Search Results (308)

Background/Objectives: Urinary tract infection (UTI) is among the most common serious bacterial infections occurring in the first 90 days of life and a leading indication for parenteral antibiotic therapy. Despite its clinical importance, no randomized trial has compared empiric antibiotic regimens, route of administration, or treatment duration specifically in this population. This review synthesizes current evidence to support rational antibiotic treatment decisions for neonates (ages 0–28 days) and young infants (ages 29–90 days), including those born prematurely. Methods: A targeted PubMed and MEDLINE search was conducted through July 2026. Studies reporting treatment outcomes, pharmacokinetic data, or antibiotic safety in infants aged 0–90 days were included. Broader pediatric data were incorporated where age-specific evidence was unavailable and are presented with explicit population caveats. Results:Escherichia coli is the predominant uropathogen across all age strata; extended-spectrum beta-lactamase (ESBL)-producing organisms account for a clinically important minority of community-acquired isolates. No comparative trial of empiric regimens existed for confirmed UTI in this age group. Shorter intravenous courses were not associated with higher 30-day recurrence rates for either nonbacteremic or bacteremic UTI after exclusion of meningitis. Intravenous-to-oral (IV-to-oral) transition with amoxicillin–clavulanate was pharmacokinetically supported and clinically safe in selected term neonates, based on indirect evidence from neonatal infection trials. Non-carbapenem therapy is appropriate for ESBL UTI without concomitant bacteremia in clinically improving infants. Exclusion of meningitis before shortening intravenous therapy or initiating oral step-down is essential, particularly in neonates ≤ 28 days of age. Conclusions: Short parenteral courses with timely transition to oral antibiotics are recommended in appropriately selected infants with UTI, consistent with antimicrobial stewardship principles and supported by observational evidence. The evidence base is limited, with key gaps in empiric regimen selection, management of premature infants, ESBL treatment in bacteremic patients, and optimal duration of parenteral and oral antibiotic therapy. Full article

Background: Multidrug-resistant (MDR) Gram-negative urinary tract infections (UTIs) frequently complicate the first post-transplant year in kidney transplant (KTX) recipients. This study characterized patterns of uropathogen susceptibility, MDR prevalence, and predictors of MDR UTI in this population. Methods: In a single-center retrospective cross-sectional study (KFSHRC, Riyadh; October 2024 to December 2025), 83 adult first-transplant recipients with a first-year Gram-negative UTI were included for analysis. Susceptibility was determined using VITEK 2/CLSI criteria, and MDR was defined according to Magiorakos/ECDC criteria. Results: Nitrofurantoin susceptibility varied significantly by species, with 89.2% in E. coli compared to 15.0% in K. pneumoniae (p < 0.001), supporting its use as a carbapenem-sparing option for E. coli but not for K. pneumoniae. Carbapenems and amikacin retained near-complete activity, whereas cephalosporins, ciprofloxacin, and trimethoprim-sulfamethoxazole exhibited resistance rates of 45 to 68%. K. pneumoniae (49.4%) and E. coli (44.6%) were the predominant uropathogens, and MDR accounted for 63.9% of episodes (95% CI 53.1 to 73.4). MDR was associated with UTI recurrence, prolonged hospitalization, and reduced microbiological eradication (69.8% vs. 86.7%). UTI recurrence was the only independent predictor of MDR status (adjusted OR, 3.99; 95% CI, 1.46 to 10.89; p = 0.007). No UTI-associated mortality occurred within one year. Conclusions: Species-directed therapy, such as nitrofurantoin for E. coli and carbapenems or aminoglycosides for broader coverage, combined with local surveillance and antimicrobial stewardship, is essential to preserve treatment options and protect graft function. Full article

