National monitoring of antibiotic resistance of pathogens causing community-acquired urinary tract infections in Russia: results of the multicenter epidemiological study «DARMIS -2023»
Authors: Kozlov Roman S. , Palagin Ivan S. , Ivanchik Nataly V. , Trushin Ivan V. , Dekhnich Andrey V. , Edelstein Mikhail V. , Perepanova Tamara S. , Belashova M.A. , Nastausheva T.L. , Ivanova I.A. , Valiullina I.R. , Momotova A.A. , Shirokova T.M. , Kotov S.V. , Pul'bere S.A. , Petrova L.V. , Eremeeva A.V. , Popov S.V. , Zhukov V.A. , Suhorukova M.V. , Plugin P.S. , Nikitina I.V. , Vityazeva V.P. , Zlobina K.A. , Ibishev H.S. , Naboka Yu.L. , Kuz'min I.V. , Petrov S.B. , Slesarevskaya M.N. , Savicheva A.M. , Husnutdinova T.A. , Moskvitina E.N. , Andronova T.I. , Dolzhenko E.V. , Sholomova L.A. , Burasova E.G. , Lupyreva E.G. , Malyavin A.I. , Sidorova R.K. , Mihajlichenko A.O. , Kataeva E.I. , Shamaeva S.H. , Ahremenko Ya.A. , Portnyagina U.S. , Ershova M.G. 
Published: January 2025

Objective.
To study in vitro activity of antimicrobials against clinical isolates obtained from patients with community-acquired urinary tract infections (UTIs) in various regions of Russia in 2023.

Materials and Methods.
The study included 1098 isolates obtained from the urine of children and adults of both sexes of all age groups with acute and exacerbation of recurrent community-acquired UTIs, including pregnant women with asymptomatic bacteriuria. Isolates were collected in 29 centers in 21 cities of Russia in 2023 as part of a multicenter prospective epidemiological study of the dynamics of antibiotic resistance of pathogens causing community-acquired UTIs in different subsets of patients («DARMIS-2023»). The categories of susceptibility of isolates to antimicrobial drugs were based on the breakpoint values of minimum inhibitory concentrations (MIC) in accordance with the Russian recommendations «Determination of susceptibility of microorganisms to antimicrobial drugs» (Version 2024-02) and the updated EUCAST criteria (v. 14.0, 2024).

Results.
Enterobacterales accounted for a total of 88.1% of all isolated bacterial pathogens (89.6% in the adult subpopulation; 82.8% in the pregnant subpopulation and 89.6% in the subpopulation of children and adolescents under 18 years of age). The most prevalent species were Escherichia coli (72.2% in the adult subpopulation; 72.8% in the pregnant women subpopulation and 68.9% in the children and adolescents under 18 years of age subpopulation) and Klebsiella pneumoniae (10.8% in the adult subpopulation; 4.8% in the pregnant women subpopulation and 9.8% in the children and adolescents under 18 years of age subpopulation). Of the oral drugs, the minimal resistance in E. coli was demonstrated for nitrofurantoin (0.4% of isolates in the adult subpopulation; 0.0% in the pregnant women subpopulation and 1.6% in the children and adolescents under 18 years of age subpopulation) and fosfomycin (9.6% of isolates in the adult subpopulation; 4.4% in the pregnant women subpopulation and 1.6% in the children and adolescents under 18 years of age subpopulation). Of the parenteral agents, meropenem and amikacin had the highest activity: 0.8% and 1.0% resistant E. coli in the adult subpopulation; no resistant E. coli in the pregnant subpopulation; 0.0% and 0.8% in the children and adolescents under 18 years of age subpopulation, respectively. For each patient subpopulation, antimicrobial resistance of E. coli to ampicillin, amoxicillin/clavulanic acid, cefotaxime, cefixime, and trimethoprim-sulfamethoxazole was more than 20%. Rates of E. coli resistance to ciprofloxacin were 36.7% in the adult subpopulation; 22.1% in the pregnant subpopulation; and 22.2% in the children and adolescents under 18 years of age subpopulation. The rate of extended-spectrum beta-lactamase production based on phenotypic test results was 29.6% in the adult subpopulation; 23.6% in the pregnant subpopulation and 33.3% in the children and adolescents under 18 years of age subpopulation.

Conclusions.
In community-acquired UTIs the main clinical problem is the persistent high rate of E. coli resistance to cephalosporins, fluoroquinolones, aminopenicillins/beta-lactamase inhibitors, as well as the increase of the extended-spectrum beta-lactamases production. Remaining high in vitro activity of fosfomycin and nitrofurans allows to consider them as drugs of choice in uncomplicated lower urinary tract infections.