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Characterization of Resistance in Gram-Negative Urinary Isolates Using Existing and Novel Indicators of Clinical Relevance: A 10-Year Data Analysis

1
Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6., 6720 Szeged, Hungary
2
Department of Ecology, Faculty of Sciences, University of Szeged, Közép fasor 52., 6726 Szeged, Hungary
3
Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6., 6725 Szeged, Hungary
4
Department of Medical Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, Dóm tér 10., 6720 Szeged, Hungary
*
Author to whom correspondence should be addressed.
Life 2020, 10(2), 16; https://doi.org/10.3390/life10020016
Received: 13 January 2020 / Revised: 5 February 2020 / Accepted: 10 February 2020 / Published: 11 February 2020
(This article belongs to the Section Microbiology and Engineering)
Classical resistance classifications (multidrug resistance [MDR], extensive drug resistance [XDR], pan-drug resistance [PDR]) are very useful for epidemiological purposes, however, they may not correlate well with clinical outcomes, therefore, several novel classification criteria (e.g., usual drug resistance [UDR], difficult-to-treat resistance [DTR]) were introduced for Gram-negative bacteria in recent years. Microbiological and resistance data was collected for urinary tract infections (UTIs) retrospectively, corresponding to the 2008.01.01–2017.12.31. period. Isolates were classified into various resistance categories (wild type/susceptible, UDR, MDR, XDR, DTR and PDR), in addition, two new indicators (modified DTR; mDTR and mcDTR) and a predictive composite score (pMAR) were introduced. Results: n = 16,240 (76.8%) outpatient and n = 13,386 (69.3%) inpatient UTI isolates were relevant to our analysis. Citrobacter-Enterobacter-Serratia had the highest level of UDR isolates (88.9%), the Proteus-Providencia-Morganella group had the highest mDTR levels. MDR levels were highest in Acinetobacter spp. (9.7%) and Proteus-Providencia-Morganella (9.1%). XDR- and DTR-levels were higher in non-fermenters (XDR: 1.7%–4.7%. DTR: 7.3%–7.9%) than in Enterobacterales isolates (XDR: 0%–0.1%. DTR: 0.02%–1.5%). Conclusions: The introduction of DTR (and its’ modifications detailed in this study) to the bedside and in clinical practice will definitely lead to substantial benefits in the assessment of the significance of bacterial resistance in human therapeutics. View Full-Text
Keywords: clinical microbiology; indicators; urinary tract infection; Gram-negative; drug resistance; usual drug resistance; difficult-to-treat resistance; UDR; DTR; MDR; XDR; PDR clinical microbiology; indicators; urinary tract infection; Gram-negative; drug resistance; usual drug resistance; difficult-to-treat resistance; UDR; DTR; MDR; XDR; PDR
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MDPI and ACS Style

Gajdács, M.; Bátori, Z.; Ábrók, M.; Lázár, A.; Burián, K. Characterization of Resistance in Gram-Negative Urinary Isolates Using Existing and Novel Indicators of Clinical Relevance: A 10-Year Data Analysis. Life 2020, 10, 16.

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