Background: Grade 1 vesicoureteral reflux (VUR) is generally considered a low-risk condition and is commonly grouped with other low-grade reflux categories in the literature. Consequently, long-term outcome data specifically addressing Grade 1 VUR remain limited. We evaluated the long-term renal and infectious outcomes of children with Grade 1 VUR and characterized their principal associated clinical phenotypes. Methods: This retrospective cohort study included children diagnosed with Grade 1 VUR between 2008 and 2025 at a tertiary pediatric urology center. Primary outcomes were breakthrough urinary tract infection (UTI), proteinuria, and new renal scar formation. Principal associated clinical phenotypes and factors associated with adverse outcomes were evaluated using univariable analyses. Results: A total of 132 children with Grade 1 VUR involving 154 refluxing renal units were included. Median age at diagnosis was 6 years (IQR 4–9.25), and median follow-up was 8 years (IQR 5–9). A principal associated clinical phenotype was identified in all patients, most commonly voiding dysfunction (38.6%), recurrent UTI (28.0%), and renal anomalies (25.0%). Breakthrough UTI occurred in 46 patients (34.8%), proteinuria in 6 (4.5%), and new renal scar formation was identified in 7 of the 70 patients who underwent paired baseline and follow-up DMSA examinations performed according to clinical indications (10.0%). Renal adverse outcomes (proteinuria and/or new renal scar formation) were identified in 10 patients. Incident renal scarring was assessable only in the selectively imaged paired DMSA subgroup. Older age at diagnosis (p < 0.001) and abnormal baseline DMSA findings (80.0% vs. 41.8%, p = 0.040) were associated with renal adverse outcomes, while female sex was associated with breakthrough UTI (p = 0.009). Conclusions: In this tertiary referral cohort of children with Grade 1 VUR and associated clinical conditions, heterogeneous clinical outcomes were observed during long-term follow-up. These findings highlight the importance of interpreting Grade 1 VUR within the broader clinical context of the child; however, the independent contribution of reflux itself cannot be determined from the present study. These findings should therefore be regarded as descriptive and hypothesis-generating. Full article

Background/Objectives: Recurrent urinary tract infection (rUTI) is common after menopause, but estrogen deficiency alone does not explain variation in recurrence, symptoms, and microbial profiles. This study aimed to synthesize evidence on the interactions among estrogen deficiency, urogenital microbial ecology, diabetes, obesity, microbial reservoirs, and anatomical, neurological, and functional modifiers of postmenopausal rUTI susceptibility. Methods: PubMed and Scopus were searched for original studies published from 1 January 2021 to 15 June 2026. A structured narrative synthesis included 62 original reports comprising clinical interventions, observational cohorts, microbiome and multi-omic studies, and cellular and animal experiments. Evidence was interpreted according to study design, population relevance, and biological directness. Results: Menopause was associated with reduced Lactobacillus dominance, higher vaginal pH, and altered vaginal or urinary communities, although findings were heterogeneous. Vaginal estrogen reduced recurrence and improved the local urogenital environment, but microbiome restoration is not established as its sole mechanism. Gut, rectal, vaginal, urinary, and bladder-wall reservoirs may contribute to persistence or repeated exposure. Diabetes was linked to dysbiosis and impaired urothelial defence, whereas obesity evidence remained less direct. Pelvic organ prolapse with incomplete emptying, elevated postvoid residual urine, age-related detrusor dysfunction, stroke, immobility, functional dependence, incontinence, and catheter exposure may further modify susceptibility. Conclusions: Postmenopausal rUTI is multifactorial. The urogenital microbiome–metabolic interface is a useful integrative framework, but not a validated causal or diagnostic model. Vaginal estrogen, urine culture, metabolic and bladder-function assessment, and antimicrobial stewardship remain the clinical foundation; microbiome-directed strategies require prospective validation. Full article

