Infecciones relacionadas con la asistencia sanitaria en pacientes ingresados en un servicio de Urología: patrones de resistencia y adecuación del tratamiento antibiótico empírico como factor pronóstico / Infections related to healthcare in patients hospitalized in a Urology service: Resistance patterns and adequacy of empirical antibiotic treatment as a prognostic factor

Objetivos: Evaluar la idoneidad de la antibioterapia empírica en IRAS y los patrones de resistencia a antibióticos de los microorganismos responsables, así como la incidencia de mortalidad y factores de riesgo en relación con IRAS. Método: Durante un periodo de 4 años se realiza un estudio prospectivo observacional sobre todos los pacientes de ambos sexos y mayores de 16 años ingresados por cualquier proceso urológico. Se evalúan la incidencia y las características de las IRAS y se analiza el microorganismo causante y sus resistencias, la antibioterapia empírica inicial y si esta precisó modificación, y las tasas de mortalidad. Resultados: De un total de 6.546 pacientes, el 6,3% sufrieron IRAS, correspondiendo el 70,5% a infección del tracto urinario y el 22,1% a infección de la herida quirúrgica. E. coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa fueron los más frecuentemente implicados (25,1, 17,5, 13,5 y 12,3%, respectivamente). E. coli y Klebsiella spp. fueron productoras de betalactamasas de espectro extendido (BLEE) en el 24,7 y el 47,8%, respectivamente. El 4,3% de Klebsiella y el 33,3% de Pseudomonas eran resistentes a carbapenemes. La resistencia global a quinolonas fue del 50% aproximadamente. Los antibióticos más frecuentemente usados de forma empírica fueron cefalosporinas de tercera y cuarta generación (33,6%) y carbapenemes (28,2%). Se obtuvo una tasa global de adecuación de antibioterapia empírica del 82,9%. La tasa de mortalidad en los pacientes con IRAS fue del 2,2%, frente al 0,3% en los pacientes sin infección. En un análisis multivariable, las variables que se asociaron a mayor riesgo de mortalidad fueron el aislamiento de enterobacterias productoras de BLEE y el tratamiento antibiótico empírico inadecuado. Conclusiones: La selección de la antibioterapia empírica fue bastante precisa. Se está observando un aumento de IRAS por microorganismos multirresistentes, como enterobacterias BLEE o P.aeruginosa multirresistentes. El riesgo de mortalidad aumenta con una antibioterapia empírica inicial inadecuada o cuando el microorganismo responsable es una enterobacteria BLEE

Objectives: To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved. Method: A prospective observational study was carried out on patients of both sexes older than 16 years, admitted by any urological process during a period of 4 years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analyzed. Results: Out of 6546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E. coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment. Conclusions: The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria

Infections related to healthcare in patients hospitalized in a Urology service: resistance patterns and adequacy of empirical antibiotic treatment as a prognostic factor. / Infecciones relacionadas con la asistencia sanitaria en pacientes ingresados en un servicio de Urología: patrones de resistencia y adecuación del tratamiento antibiótico empírico como factor pronóstico.

OBJECTIVES: To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved. METHOD: A prospective observational study was carried out on patients of both sexes older than 16years, admitted by any urological process during a period of 4years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analysed. RESULTS: Out of 6,546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P.aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E.coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment. CONCLUSIONS: The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria.

Infecciones por enterobacterias productoras de carbapenemasas en un servicio de urología. Un nuevo desafío / Infections by carbapenemase-producing enterobacteriaceae in a department of urology. A new challenge

Objetivos: Analizar las infecciones por enterobacterias productoras de carbapenemasas (EPC) y describir características y posibles factores de riesgo asociados con los pacientes de un servicio de urología. Material y métodos: Estudio observacional y retrospectivo. El criterio de inclusión fue haber estado ingresado en nuestro servicio de urología entre agosto de 2013 y diciembre de 2016. Se analizaron aquellos que presentaron positividad para EPC en al menos un cultivo. Se revisaron características basales y factores de riesgo. Asimismo se revisaron variables como presencia de infecciones urinarias previas, reingresos posteriores, el microorganismo, tipo de EPC, tratamiento administrado, un origen hospitalario o comunitario y la mortalidad. Resultados: De los 5.657 pacientes que cumplían criterio de inclusión, en 12 casos se aisló una EPC. Las infecciones por EPC representaron un 3,6% del total de infecciones relacionadas con la asistencia sanitaria y un 9,7% de las producidas por enterobacterias. Los factores analizados asociados a infección por EPC en nuestra serie son: presencia de catéteres urinarios (100%), haber sido sometido a tratamiento quirúrgico (58,3%), ingreso previo en UCI (8,3%) e inmunosupresión (16,6%). Con relación a la mortalidad, un 8,3% de los pacientes que presentaron infección por EPC fallecieron durante el ingreso. Conclusiones: Aproximadamente un 10% de las enterobacterias presenta patrón de resistencia a carbapenemasas en el paciente urológico de nuestro medio. Ser portador de catéter urinario y/o someterse a una cirugía son factores de riesgo asociados al desarrollo de estas infecciones en el paciente urológico de nuestro medio. La infección por una EPC eleva la morbimortalidad

