Introduction
Materials and methods
The global prevalence of infections in urology (GPIU) study
Pathogens and susceptibility profile in urosepsis
Pathogens
Pathogen | Geographical location | Sepsis severitya,b
| Clinical diagnosis | Overall urosepsis | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Europe
n (%) | Asia
n (%) | Africa
n (%) | Americas
n (%) | Simple urosepsis
n (%) | Severe urosepsis and uroseptic shock
n (%) | MAGI
n (%) | Pyelonephritis
n (%) | Cystitis
n (%) | ||
Gram negative
| ||||||||||
E. coli
| 127 (41 %) | 34 (52 %) | 8 (38 %) | 5 (50 %) | 121 (46.9 %) | 29 (37.2 %) | 77 (37 %) | 190 (45 %) | 240 (43 %) | 174 (43 %) |
Klebsiella spp.
| 25 (8 %) | 8 (11 %) | 6 (29 %) | 3 (30 %) | 24 (9.3 %) | 9 (11.5 %) | 17 (8 %) | 54 (13 %) | 73 (13 %) | 42 (10 %) |
P. aeruginosa
| 39 (13 %) | 3 (5 %) | 0 | 0 | 24 (9.3 %) | 11 (14. %1) | 25 (12 %) | 34 (8 %) | 48 (9 %) | 42 (10 %) |
Enterobacter spp. | 19 (6 %) | 2 (3 %) | 0 | 2 (20 %) | 14 (5.4 %) | 6 (7.7 %) | 13 (6 %) | 20 (5 %) | 42 (7 %) | 23 (6 %) |
Proteus spp.
| 14 (4 %) | 0 | 2 (10 %) | 0 | 7 (2.7) | 4 (5.1) | 7 (3 %) | 27 (6 %) | 34 (6 %) | 16 (4 %) |
Acinetobacter spp.
| 2 (1 %) | 5 (8 %) | 0 | 3 (1.2 %) | 3 (3.8 %) | 1 (1 %) | 6 (1 %) | 9 (2 %) | 7 (2 %) | |
Citrobacter spp.
| 3 (1 %) | 1 (2 %) | 0 | 0 | 2 (0.8 %) | 0 | 2 (1 %) | 7 (2 %) | 8 (1 %) | 4 (1 %) |
Gram positive
| ||||||||||
Enterococcus.
| 37 (12 %) | 5 (8 %) | 4 (19 %) | 0 | 27 (10.5 %) | 9 (11.5 %) | 23 (11 %) | 41 (10 %) | 55 (10 %) | 46 (11 %) |
S. aureus
| 12 (4 %) | 3 (5 %) | 0 | 0 | 12 (4.7 %) | 2 (2.6 %) | 7 (3 %) | 7 (2 %) | 18 (3 %) | 15 (4 %) |
CoNS | 8 (3 %) | 1 (2 %) | 0 | 0 | 7 (2.7 %) | 0 | 11 (5 %) | 6 (1 %) | 9 (2 %) | 9 (2 %) |
Other gram (+) cocci | 4 (1 %) | 0 | 1 (5 %) | 0 | 3 (1.2) | 0 (0.0) | 4 (2 %) | 0 | 4 (1 %) | 5 (1 %) |
Other bacteria | 13 (4 %) | 0 | 0 | 0 | 9 (3.5 %) | 3 (3.8 %) | 18 (9 %) | 21 (5 %) | 17 (3 %) | 13 (3 %) |
Fungi | 8 (3 %) | 4 (6 %) | 0 | 0 | 5 (1.9 %) | 2 (2.6 %) | 2 (1 %) | 14 (3 %) | 7 (1 %) | 12 (3 %) |
Total | 311 | 66 | 21 | 10 | 258 | 78 | 207 | 427 | 564 | 408 |
Pathogen | Geographical location | Sepsis severitya
| Clinical diagnosis | Overall urosepsis | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Europe %(R/total) | Asia %(R/total) | Africa %(R/total) | Americas %(R/total) | Simple %(R/total) | Severe and shock %(R/total) |
p
c
| MAGI %(R/total) | Cystitis %(R/total) | Pyelonephritis %(R/total) |
p
b
| ||
Amx/BLI | 58 % (100/172) | 70 % (21/30) | 92 % (11/12) | 75 % (3/4) | 60 % (82/136) | 64 % (21/33) | NS | 52 % (65/124) | 46 % (160/345) | 60 % (149/248) | 0.003 | 62 % (135/218) |
NS | OR 0.5 (CI 0.3–0.8) p = 0.002 | NS | ||||||||||
TZP | 34 % (47/137) | 40 % (10/25) | 50 % (4/8) | 67 % (2/3) | 37 % (40/109) | 35 % (12/34) | NS | 26 % (26/99) | 33 % (84/258) | 30 % (57/189) | NS | 36 % (63/173) |
TMP/SMX | 56 % (87/156) | 50 % (15/30) | 86 % (12/14) | 63 % (5/8) | 59 % (84/143) | 61 % (22/36) | NS | 54 % (63/117) | 52 % (182/353) | 53 % (122/232) | NS | 57 % (119/208) |
CIP | 59 % (106/181) | 61 % (22/36) | 47 % (8/17) | 22 % (2/9) | 53 % (79/148) | 55 % (23/42) | NS | 49 % (76/155) | 47 % (196/420) | 49 % (157/324) | NS | 57 % (138/243) |
LVX | 59 % (57/97) | 57 % (4/7) | 50 % (6/12) | 67 % (2/3) | 56 % (40/71) | 63 % (12/19) | NS | 42 % (41/98) | 45 % (122/271) | 39 % (76/196) | 0.009 | 58 % (69/119) |
OR 0.4 (CI 0.2–0.7), p = 0.006 | OR 0.5 (CI 0.3–0.9) p = 0.03 | OR 0.4 (CI 0.2–0.7) p = 0.002 | ||||||||||
CXM | 57 % (78/137) | 56 % (14/25) | 71 % (10/14) | 67 % (4/6) | 60 % (68/113) | 52 % (14/27) | NS | 48 % (50/104) | 42 % (142/339) | 45 % (109/245) | 0.008 | 58 % (106/182) |
NS | OR 0.5 (CI 0.3–0.7) p = 0.001 | OR 0.5 (CI 0.3–0.8), p = 0.007 | ||||||||||
CTX | 52 % (77/147) | 42 % (15/36) | 31 % (5/16) | 56 % (5/9) | 50 % (68/135) | 43 % (13/30) | NS | 36 % (41/115) | 36 % (130/363) | 39 % (110/208) | 0.02 | 49 % (102/208) |
OR 0.5 (CI 0.3–0.9) p = 0.03 | OR 0.5 (CI = 0.3–0.8), p = 0.003 | OR 0.6 (CI 0.4–0.9) p = 0.01 | ||||||||||
CAZ | 42 % (52/124) | 71 % (17/24) | 33 % (4/12) | 67 % (2/3) | 49 % (47/96) | 27 % (8/29) | 0.005 | 30 % (31/102) | 35 % (114/326) | 33 % (83/251) | 0.008 | 46 % (75/163) |
(OR = 4.07,CI 1.45–11.44, p = 0.005) | – | OR 0.4 (CI 0.2–0.8), p = 0.01 | OR 0.5 (CI 0.3–0.8), p = 0.005 | OR 0.4 (CI 0.3–0.7), p = 0.002 | ||||||||
IPM | 8 % (11/141) | 13 % (4/32) | 0 (0/7) | 0 (0/6) | 8 % (9/110) | 7 % (3/43) | NS | 12 %(14/114) | 7 % (19/289) | 12 % (29/252) | NS | 8 % (15/186) |
GEN | 36 % (68/187) | 46 % (21/46) | 75 % (12/16) | 44 % (4/9) | 37 % (57/154) | 42 % (23/55) | NS | 42 % (63/150) | 36 % (150/418) | 40 % (130/326) | NS | 40 % (105/258) |
CAZ + CIP | 38 % (42/111) | 56 % (10/18) | 33 % (4/12) | 67 % (2/3) | 45 % (37/83) | 21 % (5/24) | 0.004 | 25 % (23/93) | 28 % (82/292) | 27 % (61/227) | 0.006 | 40 % (58/144) |
OR = 5.1 CI 1.5–17.5, p = 0.009) | – | OR 0.4 (CI 0.2–0.8), p = 0.009 | OR 0.4 (CI 0.3–0.7) p = 0.003 | OR 0.4 (CI 0.2–0.7) p = 0.001 | ||||||||
CAZ + GEN | 30 % (29/97) | 52 % (12/23) | 25 % (3/12) | 67 % (2/3) | 38 % (30/80) | 23 % (5/22) | NS | 24 % (22/90) | 24 % (67/281) | 21 % (46/218) | 0.025 | 34 %(46/135) |
NS | OR 0.5 CI 03–0.9, p = 0.02 | OR 0.5 CI 0.2–0.7, p = 0.003 | ||||||||||
CAZ + TMP/SMX | 30 % (22/74) | 50 % (8/16) | 25 % (3/12) | 67 % (2/3) | 41 % (29/71) | 6 % (1/18) | 0.000 | 23 % (16/70) | 25 % (58/232) | 24 % (38/158) | NS | 33 % (35/105) |
OR 24.9 CI 2.4–255, p = 0.007 | – | |||||||||||
TZP + CIP | 33 % (36/108) | 32 % (6/19) | 50 % (4/8) | 67 % (2/3) | 36 % (30/83) | 39 % (10/26) | NS | 20 % (17/87) | 27 % (63/231) | 20 % (33/165) | 0.03 | 35 % (48/138) |
OR 0.4 (CI 0.2–0.9) p = 0.03 | NS | OR 0.5 (CI 0.3–0.9) p = 0.04 | ||||||||||
TZP + GEN | 20 % (19/93) | 26 % (6/23) | 50 % (4/8) | 67 % (2/3) | 26 % (20/77) | 19 % (5/26) | NS | 13 % (11/84) | 18 % (29/161) | 21 % (49/231) | NS | 24 % (31/127) |
TZP + TMP/SMX | 20 % (14/69) | 36 % (5/14) | 50 % (4/8) | 67 % (2/3) | 30 % (19/64) | 19 % (3/16) | NS | 16 % (11/69) | 22 % (44/199) | 19 % (24/129) | NS | 26 % (25/94) |
CIP + GEN | 31 % (41/134) | 44 % (14/32) | 44 % (7/16) | 25 % (2/8) | 31 % (35/114) | 35 % (11/32) | NS | 32 % (39/124) | 32 % (114/358) | 32 % (85/268) | NS | 34 % (64/190) |
CIP + TMP/SMX | 37 % (37/102) | 42 % (10/24) | 50 % (7/14) | 25 % (2/8) | 40 % (40/99) | 25 % (6/24) | NS | 30 % (28/95) | 33 % (101/302) | 33 % (63/190) | NS | 38 % (56/148) |