The Causative Agents and Antibiotic Susceptibility Patterns of Healthcare-Associated Urinary Tract Infections (HAUTIs) in Isfahan, Iran: The Impact on Empiric Therapy

Abstract

Background: Healthcare-associated urinary tract infections (HAUTIs) are the most prevalent healthcare-associated infection worldwide. They can lead to major problems in hospitalized patients, including the increase in the length of the hospital stay, the cost of the hospitalization, and the inappropriate administration of antibiotics. Objectives: We aim to investigate the prevalence and antibacterial sensitivity of various bacteria that cause HAUTIs. Methods: This cross-sectional study was conducted in three referral hospitals in Isfahan, Iran. Urine specimens were taken from urinary catheters of the patients with a suspected diagnosis of HA-UTI. Bacteria were identified by conventional methods, and antimicrobial sensitivity testing was performed by disk diffusion and E-test methods according to standard guidelines. Data was extracted from WHONET software, and further statistical analysis was performed by SPSS v.21. Results: Among 283 HAUTIs, Escherichia coli was the most prevalent pathogen (33.2%), followed by Enterococcus spp. (25.9%), Klebsiella pneumonia (16.6%), Pseudomonas aeruginosa (8.8%), and Acinetobacter baumannii (8.8%). Escherichia coli was more common in females. The most active antibiotics against Gram-negative isolates were nitrofurantoin (69.8%), carbapenems (69.7%), and aminoglycosides (68.3%), and the most effective antibiotics against Gram-positive isolates were linezolid (100%) and nitrofurantoin (74.5%). Conclusions: This study showed that nitrofurantoin, carbapenems, and aminoglycosides are the most effective antibiotics against Gram-negative causes of HAUTIs. Also, linezolid and nitrofurantoin demonstrated significant activity against Gram-positive isolates. As a result, for the empiric treatment of nosocomial UTI in the area under study, judicious use of the mentioned antibiotics is recommended.