Keywords
antimicrobial resistance
ESBL
catheter associated infection
urology
How to Cite
Abstract
Background: Urinary tract infections (UTIs) remain among the most prevalent bacterial infections encountered in urology, yet the escalating burden of antimicrobial resistance (AMR) has significantly complicated both empirical and targeted therapeutic strategies. Patients undergoing surgical interventions with prolonged urinary catheterization represent a particularly vulnerable subgroup, often predisposed to resistant infections.
Aim: This study aimed to characterize the frequency, microbiological spectrum, predisposing factors, and treatment outcomes of resistant UTIs in surgically treated patients at the Clinical Hospital of Tetovo, and to contextualize these findings within comparable international cohorts.
Materials and Methods: A retrospective observational analysis was conducted on 164 patients (140 men, 24 women) operated between January 2021 and January 2026. Clinical records, urine cultures, and antibiograms were reviewed. Statistical analyses included proportions with 95% confidence intervals (CIs) and chi‑square/Fisher exact tests, with significance set at p < 0.05.
Results: Resistant uropathogens were identified in 24/164 patients (14.6%; 95% CI 10.0–20.9%). Extended‑spectrum β‑lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae predominated, accounting for approximately three‑quarters of isolates. Multidrug‑resistant Pseudomonas aeruginosa and carbapenem‑resistant Enterobacterales were also observed. All affected patients had prolonged catheterization. Comorbidities were frequent, including cardiovascular disease (62.5%), diabetes mellitus (33.3%), and renal impairment (12.5%).
Conclusions: Resistant UTIs are a clinically significant challenge in surgically treated urology patients, strongly associated with catheterization, prior antibiotic exposure, and recurrent infection. The microbiological and risk‑factor profile aligns with international data. Rigorous culture‑guided therapy and catheter management remain pivotal in achieving favourable outcomes, underscoring the need for robust antimicrobial stewardship in modern urology.
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