EMPIRICAL THERAPY OF COMPLICATED URINARY TRACT INFECTIONS IN CONDITIONS OF NOSOCOMIAL INFECTION ANTIBIOTIC RESISTANCE GROWTH

Abstract

Our study demonstrates the dynamics of uropathogen antibiotic resistance in urological department. The peculiarities of complicated urinary tract infections (cUTI) is a wider range of microbial pathogens, aggressive strains of uropathogens, including producers of expanded spectrum beta-lactamases, more often septic complications and recurrence. In the absence of fundamentally new classes of antibiotics, both the indications themselves and antibiotic therapy regimens should be reviewed. Based on the recommendations of the European Association of Urology, only antibiotics with a sensitivity of more than 90% should be used for empirical treatment of cUTI. However, in real clinical conditions, realization of such principles is quite difficult. The total sample included 370 patients with complicated urinary tract infections. In 237 patients (64.1%), the disease was accompanied with urolithiasis, in 47 (12.7%) - with infravesical obstruction, in 39 (10.5%) - with anomalies of the genitourinary system, in 32 (8.6%) - with diabetes mellitus and in 15 (4,1%) - with pregnancy. The group included 120 patients (32.4%) with drainages. Septic complications were seen in 57.8% of patients. Group I consisted of 185 patients who were on treatment during 2014-2015, group II - of 185 patients on treatment during 2016-2017. Within this period of time, there was marked increase of fraction of Enterobacteriaceae spp., resistant to most part of antibiotics. Patients with drainages demonstrated the shift of the microbial landscape towards a more aggressive nosocomial microflora. It is noteworthy that the empirical therapy provided according to results of the local microbial landscape system monitoring, made possible to decrease the antibiotic resistance of the most aggressive nosocomial pathogens, such as Ps. aeruginosa, Enterococcus fecalis and Kl. pneumoniae to carbapenems, aminoglycosides (amikacin, gentamycin, tobramycin) and protected aminopenicillins. At the same time, the resistance to fluoroquinolones, semi-synthetic penicillins and cephalosporins remains high. Carbapenems, vancomycin, linezolid and colistin are antibiotics of the reserve.

Keywords

• complicated urinary tract infections
• nosocomial infections
• empirical antibiotic therapy