• Ionela-Larisa MIFTODE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Aida BADESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Egidia MIFTODE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • C. PREPELIUC “Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi
  • Olivia Simona DORNEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi


Antibiotic resistance represents a global crisis, one of the biggest challenges that humanity is facing. In addition to the SARS-Cov-2 pandemic, we are currently witnessing another, more devastating pandemic of multidrug-resistant micro-organisms, not only in hospitals but also in the community. Material and methods: we aimed to analyze the incidence and implications of urinary isolated, extended-spectrum β-lactamase-producing (ESBL+) Enterobacterales, from patients admitted between 01/01/2018 and  31/12/2018. Results: the main identified pathogen was Escherichia coli, accounting for 67.3% of all cases; the ESBL-production rate was 26.5%, with E. coli and Klebsiella pneumoniae emerging as leading etiologies. Mean age was significantly higher for patients with ESBL+ isolates (57.6 vs.  65.1 years, p<0.0001), while urinary catheterization was more frequently associated with ESBL+ strains (21.8% ESBL+ vs.  6.2% ESBL-, p<0.0001). As anticipated, antibiotic susceptibility was significantly influenced both by ESBL production and urinary catheterization, except for nitrofurantoin and fosfomycin. Conclusions: comprehensive approach  of the local antibiotic susceptibility profile can facilitate the choice of a proper therapeutic management, based on regional particularities of an East European country.

Author Biographies

Ionela-Larisa MIFTODE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)
“Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi

Aida BADESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Preventive Medicine and Interdisciplinarity
“Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi

Egidia MIFTODE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)
 “Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi

Olivia Simona DORNEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Preventive Medicine and Interdisciplinarity
“Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi


