Florentina COSTEA1†, Rodica BOCA2†, Loredana COSTEA3, Marta HRISCA1, and Violeta POPOVICI4*
1 Internal Medicine Department, Municipal Hospital, Vatra-Dornei, 725700, Romania
2 Dorna Medical, Vatra-Dornei, 725700, Romania
3 University of Medicine and Pharmacy „G.T. Popa” Iași, 700115, Romania
4 INCE/CE-MONT, Romanian Academy, Vatra-Dornei, 725700, Romania
*Corresponding author: violeta.popovici@ce-mont.ro
Abstract
In recent years, the medical community has been grappling with a pressing issue: the rise of antibiotic resistance in pathogenic microorganisms. This trend has made treating infectious diseases increasingly challenging, as the efficacy of many antibiotics has been compromised. This retrospective study examined 10,149 urine samples collected from Romanian patients residing in the northern mountainous area of the Eastern Carpathians in 2021–2022. Pathogenic bacteria were identified in 2420 (23.84%) urine cultures. Escherichia coli was preponderant (74.20±2.35%), followed by Klebsiella sp. and Enterococcus sp. (7.50±2.25% and 6.55±3.20%), Proteus sp., Pseudomonas aeruginosa and Staphylococcus aureus (2.42%, 2.18%, and 2.06%). The susceptibility of E. coli to antibiotics decreases in the order: Nitrofurantoin, Aminoglycosides (Gentamicin and Amikacin) and Cephalosporins gen III (Cefotaxime, Ceftriaxone), Fluoroquinolones (Ciprofloxacin and Levofloxacin), Fosfomycin, Amoxicillin & Clavulanic acid, Ampicillin, and Amoxicillin. Klebsiella sp. are significantly sensitive to Aminoglycosides, Amoxicillin & Clavulanic acid, Cephalosporins, and Fluoroquinolones. Enterococcus sp. has a remarkable susceptibility to Ampicillin, Amoxicillin, and Nitrofurantoin; Proteus sp. to Amoxicillin & Clavulanic acid and Cephalosporins; and P. aeruginosa to Piperacillin & Tazobactam, Amikacin, Ceftazidime, and Imipenem. S. aureus was identified in a few urine bacterial cultures, so the study was performed on methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) strains.
Our study’s findings have significant applications in UTI treatment strategy. E. coli, the most frequent pathogen of urinary tract infections, can be effectively targeted with Fluoroquinolones as the primary antibiotic therapy choice. This is particularly reassuring given the resistance levels of E. coli to Fluoroquinolones, significantly below the national average of approximately 29.1%. The second line antibiotics, including Aminoglycosides (Gentamicin, Amikacin), Beta-lactams (Amoxicillin & Clavulanic acid, Cephalosporins), and Nitrofurantoin, also revealed high inhibitory potential against E. coli and could be considered effective treatment options in urinary tract infections caused by this Gram-negative pathogen, offering hope for effective treatment strategies.
Keywords:
Urinary tract infections, pathogenic bacteria, urine bacterial culture, antibiotics,