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An evaluation of multidrug-resistant (MDR) bacteria in patients with urinary stone disease: data from a high-volume stone management center

World Journal of Urology volume 38, pages 425–432 (2020)Cite this article

Abstract

Purpose

To investigate the prevalence of MDR bacteria in patients with urinary stones and the risk factors for its formation.

Methods

A retrospective study was performed among patients with urinary stones in Beijing Tsinghua Changgung Hospital from December 2014 to May 2018. Patients with positive urinary cultures and drug sensitivity results were included. MDR were defined as any bacteria that have resistance to at least one agent in at least three classes of antibiotics. Bacteria distribution and resistance patterns were calculated.

Results

1655 patients with urinary stones were eligible for analysis, among which 367 patients had positive urinary culture, yielding 457 isolates of 45 species. Escherichia coli remained the most common organism with a prevalence of 29.3%, followed by Enterococcus faecalis (12.0%), Proteus mirabilis (10.5%), and Klebsiella pneumonia (6.8%). 44.4% isolates were identified as MDR. The three most common Gram-negative bacteria were Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae, with a MDR rate of 84.33%, 62.5%, and 48.39%, respectively. Drug-resistant rates were different between MDR and non-MDR in ampicillin, cefazolin, ceftriaxone, cefepime, gentamicin, amikacin, and levofloxacin (all with p value < 0.05). In multivariate analysis, indwelling catheters (OR 3.1, 95% CI 1.07–8.98) and antibiotics use in the last 3 months (OR 2.14, 95% CI 1.04–4.38) were significantly associated with MDR formation.

Conclusions

MDR bacteria were common among patients with urinary stones in our center and achieved high drug-resistant rates in ampicillin, first-generation and part of third-generation cephalosporins, and fluoroquinolones. Indwelling catheters and antibiotics used in the last 3 months were independent risk factors for MDR formation. Tailored antibacterial strategies still should be established according to the local bacterial spectrum and patient condition.

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References

  1. Kirkali Ziya, Rasooly Rebekah, Star Robert A, Rodgers Griffin P (2015) Urinary stone disease: progress, status, and needs. Urology 86(4):651–653

    Article  Google Scholar 

  2. Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International sepsis definitions conference. Crit Care Med 31:1250–1256

    Article  Google Scholar 

  3. Magiorakos AP, Srinivasan A, Carey RB et al (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281

    CAS  Article  Google Scholar 

  4. Zeng G, Mai Z, Xia S et al (2017) Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int 120(1):109–116

    Article  Google Scholar 

  5. Abrahams HM, Stoller ML (2003) Infection and urinary stones. Curr Opin Urol 13(1):63–67

    Article  Google Scholar 

  6. Patel ND, Shi W, Liss M et al (2014) Multi-drug resistant bacteriuria prior to percutaneous nephrolithotomy predicts for post-operative infectious complications. J Endourol 29:531–536

    Article  Google Scholar 

  7. Alanazi MQ, Alqahtani FY, Aleanizy FS (2018) An evaluation of E. coli, in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: retrospective study. Ann Clin Microbiol Antimicrob 17(1):3

    Article  Google Scholar 

  8. Bitew A, Molalign T, Chanie M (2017) Species distribution and antibiotic susceptibility profile of bacterial uropathogens among patients complaining urinary tract infections. BMC Infect Dis 17(1):654

    Article  Google Scholar 

  9. Yongzhi L, Shi Y, Jia L et al (2018) Risk factors for urinary tract infection in patients with urolithiasis-primary report of a single center cohort. BMC Urol 18(1):45

    Article  Google Scholar 

  10. Wang S, Shi YK, Huang XB et al (2014) Bacterial culture and drug sensitivity analysis of upper urinary tract calculi complicating with infection. Beijing da xue xue bao Yi xue ban J Peking Univ Health Sci 46(5):798–801

    CAS  Google Scholar 

  11. Chen D, Zhang Y, Huang J et al (2018) The analysis of microbial spectrum and antibiotic resistance of uropathogens isolated from patients with urinary stones. Int J Clin Pract 72:e13205

    Article  Google Scholar 

  12. Walton-Diaz A, Vinay JI, Barahona J, Daels P et al (2017) Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis-a non-randomized prospective observation cohort study. Int Urol Nephrol 49(1):31–35

    CAS  Article  Google Scholar 

  13. Zilberberg MD, Shorr AF (2013) Secular trends in gram-negative resistance among urinary tract infection hospitalizations in the United States, 2000–2009. Infect Control Hosp Epidemiol 34(9):940–946

    Article  Google Scholar 

  14. Lee YC (2016) Bacteremic urinary tract infection caused by multidrug-resistant enterobacteriaceae are associated with severe sepsis at admission implication for empirical therapy. Medicine 95(20):e3694

    CAS  Article  Google Scholar 

  15. Oliveira MC, Oliveira CR, Gonc¸alves KV et al (2015) Enterobacteriaceae resistant to third generation cephalosporins upon hospital admission:risk factors and clinical outcomes. Braz J Infect Dis 19:239–245

    Article  Google Scholar 

  16. Wu YH, Chen PL, Hung YP et al (2014) Risk factors and clinical impact of levofloxacin or cefazolin nonsusceptibility or ESBL production among uropathogens in adults with community-onset urinary tract infections. J Microbiol Immunol Infect 47:197–203

