Bacterial spectrum and antibiotic resistance of urinary tract infections in patients treated for upper urinary tract calculi: a multicenter analysis.

The purpose of this study is to collect information on the bacterial resistance to antibiotics of bacteria isolated from urine cultures of patients treated for upper urinary tract calculi. Data of patients with urinary tract infection and urolithiasis were retrospectively reviewed to collect information on age, gender, stone size, location, hydronephrosis, procedure of stone removal and antibiotic treatment, identification and susceptibility of pathogens, symptoms, and infectious complications. A total of 912 patients from 11 centers in 7 countries (Bulgaria, Greece, Italy, North Macedonia, Spain, and Turkey) were studied. Mean age was 54 ± 16 years and M/F ratio 322/590. Out of 946 microbial isolates, the most common were E. coli, Gram-positive, KES group (Klebsiella, Enterobacter, Serratia), Proteus spp., and P. aeruginosa. Carbapenems, piperacillin/tazobactam and amikacin showed low resistance rates to E. coli (2.5%, 7%, and 3.6%) and Proteus spp. (7.7%, 16%, and 7.4%), but higher rates were observed with Klebsiella spp., P. aeruginosa, and Gram-positive. Fosfomycin had resistance rates less than 10% to E. coli, 23% to KES group, and 19% to Gram-positive. Amoxicillin/clavulanate, cephalosporins, quinolones, and TMP/SMX showed high resistance rates to most bacterial strains. High rates of antibiotic resistance were observed in patients candidate to stone treatment from South-Eastern Europe. The empirical use of antibiotics with low resistance rates should be reserved to the most serious cases to avoid the increase of multidrug resistant bacteria. Basing on our results, carbapenems, piperacillin/tazobactam, and amikacin may be a possible option for empiric treatment of urinary stone patients showing systemic symptoms.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2020 Jun 16 [Epub ahead of print]

Elisa De Lorenzis, Alberto Budia Alba, Marcos Cepeda, Juan Antonio Galan, Petrisor Geavlete, Stilianos Giannakopoulos, Iliya Saltirov, Kemal Sarica, Andreas Skolarikos, Sotir Stavridis, Emrah Yuruk, Bogdan Geavlete, Stefan Hristoforov, M Ali Karagoz, Nikolaos Nassos, Guzmán Ordaz Jurado, Filip Paslanmaz, Marina Poza, Skender Saidi, Lazaros Tzelves, Alberto Trinchieri

Dept. of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy. ., Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain., Urology Unit, Hospital Universitario Río Hortega, Valladolid, Spain., Urolithiasis and Endourology Unit, General University Hospital, Alicante, Spain., Saint John Emergency Clinical Hospital, Bucharest, Romania., Department of Urology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece., Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria., Department of Urology, Biruni University, Medical School, Istanbul, Turkey., 2nd Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece., University Clinic of Urology, Medical Faculty Skopje, Skopje, North Macedonia., Department of Urology, The Ministry of Health, University of Health Sciences, Bagcilar Training & Research Hospital, Istanbul, Turkey., Department of Urology, Kafkas University Medical School, Kars, Turkey., Urology School, University of Milan, Milan, Italy.