1. CDC. Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) Events, January 2022. Available at: . Accessed on 17 May 2022.
2. Xiao Y, Hang Y, Chen Y, et al. A Retrospective Analysis of Risk Factors and Patient Outcomes of Bloodstream Infection with Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Chinese Tertiary Hospital. Infect Drug Resist 2020; 13: 4289-4296.
3. Liu H, Qiu S, Chen M, et al. A clinical prediction tool for extended-spectrum β-lactamase-producing Enterobacteriaceae urinary tract infection. BMC Infect Dis 2022; 22(1): 50 /
4. Akpaka PE, Vaillant A, Wilson C, Jayaratne P. Extended Spectrum Beta-Lactamase (ESBL) Produced by Gram-Negative Bacteria in Trinidad and Tobago. Int J Microbiol 2021; 2021: 5582755.
5. Leylabadlo HE, Pourlak T, Bialvaei AZ, et al. Extended-spectrum beta-lactamase producing gram negative bacteria in Iran: a review. Afr J Infect Dis 2017; 11(2): 39-53.
6. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 2015; 13(5): 269-284.
7. Larramendy S, Gaultier A, Fournier JP, et al. Local characteristics associated with higher prevalence of ESBL-producing Escherichia coli in community-acquired urinary tract infections: an observational, cross-sectional study. J Antimicrob Chemother 2021; 76(3): 789-795.
8. Miftode IL, Nastase EV, Miftode R, et al. Insights into multidrug resistant K. pneumoniae urinary tract infections: From susceptibility to mortality. Exp Ther Med 2021; 22: 1086 / doi: 10.3892/etm. 2021.10520.
9. Miftode IL, Pasare MA, Miftode RS, et al. What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe. Antibiotics 2022; 11(5): 548 / doi: 10.3390/antibiotics11050548.
10. Klein RD, Hultgren SJ. Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies. Nat Rev Microbiol 2020; 18(4): 211-226.
11. Huang L, Huang C, Yan Y, Sun L, Li H. Urinary Tract Infection Etiological Profiles and Antibiotic Resistance Patterns Varied Among Different Age Categories: A Retrospective Study From a Tertiary General Hospital During a 12-Year Period. Front Microbiol 2022; 12: 813145.
12. DeRosa A, Carter MT, Wattengel BA, et al. Antimicrobial susceptibility trends for urinary isolates in the veteran population. Am J Infect Control 2021; 49(5): 576-581.
13. Farfour E, Dortet L, Guillard T, et al. Antimicrobial Resistance in Enterobacterales Recovered from Urinary Tract Infections in France. Pathogens 2022; 11(3): 356 / doi: 10.3390/pathogens11030356.
14. Balasubramanian S, Kuppuswamy D, Padmanabhan S, et al. Extended-spectrum Beta-lactamase-producing Community-acquired Urinary Tract Infections in Children: Chart Review of Risk Factors. J Glob Infect Dis 2018; 10(4): 222-225.
15. Eshwarappa M, Dosegowda R, Aprameya IV, et al. Clinico-microbiological profile of urinary tract infection in south India. Indian J Nephrol 2011; 21(1): 30-36.
16. Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India. Ann Clin Microbiol Antimicrob 2007; 6: 4.
17. Miftode RS, Costache II, Cianga P, et al. Influence of Socioeconomic Status on the Prognosis and Profile of Patients Admitted for Acute Heart Failure during COVID-19 Pandemic: Overestimated As-pects or a Multifaceted Hydra of Cardiovascular Risk Factors? Healthcare 2021; 9(12): 1700.
18. Jansåker F, Li X, Sundquist K. Sociodemographic factors and uncomplicated cystitis in women aged 15-50 years: a nationwide Swedish cohort registry study (1997-2018). Lancet Reg Health Eur 2021; 4 :100108 / doi: 10.1016/j.lanepe.2021.100108.
19. Yun L, Yuan L, Feng X, et al. Antimicrobial susceptibility surveillance of gram-negative bacterial from Mohnarin 2011-20112. Chin J Clin Pharmacol 2014; 30: 260-277.
20. Fupin HU, Yan GUO, Demei ZHU, et al. CHINET surveillance of bacterial resistance across China: report of the results in 2016. Chin. J. Infect. Chemother. 2017; 17: 481-491.
21. Lob SH, Nicolle LE, Hoban DJ, et al. Susceptibility patterns and ESBL rates of Escherichia coli from urinary tract infections in Canada and the United States, SMART 2010-2014. Diagn Microbiol Infect Dis 2016; 85(4): 459-465.
22. Jia P, Zhu Y, Li X, et al. High Prevalence of Extended-Spectrum Beta-Lactamases in Escherichia coli Strains Collected From Strictly Defined Community-Acquired Urinary Tract Infections in Adults in China: A Multicenter Prospective Clinical Microbiological and Molecular Study. Front Microbiol 2021; 12: 663033.
23. Chenoweth CE. Urinary tract infections: 2021 Update. Infec Dis Clinic N Amer 2021; 35(4): 857-870.
24. Oumer Y, Regasa Dadi B, Seid M, Biresaw G, Manilal A. Catheter-Associated Urinary Tract Infection: Incidence, Associated Factors and Drug Resistance Patterns of Bacterial Isolates in Southern Ethiopia. Infect Drug Resist 2021; 14: 2883-2894.
25. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections, 2011. New England J Med 2014; 370: 1198-1208.
26. Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents 2001; 17(4): 299-303.
27. Weinstein JW, Mazon D, Pantelick E, et al. A decade of prevalence surveys in a tertiary-care center: Trends in nosocomial infection rates, device utilization, and patient acuity. Infect Control Hosp Epi-demiol 1999; 20(8): 543-548.
28. Munasinghe RL, Yazdani H, Siddique M, Hafeez W. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol 2001; 22(10): 647-649.
29. Saint S, Wiese J, Amory JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000; 109(6): 476-480.
30. McGuckin M. The patient survival guide: 8 simple solutions to prevent hospital and healthcare-associated infections. New York, NY: Demos Medical Publishing, 2012.
31. Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35: 464-479.
32. Weiner-Lastinger LM, Abner S, Edwards JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017. Infect Control Hosp Epidemiol 2020; 41(1): 1-18.
33. Barbadoro P, Labricciosa FM, Recanatini C, et al. Catheter-associated urinary tract infection: Role of the setting of catheter insertion. Am J Infect Control 2015; 43(7): 707-710.
34. Ahmed M. Pattern of nosocomial urinary tract infections among Sudanese patients. Br Microbiol Res J 2012; 2(2): 53-61.
35. Richelsen R, Smit J, Anru PL, Schønheyder HC, Nielsen H. Incidence of community-onset extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae infections: an 11-year population-based study in Denmark. Infect Dis (Lond) 2020; 52(8): 547-556.
36. Albaramki JH, Abdelghani T, Dalaeen A, et al. Urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and antibiotic resistance. Pediatr Int 2019; 61(11): 1127-1132.
37. Vachvanichsanong P, McNeil EB, Dissaneewate P. Extended-spectrum beta-lactamase Escherichia coli and Klebsiella pneumoniae urinary tract infections. Epidemiol Infect 2020; 149: e12.