# Urinary bacterial spectrum and antibiotic resistance trends at a Urology Clinic in Hungary between 2012 and 2023

## TL;DR

This study tracks changes in urinary bacteria and antibiotic resistance in Hungary from 2012 to 2023, showing shifts in bacterial prevalence and resistance patterns.

## Contribution

The study provides a detailed 11-year analysis of urinary bacterial resistance trends in a Hungarian urology clinic, highlighting the impact of antibiotic stewardship.

## Key findings

- Escherichia coli decreased from 53% to 40% while Proteus mirabilis increased from 4% to 6%.
- Resistance to several antibiotics decreased for multiple bacteria, but Klebsiella pneumoniae showed increased resistance to fosfomycin.
- Extended-spectrum beta-lactamase-producing bacteria and Clostridioides difficile infections declined significantly.

## Abstract

Widespread antibiotic use has promoted a concerning rise in bacterial resistance. To counteract this trend and improve the effectiveness of antibiotic treatments, implementing antibiotic stewardship and an active surveillance system is crucial. Our primary aim was to analyze the local urinary bacterial spectrum and antibiotic resistance trends.

All positive urine culture results (9423) obtained between January 1, 2012 and December 31, 2023 at the Urology Department, University of Szeged were analyzed. Spearman’s rank correlation test was then used to examine changes in bacterial spectrum, resistance trends of the five most common bacteria, and incidences of multidrug-resistant strains and nosocomial Clostridioides difficile infections.

The proportion of Escherichia coli decreased significantly from 53 to 40% (p < 0.001), whereas that of Proteus mirabilis increased from 4 to 6% (p = 0.018). We observed significant decreases in E. coli for amoxicillin/clavulanic acid (p = 0.011), cefuroxime (p = 0.033), and gentamicin (p < 0.001); Enterococcus faecalis for gentamicin (p = 0.002); Klebsiella pneumoniae for amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, ciprofloxacin, gentamicin, and trimethoprim/sulfamethoxazole (p < 0.001); Pseudomonas aeruginosa for ciprofloxacin (p = 0.001) and gentamicin (p = 0.006); and P. mirabilis for amoxicillin/clavulanic acid (p = 0.018) and trimethoprim/sulfamethoxazole (p = 0.022). Only K. pneumoniae showed a significant increase in resistance trends (fosfomycin, p < 0.001). The incidence of extended-spectrum beta-lactamase-producing bacteria decreased significantly from 14.35% to 8.92% (p < 0.001), whereas that of C. difficile infections decreased by two-thirds.

Antibiotic stewardship based on accurate surveillance can counteract the increasing trend of antibiotic resistance and help manage urinary tract infections in the future, as well as might reduce the incidence of multidrug-resistant strains and C. difficile.