Prevalence and impact of multidrug resistance in a cohort of patients admitted to emergency department for urinary tract-infections: The UTILY study, a prospective multicentre study

Abstract

Background and aim: The aim of the present study was to evaluate the prevalence and to identify the independent predictors of multi-drug resistance among a cohort of patients admitted to emergency department for urinary tract infections (UTI), and to assess the impact of antimicrobial resistance on the clinical outcomes.

Methods: We conducted a prospective multicentre study enrolling all adult patients admitted to one of the eight emergency departments participating in the study with a microbiologically confirmed diagnosis of UTI from February 2023 to July 2024. The primary outcome evaluated was 30-day mortality; secondary outcomes included 7-day mortality and clinical response.

Results: During the study period, 681 patients were admitted to one of the 8 participating facilities with signs and symptoms consistent with UTI, 327 of which presented a positive urine culture and were included in the study. A total of 128 out of 327 patients (39.1 %) had an isolation of an MDR organism. At multivariate analysis, male gender (OR 1.79, 95 % CI 1.08-2.97, p = 0.024) and hospital admission during the previous 90 days (OR 4.28, 95 % CI 1.86-9.83, p = 0,001) resulted independently associated with the isolation of an MDR pathogen. Regarding clinical outcomes, the presence of sepsis or septic shock (OR 6.25, 95 % CI 1.36-28.73, p = 0.019), and being infected with an MDR pathogen (OR 2.65, 95 % CI 1.01-6.97, p = 0.048) resulted the only variables independently associated with 30-day mortality.

Conclusions: Our study has reported a 39.1 % prevalence of MDR pathogens in patients admitted to emergency departments for UTI, with a 21 % prevalence among patients without any known risk factor.

Keywords: Antimicrobial resistance; Emergency department; MDR; UTI; Urinary tract infection.