1º Autor: Nuno Ferreira
Laboratory of Clinical Microbiology, Department of Clinical Pathology, Hospital do Divino Espírito Santo, Ponta Delgada, S. Miguel – Azores, Portugal
Coautores: Raquel A Branco 1), Sabrina C. Pimentel 1), Maria Ana S. Paço 2), Isabel Coelho 2), Lúcia E.P.R. Serpa 2)
1 – Department of Physical and Rehabilitation Medicine, Hospital do Divino Espírito Santo, Ponta Delgada, S. Miguel – Azores; 2 – Laboratory of Clinical Microbiology, Department of Clinical Pathology, Hospital do Divino Espírito Santo, Ponta Delgada, S. Miguel – Azores, Portugal;
Introduction: Urinary tract infections (UTI) and urinary tract colonizations (UTC) are common in spinal cord injury (SCI) patients. The aim of this study is to characterize microbiological profile of urine cultures in SCI patients, and to determine antibiotic susceptibility profile of most common microorganisms, in order to track antibiotic resistance and facilitate empiric antibiotic selection. Material and methods Retrospective observational study of 235 urine cultures results of 29 SCI patients of a district Portuguese hospital between January 2016 and April 2024. Data regarding socio-demographics, cause of SCI, American Spinal Injury Association Impairment Scale classification, voiding method, microbiological urine cultures profile and antimicrobial resistance were collected and statistically analysed. UTI (defined as bacteriuria, leukocyturia, positive urine culture and new onset of signs and/or symptoms) was differentiated from UTC.
Results: Patients were mostly men (86%); with mean age 52,1 years. UTI occurred in 134 (57%) specimens; UTC in 101 (43%). In both UTI and UTC: microbiological agents were mostly bacteria; Escherichia coli was the commonest overall (39%) and more frequent in indwelling catheterization (in UTI) and intermittent self-catheterization (in UTC); more frequently identified microorganisms were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis and Enterococcus faecalis. For these five more frequent bacteria, antibiotic susceptibility profile was determined. High resistance to fluoroquinolones, low resistance to cephalosporins, and very low resistance to nitrofurantoin was found. Specific multidrug-resistant organisms (MDRO) were 11,2%; mostly identified in patients with indwelling catheters. Antibiotic prescription in UTI was according to antibiogram.
Discussion: Microorganisms identified both in UTI and in UTC are distinct on different types of voiding methods. Catheterization seems to be a risk factor for bacteriuria and for drug resistance. Antibiotic prescription in UTI according to antibiogram seems to prevent development of MDRO. The two most frequently prescribed antibiotic were normal first-line antibiotics for non-complicated UTI.
Conclusion: The antibiotic susceptibility profile obtained (very low resistance to nitrofurantoin of Escherichia coli and Enterococcus faecalis, low resistance to cephalosporins, and high resistance to fluoroquinolones) can, in selected cases, facilitate empiric antibiotic selection in SCI patients.