Chronic Kidney Disease-An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections

• Published in: Biomedicines Vol. 10; no. 10; p. 2368
• Main Authors: Vacaroiu, Ileana Adela, Cuiban, Elena, Geavlete, Bogdan Florin, Gheorghita, Valeriu, David, Cristiana, Ene, Cosmin Victor, Bulai, Catalin, Lupusoru, Gabriela Elena, Lupusoru, Mircea, Balcangiu-Stroescu, Andra Elena, Feier, Larisa Florina, Simion, Ioana Sorina, Radulescu, Daniela
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 22.09.2022; MDPI
• Subjects: Age; Antibiotic resistance; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Bacterial infections; Catheters; chronic kidney disease; Chronic kidney failure; Clinical medicine; Confidence intervals; Drug resistance; Hemodialysis; Hospitalization; Hospitals; infection; Kidney diseases; Length of stay; Mortality; Multidrug resistance; multiple drug resistance; Pathogens; Patients; Physiological aspects; Public health; Regression analysis; Risk factors; Statistical analysis; Strains (organisms); Urinary tract; Urinary tract diseases; Urinary tract infections; Urine; Urogenital system; Viral infections; Romania; hemodialysis; multiple drug resistance; chronic kidney disease; infection; antimicrobial resistance; urinary tract infections
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines10102368

(1) Background: Chronic kidney disease (CKD), as well as antimicrobial resistance (AMR) represent major global health problems, with important social and economic implications. It was reported that CKD is a risk factor for antimicrobial resistance, but evidence is scarce. In addition, CKD is recognized to be a risk factor for complicated urinary tract infections (UTIs). (2) Methods: We conducted an observational study on 564 adult in-hospital patients diagnosed with urinary tract infections. The aim of the study was to identify the risk factors for AMR, as well as multiple drug resistance (MDR) and the implicated resistance patterns. (3) Results: The mean age was 68.63 ± 17.2 years. The most frequently isolated uropathogens were Escherichia coli strains (68.3%) followed by Klebsiella species (spp. (11.2%). In 307 cases (54.4%)), the UTIs were determined by antibiotic-resistant bacteria (ARBs) and 169 cases (30%) were UTIs with MDR strains. Increased age (≥65) OR 2.156 (95% CI: 1.404−3.311), upper urinary tract obstruction OR 1.666 (1.083−2.564), indwelling urinary catheters OR 6.066 (3.919−9.390), chronic kidney disease OR 2.696 (1.832−3.969), chronic hemodialysis OR 4.955 (1.828−13.435) and active malignancies OR 1.962 (1.087−3.540) were independent risk factors for MDR UTIs. In a multivariate logistic regression model, only indwelling urinary catheters (OR 5.388, 95% CI: 3.294−8.814, p < 0.001), CKD (OR 1.779, 95% CI: 1.153−2.745, p = 0.009) and chronic hemodialysis (OR 4.068, 95% 1.413−11.715, p = 0.009) were risk factors for UTIs caused by MDR uropathogens. (4) Conclusions: CKD is an important risk factor for overall antimicrobial resistance, but also for multiple-drug resistance.