Objectives: To analyse infections by carbapenemase-producing enterobacteriaceae (CPE) and describe the characteristics and potential risk factors associated with patients of a department of urology. Material and methods: Observational and retrospective study. The inclusion criterion was hospitalisation in our department of Urology between August 2013 and December 2016. We analysed those patients who were positive for CPE in at least 1 culture. We reviewed their baseline characteristics, risk factors and variables such as the presence of previous urinary tract infections, subsequent readmissions, the microorganism, type of CPE, treatment, origin (hospital or community) and mortality. Results: Of the 5,657 patients who met the inclusion criterion, a CPE was isolated in 12 cases. CPE infections represented 3.6% of all healthcare-associated infections and 9.7% of those caused by enterobacteria. The analysed factors associated with CPE infection in our series were the presence of urinary catheters (100%), undergoing surgery (58.3%), previous ICU admission (8.3%) and immunosuppression (16.6%). In terms of mortality, 8.3% of the patients who presented CPE infection died during hospitalisation. Conclusions: Approximately 10% of enterobacteria present a carbapenemase-resistance pattern in urological patients in our setting. Carrying a urinary catheter and/or undergoing surgery are risk factors associated with the development of these infections in urological patients in our setting. CPE infections increase morbidity and mortality

Infections by carbapenemase-producing enterobacteriaceae in a department of urology. A new challenge. / Infecciones por enterobacterias productoras de carbapenemasas en un servicio de urología. Un nuevo desafío.

OBJECTIVES: To analyse infections by carbapenemase-producing enterobacteriaceae (CPE) and describe the characteristics and potential risk factors associated with patients of a department of urology. MATERIAL AND METHODS: Observational and retrospective study. The inclusion criterion was hospitalisation in our department of Urology between August 2013 and December 2016. We analysed those patients who were positive for CPE in at least 1 culture. We reviewed their baseline characteristics, risk factors and variables such as the presence of previous urinary tract infections, subsequent readmissions, the microorganism, type of CPE, treatment, origin (hospital or community) and mortality. RESULTS: Of the 5,657 patients who met the inclusion criterion, a CPE was isolated in 12 cases. CPE infections represented 3.6% of all healthcare-associated infections and 9.7% of those caused by enterobacteria. The analysed factors associated with CPE infection in our series were the presence of urinary catheters (100%), undergoing surgery (58.3%), previous ICU admission (8.3%) and immunosuppression (16.6%). In terms of mortality, 8.3% of the patients who presented CPE infection died during hospitalisation. CONCLUSIONS: Approximately 10% of enterobacteria present a carbapenemase-resistance pattern in urological patients in our setting. Carrying a urinary catheter and/or undergoing surgery are risk factors associated with the development of these infections in urological patients in our setting. CPE infections increase morbidity and mortality.

Tratamiento adyuvante intravesical en cáncer de vejiga no músculo invasivo: importancia de la cepa y el mantenimiento / Adjuvant intravesical treatment for nonmuscle invasive bladder cancer: The importance of the strain and maintenance

Introducción y objetivo: El bacilo de Calmette-Guérin (BCG) intravesical es clave en la prevención de recurrencia y progresión de tumor vesical superficial. El objetivo de nuestro trabajo es evaluar comparativamente la eficacia y toxicidad entre Connaught y Tice, así como la importancia del esquema de mantenimiento. Material y métodos: Revisamos retrospectivamente a 110 pacientes con tumor vesical superficial con tratamiento endovesical adyuvante, distribuidos en 3 grupos, según el tratamiento fuese con Connaught, Tice, o ambos secuencialmente. Se ha calculado la supervivencia libre de recidiva en cada grupo y también de los pacientes que completaron el mantenimiento frente a los que no lo hicieron. Para identificar factores predictores de recidiva se llevó a cabo un análisis multivariante. Además, se ha valorado la toxicidad analizando la aparición de becegeítis, urgencia miccional, fiebre, infección urinaria y abandono del tratamiento por los efectos secundarios. Resultados: No hallamos diferencias en los parámetros de eficacia. Los pacientes del grupo Connaught completaron en menor medida el mantenimiento (38,4 frente a 72% del grupo Tice y frente a 76,3% del grupo ambas; p = 0,010). Los pacientes que completaron el mantenimiento tuvieron mejor supervivencia libre de recidiva a 60 meses (88,5 vs. 74,2%; p = 0,036), independientemente de la cepa empleada. El análisis multivariante identificó como factores de riesgo de recidiva el tamaño mayor de 3 cm, más de 3 implantes y no completar el mantenimiento. Los pacientes de Connaught experimentan mayor tasa de becegeítis, sin diferencias en el resto de los eventos estudiados. Conclusión: Completar la fase de mantenimiento es esencial, independientemente de la cepa empleada. Connaught tiene más riesgo de becegeítis y un esquema secuencial puede ser útil en ciertos escenarios

