Chronic Kidney Disease—An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion Criteria
2.2. Exclusion Criteria
2.3. Variables and Definitions
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Variable (n = 564) | (n, %) |
---|---|
Infectious complications | |
Superinfection | 23 (4.1%) |
Local complications (prostatitis, kidney abscess) | 5 (0.9%) |
Clostridioides difficile enterocolitis | 16 (2.8%) |
Concurring bacterial/viral infections
| 34 (6.03%) 20 (58.9%) 6 (17.6%) 6 (17.6%) 2 (5.9%) |
Sepsis (non-related to UTIs) | 7 (8.2%) |
Non-Infectious complications | |
Acute kidney injury | 197 (34.9%) |
AKI on CKD (n = 197) | 129 (65.5%) |
AKI stage (KDIGO) (n = 196) | |
| 53 (27%) 44 (22.4%) 99 (50.5%) |
Acute hemodialysis | 52 (9.2%) |
Appendix B
Uropathogen | Total (n = 564) (n, %) | General Antibiotic Resistance (n = 307, 54.4%) (n, %) | Multiple-Drug Resistance (n = 169, 30%) (n, %) |
---|---|---|---|
Gram negative | 516 (91.5%) | 275 (53.3%) | 150 (29.1%) |
Gram positive | 48 (8.5%) | 32 (66.7%) | 19 (39.6%) |
Escherichia coli | 385 (68.3%) | 176 (45.7%) | 87 (22.6%) |
Klebsiella spp. | 63 (11.2%) | 46 (73%) | 30 (47.6%) |
Enterococcus spp. | 36 (6.4%) | 26 (72.2%) | 18 (50%) |
Pseudomonas spp. | 34 (6%) | 31 (91.2%) | 23 (67.6%) |
Proteus spp. | 34 (6%) | 22 (64.7%) | 10 (29.4%) |
Staphylococcus spp. | 8 (1.4%) | 4 (50%) | 1 (12.5%) |
Streptococcus spp. | 4 (0.7%) | 2 (50%) | 0 (0%) |
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Variable (n = 564) | |
---|---|
Age (Mean ± SD, Median (IQR)) | 68.63 ± 17.2, 72 (61–81) |
Age ≥ 65, (n, %) | 391 (69.3%) |
Male sex (n, %) | 179 (31.8%) |
Infection type (n = 562) (n, %) | |
Cystitis | 43 (7.6%) |
Pyelonephritis | 436 (77.4%) |
Urosepsis | 93 (16.5%) |
Recurrent UTIs | 173 (30.7%) |
CAUTI | 72 (12.8%) |
Host-related risk factors for complicated UTIs | |
CKD | 308 (54.6%) |
Diabetes mellitus | 174 (30.9%) |
Urolithiasis (n = 561, NA = 3) | 106 (18.9%) |
Upper urinary tract obstruction | 113 (20.1%) |
Lower urinary tract obstruction | 81 (14.4%) |
Indwelling urinary catheter | 72 (12.8%) |
Ureteral stent | 33 (5.9%) |
Nephrostomy tube | 19 (3.4%) |
Cystostomy tube | 2 (0.4%) |
Pregnancy (n = 380) | 9 (2.4%) |
Urinary tract abnormalities (n = 563)
| 96 (17.1%) 58 (60.42%) 21 (21.88%) 17 (17.7%) |
ADPKD | 14 (2.5%) |
Immunosuppression | 19 (3.4%) |
Nursing home residents | 15 (2.7%) |
Prolonged immobilization | 61 (10.8%) |
Decubitus ulcer | 20 (3.5%) |
Malignancy | 50 (8.9%) |
Malnutrition | 34 (6%) |
Laboratory data (Mean ± SD, Median (IQR)) | |
WBC count (103/mm3) (n = 561) | 10 ± 7.18, 9.3 (5.94–14.2) |
CRP (mg/dL) (n = 373) | 17.91 ± 47.4, 5.19 (0.75–17.35) |
Fibrinogen (mg/dL) (n = 483) | 574.06 ± 198.1, 546 (438–700) |
Serum albumin (g/dL) (n = 154) | 3.58 ± 0.92, 3.68 (2.99–4.30) |
Outcomes | |
Length of hospital stay(days) (Mean ± SD, Median (IQR)) | 8.33 ± 5.82, 7 (4–10.75) |
All-cause mortality | 42 (7.5%) |
Etiologic Agent (n = 564) | CKD (n, %) | Non-CKD (n, %) | p * |
---|---|---|---|
Escherichia coli | 186 (72.7%) | 199 (64.6%) | 0.413 |
Pseudomonas spp. | 12 (4.7%) | 22 (7.1%) | |
Staphylococcus spp. | 3 (1.2%) | 5 (1.6%) | |
Streptococcus spp. | 2 (0.8%) | 2 (0.6%) | |
Proteus spp. | 16 (6.3%) | 18 (5.8%) | |
Klebsiella spp. | 22 (8.6%) | 41 (13.3%) | |
Enterococcus spp. | 15 (5.9%) | 21 (6.8%) |
Variable | Sensitive | Resistant | p * |
---|---|---|---|
Age ≥ 65 | 152 (59.1%) | 239 (77.9%) | <0.001 |
Upper urinary tract obstruction | 38 (14.8%) | 75 (24.6%) | 0.004 |
