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. 2019 Jul 11;8(3):91.
doi: 10.3390/antibiotics8030091.

Comparative Epidemiology and Resistance Trends of Proteae in Urinary Tract Infections of Inpatients and Outpatients: A 10-Year Retrospective Study

Márió Gajdács  1   2 , Edit Urbán  3
Affiliations

Comparative Epidemiology and Resistance Trends of Proteae in Urinary Tract Infections of Inpatients and Outpatients: A 10-Year Retrospective Study

Márió Gajdács et al. Antibiotics (Basel). .

Abstract

Compared with infections caused by other bacterial pathogens, urinary tract infections (UTIs) caused by Proteae are often more severe and associated with a higher rate of recurrence, sequelae, and pyelonephritis. The aim of this retrospective study was to assess and compare the prevalence of UTIs caused by different species of the Proteae tribe (namely Proteus, Morganella and Providencia species) and the antibiotic resistance levels isolated from inpatients and outpatients in a primary- and tertiary-care teaching hospital in the Southern Great Plain of Hungary, during a 10-year study period. To evaluate the resistance trends of isolated strains, amoxicillin/clavulanic acid, ceftriaxone, meropenem, ertapenem, gentamicin, ciprofloxacin, and fosfomycin were chosen as indicator antibiotics, based on local antibiotic utilization data. Members of Proteae were more frequently isolated in the case of inpatients (7.20 ± 1.74% vs. 5.00 ± 0.88%; p = 0.0031), P. mirabilis was the most frequently isolated member of the group. The ratio of resistant strains to sulfamethoxazole/trimethoprim, ciprofloxacin, ceftriaxone, and fosfomycin was significantly higher in the inpatient group. In the case of amoxicillin/clavulanic acid, ceftriaxone, ciprofloxacin, and sulfamethoxazole/trimethoprim, the ratio of resistant isolates was markedly higher between 2013-2017 (p < 0.01). Resistance developments of Proteae, coupled with their intrinsic non-susceptibility to several antibiotics (tetracyclines, colistin, nitrofurantoin) severely limits the number of therapeutic alternatives, especially for outpatients.

Keywords: Morganella; Proteus; Providencia; UTI; antibiotic; epidemiology; fosfomycin; indicator; resistance; urinary tract infection.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1
Ratio of Proteae in positive urine samples of inpatients and outpatients during the study period.
Figure 2
Figure 2
Resistance levels of Proteae originating from inpatient and outpatient urinary tract infections AMC resistance levels correspond to P. mirabilis isolates only.
Figure 3
Figure 3
Study site in Hungary (Southern Great Plain of Hungary: in green; Albert Szent-Györgyi Clinical Center, Szeged: in red).
See this image and copyright information in PMC

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