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Antimicrob Resist Infect Control. 2018 Sep 14;7:111. doi: 10.1186/s13756-018-0401-6. eCollection 2018.

Predictive factors for multidrug-resistant gram-negative bacteria among hospitalised patients with complicated urinary tract infections.

Author information

1Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
2Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
3Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
4University of Barcelona, Barcelona, Spain.
5Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
AiCuris Anti-infective Cures GmbH, Wuppertal, Germany.
7UCL Department of Applied Health Research, University College London, London, UK.
8Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain.
9Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
10Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.



Patients with complicated urinary tract infections (cUTIs) frequently receive broad-spectrum antibiotics. We aimed to determine the prevalence and predictive factors of multidrug-resistant gram-negative bacteria in patients with cUTI.


This is a multicenter, retrospective cohort study in south and eastern Europe, Turkey and Israel including consecutive patients with cUTIs hospitalised between January 2013 and December 2014. Multidrug-resistance was defined as non-susceptibility to at least one agent in three or more antimicrobial categories. A mixed-effects logistic regression model was used to determine predictive factors of multidrug-resistant gram-negative bacteria cUTI.


From 948 patients and 1074 microbiological isolates, Escherichia coli was the most frequent microorganism (559/1074), showing a 14.5% multidrug-resistance rate. Klebsiella pneumoniae was second (168/1074) and exhibited the highest multidrug-resistance rate (54.2%), followed by Pseudomonas aeruginosa (97/1074) with a 38.1% multidrug-resistance rate. Predictors of multidrug-resistant gram-negative bacteria were male gender (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.20-2.29), acquisition of cUTI in a medical care facility (OR, 2.59; 95%CI, 1.80-3.71), presence of indwelling urinary catheter (OR, 1.44; 95%CI, 0.99-2.10), having had urinary tract infection within the previous year (OR, 1.89; 95%CI, 1.28-2.79) and antibiotic treatment within the previous 30 days (OR, 1.68; 95%CI, 1.13-2.50).


The current high rate of multidrug-resistant gram-negative bacteria infections among hospitalised patients with cUTIs in the studied area is alarming. Our predictive model could be useful to avoid inappropriate antibiotic treatment and implement antibiotic stewardship policies that enhance the use of carbapenem-sparing regimens in patients at low risk of multidrug-resistance.


Complicated urinary tract infection; Gram-negative bacteria; Multidrug-resistance; Predictive model of multidrug-resistance gram-negative bacteria

Conflict of interest statement

This study was approved by the local research ethics committee of each site. The processing of patients’ personal data was anonymised and complied with local data protection legislations and with the European Union Data Protection Directive (95/46/EC). As no individual data is published as well as no intervention was performed to patients, patient consent was waived by the Ethics Committee.No applicable.Authors IA, CV, IW, and CV belong to EFPIA (European Federation of Pharmaceutical Industries and Association) member companies in the IMI JU and costs related to their part in the research were carried by the respective company as in kind contribution under the IMI JU scheme. Other authors declare no potential conflicts.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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