title: Antimicrobial resistance in urosepsis: outcomes from the multinational, multicenter global prevalence of infections in urology (GPIU) study 2003-2013.
abstract: OBJECTIVE
  Primary objective was to identify the (1) relationship of clinical severity of urosepsis with the pathogen spectrum and resistance and (2) appropriateness of using the pathogen spectrum and resistance rates of health-care-associated urinary tract infections (HAUTI) as representative of urosepsis. The secondary objective was to provide an overview of the pathogens and their resistance profile in patients with urosepsis.
  
  
  METHODS
  A point prevalence study carried out in 70 countries (2003-2013). Population studied included; 408 individuals with microbiologically proven urosepsis, 1606 individuals with microbiological proof of HAUTI and 27,542 individuals hospitalised in urology wards. Main outcomes are pathogens and resistance identified in HAUTIs and urosepsis including its clinical severity. A statistical model that included demographic factors (study year, geographical location, hospital setting) was used for analysis.
  
  
  RESULTS
  Amongst urology practices, the prevalence of microbiologically proven HAUTI and urosepsis was 5.8 and 1.5 %, respectively. Frequent pathogens in urosepsis were E. coli (43 %), Enterococcus spp. (11 %), P. aeruginosa (10 %) and Klebsiella spp. (10 %). Resistance to commonly prescribed antibiotics was high and rates ranged from 8 % (imipenem) to 62 % (aminopenicillin/β lactamase inhibitors); 45 % of Enterobacteriaceae and 21 % of P. aeruginosa were multidrug-resistant. Resistance rates in urosepsis were higher than in other clinical diagnosis of HAUTI (Likelihood ratio <0.05).
  
  
  CONCLUSIONS
  It is not appropriate to use the pathogen spectrum and resistance rates of other HAUTIs as representative of urosepsis to decide on empirical treatment of urosepsis. Resistance rates in urosepsis are high, and precautions should be made to avoid further increase.
authors.affiliation: Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, England, UK. drzafer@gmail.com.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Tandoğdu
authors.affiliation: Department of Urology, University of Florence, Florence, Italy.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Bartoletti
authors.affiliation: Department of Urology, Santa Maria Annunziata Hospital, Florence, Italy.
authors.forename: Tomasso
authors.initials: T
authors.lastname: Cai
authors.affiliation: Department of Urology, Trakya Medical School, Edirne, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Çek
authors.affiliation: Department of Urology, Lund University, Lund, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Grabe
authors.affiliation: TB Research Institute, Novosibirsk, Russia.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Kulchavenya
authors.affiliation: Jahn Ferenc South Pest Teaching Hospital, Budapest, Hungary.
authors.forename: Bela
authors.initials: B
authors.lastname: Köves
authors.affiliation: Cubist Pharmaceuticals Inc., Lexington, MA, USA.
authors.forename: Vandana
authors.initials: V
authors.lastname: Menon
authors.affiliation: Department of Urology, Technical University of Munich, Munich, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Naber
authors.affiliation: S.R. Urology Institute, Moscow, Russia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Perepanova
authors.affiliation: Jahn Ferenc South Pest Teaching Hospital, Budapest, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Tenke
authors.affiliation: Department of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Wullt
authors.affiliation: Department of Urology, Oslo University, Oslo, Norway.
authors.forename: Truls Erik Bjerklund
authors.initials: TE
authors.lastname: Johansen
authors.affiliation: Department of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Wagenlehner
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology*; D013997:Time Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D000890:Anti-Infective Agents
keywords: Pathogens; Prevalence; Resistance; Urosepsis