Fuente: Microorganisms - Revista científica (MDPI) Microorganisms, Vol. 14, Pages 916: Clinical Predictors and Pathogen Resistance Dynamics in Hospitalized Patients with Urinary Tract Infections: A 2025 Institutional Study
Microorganisms doi: 10.3390/microorganisms14040916
Authors:
Ruxandra Laza
Ioana-Melinda Luput-Andrica
Adelina-Raluca Marinescu
Talida-Georgiana Cut
Alexandra Herlo
Andra-Elena Saizu
Andreea-Cristina Floruncut
Narcisa Nicolescu
Romanita Jumanca
Daniela-Ica Rosoha
Voichita Elena Lazureanu
Romosan Ana-Maria

The escalating prevalence of antimicrobial resistance (AMR) in Gram-negative uropathogens represents a critical bottleneck in global clinical management. This study evaluated shifting resistance phenotypes and patient risk profiles to identify independent predictors of multidrug resistance (MDR). A comprehensive retrospective analysis was conducted on a cohort of 318 patients, utilizing statistical modeling to evaluate the impact of demographics, prolonged hospitalization, and comorbidities on MDR. Findings revealed a significant longitudinal exacerbation of resistance since 2012. A majority of Klebsiella pneumoniae strains and nearly all Myroides and Providencia species exhibited high-level resistance to cephalosporin/beta-lactamase inhibitor combinations. While high-dose piperacillin-tazobactam remains a therapeutic alternative, its utility is increasingly constrained by escalating Minimum Inhibitory Concentrations (MICs) for Klebsiella and Escherichia coli (E. coli). Statistical modeling identified advanced age as the primary independent driver, with MDR risk increasing linearly with every additional year of age. Furthermore, indwelling catheterization was strongly associated with resistant infections, while human immunodeficiency virus (HIV) status emerged as a significant cofactor in the selection of highly resistant strains. These findings underscore the need for a critical recalibration of therapeutic frameworks, prioritizing precision-guided stewardship. Pharmacodynamic optimization, through extended or continuous infusion regimens and individualized loading doses, is essential to mitigate the clinical burden of resistant pathogens within vulnerable geriatric cohorts.