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Article

Chronic Kidney Disease—An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections

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Department of Nephrology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Department of Nephrology, Sfantul Ioan Clinical Emergency Hospital, 042122 Bucharest, Romania
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Department of Urology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Department of Urology, Sfantul Ioan Clinical Emergency Hospital, 042122 Bucharest, Romania
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Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, 011356 Bucharest, Romania
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Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Discipline of Physiology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Author to whom correspondence should be addressed.
Academic Editor: Ramón C. Hermida
Biomedicines 2022, 10(10), 2368; https://doi.org/10.3390/biomedicines10102368
Received: 31 August 2022 / Revised: 18 September 2022 / Accepted: 19 September 2022 / Published: 22 September 2022
(This article belongs to the Special Issue Genetics and Epigenetics of Kidney Diseases)
(1) Background: Chronic kidney disease (CKD), as well as antimicrobial resistance (AMR) represent major global health problems, with important social and economic implications. It was reported that CKD is a risk factor for antimicrobial resistance, but evidence is scarce. In addition, CKD is recognized to be a risk factor for complicated urinary tract infections (UTIs). (2) Methods: We conducted an observational study on 564 adult in-hospital patients diagnosed with urinary tract infections. The aim of the study was to identify the risk factors for AMR, as well as multiple drug resistance (MDR) and the implicated resistance patterns. (3) Results: The mean age was 68.63 ± 17.2 years. The most frequently isolated uropathogens were Escherichia coli strains (68.3%) followed by Klebsiella species (spp. (11.2%). In 307 cases (54.4%)), the UTIs were determined by antibiotic-resistant bacteria (ARBs) and 169 cases (30%) were UTIs with MDR strains. Increased age (≥65) OR 2.156 (95% CI: 1.404–3.311), upper urinary tract obstruction OR 1.666 (1.083–2.564), indwelling urinary catheters OR 6.066 (3.919–9.390), chronic kidney disease OR 2.696 (1.832–3.969), chronic hemodialysis OR 4.955 (1.828–13.435) and active malignancies OR 1.962 (1.087–3.540) were independent risk factors for MDR UTIs. In a multivariate logistic regression model, only indwelling urinary catheters (OR 5.388, 95% CI: 3.294–8.814, p < 0.001), CKD (OR 1.779, 95% CI: 1.153–2.745, p = 0.009) and chronic hemodialysis (OR 4.068, 95% 1.413–11.715, p = 0.009) were risk factors for UTIs caused by MDR uropathogens. (4) Conclusions: CKD is an important risk factor for overall antimicrobial resistance, but also for multiple-drug resistance. View Full-Text
Keywords: chronic kidney disease; hemodialysis; urinary tract infections; infection; antimicrobial resistance; multiple drug resistance chronic kidney disease; hemodialysis; urinary tract infections; infection; antimicrobial resistance; multiple drug resistance
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MDPI and ACS Style

Vacaroiu, I.A.; Cuiban, E.; Geavlete, B.F.; Gheorghita, V.; David, C.; Ene, C.V.; Bulai, C.; Lupusoru, G.E.; Lupusoru, M.; Balcangiu-Stroescu, A.E.; Feier, L.F.; Simion, I.S.; Radulescu, D. Chronic Kidney Disease—An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections. Biomedicines 2022, 10, 2368. https://doi.org/10.3390/biomedicines10102368

AMA Style

Vacaroiu IA, Cuiban E, Geavlete BF, Gheorghita V, David C, Ene CV, Bulai C, Lupusoru GE, Lupusoru M, Balcangiu-Stroescu AE, Feier LF, Simion IS, Radulescu D. Chronic Kidney Disease—An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections. Biomedicines. 2022; 10(10):2368. https://doi.org/10.3390/biomedicines10102368

Chicago/Turabian Style

Vacaroiu, Ileana Adela, Elena Cuiban, Bogdan Florin Geavlete, Valeriu Gheorghita, Cristiana David, Cosmin Victor Ene, Catalin Bulai, Gabriela Elena Lupusoru, Mircea Lupusoru, Andra Elena Balcangiu-Stroescu, Larisa Florina Feier, Ioana Sorina Simion, and Daniela Radulescu. 2022. "Chronic Kidney Disease—An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections" Biomedicines 10, no. 10: 2368. https://doi.org/10.3390/biomedicines10102368

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