Background and objective: Intravesical Bacille Calmette-Guérin (BCG) is essential for preventing the recurrence and progression of superficial bladder tumours. The aim of our study was to compare the efficacy and toxicity of the Connaught and Tice strains, as well as the importance of the maintenance regimen. Material and methods: We retrospectively reviewed 110 patients with superficial bladder tumours who underwent adjuvant endovesical treatment. The patients were distributed into 3 groups, based on whether the treatment was with the Connaught strain, the Tice strain or both sequentially. We calculated the relapse-free survival rate in each group and compared the patients who completed the maintenance treatments against those who did not. To identify the predictors of relapse, we performed a multivariate analysis. We also assessed the toxicity by analysing the onset of BCGitis, urinary urgency, fever, urinary tract infection and treatment withdrawing due to adverse effects. Results: We found no differences in the efficacy parameters. The patients in the Connaught group completed the maintenance to a lesser extent (38.4 vs. 72% for the Tice group and 76.3% for both groups; P=.010). The patients who completed the maintenance had better relapse-free survival at 60 months (88.5 vs. 74.2%; P=.036), regardless of the strain employed. The multivariate analysis identified a size larger than 3 cm, more than 3 implants and not completing the maintenance as risk factors of relapse. The patients with the Connaught strain had higher rates of BCGitis, with no differences in the other events studied. Conclusion: Completing the maintenance phase is essential, regardless of the strain employed. The Connaught strain has a greater risk of BCGitis, and a sequential regimen could be useful in certain scenarios

Adjuvant intravesical treatment for nonmuscle invasive bladder cancer: The importance of the strain and maintenance. / Tratamiento adyuvante intravesical en cáncer de vejiga no músculo invasivo: importancia de la cepa y el mantenimiento.

BACKGROUND AND OBJECTIVE: Intravesical Bacille Calmette-Guérin (BCG) is essential for preventing the recurrence and progression of superficial bladder tumours. The aim of our study was to compare the efficacy and toxicity of the Connaught and Tice strains, as well as the importance of the maintenance regimen. MATERIAL AND METHODS: We retrospectively reviewed 110 patients with superficial bladder tumours who underwent adjuvant endovesical treatment. The patients were distributed into 3 groups, based on whether the treatment was with the Connaught strain, the Tice strain or both sequentially. We calculated the relapse-free survival rate in each group and compared the patients who completed the maintenance treatments against those who did not. To identify the predictors of relapse, we performed a multivariate analysis. We also assessed the toxicity by analysing the onset of BCGitis, urinary urgency, fever, urinary tract infection and treatment withdrawing due to adverse effects. RESULTS: We found no differences in the efficacy parameters. The patients in the Connaught group completed the maintenance to a lesser extent (38.4 vs. 72% for the Tice group and 76.3% for both groups; P=.010). The patients who completed the maintenance had better relapse-free survival at 60 months (88.5 vs. 74.2%; P=.036), regardless of the strain employed. The multivariate analysis identified a size larger than 3cm, more than 3 implants and not completing the maintenance as risk factors of relapse. The patients with the Connaught strain had higher rates of BCGitis, with no differences in the other events studied. CONCLUSION: Completing the maintenance phase is essential, regardless of the strain employed. The Connaught strain has a greater risk of BCGitis, and a sequential regimen could be useful in certain scenarios.

