URO-RESIST: A Real-World Retrospective Study on Multidrug-Resistant Sepsis with Urinary Tract Infection, Clinical Predictors, Inflammatory Biomarkers, and Patient Outcomes

Abstract

Background: Sepsis with Urinary Tract Infection (UTI) is a serious condition with high morbidity and mortality, increasingly complicated by multidrug-resistant (MDR) infections. Prompt diagnosis and appropriate treatment are key to improving outcomes and limiting antimicrobial resistance. The URO-RESIST study aimed to assess the relationship between clinical features, inflammatory biomarkers (C-reactive protein and procalcitonin, CRP and PCT, respectively), microbiological profiles, and outcomes in patients with sepsis with UTI. A secondary aim was to compare microbiological patterns between institutionalized patients and those living at home without known MDR risk factors. Methods: A retrospective cohort study was conducted on 231 patients with sepsis with UTI. admitted to the Infectious Diseases Unit of Chieti Hospital, Italy, between 2014 and 2024 (excluding 2020–2021). Data on clinical, laboratory, and microbiological variables were collected. MDR organisms were defined per European Centre for Disease Prevention and Control (ECDC) criteria. Analyses included non-parametric tests and logistic regression. Results: MDR pathogens were identified in over 40% of cases. Patients from long-term care facilities had higher CRP levels and a higher prevalence of MDR infections. Carbapenems were frequently used, though empirical treatment was sometimes inappropriate. PCT did not differ significantly between MDR and non-MDR groups and had limited prognostic value. CRP and MDR presence were both associated with worse outcomes and longer hospital stays. Functional dependence and dementia were strongly linked to MDR infections. Age correlated with comorbidities but was not an independent predictor of outcome. Conclusions: MDR infections worsen the course of sepsis with UTI. CRP may outperform PCT in assessing severity, especially in institutionalized patients. Functional and cognitive impairments increase vulnerability to MDR pathogens. These findings support the need for rapid diagnostics, targeted antibiotic use, and personalized care strategies.