Background/Objectives: Colorectal cancer (CRC) with bladder involvement represents a distinct subgroup of locally advanced disease frequently accompanied by urinary tract-related manifestations (UTRMs). However, the clinical relevance of prediagnostic UTRMs in this high-risk population remains unclear. This study investigated the association between UTRMs and oncologic outcomes in patients with bladder-involved CRC. Methods: We conducted a population-based retrospective cohort study using the National Health Insurance Research Database and Catastrophic Illnesses Database (2000–2020). A total of 2608 patients with CRC involving the bladder were included. Patients with prediagnostic UTRMs, including urinary frequency, urgency, dysuria, hematuria, and urinary tract infections, were identified using diagnostic codes recorded within 6 months before CRC diagnosis. Inverse probability of treatment weighting was applied to balance baseline characteristics. Patients were followed from CRC diagnosis until disease recurrence, death, or end of the study period. Weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Patients with UTRMs had a significantly higher risk of disease recurrence than those without UTRMs (adjusted HR 1.57). Patients with UTRMs requiring antibiotic treatment exhibited an even greater recurrence risk (adjusted HR 4.17), although this finding should be interpreted cautiously because of the limited sample size. Associations between UTRMs and recurrence were generally consistent across subgroup analyses. In contrast, UTRMs were not significantly associated with CRC-specific mortality. Conclusions: Prediagnostic UTRMs were associated with an increased risk of recurrence in patients with CRC involving the bladder. These readily obtainable preoperative clinical manifestations may provide supplementary information for postoperative surveillance in this high-risk population. Further studies are warranted to validate these findings. Full article

Recurrent urinary tract infection (rUTI) continues to pose a formidable clinical challenge, largely owing to the rapid clearance of therapeutic agents from the bladder caused by short intravesical residence time and periodic urinary voiding. Although intravesical drug delivery has emerged as a promising local therapeutic strategy, conventional liquid instillations and physically crosslinked hydrogels frequently fail to sustain structural integrity and prolonged drug release within the dynamically changing bladder microenvironment. Herein, we develop a photocrosslinkable, pH-responsive intravesical floating drug delivery system (iFDDS) for sustained antimicrobial delivery. This system is fabricated using diacrylated Pluronic F127 (F127DA) as the core network-building component. The covalently crosslinked F127DA network confers superior mechanical stability while preserving amphiphilic micellar domains that enable efficient loading of hydrophobic drugs. A tertiary amine-based pH-responsive crosslinker (CLMA) is further integrated into the hydrogel matrix, endowing iFDDS with enhanced swelling capacity under the mildly acidic microenvironment. Additionally, lyophilization-induced porous architecture reduces the apparent density of the iFDDS below that of urine, achieving stable flotation for over 48 h and effectively mitigating the risk of urinary tract obstruction. The optimized iFDDS exhibits favorable catheter deliverability, shear-thinning rheological behavior adaptable to dynamic fluid conditions, and excellent biocompatibility with bladder epithelial cells. Upon loading with rifampicin, the iFDDS demonstrates potent and sustained antibacterial efficacy against Escherichia coli. This study establishes a robust, environment-adaptive platform for intravesical therapy, offering a viable strategy to address the short residence time limitation of conventional formulations and improve the therapeutic management of rUTI. Full article

