Prospective surveillance reveals high rates of antimicrobial resistance in urinary tract infections among patients with cirrhosis.

INTRODUCTION AND

OBJECTIVES

As antimicrobial resistance rises, selecting appropriate empirical antibiotics for treating urinary tract infections (UTIs) has become complex. This study aimed to estimate the antimicrobial susceptibility patterns of microorganisms that cause UTIs in patients with cirrhosis.

MATERIALS AND

METHODS

This study analyzed UTI episodes in patients with cirrhosis from Argentina and Uruguay (Dec 2020-July 2024). The coordinating center reviewed all antibiograms.

RESULTS

A total of 277 UTI episodes in 233 patients were included (community-acquired: 119, healthcare-associated: 68, and nosocomial: 90). Escherichia coli and Klebsiella pneumoniae were the predominant pathogens (70.6 %, n = 202). Multidrug resistance and extensive drug resistance were observed in 51.6 % and 11.6 % of the episodes, respectively. Carbapenemase-producing organisms were particularly prevalent in nosocomial infections (30.3 %, 95 % CI: 21.5-40.8). In community-acquired UTIs, coverage rates for ceftriaxone, cefepime, and piperacillin-tazobactam ranged from 60-70 %. Aminoglycosides (82.2 %, 95 %CI: 74.1-88.2) and carbapenems (90.0 %, 95 %CI: 83.0-94.2) provided coverage exceeding 80 %. For nosocomial UTIs, carbapenems demonstrated suboptimal coverage; in contrast, adequate coverage was observed with ceftazidime-avibactam plus aztreonam (83.0 %, 95 %CI: 73.4-89.6) or plus vancomycin (76.1 %, 95 %CI: 65.9-84.0).

CONCLUSIONS

The study highlights alarming antimicrobial resistance, particularly in nosocomial UTIs. Traditional antibiotics, such as ceftriaxone for community-acquired UTIs and carbapenems or piperacillin/tazobactam for nosocomial infections, fail to provide sufficient empirical coverage. More comprehensive approaches to empirical treatment, such as combination therapies or newer antibiotics targeting resistant pathogens, are needed.