Antimicrobial resistance and antibiotic therapy in patients with urinary tract infections and asymptomatic bacteriuria: A Peruvian perspective

Overdiagnosis and overtreatment of urinary tract infections (UTIs) and asymptomatic bacteriuria (AB) increase antimicrobial resistance. The aim of this study was to evaluate resistance patterns and antibiotic therapy in patients with UTIs and AB in Peru. Cross-sectional study based on 164 urine cultures and antimicrobial susceptibility testing. A total of 62 cases of AB and 102 of UTI were identified. Women (116, 70.7%) and older adults (60, 36.6%) predominated. A total of 4582 antibiotic prescriptions were recorded, with a therapeutic pattern in both UTI and AB centered on the use of meropenem (540, 21.3%) and (333, 16.3%), vancomycin (221, 8.7%) and (454, 22.2%), ceftriaxone (369, 14.5%) and (176, 8.6%) and ceftazidime (227, 8.9%) and (274, 3.4%), respectively. In general, antibiotic therapy was bactericidal in (87, 53.0%) cases, from the surveillance group in (98, 59.8%) cases, monotherapy in (112, 68.3%) cases, and in cycles of ≤7 days. UTI was associated with a higher burden of comorbidities, including chronic renal failure, hypertension, and diabetes. Fifteen bacterial species were isolated in both clinical entities, with a predominance of Gram-negative bacilli, mainly Escherichia coli and Klebsiella pneumoniae, both of which exhibited high resistance to cephalosporins, sulfonamides, and ampicillin/sulbactam. Among Gram-positive bacteria, Enterococcus faecalis and E. faecium showed resistance to erythromycin, tetracycline, and quinolones. The widespread use of antibiotics from the surveillance group and similar antibiotic therapy in AB and UTI, revealed a critical gap in the implementation of clinical guidelines and the urgent need to accurately differentiate between the two diagnoses to avoid overprescribing and help contain bacterial resistance.