Background/Objectives: Intermittent ureteropelvic junction obstruction (UPJO), classically termed Dietl’s crisis, may be missed when imaging is obtained outside symptomatic periods. The challenge is amplified in duplicated collecting systems, where the obstructed moiety may not be recognized on screening ultrasonography. Case Presentation: A 14-year-old boy presented with recurrent severe right flank pain triggered by heavy fluid intake, associated with nausea and vomiting and separated by symptom-free intervals. An initial renal ultrasound performed between attacks was normal. One week later, the same pain pattern recurred together with a febrile urinary tract infection. Computed tomography urography (CTU) demonstrated an incomplete right duplex collecting system with a bifid ureter, marked hydronephrosis of the lower moiety, delayed contrast excretion, and focal narrowing at the lower-moiety ureteropelvic junction adjacent to one crossing artery and one crossing vein. Diuretic ^99mTc-mercaptoacetyltriglycine (MAG3) renography documented obstructive drainage, with a post-furosemide drainage half-time (T1/2) > 20 min, differential renal function of 51% on the right, and split moiety function of 31% (upper) and 20% (lower). The patient underwent transperitoneal robot-assisted dismembered Anderson–Hynes pyeloplasty of the lower moiety with the reconstructed ureteropelvic junction repositioned anterior to the crossing vessels; a 6 Fr × 26 cm double-J stent was placed and subsequently removed at 4 weeks postoperatively. Total skin-to-skin operative time was 75 min, estimated blood loss < 100 mL, and the postoperative course was uneventful. At early 3-month follow-up, the patient remained free of Dietl-type episodes, and ultrasonography showed marked reduction in lower-moiety hydronephrosis. Selective postoperative CTU, obtained because of the unusual bifid anatomy, demonstrated patent drainage. Conclusions: A normal interval ultrasound should not exclude intermittent UPJO when the history is stereotypical, and cross-sectional plus functional imaging is decisive when duplex anatomy and crossing vessels coexist. Full article

Urinary tract infections (UTIs) are considered a significant public health issue due to their high incidence and prevalence, most notably among women. The potential for complications, including recurrent infections and antibiotic resistance, negatively impacts patient quality of life and correspondingly results in elevated healthcare costs. Efficacy of antibiotic pharmacotherapy has been shown to be limited in the treatment of UTIs. The use of antibiotics has been further exacerbated by the unprecedented spread of antimicrobial-resistant organisms. This paper reviews the microbiome specific to UTIs and the formation of biofilms in UTI patients, and presents the current status of novel biological and chemical approaches designed to inhibit and eradicate biofilms in UTI patients. Full article

Background: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder associated with recurrent febrile urinary tract infections, renal scarring, hypertension, and potential long-term renal morbidity. Postoperative outcomes after ureteral reimplantation may be influenced by reflux grade, reflux etiology, bladder function, renal status, operative technique, surgeon experience, and follow-up intensity. However, real-world evidence from low- and middle-income healthcare settings remains limited, particularly for surgically treated children with high-grade VUR. Objective: To describe postoperative outcomes after ureteral reimplantation in children with Grade III–V VUR and to explore the association of VUR grade and surgical approach with reflux resolution, recurrence, and reintervention in a surgically selected pediatric cohort. Methods: We conducted a retrospective cohort study at a tertiary pediatric referral center in Ecuador. The study included 90 children aged 0 to 15 years with Grade III–V VUR confirmed by voiding cystourethrography who underwent open or laparoscopic ureteral reimplantation between January 2019 and January 2024. Demographic, clinical, imaging, and surgical variables were extracted from medical records. Postoperative outcomes included reflux resolution, recurrence, and reintervention. Logistic regression models were used as exploratory analyses only. Because the cohort included only operated patients, treatment allocation was nonrandomized, event numbers were limited, and several relevant prognostic variables were incompletely documented, adjusted estimates were interpreted cautiously and were not used to infer causality. Results: Overall reflux resolution was achieved in 68 of 90 patients (75.6%), recurrence occurred in 12 patients (13.3%), and reintervention was required in 8 patients (8.9%). Resolution rates were similar after open and laparoscopic surgery (44/59, 74.6% vs. 24/31, 77.4%; p = 0.766). Recurrence was numerically lower after laparoscopic than open reimplantation, but the difference was not statistically significant (2/31, 6.5% vs. 10/59, 16.9%; p = 0.164). Reintervention rates were also similar between groups (3/31, 9.7% vs. 5/59, 8.5%; p = 0.849). In exploratory multivariable analysis, Grade V VUR was associated with lower odds of reflux resolution (OR, 0.06; 95% CI, 0.01–0.40; p = 0.003) and higher odds of recurrence (OR, 16.69; 95% CI, 1.88–148.32; p = 0.012) compared with Grade III VUR. Surgical approach was not independently associated with resolution, recurrence, or reintervention. The small Grade V subgroup, the limited number of recurrence and reintervention events, and the wide confidence intervals indicate substantial statistical imprecision. Conclusions: In this surgically treated pediatric cohort from a tertiary referral center in Ecuador, ureteral reimplantation was associated with reflux resolution in approximately three-quarters of patients. Higher reflux grade, particularly Grade V disease, was associated with less favorable postoperative outcomes in exploratory analyses, but these findings should not be interpreted as causal or definitive because of the small subgroup size, limited event numbers, selection bias, and incomplete documentation of reflux etiology, bladder dysfunction, renal scarring, renal function, surgeon experience, and follow-up duration. Open and laparoscopic approaches showed comparable resolution and reintervention rates, while the lower recurrence observed after laparoscopy did not reach statistical significance. Future prospective studies should standardize outcome definitions, distinguish imaging-confirmed from clinically documented resolution, report follow-up duration, and account for reflux etiology, bladder function, renal status, surgical experience, and healthcare access. Full article

