Resistance of Enterobacterales causing community-acquired urinary tract infections in the Russian Federation in 2024: data from the RESOURCE-2 study

Andreeva E.M., Izotova A.A., Mikhailova L.V., Rafalskiy V.V., Kovalenko N.A., Erenburg A.V., Gadzhieva Z.K., Kryukova N.O., Roitman A.P., Shabanova N.E., Zakharova A.V., Priputnevich T.V., Yakovlev S.V.

1) Immanuel Kant Baltic Federal University, Kaliningrad, Russia; 2) I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia; 3) Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia, Moscow, Russia; 4) V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 5) Independent Laboratory INVITRO LLC, Moscow, Russia

Introduction. The problem of rational antimicrobial therapy for urinary tract infections (UTIs) remains highly relevant for physicians of various specialties. Knowledge of the level of antibiotic resistance among UTI pathogens is critically important for the choice of empirical therapy, prevention of recurrence, chronic infection, and complications such as urosepsis and stone formation.
Aim. To analyze antibacterial resistance data for the main pathogens causing community-acquired UTIs, namely Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis, in the Russian Federation in 2024.
Materials and methods. A retrospective analysis was performed on 185,480 urine samples collected in outpatient settings throughout Russia. Microorganism identification was carried out using an automated analyzer and identification systems (VITEK2, MALDI Biotyper). Antimicrobial susceptibility was determined in accordance with the Russian guidelines “Determination of susceptibility to antimicrobial agents” 2024 [14].
Results. Pathogens at a diagnostic titer (≥104 CFU/mL) were isolated in 23.5% (n=43,550) of the analyzed samples. The distribution of pathogens was as follows: E. coli – 64.1%, K. pneumoniae – 13.1%,
P. mirabilis – 3.6%. The resistance profile of E. coli varied substantially depending on the demographic group. The most unfavorable situation was observed in adult men, with resistance to fluoroquinolones exceeding 57% and resistance to third-generation cephalosporins approximately 48%, whereas the most favorable situation was observed in pregnant women. Fosfomycin and nitrofurantoin retained the highest activity against E. coli in women, with more than 96% of strains remaining susceptible. K. pneumoniae was characterized by a markedly higher level of resistance to all major classes of antibacterial agents, including critically low susceptibility to meropenem (70.7%). P. mirabilis retained high susceptibility to carbapenems (98.4%) and third-generation cephalosporins (83.9%).
Conclusions. The obtained data highlight the need to take into account the patient’s sex, age, and physiological status when selecting empirical therapy for UTIs. Fosfomycin and nitrofurantoin confirmed their status as first-line agents for uncomplicated UTIs in women. The high resistance of uropathogens to fluoroquinolones and co-trimoxazole necessitates restricting their use. The identified increase in resistance of K. pneumoniae to amikacin requires special attention in the treatment of complicated UTIs.

Keywords

About the Authors

Corresponding author: V.V. Rafalskiy – Ph.D., MD, Professor, Head of the Department of General and Clinical Pharmacology, Director of the Center for Clinical Research, Institute of Medicine and Life Sciences (MEDBIO), Immanuel Kant Baltic Federal University, Kaliningrad, Russia; e-mail: v.rafalskiy@mail.ru

Similar Articles