MP379CHRONIC KIDNEY DISEASE AS A RISK FACTOR FOR ANTIMICROBIAL MULTIDRUG RESISTANCE OF UROPATHOGENIC BACTERIA

Abstract

INTRODUCTION AND AIMS: Patients with chronic kidney disease (CKD) have increased risk of urinary tract infections (UTIs). The recent emergence of multidrugresistant (MDR) uropathogens is an alarming public health issue which complicates therapeutic strategies for UTIs. The present study aimed to determine the asssociation between CKD and MDR among inpatients with UTI. METHODS: We prospectively assessed the urine samples obtained from all inpatients suspected of having a UTI, admited in County Hospital Timisoara, between January 2012 and January 2013. Demographic variables of these patients, uropathogens and their antimicrobial susceptibilities were evaluated. Isolated bacteria were identified by standard tests, and antibiotic susceptibility was determined by disk diffusion method. An MDR UTI was defined as an infection caused by an uropathogen resistant to three or more classes of drugs. CKD was defined acording to the KDIGO guideline. RESULTS: During the follow-up period, from the 4328 samples analyzed, 1135 (26.22%) were cultures-positive for bacterial infection. The most frequently isolated microorganisms were Escherichia coli (61.32%), Klebsiella spp. (22.02%), Proteus mirabillis (8.01%), Pseudomonas aeruginosa (4.41%). Three hundred forty nine (30.74%) isolates were MDR. Pseudomonas aeruginosa presented the highest percentage of MDR isolates (60%). Univariate analysis showed an increased risk of MDR in males (odds ratio [OR]=3.16, p<0.001), in patients with diabetes mellitus (OR=1.65, p=0.0002), in chronic obstructive pulmonary disease (OR=5.09, p<0.001), in patients with urinary catheter before admission (OR=2.76, p<0.001), in patients with previous UTIs (OR=2.20, p<0.001) and in patients with CKD (OR=2.75, p<0.001). In multivariable analysis, CKD remained an independent predictor for MDR (OR=3.04, 95%CI:2.23 to 4.13, p<0.001). CONCLUSIONS: A high prevalence of MDR in bacterial uropathogens was observed. Particularly, resistance patterns were alarmingly higher for Pseudomonas. CKD turned out to be an independent predictor for UTI with MDR bacteria.