Abstract
Introduction: Multidrug-resistant -urinary tract infection (MDR-UTI) is considered a significant source of in-hospital mortality and morbidity in critically ill patients in intensive care units (ICUs).
Objectives: This study aimed to evaluate the prevalence and risk factors of MDR-UTI among critically ill Egyptian patients. In addition, the study aimed to determine the potential risk factors in various ICUs at Ain Shams University Hospital, Cairo, Egypt.
Patients and Methods: The current cross-sectional study included 383 adult patients with positive urine cultures enrolled from different medical and surgical ICUs within a 6-month duration. MDR-UTI was defined as isolates that exhibited resistance or intermediate susceptibility to ≥3 of the antimicrobial categories. Antibiotic resistance rates and patterns were identified using the disc diffusion method and automated antimicrobial susceptibility testing by Vitek 2. Full clinical evaluation and biochemical analysis were done. Healthcare-associated risks were surveyed, including chronic indwelling urinary catheters, hospitalization for at least 48 hours, regular hemodialysis, or undergoing urological procedures within the past three months.
Results: MDR-UTI prevalence was observed in approximately 173 patients, accounting for 45.2% of the total. The mean age of studied patients was 63.07 ±17.82 years, with 53.3% being females. Additionally, the average duration of hospitalization was 3.32 ±3.08 days. There was a highly statistically significant relation between MDR-UTI results and hospitalization for at least 48 hours. Enterococcus and Klebsiella were significantly more prevalent among MDR-UTI cases (41.6% and 46.8 % respectively). Escherichia coli was the predominant uropathogenic microorganism in patients with non-MDR UTI, accounting for 49.0% of cases. Penicillin was the most prevalent antimicrobial resistance. The presence of chronic indwelling urinary catheters is the most common healthcare-associated risk factor for MDR UTI, with a 78% prevalence. At the time of admission to the ICU, 59% of the patients with MDR-UTI had septic shock, while 18.5% had acute kidney injury (AKI).
Conclusion: The prevalence of MDR-UTI was 45.2% among critically ill patients in the ICUs of Ain Shams University Hospital. Klebsiella and Enterococcus were the most common uropathogenic among MDR UTIs, with resistance mainly to penicillins and carbapenems. The hospital stay >48 hours, hemodialysis, and urological procedures were the most significant risk factors for MDR-UTI. Patients with septic shock and AKI were significantly associated with the presence of MDR-UTI.