Serratia marcescens has emerged as an important opportunistic pathogen in intensive care units (ICUs), where critically ill patients, invasive devices, antimicrobial exposure, and complex environmental reservoirs create favorable conditions for colonization, infection, and recurrent outbreaks. This narrative review synthesizes evidence from the past decade regarding the clinical and molecular epidemiology, environmental persistence, device-associated transmission, biofilm-mediated resistance, and infection-control strategies of S. marcescens in ICU settings. The literature was reviewed using an integrative approach informed by Ferrari’s narrative review framework, with thematic synthesis across clinical, microbiological, environmental, and genomic domains. Recent evidence indicates that ICU-associated S. marcescens infections frequently involve respiratory tract colonization, ventilator-associated pneumonia, bloodstream infection, urinary tract infection, and device-related transmission. Hospital water systems, sink drains, wet surfaces, ventilator circuits, reusable equipment, and contaminated antiseptic or liquid products may serve as persistent reservoirs, particularly when biofilm formation supports long-term survival and recurrent dissemination. At the molecular level, S. marcescens demonstrates substantial genomic diversity, intrinsic and acquired antimicrobial resistance, inducible AmpC β-lactamase activity, efflux-mediated tolerance, and plasmid-associated resistance gene transfer. This review particularly emphasizes the molecular determinants that enable S. marcescens to persist in ICU ecosystems, including AmpC-mediated β-lactam resistance, efflux-associated tolerance, quorum-sensing-regulated biofilm formation, plasmid-mediated horizontal gene transfer, and WGS-defined clonal transmission. Whole-genome sequencing, rapid molecular diagnostics, active surveillance, environmental sampling, and integrated infection-control bundles have become increasingly important for distinguishing clonal outbreaks from endemic transmission and guiding timely interventions. Emerging perspectives emphasize the need to combine antimicrobial stewardship, environmental engineering, respiratory-care auditing, anti-biofilm strategies, and AI-assisted real-time surveillance into adaptive ICU infection-control frameworks. Overall, S. marcescens should be regarded not merely as an episodic outbreak organism, but as a highly adaptable ICU-associated pathogen requiring multidisciplinary prevention strategies. Full article

