Carbapenemase-producing uropathogens in real life: epidemiology and treatment at a County Emergency Hospital from Eastern Romania

Abstract

Urinary tract infections are a public health problem exacerbated by the rising concern of antibiotic resistance. Carbapenem-resistant Enterobacterales (CRE), mostly isolated from urine samples, represent an immediate public health threat, often associated with healthcare settings. This study investigated 27 cases of carbapenemase-producing organisms (CPO) detected in urinalysis over one year. There was a significant association between the presence of chronic indwelling urinary catheters and the temporary use of urinary catheters, with both groups accounting for 66.7% of all cases. We identified two modes of transmission for extended drug-resistant microorganisms: inter-hospital spread, covering wide geographical distances (involving four healthcare units across two other counties), and intra-hospital transmission (12 departments within our institution). Medium-size hospitals should thoroughly investigate their specific carbapenemase-producing strains. Their laboratories must be well-supplied to handle this situation and perform the necessary testing accurately. Treatment options should be available based on presumed susceptibility and antimicrobial susceptibility testing, with a range of antibiotics available, including novel agents such as Ceftazidime-avibactam, as well as established options like Aminoglycosides and Colistin. Adherence to rigorous catheter handling protocols, as emphasized by national and international guidelines, is essential and should be implemented consistently across all hospital departments.

Keywords: AMR: Antimicrobial resistance; CA-UTI: Catheter-associated urinary tract infection; CRE: Carbapenem-resistant Enterobacterales; CREC: Carbapenem-resistant E. coli; CRKP: Carbapenem-resistant Klebsiella pneumoniae; DTR: Difficult-to-treat; ICU: Intensive care unit; ID: Infectious disease; MDR: Multi-drug resistant; SIRS: Systemic inflammatory response syndrome; US: United States; UTI: Urinary tract infections; XDR: Extended drug-resistant; carbapenemase; epidemiology; nonacademic hospital; treatment; uropathogens.