Clinical, Microbiological Profile, and Treatment Outcomes of Carbapenem-Resistant Urinary Tract Infections in a Tertiary Care Hospital

Abstract

Carbapenem-resistant urinary tract infections (CR-UTIs) are a major global health threat. Many factors contribute to the increasing incidence of CR-UTI. Owing to the limited availability of treatment options, CR-UTIs are highly challenging to treat. This was a single-center, hospital-based, observational, retrospective cohort study. We investigated the treatment results, microbiological profiles, and clinical manifestations of CR-UTI at our institution between January 2017 and December 2021. All patients exhibiting clinical signs and symptoms of urinary tract infection (UTI) and a urine culture that showed growth of a single organism greater than 105 colony-forming units/ml were included. All patients were considered for a 1-year follow-up. From January 2017 to December 2022, 3016 (31%) CR-UTI episodes were noted. Approximately, 75% of CR-UTI episodes were caused by the most prevalent urinary pathogens, Escherichia coli and Klebsiella pneumoniae. Within 28 days, 308 patients (12.59%) died. Enterobacteriaceae treated for a minimum of 7–10 days showed a greater response to Aminoglycosides, Fosfomycin, Ceftizoxime, Colistin with Carbapenem, Tigecycline with Carbapenem, and Ceftazidime/avibactam. Within a year, 994 CR-UTI episodes were identified in patients who were available for follow-up; and 38% of these episodes were the result of relapse. Three-quarters of the remaining incidents were recurrent, accounting for a higher mortality rate (14.2%) within a year. Despite effective antibiotic treatment, CR-UTIs are associated with early relapse and recurrence. Newer effective treatment and preventive strategies are required to address this pandemic.