Antimicrobial Resistance among Urology Patients with Documented Bacteriuria and Predictors of Urosepsis: A Single-Center, Retrospective Surveillance Study

Abstract

Aims: We aimed to identify predictors of microbiologically-proven urosepsis in Urology. Further to that, we intend to determine the microbiological diversity and incidence of antibiotic resistance among consecutive urological patients undergoing treatment in Urology department. Study Design: This was a cross-sectional retrospective study performed in Hospital Sultanah Bahiyah, Malaysia. A database of positive urine cultures from the Urology department between 1 January 2019 and 31 January 2020 were analysed. Methodology: All adult patients with positive urine culture were included in this study. Urine cultures were performed for patients symptomatic for urinary tract infections or asymptomatic patients planned for urological procedures. A total of 348 subjects were included for analysis. Patients’ demographics and variables of interest were collected via digital clinical notes. Results and Conclusion: 348 subjects were included. Among Urology patients with proven bacteriuria, incidence of urosepsis was 12.1%. Stepwise multivariate logistic regression revealed that younger patients, the presence of multidrug resistant organism (MDRO) isolates, pre-existing chronic kidney disease (CKD), and the presence of underlying malignancies were all predictors of Urosepsis (all p<0.05). From the total, 94% of uropathogens were Gram negative organisms with the 3 common organisms being E.coli (24%) followed by K. pneumoniae (11.8%), and P. aeruginosa (15.2%). P. aeruginosa (26.2%) were commonest in urosepsis. Antimicrobial resistance (AMR) including MDRO, is alarmingly high and concerning. In urosepsis, AMR rate was more than 10 percent for all commonly used antibiotics including carbapenems. To improve guideline development, empirical combination antibiotics therapy should be studied employing urosepsis predictors. Judicious use of antibiotics with adherence to antibiotic stewardship and infection control to curb emergence of AMR is important.