Antibiotics | Clinical Characteristics, Inflammatory Markers, and Prognosis of Patients with Multidrug-Resistant UTI-Related Sepsis

This study systematically evaluated the association between multidrug resistance (MDR) and clinical characteristics, inflammatory markers, and prognosis in patients with urinary tract infection-related sepsis through a ten-year retrospective analysis. It was found that MDR infections were more common in patients from long-term care facilities and were linked with longer hospital stays and higher C-reactive protein (CRP) levels. CRP outperformed procalcitonin (PCT) in assessing infection severity, especially in institutionalized patients.

 

Literature Overview
This paper, titled 'URO-RESIST: A Real-World Retrospective Study on Multidrug-Resistant Sepsis with Urinary Tract Infection, Clinical Predictors, Inflammatory Biomarkers, and Patient Outcomes', published in the journal 'Antibiotics', reviews and summarizes clinical data from 231 patients diagnosed with urinary tract infection-related sepsis. The study focuses on the prevalence of multidrug-resistant pathogens, patient origin (home vs. care facility), inflammatory biomarkers (CRP vs. PCT), and their predictive value on hospitalization duration and outcomes. The research also compares differences in microbial profiles and inflammatory responses between patients from different living environments, highlighting functional dependency and cognitive impairment as potential risk factors for MDR infection.

Background Knowledge
Urinary tract infections (UTIs) are common hospital-acquired infections, particularly in elderly, chronically catheterized, or immunocompromised populations, where they are more likely to progress into sepsis. In recent years, the emergence of multidrug-resistant (MDR) pathogens has significantly increased treatment complexity and mortality. Although international guidelines recommend early administration of appropriate antibiotics and source control, there remains debate on how to perform risk stratification based on inflammatory markers such as CRP and PCT. This study fills a gap in real-world data by demonstrating the role of CRP in assessing sepsis severity, predicting MDR infection, and evaluating prognosis, providing important clinical reference for healthcare professionals.

 

 

Research Methods and Experiments
This was a single-center retrospective cohort study that included 231 patients diagnosed with urinary tract infection-related sepsis at the Department of Infectious Diseases, Ospedale di Chieti, Italy, between January 2014 and July 2024. Data from 2020–2021 were excluded to avoid confounding effects of the COVID-19 pandemic. Clinical, laboratory, and microbiological data were collected, with MDR pathogens defined using ECDC criteria. Non-parametric tests and logistic regression analyses were employed to evaluate relevant variables.

Key Conclusions and Perspectives

• Over 40% of patients were infected with MDR pathogens, with institutionalized patients showing significantly higher CRP levels compared to those living at home.
• Both the presence of MDR infection and elevated CRP levels were significantly associated with poorer clinical outcomes and prolonged hospitalization, whereas PCT did not show significant differences between MDR and non-MDR groups.
• Dementia and bedridden status were identified as significant independent predictors of MDR infection, suggesting that functional dependency and cognitive impairment increase infection risk.
• Although age was correlated with the number of comorbidities, it was not an independent predictor of adverse prognosis by itself.
• Carbapenems were used in nearly half of the patients, but some received inappropriate initial therapy, highlighting the need for faster microbiological diagnostics to optimize antibiotic selection.

Research Significance and Prospects
This study emphasizes that CRP may serve as a more suitable biomarker than PCT for assessing sepsis severity in real clinical settings, particularly among residents of long-term care facilities. Additionally, patients with functional dependency or cognitive impairment should be considered high-risk for MDR infections and require enhanced preventive and management strategies. Future research should focus on developing novel biomarkers, refining personalized antibiotic strategies, and investigating the mechanisms underlying the influence of different care environments on MDR infection risk.

 

 

Conclusion
In summary, this study reveals the high prevalence of MDR infections in urinary tract infection-related sepsis and their significant impact on clinical outcomes. As an inflammatory marker, CRP demonstrated superior performance in predicting infection severity compared to PCT, particularly in patients from long-term care facilities. The research recommends early clinical identification of patients with functional dependency and cognitive impairment, and optimization of antibiotic strategies to reduce MDR infection rates and improve patient outcomes. Further validation of the independent predictive value of CRP in MDR infections is warranted, along with exploration of more precise diagnostic and intervention strategies.

 

Livia Moffa, Claudio Tana, Claudio Ucciferri, Jacopo Vecchiet, and Katia Falasca. URO-RESIST: A Real-World Retrospective Study on Multidrug-Resistant Sepsis with Urinary Tract Infection, Clinical Predictors, Inflammatory Biomarkers, and Patient Outcomes. Antibiotics.