ポーランドにおける国際尿路感染症ガイドラインの適用：ポーランド南部からの疫学的洞察

Urinary tract infections (UTIs) are a common condition and represent the second most prevalent infectious illness globally.  Objectives: This study aimed to determine the species-specific share in positive culture 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. Study participants were grouped into three categories: premenopausal women, postmenopausal women, and men. Antibiotics were classified according to the WHO AWaRe (World Health Organisation Access, Watch, Reserve) framework.  Results: 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 out-patient status. In inpatients, Escherichia coli (E. coli) was 73% susceptible to co-trimoxazole and ≥86.9% to cephalosporins only in premenopausal women, but ~76.6% in men and postmenopausal women. Klebsiella pneumoniae exceeded 80% only with cefoperazone / sulbactam (86.3%), with other drugs susceptibility <60%. Outpatient E. coli isolates showed 91.9% susceptibility to nitrofurantoin, but most other Access group agents fell below 60%, except gentamicin (92%). Resistance was frequent: Extended-Spectrum Beta-Lactamases occurred in 12.8% of outpatient and 32.9% of inpatient Enterobacterales and High-Level Aminoglycoside Resistance in 56.5% of inpatient Enterococcus faecalis and 63.7% of Enterococcus faecium.  Conclusions: Due to the high potential risk of empirical therapy ineffectiveness based on current guidelines, its coherence to clinical reality should be further evaluated using more locally derived data.