    CAS  Article  Google Scholar 

  17. Tenney J, Hudson N, Alnifaidy H, Li JTC, Fung KH (2018) Risk factors for acquiring multidrug-resistant organisms in urinary tract infections: a systematic literature review. Saudi Pharm J. 26(5):678–684

    Article  Google Scholar 

  18. Cohen-Nahum K, Saidel-Odes L, Riesenberg K et al (2010) Urinary tract infections caused by multi-drug resistant proteus mirabilis: risk factors and clinical outcomes. Infection 38(1):41–46

    CAS  Article  Google Scholar 

  19. Yuan X, Liu T, Wu D et al (2018) Epidemiology, susceptibility, and risk factors for acquisition of MDR/XDR Gram-negative bacteria among kidney transplant recipients with urinary tract infections. Infect Drug Resist 11:707–715

    CAS  Article  Google Scholar 

  20. Lozano V, Fernandez G, Spencer PL et al (2015) Staphylococcus epidermidis in urine is not always benign: a case report of pyelonephritis in a child. J Am Board Fam Med 28(1):151–153

    Article  Google Scholar 

  21. Gould CV, Umscheid CA, Agarwal RK et al (2010) Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 31(4):319–326

    Article  Google Scholar 

  22. Kim J, Park HD, Chung S (2012) Microfluidic approaches to bacterial biofilm formation. Molecules 17(8):9818–9834

    CAS  Article  Google Scholar 

  23. Maharjan G, Khadka P, Siddhi Shilpakar G, Chapagain G, Dhungana GR (2018) Catheter-associated urinary tract infection and obstinate biofilm producers. Can J Infect Dis Med Microbiol 26(2018):7624857

    Google Scholar 

  24. Struelens MJ, Byl B, Vincent JL (1999) Antibiotic policy: a tool for controlling resistance of hospital pathogens. Clin Microbiol Infect 5:S19–S24

    Article  Google Scholar 

  25. Andersson DI, Hughes D (2011) Persistence of antibiotic resistance in bacterial populations. FEMS Microbiol Rev 35(5):901–911

    CAS  Article  Google Scholar 

  26. Rossignol L, Vaux S, Maugat S et al (2016) Incidence of urinary tract infections and antibiotic resistance in the outpatient setting: a cross-sectional study. Infection 45(1):1–8

    Google Scholar 

  27. Pouladfar G, Basiratnia M, Anvarinejad M (2017) The antibiotic susceptibility patterns of uropathogens among children with urinary tract infection in Shiraz. Medicine 96(37):e7834

    Article  Google Scholar 

  28. Mayfield D, Jones SAH, Karlowsky JA et al (2001) Multidrug-resistant urinary tract isolates of Escherichia coli: prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother 45(5):1402–1406

    Article  Google Scholar 

  29. Wollin DA, Joyce AD, Gupta M et al (2017) Antibiotic use and the prevention and management of infectious complications in stone disease. World J Urol 35:1–11

    Article  Google Scholar 

  30. Lee CC, Wang JL, Lee CH et al (2017) Clinical benefits of antimicrobial de-escalation in adults with community-onset monomicrobial, escherichia coli, klebsiella, species and proteus mirabilis, bacteremia. Int J Antimicrob Agents 50:371–376 (S0924857917302534)

    CAS  Article  Google Scholar 

  31. Tabah A, Cotta MO, Garnachomontero J et al (2016) A systematic review of the definitions, determinants, and clinical outcomes of antimicrobial de-escalation in the intensive care unit. Clin Infect Dis 62(8):1009–1017

    Article  Google Scholar 

  32. Mariappan P, Smith G, Bariol SV et al (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173(5):1610–1614

    Article  Google Scholar 

  33. Korets R, Graversen JA, Kates M et al (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186(5):1899–1903

    Article  Google Scholar 

  34. Foxman B (2010) The epidemiology of urinary tract infection. Nat Rev Urol 7(12):653–660

    Article  Google Scholar 

  35. Al Yousef SA et al (2016) Clinical and laboratory profile of urinary tract infections associated with extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae. Ann Clin Lab Sci 46(4):393–400

    CAS  PubMed  Google Scholar 

  36. Osman Y, Elshal AM, Elawdy MM et al (2016) Stone culture retrieved during percutaneous nephrolithotomy: is it clinically relevant? Urolithiasis 44(4):1–6

    Article  Google Scholar 

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Author information

Affiliations

  1. Department of Urology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, China

    Shu Wang, Xin Zhang & Jianxing Li

  2. Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, USA

    Shu Wang

  3. University of North Carolina at Chapel Hill, Chapel Hill, USA

    Yitian Zhang

Authors
  1. Shu Wang
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  2. Yitian Zhang
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  3. Xin Zhang
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  4. Jianxing Li
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Contributions

WS, data management, manuscript writing and editing; ZYT, data analysis; ZX, data management; LJX, project development.

Corresponding author

Correspondence to Jianxing Li.

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There was no conflict of interest.

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This study was approved by the local ethics board, and all subjects provided written informed consent.

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Wang, S., Zhang, Y., Zhang, X. et al. An evaluation of multidrug-resistant (MDR) bacteria in patients with urinary stone disease: data from a high-volume stone management center. World J Urol 38, 425–432 (2020). https://doi.org/10.1007/s00345-019-02772-0

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  • DOI: https://doi.org/10.1007/s00345-019-02772-0

Keywords

  • Urinary stones
  • Infection
  • MDR
  • Antibiotics