The prevalence of multiple drug resistant urinary tract infections: A single-centered, observational retrospective study in King Abdulaziz Specialized Hospital, Taif, Saudi Arabia

Faisal K. Alhomayani; Naif M. Alazwari; Mohammed S. Alshhrani; Ali S. Alkhudaydi; Abdullah S. Basaba; Tariq M. Alharthi; Muhanad M. Alghamdi; Abdulaziz S. Aljuaid; Nasser M. Alosimi; Abdulmajeed M. Alqethami

doi:10.15537/smj.2022.43.8.20220238

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Table 1

- Frequency distribution of the biosociodemogaphic characteristics of the studied patients.

Characteristics	n (%)
Age, mean±SD (range)
<30	18±7.5
30-50	38±15.8
50-70	71±29.6
>70	113±47.1
Gender
Female	134 (55.8)
Male	106 (44.2)
Positive culture UTI
MDR	111 (46.3)
Non MDR	129 (53.8)
Chronic medical disease (MDR)
Hypertension	64 (57.7)
Diabetes mellitus	69 (62.2)
Congestive heart failure	13 (11.7)
Chronic lung disease	3 (2.7)
Chronic liver disease	2 (1.8)
Chronic renal failure	31 (27.9)
Bedridden	40 (36.0)
Ventral nervous system disorders like CVA	28 (25.2)
Malignancy	7 (6.3)
Human immunodeficiency virus	0 (0.0)
Risk factors (MDR)
Previous hospitalization (≤1 year)	66 (59.5)
UTI in (≤1 year)	48 (43.2)
Previous antibiotics (≤3 months)	40 (36.0)
Urinary catheters (≤3 months)	57 (51.3)
Urologic diseases	34 (30.6)
Immunosuppressive/chemotherapy drugs (≤3months)	12 (10.8)

Values are presented as number and percentage (%). SD: standard deviation. UTI: urinary tract infection, MDR: multidrug resistance, CVA: cerebral vascular attack

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Table 2

- Distribution of drug susceptibility in multidrug resistance group (N=111).

Variables	n (%)
Cipro	23 (20.7)
Pipracillin tazbactam	1 (0.9)
Ceftrixone	9 (8.1)
Ceftazidime	1 (0.9)
Meropinum or meropenem	27 (24.3)
Levofloxacin	5 (4.5)
Metronedazole	1 (0.9)
Tazocine	17 (15.3)
Augmentin	8 (7.2)
Linezolid	4 (3.6)
Levofluxacin	1 (0.9)
Vancomycin	1 (0.9)
Cefepime	1 (0.9)
Doxy	1 (0.9)
Tigecycline	1 (0.9)
Cefazolin	1 (0.9)

Values are presented as number and percentage (%).

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Table 3

- Correlation between age, gender, urinary tract infection in ≤1 year, urologic diseases, and presence of multiple drug resistance.

Variables	Groups			Chi-square
	MDR	Non-MDR	Total	X²	P-value
Age
<30	3 (2.7)	15 (11.6)	18 (7.5)	20.061	<0.001^{^*}
30-50	13 (11.7)	25 (19.4)	38 (15.8)
50-70	27 (24.3)	44 (34.1)	71 (29.6)
>70	68 (61.3)	45 (34.9)	113 (47.1)
Gender
Female	54 (48.6)	80 (62.0)	134 (55.8)	4.323	0.038^{^*}
Male	57 (51.4)	49 (38.0)	106 (44.2)	4.323	0.038^{^*}
UTI in ≤1 year
No	1 (56.8)	127 (98.4)	190 (79.2)	62.88	<0.001^{^*}
Yes	48 (43.2)	2 (1.6)	50 (20.8)	62.88	<0.001^{^*}
Urologic diseases
No	78 (70.3)	109 (84.5)	187 (77.9)	7.01	0.008^{^*}
Yes	33 (29.7)	20 (15.5)	53 (22.1)	7.01	0.008^{^*}

Values are presented as number and percentage (%).

↵* Significant at p<0.05. MDR: multiple drug resistance, UTI: urinary tract infection

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Table 4

- Frequency distribution of patients’ culture profile.

