P-57 SUSCEPTIBILITY PATTERNS AND EMPIRICAL ANTIBIOTIC GUIDANCE FOR URINARY TRACT INFECTIONS IN PATIENTS WITH CIRRHOSIS

Abstract

Conflict of interest: No Introduction and Objectives: The lack of data on bacterial susceptibility in urinary tract infections (UTI) among patients complicates empirical antibiotic selection. Aims: To assess the antibiotic susceptibility of UTI-causing bacteria in patients with cirrhosis and recommend appropriate antibiotic therapy. Patients / Materials and Methods: Cross-sectional study using data from the prospective registry of bacterial infections in adult patients with cirrhosis in Argentina and Uruguay. We included episodes of culture-positive UTI in patients hospitalized for this condition or who developed a UTI during their stay. Antibiotic susceptibility patterns and recommendations are presented according to the site of acquisition. According to our definition, empirical antibiotic treatment should aim to cover roughly 80% of anticipated bacteria in stable patients and 90% in critically-ill patients. Results and Discussion: A total of 278 episodes were included, involving 227 patients recruited from 20 centers between Dec/2020 and July/2024. Of these, 97% (n=269) were monobacterial, and 3% (n=9) involved infections with two bacteria, resulting in 287 isolates. The most frequent isolates were enterobacteria, especially E. coli (43%), notably in community-acquired (CA) UTI (60%); K. pneumoniae accounted for 28% of the isolates, rising to 40% in nosocomial UTI. The most frequent Gram-positive cocci was enterococcus (14%). The table displays the susceptibility patterns for various antibiotics and highlights those suitable for empirical treatment according to the observed coverage. Multidrug resistance was observed in 52% (CI95: 46-58) of episodes: 40% (CI95: 32-50) in community-acquired and 68% (CI95: 57-77) in nosocomial infections. It is concerning that half of UTI are caused by multidrug-resistant organisms, and that only combinations of broad-spectrum antibiotics offer adequate coverage for nosocomial infections. Conclusions: For the first time in Latin America, we provide high-quality data to guide empirical antibiotic recommendations for UTI in patients with cirrhosis.