Challenges in the Treatment of Urinary Tract Infections: Antibiotic Resistance Profiles of <i>Escherichia coli</i> Strains Isolated from Young and Elderly Patients in a Southeastern Romanian Hospital

Challenges in the Treatment of Urinary Tract Infections: Antibiotic Resistance Profiles of <i>Escherichia coli</i> Strains Isolated from Young and Elderly Patients in a Southeastern Romanian Hospital

<b>Background/Objectives</b>: Urinary tract infections (UTIs) represent a significant public health challenge, with <i>Escherichia coli</i> being the primary causative pathogen. The rise in antimicrobial resistance (AMR), further intensified by shifts in antibiotic prescribin...

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Main Authors: Andreea-Elena Topa, Constantin Ionescu, Anca Pinzaru, Elena Mocanu, Ana Maria Iancu, Elena Dumea, Bogdan Florentin Nitu, Florin Gabriel Panculescu, Simona Claudia Cambrea
Format: Article
Language:English
Published: MDPI AG 2025-04-01
Series:Biomedicines
Subjects:
<i>Escherichia coli</i>
urinary tract infections
antimicrobial resistance
antibiotic stewardship
Online Access:https://www.mdpi.com/2227-9059/13/5/1066
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Summary:<b>Background/Objectives</b>: Urinary tract infections (UTIs) represent a significant public health challenge, with <i>Escherichia coli</i> being the primary causative pathogen. The rise in antimicrobial resistance (AMR), further intensified by shifts in antibiotic prescribing practices during and after the COVID-19 pandemic, poses substantial difficulties in treatment optimization and clinical management. <b>Methods</b>: This retrospective study analyzed 644 <i>E. coli</i> strains from urine samples collected in a southeastern Romanian hospital during two periods: pre-pandemic (2018–2019, N = 361) and post-pandemic (2023–2024, N = 283). Antimicrobial susceptibility was assessed using the VITEK automated system for key antibiotic classes. <b>Results</b>: A significant increase in fluoroquinolone resistance was observed, especially for ciprofloxacin (<i>p</i> = 0.02), alongside rising ceftriaxone resistance (<i>p</i> = 0.004), suggesting the spread of ESBL-producing strains. Resistance to trimethoprim/sulfamethoxazole, ampicillin, and amoxicillin/clavulanic acid remained high, limiting their empirical use. Carbapenem resistance was low (<i>p</i> > 0.1), while nitrofurantoin and fosfomycin retained high efficacy (<i>p</i> = 0.26 and <i>p</i> = 0.64). <b>Conclusions</b>: The post-pandemic period showed a concerning rise in resistance to fluoroquinolones and third-generation cephalosporins, highlighting the need for stricter antimicrobial stewardship. Carbapenems remain effective for severe infections, while nitrofurantoin and fosfomycin are reliable first-line options for uncomplicated UTIs. Continuous AMR surveillance is essential to optimize treatment and curb multidrug-resistant strains.
ISSN:2227-9059

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