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23/01/2025 - Press release

Nearly two out of three hospital admissions for healthcare-associated urinary tract infections are caused by multidrug-resistant bacteria.

• According to a multicenter study published in the Journal of Hospital Infection, involving twelve hospitals across the country.
• Patients hospitalized due to healthcare-associated urinary tract infections caused by antibiotic-resistant bacteria require longer hospital stays-an average of three additional days compared to cases caused by bacteria that respond to treatment.
• The authors warn about the high number of cases caused by resistant bacteria, emphasizing the need to take stricter precautions in the use of antibiotics.

Nearly two out of three hospital admissions for healthcare-associated urinary tract infections in the country 61% are caused by antibiotic-resistant bacteria. This finding is highlighted in a state-level multicenter study published in the Journal of Hospital Infection, led by the Infectious Diseases Service of Hospital del Mar and its research institute. This is a concerning trend, considering that urinary tract infections are among the most common types of infections and a leading cause of hospitalizations. Healthcare-associated urinary tract infections account for 12% to 24% of all hospital admissions. The study was supported by the Grup d'Estudi d'infeccions Relacionades amb l'Assistència Sanitària (GEIRAS) of the Spanish Society of Infectious Diseases and Clinical Microbiology.

The results indicate that patients hospitalized with a urinary tract infection caused by antibiotic-resistant bacteria require longer hospital stays-three additional days on average, with a mean of 13 days compared to 10 days for cases in which antibiotics are effective. Furthermore, fever and signs of infection take longer to resolve. After three days of hospitalization, 13% of patients with resistant bacteria still had a fever, compared to 7% of those treated effectively with antibiotics. Other infection symptoms persisted in 12% of resistant cases, compared to 7.5% of treatable cases.

The study analyzed data from 443 cases treated in 12 hospitals across the country between August 2015 and April 2019. Participating hospitals included Hospital del Mar, Hospital Universitari de Bellvitge, Hospital de Sant Pau, and Hospital Clínic in Barcelona; Hospital Mútua de Terrassa; Hospital Universitario Ramón y Cajal and Hospital Universitario Gregorio Marañón in Madrid; Hospital Universitari Son Espases in Palma, Mallorca; Hospital Universitario Marqués de Valdecilla in Santander; Complexo Hospitalario Universitario de Pontevedra; Hospital Clínico Universitario "Lozano Blesa" in Zaragoza; and Clínica Universidad de Navarra. Researchers from the CIBER in Infectious Diseases (CIBERINFEC) also participated, providing a fairly accurate snapshot of the situation in Spain regarding this issue.

"These are very concerning findings," says Dr. Juan Pablo Horcajada, Head of the Infectious Diseases Service at Hospital del Mar, coordinator of the Infectious Pathology and Antimicrobials Research Group at its research institute, CIBERINFEC researcher, and study organizer. "This 61% means that treating these infections with antibiotics is increasingly complex. Only specific treatments can be used, which increases drug costs as well as expenses related to longer hospital stays, making it more difficult to manage these patients," he adds. According to Dr. Horcajada, "This study shows that we are already on the brink of the pandemic caused by antibiotic resistance."

The most commonly detected resistant bacteria were Escherichia coli (74% of cases) and Klebsiella pneumoniae (59%). Of the 443 cases, 220 acquired the infection in hospitals, while 223 were related to other types of healthcare. The presence of antibiotic-resistant infections did not result in higher mortality rates, as this pathology generally has a relatively low mortality index.

"Antibiotic-resistant infections pose a risk to hospitals and long-term care facilities," explains Dr. Sílvia Gómez-Zorrilla, attending physician in the Infectious Diseases Service at Hospital del Mar, researcher at its institute and CIBERINFEC, and study coordinator. She emphasizes, "The results of our study highlight the need for appropriate antibiotic use in both hospital settings and intermediate or long-term care facilities to prevent the continued rise of antibiotic resistance."

To address this issue, the study authors advocate for improved infection control in healthcare facilities, optimization of antibiotic use through PROA (Antibiotic Stewardship Programs), and investment in research to develop new treatments. A 2019 study attributed nearly 5 million deaths worldwide to antibiotic resistance, making it the third leading cause of mortality after heart attacks and strokes.

From left to right, Inmaculada López Montesinos, Silvia Gómez Zorrilla, Juan Pablo Horcajada, Elena Sendra

Reference Article

Gómez-Zorrilla S, Becerra-Aparicio F, Sendra E, Zamorano L, Grau I, Pintado V, Padilla B, Benito N, Boix-Palop L, Fariñas MC, Peñaranda M, Gamallo MR, Martinez JA, Morte-Romea E, Del Pozo JL, López Montesinos I, Durán-Jordà X, Ponz R, Cotarelo M, Cantón R, Oliver A, Ruiz-Garbajosa P, Horcajada JP; ITUBRAS-2 Group. Risk factors and clinical impact of multidrug resistance in healthcare-associated bacteraemic urinary tract infections: a post-hoc analysis of a multicentre prospective cohort in Spain. J Hosp Infect. 2024 Sep;151:173-185. doi: 10.1016/j.jhin.2024.05.020. Epub 2024 Jun 28. PMID: 38945399.

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