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Causative Agents of Urinary Tract Infections in Elderly Men with Benign Prostatic Hyperplasia: a Microbiological Evaluation by Mustafa Behcet, Fatma Avcioglu

Background: Benign prostatic hyperplasia is an important risk factor for urinary tract infections. In this study, the causative agents of urinary tract infections were isolated from urine samples of benign prostatic hyperplasia patients aged 65 and older. Bacteremia risk and the patterns of antibiotic resistance were investigated to guide clinicians in empirical antibiotic treatment.
Methods: Between 2015 and 2019, cultures of bacteria and yeast were made from urine samples from 655 patients with benign prostatic hyperplasia. The patients were divided into three groups based on age: 65 - 74, 75 - 84, and ≥ 85. The identification and antibiotic susceptibility tests of microorganisms were performed using the BD Phoenix (Becton Dickinson, USA) and the VITEK®2 Compact (bioMérieux, France) automated systems, as well as traditional methods.
Results: Microbial growth was detected in 24% of the patients. No significant differences were found concerning age (p = 0.15). The most commonly isolated microorganism was Escherichia coli (47.8%), followed by Klebsiella pneumoniae (22%), Enterococcus faecalis (8.8%), Pseudomonas aeruginosa (5.7%), and Candida albicans (4.4%). Escherichia coli showed no resistance to carbapenems. On the other hand, resistance values of 1% for amikacin, 5% for fosfomycin, 11% for nitrofurantoin, 13% for piperacillin/tazobactam, and 24% for gentamicin were detected. Resistance value for trimethoprim/sulfamethoxazole, ciprofloxacin, ceftazidime, ceftriaxone, cefixime, cefuroxime, and ampicillin were more than 50%. Also, bacterial growth occurred in 9% of blood culture samples made simultaneously with urine culture from 55 patients.
Conclusions: High resistance rates to some antibiotics frequently used in empirical antibiotic treatment of urinary tract infections have reached alarming levels in elderly male patients with benign prostatic hyperplasia. Therefore, identifying resistance patterns is important to contribute to rational antibiotic use policies. In addition, the risk of Candida-related urinary tract infections and bacteremia should be considered in these patients.

DOI: 10.7754/Clin.Lab.2020.200940