Variables	n (%)
Common organisms (MDR and non-MDR)
E. coli	41 (17.1)
Klebsiella spp	44 (18.3)
Proteus spp	30 (12.5)
Enterococcus spp	21 (8.8)
Others	146 (60.8)
Non-MDR organisms
E. coli	23 (17.8)
Klebsiella spp	26 (20.2)
Proteus spp	24 (18.6)
Enterococcus spp	14 (10.9)
Mixed MDR	5 (3.9)
Others	24 (18.6)
MDR organisms
Gram-positive	19 (17.1)
Gram-negative	92 (82.9)
Anaerobes	95 (85.6)
Aerobes	16 (14.4)
Empirical antibiotics for culture positive MDR
Ciprofloxacin	41 (36.9)
Amoxicillin/clavulanic acid	15 (13.5)
Piperacillin/tazobactam	11 (9.9)
Ceftriaxone	29 (26.1)
Ceftazidime	9 (8.1)
Others	6 (5.4)

Values are presented as number and percentage (%). MDR: multidrug resistant, E. coli: Escherichia coli, spp: several species

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Table 5

- Frequency of antimicrobial resistance of common multiple drug resistance uropathogens (N=87).

Antibiotics	MDR organisms				Chi-square
	E.coli (n=23)	Klebsiella spp (n=26)	Proteus spp (n=24)	Enterococcus spp (n=14)	X²	P-value
Ciprofloxacin	19 (82.6)	24 (92.3)	22 (91.7)	14 (100)	3.360	0.339
Gentamicin	13 (56.5)	16 (61.5)	18 (75.0)	7 (50.0)	2.874	0.411
Ampicillin	9 (39.1)	20 (76.9)	12 (50.0)	3 (21.4)	13.187	0.004^*
Amoxcillin/clavulanic acid	10 (43.5)	21 (80.8)	15 (62.5)	4 (28.6)	12.649	0.005^*
Piperacillin/tazobactam	3 (13.0)	3 (11.5)	1 (4.2)	0 (0.0)	2.918	0.404
Ceftriaxone	9 (39.1)	22 (84.6)	11 (45.8)	2 (14.3)	20.849	<0.001^*
Ceftazidime	7 (30.4)	11 (42.3)	9 (37.5)	1 (7.1)	5.586	0.134
Cefepime	7 (30.4)	12 (46.2)	10 (41.7)	1 (7.1)	6.915	0.075
Tetracycline	1 (4.4)	0 (0.0)	2 (8.3)	5 (35.7)	15.093	0.002^*
Co-trimoxazole	15 (65.2)	6 (23.1)	9 (37.5)	1 (7.1)	15.555	<0.001^*
X²	46.953	99.301	63.349	56.925
P-value	<0.001^*	<0.001^*	<0.001^*	<0.001^*

↵^* Significant relationship. Values are presented as number and percentage (%). MDR: multiple drug resistance, E. coli: Escherichia coli, spp: several species

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Table 6

- Multivariate logistic regression analysis of risk factor of multiple drug resistance in urinary tract infection patients.

Variables	B	S.E.	Wald	P-value	Odd ratio	95% CI
						Lower	Upper
Age	0.01	0.009	3	0.083	0.98	0.98	1
Gender	0.57	0.35	2.65	0.1	0.58	0.28	1.12
UTI in ≤1 year	3.4	0.77	19.25	<0.001^*	0.03	0.007	0.15
Urologic diseases	0.51	0.4	1.58	0.209	0.59	0.26	1.33
Escherichia coli	0.001	0.41	0.001	0.999	0.99	0.44	2.24
Klebsiella pneumoniae	0.46	0.44	1.1	0.292	0.62	0.26	1.49
Proteus mirabilis	1.5	0.54	7.67	0.006^*	0.22	0.07	0.64
Enterococcus faecium	1.08	0.72	2.22	0.136	0.33	0.08	1.4
Cipro	0.25	0.43	0.34	0.556	1.29	0.54	3.05
Ceftrixone	1.83	0.69	3.94	0.047^*	0.25	0.06	0.98
Meropinum or meropenem	0.45	0.63	0.5	0.477	0.63	0.18	2.21
levofloxacin	0.02	0.89	0.001	0.978	0.97	0.17	5.58
Tazocine	0.56	0.47	1.4	0.236	0.56	0.22	1.44
Augmentin	1.02	0.74	1.19	0.166	0.35	0.08	1.53
Linezolid	0.55	1.6	0.11	0.731	0.57	0.02	13.26
Constant	3.09	0.8	14.94	<0.001	22.15