PP 8 - Comparison of microbiological profile and associated factors between acute simple cystitis and acute complicated urinary tract infections including pyelonephritis among adults presenting to a tertiary care center in Sri Lankarinary tract infections including pyelonephritis among adults presenting to a tertiary care center in Sri Lanka

Silva SCUM¹, Piyasiri DLB¹, Jayasekera PK¹, Gamlath NM² , ¹ National Hospital Galle, Sri Lanka, ²Family Health Bureau, Ministry of Health, Sri Lanka

Abstract

Introduction

Community-acquired urinary tract infections (UTIs) represent a global health challenge, categorized into acute simple cystitis (ASC), presenting mainly to outpatient department (OPD) and acute complicated UTIs including pyelonephritis (ACUP), often requiring hospitalization. Understanding the disparities in associated factors and microbiological profile between these groups is critical for optimizing empirical management.

Objectives

The study aimed to describe and compare uropathogens, antibiotic susceptibility and associated factors among adults attending National Hospital Galle (NHG) with ASC and ACUP.

Design, setting, and methods

A descriptive cross-sectional study was conducted from November 2023 to March 2024 at NHG. Patients ≥14 years with ASC and ACUP were enrolled. The associated factors were collected into an interviewer-administered questionnaire. Urine cultures were processed according to the standard operating procedure.

Results

A total of 492 were analyzed (246 ASC, 246 ACUP). Mean age was higher in ACUP (56.29 years) than ASC (47.15 years) which was statistically significant (p=<0.001). Females predominated in both groups (ASC-70.3%, n=173; ACUP- 61.4%, n=151). Comorbidities including diabetes mellitus, hypertension, chronic kidney disease were significantly more prevalent in ACUP (p < 0.001). Squatter toilet use was higher among ACUP (68.7%, n=169; ASC-56.5%, n=139). Lower level of education (below A/Ls) was associated with ACUP (p=0.0015). Recent sexual history was a significant risk factor among ASC (8.9%, n=22) than ACUP (2.8%, n=7) (p=0.005). There was no statistically significant difference in occupation and immunological factors (such as HIV, long-term steroids, and chemotherapy).

The predominant uropathogen in both was E. coli (ASC 26.0%, n=64; ACUP 30.1%, n=74). ACUP comparatively demonstrated reduced susceptibility to amoxicillin, fluoro-quinolones, gentamicin, meropenem, mecillinam. Carbapenem resistance (ACUP 4.1%, n=10; ASC 0.4%, n=1; p=0.004), and multidrug resistance (ACUP 17.1%, n=42; ASC 11.0%, n=27; p<0.001) were more in ACUP and was statistically significant.

 Conclusions

ASC was linked to recent sexual activity and, while lower level of education, older age (age>47 years) and comorbidities were associated with ACUP. The spectrum of uropathogens was the same, but carbapenem and multidrug resistance were more pronounced in ACUP.