Antimicrobial susceptibility profile of multidrug-resistant uropathogens in community-acquired urinary tract infections in Spain: A multicenter GEIAP-SEIMC study.

INTRODUCTION

Urinary tract infections are one of the leading causes of antibiotic prescribing in Primary Care and they generate a high volume of urine cultures in Microbiology laboratories. The empirical management of these infections has been complicated by the increase in antimicrobial resistance.

OBJECTIVE

To evaluate the antimicrobial susceptibility profiles of extended-spectrum β-lactamase (ESBL) and/or carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa isolated from urine samples of patients attending Primary Care in Spain during 2022.

METHODS

A descriptive, retrospective, multicenter study including urine samples obtained in Primary Care and processed in 43 Spanish laboratories. Data were collected through a structured survey developed by the Primary Care Infection Study Group and distributed via the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).

RESULTS

Escherichia coli and Klebsiella pneumoniae were the predominant uropathogens and they accounted for 8.4% and 10.3% respectively. The most frequent carbapenemase was OXA-48. Both ESBL-producing E. coli and K. pneumoniae showed high susceptibility to carbapenémicos and aminoglycosides, whereas ciprofloxacin and cotrimoxazole showed low activity. Susceptibility of ESBL-producing E. coli to fosfomycin and nitrofurantoin was 85.8% and 95.6%, respectively. Pseudomonas aeruginosa accounted for 1.7% of isolates, showing high susceptibility to antipseudomonal agents except for quinolones, and 5.4% of them were classified as extremely drug-resistant.

CONCLUSION

Elevated levels of resistance to some first-line oral antibiotics were observed. The growing prevalence of multidrug-resistant uropathogens limits empirical treatment options in Primary Care and highlights the need for up-to-date local and national antimicrobial susceptibility data.