Antibiotic resistance in adult female patients hospitalized for acute pyelonephritis: Rates and predicting factors

A Systematic Literature Review of the Epidemiology of Complicated Urinary Tract Infection

INTRODUCTION

Urinary tract infections (UTIs) are common bacterial infections and present with heterogeneous clinical phenotypes. Whereas many uncomplicated UTIs resolve spontaneously or with antibiotic treatment, a complicated UTI (cUTI) presents with greater morbidity and a higher risk of treatment failures. The goal of this study was to estimate the real-world epidemiology of cUTI, including acute pyelonephritis (AP) and catheter-associated UTIs (CAUTIs), and its associated mortality internationally.

METHODS

A systematic literature search was conducted using PubMed, Embase, Cochrane, and EconLit databases for relevant articles published between July 2013 and July 2023 covering Europe and the following countries: France, Italy, Germany, Spain, the UK, China, Japan, and the US (US). Search terms relating to cUTI, AP, CAUTI, outcomes of interest (epidemiology), and real-world research designs were used. There were no language limitations (protocol registry: PROSPERO-CRD42023454794).

RESULTS

Database searches yielded 1014 unique records, of which 91 met the prespecified inclusion criteria; bibliography and conference abstract searches yielded 27 additional records for a total of 118 records for inclusion. Disease presentation and reported outcomes varied widely across studies, and most studies reporting incidence and prevalence of cUTI were from the US (21 of 29). No studies reporting incidence or prevalence rates of cUTI in China, Germany, or the UK were identified. Overall, high antibiotic resistance rates were reported in both inpatient and outpatient settings. The inpatient cohort mortality rates were highly variable (0-50%) depending on the patient population.

CONCLUSIONS

While disease presentation and reported outcomes varied widely across studies, cUTIs represent a considerable burden in terms of incidence, prevalence, drug resistance, and mortality, yet vast knowledge gaps remain in the literature. There is a crucial need to address these gaps to effectively evaluate new treatments and improve future analyses of cUTI burden and outcomes.

[Infectious emergencies in urology]

OBJECTIVE

To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology.

MATERIAL AND METHODS

Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies.

RESULTS

Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection.

CONCLUSION

Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.