Infección de herida quirúrgica en urología. Análisis de factores de riesgo y microorganismos asociados / Surgical wound infection in urology. Analysis of risk factors and associated microorganisms

Objetivos. La cirugía abierta sigue teniendo un papel fundamental en urología, y la infección de la herida quirúrgica es una de sus principales complicaciones. Nuestro objetivo fue analizar la infección de la herida quirúrgica en pacientes intervenidos por nuestro servicio de urología y valorar factores de riesgo, microorganismos y resistencias por tipo de cirugía. Material y métodos. Estudio prospectivo y observacional. Incluyó 940 pacientes: 370 cirugías abdominal/lumbar abierta y 570 genitoperineales. Analizamos edad, sexo, comorbilidades, estancia y tipo de cirugía, así como microorganismos causantes y resistencias a antibióticos. Resultados. En cirugía genitoperineal hallamos 15 casos (2,6%) de infección de la herida quirúrgica, asociándose a cateterismo urinario previo. La mayoría de los microorganismos aislados corresponden a enterobacterias, destacando las resistencias a betalactámicos. En cirugía abdominal/lumbar encontramos 41 casos (11,1%) de infección de la herida quirúrgica. La incidencia fue del 3,3% en cirugía prostática, del 9,8% en cirugía renal y del 45,0% en cistectomía. Padecer cardiopatía se asoció a mayor incidencia de infección de la herida quirúrgica. Los microorganismos más frecuentes fueron Enterococcus spp. (27,1%), E.coli (22,9%) y Staphylococcus aureus (14,6%). Enterococcus es resistente a ampicilina en el 37,5% y E.coli productor de betalactamasas, en el 41,7%. Conclusiones. Encontramos escasa incidencia de infección de la herida quirúrgica en cirugía genitoperineal, comparada con la renal y cistectomía. La presencia de cardiopatía y portar catéter urinario previo son factores asociados a infección de la herida quirúrgica. Enterococcus y E.coli son los patógenos más frecuentes, con altas tasas de resistencia (AU)

Objectives. Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. Material and methods. This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. Results. For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. Conclusions. We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance (AU)

Surgical wound infection in urology. Analysis of risk factors and associated microorganisms. / Infección de herida quirúrgica en urología. Análisis de factores de riesgo y microorganismos asociados.

OBJECTIVES: Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. MATERIAL AND METHODS: This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. RESULTS: For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. CONCLUSIONS: We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance.

Infecciones urinarias adquiridas en la comunidad que requieren hospitalización: factores de riesgo, características microbiológicas y resistencia a antibióticos / Community-associated urinary infections requiring hospitalization: Risk factors, microbiological characteristics and patterns of antibiotic resistance

Objetivo: Las infecciones del tracto urinario (ITU) suelen manejarse ambulatoriamente. Sin embargo, un pequeño porcentaje requiere ingreso hospitalario. Nuestro objetivo fue analizar los factores de riesgo y características microbiológicas de las infecciones urinarias adquiridas en la comunidad (ITU-AC) que requieren hospitalización. Material y métodos: Realizamos un estudio prospectivo desde noviembre de 2011 a diciembre de 2013 evaluando la incidencia, factores de riesgo, patrones microbiológicos y tasas de resistencia en los pacientes con ITU-AC que requieren ingreso. Resultados: Cuatrocientos cincuenta y siete pacientes ingresaron en nuestro servicio con diagnóstico de ITU-AC. La edad media fue 56,2 ± 19,85 años, el 52,1% eran mujeres, el 19,7% portaban catéter urinario y el 11,4% habían presentado ITU en los meses previos. Los microorganismos más frecuentemente aislados fueron Escherichia coli (60,6%), Klebsiella (9,2%), Enterococcus (8,4%) y Pseudomonas (7,2%). Enterobacteriaceae diferentes a E. coli fueron más frecuentes en pacientes de mayor edad. Enterococcus fueron más frecuentemente aislados en pacientes que habían tenido ITU previa y en aquellos portadores de catéter urinario. E. coli mostró unas resistencias del 23,5% para amoxicilina/ácido clavulánico, 16,6% para cefalosporinas de tercera generación, 31,3% para quinolonas y16,7% para aminoglucósidos. Del total de E. coli 11,4% fueron productores de betalactamasas de espectro extendido (BLEE). Los Enterococcus y Pseudomonas mostraron resistencias a quinolonas del 50,0% y 61,5% respectivamente. Conclusiones: ITU-AC que requieren hospitalización se presentan más frecuentemente en varones de mayor edad, portadores de catéter urinario, litiasis urinaria y con episodios previos de ITU. Estos factores también se asocian con infecciones producidas por gérmenes diferentes a E. coli y altas tasas de resistencia

Objective: Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. Material and methods: A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. Results: Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2 ± 19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + βlactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. Conclusions: CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates

Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance.

OBJECTIVE: Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. MATERIAL AND METHODS: A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. RESULTS: Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + ß lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. CONCLUSIONS: CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates.