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Article History Received: April 15 ,2020 Accepted: June 01 ,2020 Published: June 10 ,2020 [1] Minardi D, d’Anzeo G, Cantoro D, Conti A, Muzzonigro G. Urinary tract infections in women: Etiology and ... [2] Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging ... [3] Abbo LM, Hooton TM. Antimicrobial stewardship and urinary tract infections. Antibiotics ... [4] Halaji M, Shahidi S, Atapour A, Ataei B, Feizi A, Havaei SA. Characterization of extended-spectrum β-lactamase-producing uropathogenic Escherichia coli among Iranian kidney transplant patients. Infect ... [5] Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev... [6] Dadgostar P. Antimicrobial resistance: Implications and ... [7] Monack DM, Schwartz DJ, Conover MS, Hannan TJ, Hultgren SJ. Uropathogenic Escherichia coli superinfection enhances the severity of mouse bladder infection. PLoS... [8] Beahm NP, Nicolle LE, Bursey A, Smyth DJ, Tsuyuki RT. The assessment and management of urinary tract infections in adults: Guidelines for pharmacists. Can Pharm J ... [9] Oliva A, Giacobbe DR, Di Luca M, Miller NS. New insights into infections due to multidrug resistant Gram negative bacteria: The interplay between lab and clinic. Biomed Res ... [10] Ventola CL. The antibiotic resistance crisis: Part 1: causes and threats. Pharm ... [11] Fallah F, Parhiz S, Azimi L, Rashidan M. Distribution and antibiotic resistance pattern of bacteria isolated from patients with community-acquired urinary tract infections in Iran: A cross-sectional ... [12] Kornfält Isberg H, Melander E, Hedin K, Mölstad S, Beckman A. Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance, and ... [13] Nicolle LE. Complicated urinary tract infection in adults. Can J Infect Dis ... [14] Bidell MR, Opraseuth MP, Yoon M, Mohr J, Lodise TP. Effect of prior receipt of antibiotics on the pathogen distribution and antibiotic resistance profile of key Gramnegative pathogens among patients with... [15] Mirzarazi M, Rezatofighi SE, Pourmahdi M, Mohajeri MR. Antibiotic resistance of isolated Gram negative bacteria from urinary tract... [16] Motamedifar M, Sedigh Ebrahim-Saraie H, Mansury D, Nikokar I, Hashemizadeh Z. Prevalence of etiological agents and antimicrobial resistance patterns of bacterial meningitis in ... [17] Sahoo KC, Tamhankar AJ, Johansson E, Lundborg CS. Antibiotic use, resistance development and environmental factors: A qualitative study among healthcare professionals in Orissa, India. BMC Public Health. 2010;10(1):629. Aims: Numerous microbial agents have been identified as the causative agents of UTIs, such as Escherichia coli. The spread of antibiotic resistance is increasing among strains causing UTIs. The present study aimed to investigate the prevalence of etiological agents of UTIs and their antibiotic resistance patterns and to determine related risk factors and treatment outcomes of antibiotic resistance in Razi teaching hospital, Guilan, North of Iran. Material & Methods: This retrospective cross-sectional study was performed from April 2017 to September 2018. All patients with clinical symptoms of UTI were included. The patients’ complete medical records were assessed. Moreover, bacterial isolation and identification were performed by conventional bacteriological and standard biochemical tests. Antibiotic susceptibility testing was performed using the disk diffusion method based on the CLSI recommendation. Findings: Gram-negative bacilli were identified as the most common causative agents of UTIs in all cases (140, 100%), of which E. coli had the highest isolation rate with 76 cases (54.3%), followed by Klebsiella spp. with 23 cases (16.4%). Antibacterial susceptibility tests revealed that 64.3% of the isolates were resistant to three antibiotics of different classes (MDR phenotype). Conclusion: In conclusion, Gram-negative bacilli were the most common causative agents of UTIs, and E. coli had the highest isolation rate (54.3%). Regarding the high prevalence of antibiotic resistance and MDR phenotype, paying attention to drug resistance patterns of pathogens and proper and correct administration of antibiotics as well as proper and timely monitoring of treatment, could help physicians decrease the patients’ mortality rate.

The Effect of Antibiotic Resistance on Therapeutic Outcomes of Urinary Tract Infections in Hospitalized Patients with UTI