Prevalence and Risk Factors of Multidrug-Resistant Urinary Tract Infections among Critically Ill Patients in Ain Shams University Hospitals

Abstract

Abstract Background Multidrug-resistant infections are becoming a major source of in-hospital mortality and morbidity in ICU patients, numerous independent risk factors for infections by MDR bacteria have been identified, ICUs are often considered the epicenter of development, amplification and dissemination of drug-resistant microorganisms Aim and Objectives To determine the prevalence, possible risk factors and outcome in critically ill patients in ICU with multidrug resistant urinary tract infections in Ain Shams University Hospitals. Subjects and Methods This was cross-sectional study that included 383 patients who were admitted to different intensive care units in Ain Shams university hospitals during a period of Six months (March 2022 – August 2022). Patients were identified by review of urine specimens sent to the microbiology laboratory for urine cultures, for patients suspected clinically of UTI or in those with urinalysis demonstrating increased white blood cells count, Multidrug resistant (MDR) was defined as isolates that were resistant or intermediate susceptible to ≥ 3 of the following antimicrobial categories: (a1) penicillin (b) cephalosporins (c) carbapenems; (d) fluoroquinolones; (e) gentamicin or amikacin; (f) TMP-SMX; and (g) nitrofurantoin Results The prevalence of multi- drug resistant UTI was about 45.2%. Hypertension and Diabetes mellitus were the most common medical comorbidities. The presence of chronic indwelling urinary catheters was the most common healthcare-associated risk factor for MDR UTI. Klebsiella and enterococcus were significantly more prevalent among MDR cases (41.6 % and 46.8% respectively). Penicillin had the most common antimicrobial resistance in our study. 59% of the patients with MDR UTI presented with septic shock, 18.5% presented with AKI as the second most common cause of hospital admission in MDR UTI patients. MDR UTI patients had higher mean serum creatinine and lower eGFR in comparison to non-MDR group. Conclusion Multi- drug resistant UTI had 45.2% prevalence among critically ill patients in Ain Shams university hospitals with many risk factors. In addition, higher CRP, lower eGFR and lower haemoglobin level are associated with MDR urinary tract infections.