Ces Urol 2022, 26(1):38-48 | DOI: 10.48095/cccu2022001

Antimicrobial resistance development - prevalence and antibiotic resistance patterns of bacterial strains in urine.

Vít Paldus¹, Vladimír Šámal^{1, 2}, Daniela Fáčková³, Jan Mečl¹

¹ Urologické oddělení Krajské nemocnice Liberec, a. s., Liberec

² Urologická klinika Fakultní nemocnice a Lékařské fakulty UK, Hradec Králové

³ Oddělení klinické mikrobiologie Krajské nemocnice Liberec, a. s., Liberec

Paldus V, Šámal V, Fáčková D, Mečl J. Antimicrobial resistance development - prevalence and antibiotic resistance patterns of bacterial strains in urine.

Objective: Antimicrobial resistance (AMR) has become a global concern. However there are significant differences with regard to local epidemiological factors across continents, countries and even medical facilities. Local assessment of antimicrobial resistance development is one of the essential tools in the fight against the AMR spread. The aim of our work is to evaluate the occurrence of resistant urinary strains, analyze the development of resistance and compare AMR in intensive care units (ICU) with standard department of urology.

Materials and methods: We analysed bacterial antibiotic resistance patterns of urinary tract strains in our medical facility between the years 2013-2020. We assessed the susceptibility of bacterial strains to the different antibiotics and compared the resistance patterns in ICU-s with our department of urology. We assessed the increase in number of resistant strains acting via enzymatic modification of antibiotics during this period. Namely the Extented Spectrum Beta-lactamase strains (ESBL), Beta-lactamase AmpC strains, carbapenemase producing Enterobacteriaceae (CPE), Vancomycin-resistant Enterococci (VRE) and Methicillin-resistant Staphylococcus aureus (MRSA).

Results: Overall 35 831 positive bacterial cultures were assessed. We detected 4114 resistant strains altogether (11.5 %). Among them ESBL strains were the most frequent (7.8 %), with the resistance nearly doubled between 2013 and 2015 (5.6 % and 10.3 %, respectively). The adopted preventive measures have led to reduction of sustained growth of resistance, however the odds for the occurrence of resistance remain higher in the following years in comparison with 2013 (maxOR: 1.93, 95 % CI; 1.64-2.27). The increase in VRE strains during the last 3 years and in CPE strains in the last year (0.3 %) may jeopardize the efficacy of one of the last groups of antibiotics. Antimicrobial resistance namely to beta-lactam antibiotics was significantly higher in ICU-s compared to standard wards (p < 0.00).

Conclusion: Our data demonstrate the development of AMR. At least one out of ten patients treated for urinary tract infection (UTI) in our medical facility suffers from UTI caused by resistant strains. Occurrence of new types of antimicrobial resistance previously not observed in our medical facility is a serious threat.

Keywords: Antimicrobial resistance, ESBL, AmpC, CPE, VRE, MRSA.

Received: November 30, 2021; Revised: January 13, 2022; Accepted: January 14, 2022; Prepublished online: January 18, 2022; Published: March 30, 2022