Pathogen distribution and antibiotic sensitivity analysis in urosepsis associated with urinary stones: A retrospective observational study

Abstract

Urosepsis is the most serious type of urinary tract infection, and its incidence is gradually increasing. The pathogenic flora that emerge in urosepsis associated with urinary stones are complex, virulent, and resistant to antibiotics, and empirical antibiotics are not always effective in treating them. This study aims to analyze the distribution of pathogenic bacteria, as well as the sensitivity of antibiotics to these bacteria, in patients with urosepsis associated urinary stones. The case data of patients treated at our single-center hospital between July 2015 and February 2025 were retrospectively collected. We examined the differences in clinical characteristics between the urine pathogenic bacteria culture-positive and culture-negative groups, and characterized the distribution of pathogenic bacteria and antibiotic sensitivity rates. We acquired 64 patients with a mean age of 57.9 ± 15.5 years, including 20 males and 44 females. Forty cases (62.5%) yielded positive urine culture results, and 24 cases (37.5%) had negative urine cultures. Female patients and patients with diabetes had a 32.7% and 43.1% higher culture-positive rate than males and those without diabetes, P = .012 and P = .003, respectively. Fifty culture results were screened, including 33 cases (66%) of gram-negative bacteria, 10 cases (20%) of gram-positive bacteria, and 7 cases (14%) of fungi. The most common gram-negative bacteria were Escherichia coli (E coli) (n = 25, 50%), followed by Proteus mirabilis (P mirabilis) (n = 5, 10%). The most common gram-positive bacteria were Enterococcus faecium (E faecium) (n = 8, 16%). The antibiotic sensitivity test indicated that E coli was most susceptible to tigecycline (100%), nitrofurantoin (100%), ertapenem (92%), imipenem (92%), meropenem (92%), and amikacin (92%). Antibiotics to which E faecium was highly susceptible included vancomycin (100%) and daptomycin (100%). Among patients with urinary-stone-associated urosepsis, women and those with diabetes are likelier to exhibit urine culture-positive pathogens, with the principal pathogens being gram-negative bacteria, mainly E coli. Carbapenems have the highest overall susceptibility to gram-negative bacteria.

Keywords: antibiotic sensitivity; pathogen distribution; urinary stones; urosepsis.