Lower urinary tract obstruction | 28 (10.9%) | 53 (17.4%) | 0.040 |
Urolithiasis | 40 (15.6%) | 66 (21.6%) | 0.083 |
Indwelling urinary catheter | 22 (8.6%) | 95 (30.9%) | <0.001 |
Urinary tract abnormality | 42 (16.3%) | 54 (17.6%) | 0.736 |
Autosomal dominant polycystic kidney disease | 7 (2.7%) | 7 (2.3%) | 0.790 |
CKD | 109 (42.4%) | 199 (64.8%) | <0.001 |
CKD stage | |||
KDIGO G1 | 5 (4.8%) | 1 (0.5%) | 0.021 |
KDIGO G2 | 10 (9.5%) | 29 (15.1%) | |
KDIGO G3 | 47 (44.8%) | 66 (34.4%) | |
KDIGO G4 | 20 (19%) | 54 (28.1%) | |
KDIGO G5 | 23 (21.9%) | 42 (21.9%) | |
Chronic hemodialysis | 4 (1.6%) | 14 (4.6%) | 0.054 |
Immunosuppression | 5 (1.9%) | 14 (4.6%) | 0.103 |
Nursing home residents | 2 (0.8%) | 13 (4.2%) | 0.015 |
Prolonged immobilization | 21 (8.2%) | 40 (13%) | 0.077 |
Malignancy | 17 (6.6%) | 33 (10.7%) | 0.102 |
Diabetes mellitus | 79 (30.7%) | 95 (30.9%) | 1.000 |
Variable | OR (95% CI) | p | Model Parameters |
---|---|---|---|
Age ≥ 65 | 1.709 (1.143–2.556) | 0.009 | Χ2(6) = 75.085 p < 0.001 Nagelkerge R2 = 0.167 Hosmer–Lemeshow Test: p = 0.857 Se: 68.5%, Sp: 61.3% Accuracy: 65.2% |
Upper urinary tract obstruction | 1.240 (0.753–2.041) | 0.397 | |
Lower urinary tract obstruction | 1.099 (0.642–1.882) | 0.731 | |
Indwelling urinary catheter | 3.386 (1.977–5.802) | <0.001 | |
CKD | 1.846 (1.273–2.677) | 0.001 | |
Nursing home residents | 4.133 (0.878–19.468) | 0.073 | |
Constant | 0.439 | <0.001 |
Variable | Non-MDR | MDR | p * |
---|---|---|---|
Age ≥ 65 | 256 (64.8%) | 135 (79.9%) | <0.001 |
Upper urinary tract obstruction | 69 (17.6%) | 44 (26.2%) | 0.022 |
Lower urinary tract obstruction | 56 (14.2%) | 25 (14.9%) | 0.896 |
Urolithiasis | 68 (17.3%) | 38 (22.6%) | 0.158 |
Indwelling urinary catheter | 44 (11.1%) | 73 (43.2%) | <0.001 |
Urinary tract abnormalities | 68 (17.3%) | 28 (16.6%) | 0.903 |
Autosomal dominant polycystic kidney disease | 12 (3%) | 2 (1.2%) | 0.248 |
CKD | 188 (47.6%) | 120 (71%) | <0.001 |
CKD stage | |||
KDIGO G1 | 6 (3.3%) | 0 (0%) | 0.037 |
KDIGO G2 | 30 (16.5%) | 9 (7.8%) | |
KDIGO G3 | 69 (37.9%) | 44 (38.3%) | |
KDIGO G4 | 42 (23.1%) | 32 (27.8%) | |
KDIGO G5 | 35 (19.2%) | 30 (26.1%) | |
Chronic hemodialysis | 6 (1.5%) | 12 (7.1%) | 0.003 |
Immunosuppression | 10 (2.5%) | 9 (5.3%) | 0.124 |
Nursing home residents | 9 (2.3%) | 6 (3.6%) | 0.399 |
Prolonged immobilization | 38 (9.6%) | 23 (13.6%) | 0.183 |
Malignancy | 28 (7.1%) | 22 (13%) | 0.034 |
Diabetes mellitus | 118 (29.9%) | 56 (33.1%) | 0.486 |
Variable | OR (95% CI) | p | Model Parameters |
---|---|---|---|
Age ≥ 65 | 1.502 (0.930–2.426) | 0.096 | Χ2(6) = 90.689 p < 0.001 Nagelkerge R2 = 0.212 Hosmer–Lemeshow Test: p = 0.543 Se: 45.8%, Sp: 88.8% Accuracy: 75.9% |
Upper urinary tract obstruction | 0.798 (0.465–1.369) | 0.412 | |
Indwelling urinary catheter | 5.388 (3.294–8.814) | <0.001 | |
CKD | 1.779 (1.153–2.745) | 0.009 | |
Chronic hemodialysis | 4.068 (1.413–11.715) | 0.009 | |
Malignancies | 1.163 (0.591–2.288) | 0.661 | |
Constant | 0.146 | <0.001 |
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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.; et al. 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
Vacaroiu IA, Cuiban E, Geavlete BF, Gheorghita V, David C, Ene CV, Bulai C, Lupusoru GE, Lupusoru M, Balcangiu-Stroescu AE, et al. 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 StyleVacaroiu, 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, and et al. 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