P1641 Clinical and epidemiological characteristics of urinary tract infections caused by multidrug-resistant bacteria among adult patients: lessons from a nation-wide multi-center, retrospective, observational cohort study from Hungary Eva Livia Nagy*1, Bela Kadar1,2,3, Balint Gergely Szabo1,2,4, Bernadett Zentai5, Viktoria Takacs6, Zsuzsanna Feher7, Eszter Vad8, Botond Lakatos1, László Rókusz9, Katalin Kristóf10

1 Department of Infectious Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary, 2 3rd Department of Internal Medicine, Departmental Group of Infectology, Semmelweis University, Budapest, Hungary, 3 Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary, 4 Károly Rácz School of PhD Studies, Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary, 5 Department of Infectious Diseases, Saint George University Teaching Hospital of Fejér County, Székesfehérvár, Hungary, 6 Institute of Clinical Pharmacology, Infectious Diseases and Allergology, University of Debrecen Gyula Kenézy Hospital, Debrecen, Hungary, 7 Department of Infectious Diseases, Markusovszky University Teaching Hospital, Szombathely, Hungary, 8 Central Microbiological Laboratory, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary, 9 1st Department of Internal Medicine, Hungarian Defence Forces Medical Centre, Budapest, Hungary, 10 Institute of Laboratory Medicine, Laboratory of Clinical Microbiological Diagnostics, Semmelweis University, Budapest, Hungary Background: Urinary tract infections (UTIs) show high prevalence among infectious diseases worldwide. Growing antimicrobial resistance and changing patient characteristics increase the need for data regarding outcomes. Our aim was to analyze clinical and epidemiological characteristics of UTIs caused by multidrug-resistant (MDR) bacteria in Hungary. Materials/methods: We conducted a nationwide multicentric, retrospective observational cohort study of MDR- UTI cases diagnosed between January, 2016 – March, 2017. We included all adult (≥18 years at diagnosis) patients who were treated with clinically and microbiologically verified UTIs, caused by MDR uropathogens. Data collection was performed at four referral centres (Budapest, Debrecen, Székesfehérvár, Szombathely) by collecting anamnestic and clinical parameters (comorbidities, urinary complicating factors, previous antibiotic therapies and hospitalizations, disease onset, diagnostic findings, therapeutical measures, outcomes). Primary outcome was clinical cure, defined as survival, cessation of UTI symptoms, negative urinalysis and culture, normalization of acute phase parameters at treatment discontinuation. Results: A total of 321 patients were included (median age 71.5±14.2 years, 55.6% female), 73.5% (236/321) were admitted from the community, 31.8% (102/321) with symptoms consistent with UTI. The monthly estimated prevalence corresponded to 7.2 MDR-UTI cases per 1.000 patients. Leading comorbidities were chronic heart (45.8%, 147/321) and cerebral diseases (43.9%, 141/321). Previous antibiotic therapy was explored in 58.6% (188/321), with cephalosporins (20.6%, 66/321) and fluoroquinolones (28.3%, 91/321) as common agents, while previous hospitalization was documented in 58.3% (187/321). Complicating factors were found in 76.0% (244/321), with 43.6% (140/321) of recent urinary tract interventions. Main manifestations were urocystitis (64.8%, 208/321) and urosepsis (24.6%, 79/321), bacteraemias were detected in low rates (13.4%, 43/321). Common empirical antibiotics were ceftriaxone (32.7%) and ciprofloxacin (20.5%), targeted change occurred in 42.4% (136/321), with fosfomycin (22.9%) and imipenem/cilastatin (21.5%) as frequently used agents. Clinical cure was 56.4% (181/321), in-hospital all-cause mortality was 19.9% (64/321). Control urinalysis was only performed in 38.0%, half of patients retained a positive urine culture. Conclusions: Our study is the first nationwide report from Hungary concerning MDR-UTI. Results reflect international trends. Cases mainly arose among elderly, polyhospitalized patients with frequent urinary interventions. The recovery rate could be attributed to inadequate empirical antimicrobial therapies and low rates of targeted changes.

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