Background: Vitamin D, through its role in antimicrobial peptide (AMP) expression, may influence innate immunity and inflammation in urinary tract infections (UTIs). This study evaluated its role in patients with vesicoureteral reflux (VUR) and its contribution to the pathophysiology of reflux nephropathy (RN). Methods: We conducted a cross-sectional observational study of 25 pediatric patients with VUR, representing a subgroup analysis of a larger cohort examined in a previous study. We determined patients’ vitamin D status, correlated it with recurrent UTIs and RS, and explored its relationship with urinary LL-37, NGAL, and IL-6 levels as markers of innate immune function. Results: Serum vitamin D levels ranged from 10.7 to 123.2 ng/mL (mean 39.5 ng/mL); 12% had deficiency and 20% had insufficient levels. Low vitamin D levels were detected in patients with more than five acute pyelonephritis (APNs), with a mean value classified as insufficient (27.3 ng/mL). Patients with RS had a lower mean vitamin D level compared to those without (30.51 ng/mL vs. 41.23 ng/mL), though the difference was not statistically significant (p = 0.39). No significant associations were found between vitamin D and urinary IL-6 or NGAL levels. A strong positive correlation was observed between vitamin D and urinary LL-37/creatinine (r = 0.78, r² = 0.61). Conclusions: Vitamin D appears to influence the frequency of UTIs and the development of RS, primarily by modulating LL-37 secretion, suggesting a possible role in the pathophysiology of RN. Full article

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and are traditionally considered acute and self-limited conditions. However, growing evidence suggests that recurrent or persistent UTIs may contribute to chronic kidney disease (CKD) progression through complex interactions between uropathogens and host responses. This review examines the pathophysiological links of UTIs caused by uropathogenic Escherichia coli, Klebsiella spp., and Enterococcus spp. and the development of chronic renal injury. Pathogen-specific persistence mechanisms, including intracellular survival, biofilm formation, and chronic colonization, may promote sustained inflammation, oxidative stress, and maladaptive repair responses. These processes are associated with tubular injury and progressive fibrotic remodeling. In addition, host-related factors such as diabetes, immune dysfunction, and antimicrobial resistance may further influence disease progression. Emerging biomarkers of inflammation, tubular injury, and fibrosis may improve early detection and risk stratification in patients with recurrent or complicated UTIs. Collectively, these findings support the concept that recurrent UTIs may represent potential contributors to CKD progression in susceptible individuals and highlight the importance of early recognition, pathogen-oriented management, and improved diagnostic strategies. Full article

