Microbiological analysis of complicated urinary tract infections in a specialised urology unit in KwaZulu-Natal Province, South Africa, 2021 - 2023.

BACKGROUND: Complicated urinary tract infections (cUTIs) are a growing burden in urological patients, particularly those with prior catheterisation or surgical procedures. Appropriate empirical antimicrobial therapy is an essential component in the management of these patients; therefore, treatment guidelines need to be reviewed periodically. OBJECTIVES: To evaluate the microbiological causes and antimicrobial resistance (AMR) patterns of cUTIs in a specialised urology department in KwaZulu-Natal Province, South Africa. METHOD: A retrospective study was conducted on all positive urine cultures of patients attending a urology clinic and ward from 1 January 2021 to 31 December 2023. Samples were processed according to standard operating procedures. RESULTS: A total of 820 specimens were analysed in this study. Escherichia coli was the most common causative agent of cUTIs, accounting for 47% of all isolates, followed by Klebsiella spp. (15%). Enterococcus spp. was the most prevalent Gram-positive uropathogen. Notably, high resistance patterns were observed, with ciprofloxacin resistance rates of 79.4% in E. coli and 50.8% in Klebsiella spp. Extended-spectrum beta-lactamase-producing bacteria were detected in 43.3% of E. coli and 40.2% of Klebsiella spp. isolates, while carbapenem resistance was detected in 15.3% of Klebsiella spp. CONCLUSION: Our study shows the importance of antibiotic surveillance to guide empirical antimicrobial therapy based on local microbiological data. Owing to the increase in resistance of common uropathogens to commonly used antimicrobials, we advocate revised guidelines for the empirical treatment of cUTIs.