Introduction. .Inflammatory diseases of the urinary system in the vast majority of cases are associated with an infectious agent and require antibacterial therapy. Prescription of treatment is often urgent empirical, because effective therapy requires studying the “microbial landscape”. Due to the existence of regional diff rences in the level of antimicrobial resistance, an important task is to conduct local monitoring of resistance, including at the level of each medical institution, including to achieve the goals of effective antibacterial therapy and prevention of complications. Purpose of the study: to study the spectrum of uropathogens and the phenotypes of their sensitivity to antimicrobial drugs (AMPs) for urinary tract infections in the adult population ex- amined in the conditions of the State Budgetary Institution of City Clinical Hospital No. 11 of Ryazan.
Materials and methods. A retrospective local microbiologically supported study of the results of urine culture and determination of the spectrum of activity of antimicrobial drugs for 2022 was conducted. The study included 1992 patients over 18 years of age who underwent inpatient conservative/surgical treatment for kidney and urinary tract infections (UTI) at the City Clinical Hospital No. 11 of Ryazan. In this group of patients, 2198 microbiological studies were performed. Isolation and species identification of UTI pathogens was carried out from urine samples collected in disposable sterile containers before the start of antibacterial therapy. The sensitivity of microorganisms to AMPs was determined by the phenotypic disk diffusion method and the analytical method of carbopenem inactivation.
Results. The dominant pathogens of UTI in the study were Escherichia coli (52.9%) and K. pneumoniae (10.9%). Resistance determinants were identified in the E. coli group in 26.5% of cultures, and in the K. pneumoniae group in 51%. The most common mechanism of resistance is the production of plasmid extended-spectrum β-lactamases. The following AMPs demonstrated the greatest activity against E. coli: 3-4 generation cephalosporins, amikacin (100%), gentamicin, fosfomycin, nitrofurantoin (93.7%). Against K. pneumonia, 3-4 generation cephalosporins, amikacin, chloramphenicol (100%), and gentamicin (95.5%) had high activity. Cefoperazone/sulbactam, imipenem, ertapenem, meropenem (100%) had the greatest activity against all resistant microorganisms. In addition to the above-mentioned AMPs, amikacin (99.5%), tigecycline (100%), and fosfomycin (90%) were highly effective against resistant E. coli.
Conclusions. In the adult population undergoing inpatient treatment at City Clinical Hospital No. 11 of Ryazan for UTIs, gram-negative bacteria were predominantly cultured from urine (75.5%), among which bacteria of the order Enterobacterales predominated. Among these uroisolates, determinants of resistance to antimicrobial drugs were identified in 29.5% - mainly ESBL class A producers (88.7%). These features of antibiotic resistance of uropath- ogenic strains of enterobacteria, on the one hand, allow the use of β-lactam antibiotics for empirical therapy, on the other hand, determine the need for a personalized approach to the prescription of antimicrobial agents.
