Comparative Analysis of Complicated Urinary Tract Infections Caused by Extensively Drug-Resistant <i>Pseudomonas aeruginosa</i> and Extended-Spectrum β-Lactamase-Producing <i>Klebsiella pneumoniae</i>

• Main Authors: Elena Sendra (Author), Inmaculada López Montesinos (Author), Alicia Rodriguez-Alarcón (Author), Juan Du (Author), Ana Siverio-Parés (Author), Mar Arenas-Miras (Author), Esperanza Cañas-Ruano (Author), Nuria Prim (Author), Xavier Durán-Jordà (Author), Fabiola Blasco-Hernando (Author), Enric García-Alzorriz (Author), Francesc Cots (Author), Olivia Ferrández (Author), Silvia Gómez-Zorrilla (Author)
• Format: Book
• Published: MDPI AG, 2022-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

The objective was to compare clinical characteristics, outcomes, and economic differences in complicated urinary tract infections (cUTI) caused by extensively drug-resistant <i>Pseudomonas aeruginosa</i> (XDR <i>P. aeruginosa</i>) and extended-spectrum beta-lactamase-producing <i>Klebsiella pneumoniae</i> (ESBL-K. <i>pneumoniae</i>). A retrospective study was conducted at a tertiary care hospital. Patients with XDR <i>P. aeruginosa</i> and ESBL-<i>K. pneumoniae</i> cUTIs were compared. The primary outcome was clinical failure at day 7 and at the end of treatment (EOT). Secondary outcomes: 30- and 90-day mortality, microbiological eradication, and economic cost. Two-hundred and one episodes were included, of which 24.8% were bloodstream infections. Patients with XDR <i>P. aeruginosa</i> cUTI more frequently received inappropriate empirical therapy (<i>p</i> < 0.001). Nephrotoxicity due to antibiotics was only observed in the XDR <i>P. aeruginosa</i> group (26.7%). ESBL-<i>K. pneumoniae</i> cUTI was associated with worse eradication rates, higher recurrence, and higher infection-related readmission. In multivariate analysis, XDR <i>P. aeruginosa</i> was independently associated with clinical failure on day 7 of treatment (OR 4.34, 95% CI 1.71-11.04) but not at EOT, or with mortality. Regarding hospital resource consumption, no significant differences were observed between groups. XDR <i>P. aeruginosa</i> cUTI was associated with worse early clinical cures and more antibiotic side effects than ESBL-<i>K. pneumoniae</i> infections. However, no differences in mortality or in hospitalization costs were observed.

Item Description

10.3390/antibiotics11111511
2079-6382