Dynamics of antibiotic resistance of the dominant gram-negative flora of the urinary tract in the adult population of the Central Federal District and Moscow

Introduction. Antibiotic resistance in gram-negative bacteria causing urinary tract infections (UTIs) poses a serious threat to healthcare and requires regular monitoring of local resistance trends. Objective. To assess the dynamics of antibiotic resistance of dominant gram-negative flora of the urogenital tract in the adult population of the Central Federal District and Moscow in 2017–2022.

Materials and methods. A retrospective analysis of 34,532 urine samples from patients over 18 years of age with bacteriuria ≥105 CFU/ml was conducted. Microorganism identification was performed using MALDI-TOF MS, and sensitivity testing was performed using the disk diffusion method according to EUCAST standards. The dynamics of resistance to amikacin, gentamicin, tobramycin, ampicillin, levofloxacin, ciprofloxacin, cefepime, ceftazidime, and meropenem were studied. Results. In the period from 2017 to 2022, there was a statistically significant increase in the proportion of Escherichia coli and Klebsiella pneumoniae isolates resistant to cephalosporins, fluoroquinolones, and carbapenems. The detection rate of cephalosporin-resistant Proteus mirabilis isolates increased 3-fold in 2022 compared to 2017 (p<0.0001). The increasing resistance of urinary tract infections to cephalosporins, fluoroquinolones, and carbapenems poses a critical threat to empirical therapy. Conclusion. The growing resistance of dominant uropathogens to cephalosporins, fluoroquinolones, and carbapenems poses a critical threat to empirical UTI therapy and requires increased monitoring of the rational use of antimicrobials and increased epidemiological control.><0.0001) ). The increasing resistance of urinary tract infections to cephalosporins, fluoroquinolones, and carbapenems poses a critical threat to empirical therapy.

Conclusion. The growing resistance of dominant uropathogens to cephalosporins, fluoroquinolones, and carbapenems poses a critical threat to empirical UTI therapy and requires increased monitoring of the rational use of antimicrobials and increased epidemiological control.

1. Ajulo S., Awosile B., Global antimicrobial resistance and use surveillance system (GLASS2022): Investigating the relationship between antimicrobial resistance and antimicrobial consumption data across the participating countries // Plos.– 2024.

2. Murray C J L, et al., Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis // The lancet. 2022. Volume 399.

3. Torumkuney D., Kozlov R., Sidorenko S., Kamble P., Lezhnina M., Galushkin A., Kundu S., Country data on AMR in Russia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome// Journal of Antimicrobial Chemotherapy, Volume 77, Issue Supplement_1, September 2022, Pages i61–i69, https://doi.org/10.1093/jac/dkac218

4. Kozlov R. S., Palagin I. S., Ivanchik N.V., Trushin I.V., Dekhnich A.V., et al. National monitoring of antibiotic resistance of pathogens causing community-acquired urinary tract infections in Russia: results of the multicenter epidemiological study «DARMIS 2023». Clinical Microbiology and Antimicrobial Chemotherapy. 2024. 26 (3): 328–337. (In Russ.).

5. Mamishi S., Sadeghi R.H., Moghaddam S. S., Pourakbari B., Poormohammadi S., Anvari M.S., Mahmoudi S., Carbapenem resistance in gram-negative pathogens in an Iranian hospital: high prevalence of OXA-type carbapenemase genes // Clin Exp Pediatr Vol. 68, No. 1, 65–72, 2025

6. Rawat D., Nair D., Extended-spectrum β-lactamases in Gram Negative Bacteria // Glob Infect Dis 2010 Sep-Dec; 2 (3): 263–274. DOI: 10.4103/0974–777X.68531

7. Naas T., Cuzon G., Truong H., Bernabeu S., Nordmann P., Evaluation of a DNA microarray, the check-points ESBL/KPC array, for rapid detection of TEM, SHV, and CTX–M extended-spectrum beta-lactamases and KPC carbapenemases // Antimicrob Agents Chemother 2010 Aug; 54 (8): 3086–92. DOI: 10.1128/AAC.01298–09

8. Freitas D.Y., Araújo S., Folador A.R. C., Ramos R. T. J., Azevedo J.S. N., Extended Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria Recovered From an Amazonian Lake Near the City of Belém, Brazil. Front. Microbiol, 28 February 2019, Volume 10. 2019 https://doi.org/10.3389/fmicb.2019.00364

9. Ny S., Kozlov R., Dumpis U., Edquist P., Gröndahl-Yli-Hannuksela K., Kling A-M., Lis D. O., Lübbert C., Pomorska-Wesołowska M., Palagin I., Vilde A., Vuopio J., Walter J., Wisell K. T., NoDARS ESBL-carrier working group. Large variation in ESBL-producing Escherichia coli carriers in six European countries including Russia // European Journal of Clinical Microbiology & Infectious Diseases (2018) 37:2347–2354. https://doi.org/10.1007/s10096 018 3382 8

10. Husna A., Md Rahman M., Badruzzaman A. T. M., Sikder M.H., Islam M.R., Md Rahman T., Alam J., Ashour H., Extended-Spectrum β-Lactamases (ESBL): Challenges and Opportunities // Biomedicines 2023 Oct 30; 11 (11): 2937. DOI: 10.3390/biomedicines11112937

11. Liao Q., Yuan Y., Zhang W., Deng J., Wu S., Liu Y., Xiao Y., Kang M., Detection and Characterization of Carbapenemases in Enterobacterales With a New Rapid and Simplified Carbapenemase Detection Method Called rsCDM // Front. Microbiol., 28 April 2022. Volume 132022. https://doi.org/10.3389/fmicb.2022.860288

12. Tao S., Chen H., Li N., Wang T., Liang W., The Spread of Antibiotic Resistance Genes In Vivo Model // Can J Infect Dis Med Microbiol. 2022 Jul 18; 2022: 3348695. DOI: 10.1155/2022/3348695

13. https://www.eucast.org/ast_of_bacteria

14. https://clsi.org/about/news/ast-news-update 2019-practical-tips 2/

15. Gaur P., Hada V., S Rath R., Mohanty A., Singh P., Rukadikar A., Interpretation of Antimicrobial Susceptibility Testing Using European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI) Breakpoints: Analysis of Agreement // Cureus. 2023 Mar 31;15(3): e36977. DOI: 10.7759/cureus.36977

16. Shalekenov B.U., Bisekenova A. L., Ramazanova B.A., Adambekov D.A., Shalekenov S. B., Species structure and molecular genetic characteristics of antibiotic-resistant strains of gram-negative microorganisms isolated from patients of the urology department. Urology 2018 No. 1. (In Russ.). DOI: https://dx.doi.org/10.18565/urology.2018.1.77–83

17. Neuzillet Y. et al. French results of the ARESC study: clinical aspects and antimicrobial susceptibility of uropathogens // Prog Urol. 2012 Feb; 22 (2): 80–86

18. Altamimi I. et al. Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID 19 Pandemic. Antibiotics, 2024. DOI: 10.3390/antibiotics13030216.