Prescribing practices for initial antimicrobial therapy in complicated urinary tract infections: an investigator-initiated study in the Bryansk Region

BACKGROUND: Over the past decades, many countries have experienced a significant increase in antimicrobial resistance among pathogens. This greatly complicates the selection of optimal antimicrobial therapy (AMT) regimens, which are important for treating individual patients and for the functioning of the healthcare system as a whole. In this context, one possible tool for rationalizing AMT is conducting prospective epidemiological studies to monitor antimicrobial resistance.

AIM: To study actual prescribing practices for antimicrobial therapy in complicated urinary tract infections in the Bryansk region.

METHODS: This prospective study analyzes data collected through patient interviews, medical record review, and the regional medical information system for patients who received outpatient or inpatient care at Bryansk Regional Hospital No. 1 from 2022 to 2025. The study included 147 cases of complicated urinary tract infections (cUTIs) in 133 patients.

RESULTS: According to previous studies, combination AMT regimens have demonstrated the greatest efficacy in cUTI. In complicated infections, particularly hospital-acquired infections or those with previous AMT exposure, the efficacy of fluoroquinolones and third-generation cephalosporins as monotherapy declines sharply. The most frequently prescribed initial therapy for cUTI included parenteral third-generation cephalosporins (44.2%), third-generation aminoglycosides (29.9%), fluoroquinolones (22.4%), carbapenems (14.9%), and beta-lactamase inhibitor-protected aminopenicillins (13.6%). In immunocompromised patients, cUTI are often caused by rare and atypical pathogens, particularly gram-positive bacteria. Therefore, it is recommended that these patients receive AMT regimens that include drugs with the broadest possible spectrum of activity.

CONCLUSION: When selecting AMT, age-related functional and morphological changes of the urinary system should be considered. A promising direction is the development of algorithms for switching from parenteral to enteral administration of antimicrobial agents in patients with cUTI, which would improve long-term outcomes by shortening hospital stay and reducing the risk of catheter-associated infections. In regions with a high prevalence of fluoroquinolone-resistant and extended-spectrum beta-lactamase-producing E. coli strains (> 10%), initial empirical therapy with aminoglycosides or carbapenems is recommended until susceptibility data to other antimicrobial agents are available.