Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun 18;55(6):285.
doi: 10.3390/medicina55060285.

Resistance Trends and Epidemiology of Citrobacter- Enterobacter- Serratia in Urinary Tract Infections of Inpatients and Outpatients (RECESUTI): A 10-Year Survey

Márió Gajdács  1   2 , Edit Urbán  3
Affiliations

Resistance Trends and Epidemiology of Citrobacter- Enterobacter- Serratia in Urinary Tract Infections of Inpatients and Outpatients (RECESUTI): A 10-Year Survey

Márió Gajdács et al. Medicina (Kaunas). .

Abstract

Background and objectives: Urinary tract infections (UTIs) are the third most common infections in humans, representing a significant factor of morbidity, both among outpatients and inpatients. The pathogenic role of Citrobacter, Enterobacter, and Serratia species (CES bacteria) has been described in UTIs. CES bacteria present a therapeutic challenge due to the various intrinsic and acquired resistance mechanisms they possess. Materials and Methods: The aim of this study was to assess and compare the resistance trends and epidemiology of CES pathogens in UTIs (RECESUTI) in inpatients and outpatients during a 10-year study period. To evaluate the resistance trends of isolated strains, several antibiotics were chosen as indicator drugs based on local utilization data. 578 CES isolates were obtained from inpatients and 554 from outpatients, representing 2.57 ± 0.41% of all positive urine samples for outpatients and 3.02 ± 0.40% for inpatients. E. cloacae was the most prevalent species. Results: The ratio of resistant strains to most of the indicator drugs was higher in the inpatient group and lower in the second half of the study period. ESBL-producing isolates were detected in 0-9.75% from outpatient and 0-29.09% from inpatient samples. Conclusions: Resistance developments of CES bacteria, coupled with their intrinsic non-susceptibility to several antibiotics, severely limits the number of therapeutic alternatives, especially for outpatients.

Keywords: Citrobacter; ESBL; Enterobacter; Serratia; UTI; antibiotic; epidemiology; fosfomycin; indicator; resistance; urinary tract infection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest, monetary or otherwise.

Figures

Figure 1
Figure 1
Age distribution of the affected patients in the outpatient and inpatient group.
Figure 2
Figure 2
Frequency and species distribution of Citrobacter, Enterobacter, and Serratia (CES) isolates in outpatient samples (2008—2017).
Figure 3
Figure 3
Frequency and species distribution of CES isolates in inpatient samples (2008—2017).
See this image and copyright information in PMC

References

    1. Gupta K., Hooton T.M., Naber K.G., Wullt B., Colgan R., Miller L.G., Moran G.J., Nicolle L.E., Raz R., Schaeffer A.J., et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin. Infect. Dis. 2011;52:e103–e120. doi: 10.1093/cid/ciq257. - DOI - PubMed
    1. Wiedemann B., Heisig A., Heisig P. Uncomplicated urinary tract infections and antibiotic resistance-epidemiological and mechanistic aspects. Antibiotics. 2014;3:341–352. doi: 10.3390/antibiotics3030341. - DOI - PMC - PubMed
    1. Hooton T.M., Bradley S.F., Cardenas D.D., Colgan R., Geerlings S.E., Rice J.C., Saint S., Schaeffer A.J., Tambayh P.A., Tenke P., et al. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin. Infect. Dis. 2010;50:625–663. doi: 10.1086/650482. - DOI - PubMed
    1. Flores-Mireles A.L., Walker J.N., Caparon M., Hultgren S.J. Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nat. Rev. Microbiol. 2015;13:269–284. doi: 10.1038/nrmicro3432. - DOI - PMC - PubMed
    1. Stefaniuk E., Suchocka U., Bosacka K., Hryniewicz W. Etiology and antibiotic susceptibility of bacterial pathogens responsible for community-acquired urinary tract infections in Poland. Eur. J. Clin. Microbiol. Infect. Dis. 2016;35:1363–1369. doi: 10.1007/s10096-016-2673-1. - DOI - PMC - PubMed

MeSH terms

Substances

LinkOut - more resources