# Nonenteric Pathogens in Urinary Tract Infections: Epidemiology and Resistance Patterns in Albania

## TL;DR

This study examines nonenteric bacteria causing urinary tract infections in Albania, finding high rates of antibiotic resistance, especially in women and young adults.

## Contribution

The study provides new insights into the prevalence and resistance patterns of nonenteric pathogens in community-acquired UTIs in Albania.

## Key findings

- Nonenteric pathogens accounted for 27.7% of positive urine cultures, with Enterococcus faecalis and Pseudomonas aeruginosa being the most common.
- Pseudomonas aeruginosa showed high resistance to tigecycline and levofloxacin, while Enterococcus faecalis had significant resistance to vancomycin and teicoplanin.
- Multidrug resistance was highest in Pseudomonas aeruginosa at 26.5%, highlighting the need for improved antibiotic stewardship.

## Abstract

Introduction: Antibiotic resistance is a growing global health crisis that complicates the treatment of urinary tract infections (UTIs). While Enterobacterales are primary UTI pathogens, nonenteric pathogens such as Pseudomonas aeruginosa, Burkholderia cepacia, and Enterococcus spp. are increasingly recognized, posing challenges due to their complex resistance mechanisms. This study aims to investigate the prevalence, resistance patterns, and multidrug resistance (MDR) of nonenteric pathogens in community-acquired UTIs in Albania.

Materials and Methods: The study was conducted in an outpatient clinic from September 2023 to September 2024, involving adults (≥ 18 years) and excluding individuals with recent antibiotic use or pregnancy. Urine samples were processed using blood and MacConkey Agar, followed by bacterial identification and susceptibility testing with the VITEK 2 system. A total of 11 antibiotics belonging to β-lactams, fluoroquinolones, glycylcyclines, oxazolidinones, lipopeptides, glycopeptides, and tetracyclines were tested. Statistical analysis was performed using SPSS, with significance set at p < 0.05.

Results: A total of 550 urine cultures were analyzed, of which 372 (67.6%) were positive for bacterial growth. Among these, 27.7% were identified as nonenteric pathogens, with a higher occurrence in females (66%) and young adults (18–39 years) (60.2%). Enterococcus faecalis was the most common Gram-positive pathogen (15.2% of the positive samples), while P. aeruginosa was the most frequent Gram-negative pathogen (9.1%). P. aeruginosa showed significant resistance to tigecycline (91.2%) and levofloxacin (38.2%), with no resistance to meropenem. E. faecalis showed high resistance to vancomycin (53.6%) and teicoplanin (46.4%), while S. saprophyticus showed moderate resistance. MDR prevalence was highest in P. aeruginosa (26.5%).

Conclusion: This study highlights the high prevalence of community-acquired UTIs in Albania, particularly among females, and concerning MDR rates. To address these challenges, it is crucial to implement standardized treatment protocols, improve antibiotic stewardship, and promote research to track resistance patterns, ultimately enhancing patient care and combating antibiotic resistance.