Background/Objectives: Escherichia coli is the predominant pathogen in community-onset urinary tract infections (UTIs) requiring hospitalization. This study characterized antimicrobial resistance profiles, biofilm formation, extended-spectrum β-lactamase (ESBL) gene distribution, and phylogenetic background of E. coli isolates from hospitalized UTI patients in Western Mexico. Methods: Seventy isolates (September 2023–September 2024) underwent susceptibility testing (CLSI M100, 35th edition), multiplex PCR for blaTEM, blaCTX-M, and blaSHV genes, crystal violet biofilm quantification, and Clermont quadruplex PCR phylotyping. Associations were evaluated by Fisher’s exact test with Benjamini–Hochberg FDR (BH-FDR) correction. Results: ESBL phenotype and MDR were detected in 57.1% and 58.6% of isolates. After BH-FDR correction, ESBL production was significantly associated with amikacin (OR = 5.55; 95% CI: 1.80–18.74; q = 0.002) and TMP-SMX non-susceptibility (OR = 3.00; 95% CI: 1.02–9.23; q = 0.036); ciprofloxacin non-susceptibility was linked to MDR status (OR = 7.21; 95% CI: 1.28–75.66; q = 0.017) but not ESBL phenotype. Biofilm was detected in 77.1% of isolates. blaTEM predominated among ESBL producers (85.0%). Phylogroup B2 (51.4%) was inversely associated with recurrent UTI on both univariate (OR = 0.17; 95% CI: 0.03–0.73; p = 0.008) and adjusted analysis (adjusted OR = 0.19; 95% CI: 0.05–0.81; p = 0.025). Phylogroup C (22.9%) exhibited the highest MDR prevalence (81.3%) and the highest biofilm formation rate among phylogroups (87.5%). Conclusions: The high prevalence of ESBL-producing and MDR E. coli, combined with an unexpected predominance of blaTEM, reveals a distinctive local resistance landscape diverging from regional trends. The inverse association of phylogroup B2 with recurrence and TMP-SMX resistance reinforces the clinical value of phylogenetic surveillance in guiding UTI management strategies. Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is of great concern because of the difficulties encountered in the management of infections it may cause. This study aims to identify possible difficulties in the management of K. pneumoniae infections in the current context of antibiotic resistance, particularly regarding carbapenem resistance. Methods: This is a retrospective, cross-sectional study that analyses epidemiological, clinical and bacteriological features identified in all patients with CRKP infections/colonization admitted during 2024 in an infectious diseases hospital. Results: Carbapenemase-producing K. pneumoniae isolates were co-harboring NDM+OXA-48 in 55.2% of cases. NDM+OXA-48-producing K. pneumoniae (116 isolates, 55.2%) was correlated with high resistance to aztreonam (100%, p = 0.01), ceftazidime–avibactam (100%, p < 0.01), trimethoprim–sulfamethoxazole (99.1%, p < 0.01), gentamycin (94.8%, p < 0.01), amikacin (93.8%, p < 0.01), colistin (79.8%, p < 0.01). OXA-48-producing K. pneumoniae (29 isolates, 13.8%) was correlated with lower resistance to ceftazidime–avibactam (11.5%, p < 0.01), amikacin (48.1%, p < 0.01), colistin (51.7%, p = 0.01), and gentamycin (65.5%, p < 0.01). We found in vitro synergistic effects of ceftazidime/avibactam + aztreonam for 32/32 CRKP isolates and of colistin + tigecycline for 12/14 CRKP isolates. Higher recurrence of CRKP infections was recorded in patients with urinary tract conditions (RR = 11.58, 95%CI: 1.58–81.91) and upper urinary tract devices (RR = 3.53, 95% CI: 1.72–7.22). In this study, adequate antibiotic treatment, compared to excessive antibiotic treatment in CRKP infections, was associated with shorter treatment duration (p = 0.02) and shorter length of hospitalization (p = 0.04). Conclusions: In our study, CRKP is frequently coharboring NDM+OXA-48, having limited treatment options. Implementing new treatment strategies, testing antibiotic synergies for older antibiotics in order to identify alternative treatment options and avoiding unnecessary carbapenem consumption are essential for decreasing the burden of CRKP infections. Full article

Background: The emergence and spread of urinary carbapenem-resistant organisms (CROs) are a major public health concern, particularly in Sri Lanka. Therefore, we aimed to detect and genotypically characterize CROs in urinary tract infections (UTIs) and their clinical outcomes. Methods: Urinary CROs were collected from two hospitals in Sri Lanka from January to December, 2023. Among 7640 urine samples, 100 CROs were identified by disk diffusion method, and 99 were detected by BD Pheonix^TM automated system. The presence of eight carbapenemase genes; bla_KPC, bla_NDM, bla_VIM, bla_IMP, bla_OXA-23, bla_OXA-48, bla_OXA-51, and bla_OXA-58, among 97 CROs was detected by a multiplex PCR kit. Results: Out of 99 urinary CROs, K. pneumoniae (33.3%; n = 33/97) was the most common species. Among the 97 isolates tested by PCR, a single carbapenemase gene was detected in 35.05% (34/97), while two or more genes co-occurred in 39.18% (38/97). The most frequently identified gene was bla_OXA-51 (47.4%), followed by bla_OXA-58 (41.2%). Most patients (95.74%; n = 90/97) showed clinical improvement within seven days of treatment. Among the 93 patients discharged and followed for three months, 74.20% (n = 69/93) experienced at least one mild UTI recurrence. A total of 10 patients died during the study period. Of which, four (40%) during hospitalization and six (60%) during follow-up, though none of the deaths were attributed to UTIs. Conclusions: K. pneumoniae, showed the highest carbapenemase gene diversity. Recurrent UTIs were observed during the follow-up period. Continuous surveillance and implementation of targeted infection control programs are needed to minimize further emergence and spread of carbapenemase genes. Full article