Clinical Spectrum of Recurrent Urinary Tract Infections: A Single-Center Study

Abstract

A retrospective observational study was undertaken to evaluate the clinical profile of recurrent urinary tract infections (UTIs)
in a tertiary care hospital. Patients <18 years, kidney-transplant recipients, those on immunosuppressive agents and pregnant
patients were excluded. Patients with ≥2 episodes of culture positive UTIs were included. Demographic details, investigations
and treatment were recorded. Out of total 48 patients, 18 were female and 30 male. The common manifestations were acute
pyelonephritis (52%), emphysematous pyelonephritis (20%) and cystitis (25%). Extended-spectrum beta-lactamase (ESBL)-
producing Escherichia coli (48%) was the most frequent organism isolated followed by Klebsiella spp. (29%) and Pseudomonas
spp. (23%). Recurrent episodes of UTI with same organisms were noted in 62% patients. Death occurred in 12.5% patients
due to septic shock. Renal calculi (24%) and double J (DJ) stent placement (30%) were associated with recurrent UTIs,
though this was not statistically significant. Resistance to higher antibiotics (colistin, carbapenems, piperacillin-tazobactam,
cefoperazone-sulbactam, third-generation cephalosporins) (65.4%, r = 0.81), diabetes (62.5%, r = 0.79), urological procedure
(39.5%, r = 0.68), prior hospitalization (75%, r = 0.84), history of UTI prior to the study period (44%, r = 0.72) and need for
per urethral catheter (PUC) beyond 7 days (35%, r = 0.74) had significant correlation with recurrent UTIs.