Regional Antibiotic Resistance of the Main Uropathogens
Authors: Sova Serhii , Trilis Oksana , Nurimanov Kamil 
Published: June 2024

The most important reason for the increase in mortality from infectious factors on the planet is the acquisition of resistance to antibacterial agents by microflora. Therefore, modern guidelines for the treatment of human infectious diseases recommend considering the regional sensitivity of the microflora when choosing an antibiotic. The treatment of infectious lesions of the urinary system is no exception, the disease of which is annually included in the list of the most frequent reasons for increasing the «burden of disease» on the planet. Therefore, the study of the microbial landscape of uropathogenic flora and its sensitivity to modern antibiotics in the Ukrainian population will contribute to increasing the effectiveness of treatment, especially empirical treatment, and reducing the antibiotic resistance of local uropathogens.
The objective: optimization of the therapy of infectious and inflammatory diseases of the urinary system by considering the sensitivity of the main regional uropathogens to antibacterial agents.
Materials and methods. Bacteriological research was carried out on 545 urine samples of symptomatic inpatients and outpatients aged 19 to 95 years, in whom pathological changes in urine sediment were determined during the examination. According to the sex distribution, women predominated in both groups in the ratio of 1.6:1 and 3.8:1, respectively. Identification of causative agents and their properties, as well as sensitivity to antibiotics, was carried out according to the standardized methods of domestic and international guidelines. The growth of microflora with the number of colony-forming units in 1 ml ≥ 104 (CFU/ml) was considered clinically significant. Statistical analysis was carried out with the help of the statistical package EZR v. 1.50. The critical level of significance is 0.05.
Results. In urine samples obtained from patients of a multidisciplinary hospital, 81.7% of identified microorganisms were Escherichia coli (31.5%), Enterococcus faecalis (17.2%), Klebsiella spp. (16.2%), Candida albicans (6.6%), Acinetobacter species (5.6%) and Staphylococcus aureus (4.6%). In the outpatient group of patients, 92.1% of uropathogens were Escherichia coli (52.3%), Klebsiella spp. (13.6%), Staphylococcus aureus (13.6%), Enterococcus faecalis (8.0%) and Enterobacter sрp. (4.6%).
In the spectrum of pathogens of infectious and inflammatory diseases of the urinary system, the role of microorganisms that form a capsule (Klebsiella spp., Acinetobacter sрp.) has been increasing in recent years: among the uropathogens in examined inpatients in 2013 (n=122) and 2022 (n=108) proportion of Klebsiella spp. increased, respectively, from 14.8% to 37%; and the proportion of Acinetobacter sрp. from 2.8% to 3.3%. The majority of uropathogens identified from the urine of patients of a multidisciplinary somatic hospital, in contrast to the outpatient group, was characterized by polyresistance to the action of antibacterial agents. Escherichia coli and Klebsiella spp. were sensitive only to fosfomycin and carbapenems, and Enterococcus faecalis – to fosfomycin, amoxicillin clavulonate, ampicillin sulbactam, vancomycin, meropenem and linezolid. Acinetobacter sрp. was insensitive to all antibiotics used in the study.
The growth of fungi of the genus Candida albicans was inhibited by the main antifungal drugs of the «access» category – fluconazole, itraconazole, and ketoconazole, with a tendency toward a gradual increase in resistance, which was indicated by a significant number of moderately sensitive strains – 35, 25, and 10%, respectively.
Conclusions. The spectrum of uropathogenic flora in patients of a multidisciplinary hospital is characterized by greater diversity and a more frequent combination of several types of microorganisms in one patient compared to the outpatient group. The most common causative agents of infectious and inflammatory diseases of the urinary tract in the Kyiv region are polyresistant strains of Escherichia coli, Enterococcus faecalis and Klebsiella spp. In the spectrum of pathogens of infectious and inflammatory diseases of the urinary system, the role of microorganisms that form a capsule (Klebsiella spp., Acinetobacter sрp.) has been increasing in recent years. Therefore, we are witnessing the evolutionary success of the protective mechanism of capsule formation, which is related, among other things, to the phenomenon of Bacterial Quorum Sensing in microorganisms and the formation of biofilms.
Implementation of the obtained results of the study of regional sensitivity of uropathogens to antibacterial agents in medical practice will improve the results of treatment of infectious and inflammatory urological pathology and prevent the growth of antibiotic resistance of the local flora.