive antimicrobial resistance patterns of urinary pathogens in a Romanian tertiary hospital.
• To identify the prevalence of multidrug-resistant (MDR) organisms, particularly Klebsiella species and urease-positive bacteria.
• To provide data supporting the development of locally guided empirical treatment strategies for UTIs.

Main Methods:

• Analysis of all positive urine cultures over 13 consecutive months (February 2025-February 2026), with the first isolate per patient as the primary unit (n=2331) and the full dataset (n=3348) analyzed secondarily.
• Determination of resistance phenotypes including putative extended-spectrum beta-lactamase (ESBL) production, carbapenem resistance, multidrug resistance (MDR), and vancomycin-resistant Enterococci (VRE) based on established criteria.
• Statistical analysis using chi-square/Fisher tests with Benjamini-Hochberg correction to identify significant associations in resistance rates.

Main Results:

• Escherichia coli (40.5%), Enterococcus spp. (22.2%), and Klebsiella spp. (18.9%) were the predominant urinary pathogens.
• Overall, 15.3% of first isolates were MDR. Klebsiella spp. exhibited high rates of MDR (36.2%), putative ESBL (22.8%), and carbapenem resistance (14.7%), significantly higher than E. coli.
• Pseudomonas spp. showed high carbapenem resistance (48.1%). E. coli maintained good susceptibility to nitrofurantoin and fosfomycin, but resistance to trimethoprim-sulfamethoxazole and fluoroquinolones was substantial.

Conclusions:

• The urinary resistance burden in this Romanian hospital is significant and unevenly distributed, with Klebsiella and Pseudomonas species being key reservoirs of resistance.
• Urease-positive organisms present a distinct resistance profile, with high trimethoprim-sulfamethoxazole resistance but preserved carbapenem susceptibility.
• Findings underscore the need for stratified, locally informed empirical UTI treatment guidelines and integrated antimicrobial stewardship and infection control programs.