Antibiotic resistance of uropathogens in patients with nephrolithiasis and concomitant coronary heart disease

Objective: to identify the main causative agents of chronic calculous pyelonephritis and determine their antibiotic resistance in patients with nephrolithiasis combined with coronary heart disease (CHD).

Material and methods. A retrospective case-control study included 181 patients aged 57 to 82 years old who were treated at the urological center of branch no. 1 of Burdenko Main Military Clinical Hospital in 2014–2019. All patients long-term suffered from urolithiasis complicated by chronic calculus pyelonephritis in combination with CHD. Clinically significant results of bacteriological urine examinations (CFU≥103) were analyzed. The midstream urine specimen cultivation was performed sectorally on Endo agar. The minimum suppressive concentration of the test antibacterial preparations for each of the detected microorganisms was determined by dilution on a dense Müller–Hinton agar culture medium (BBL, USA). The results were processed using the Shapiro–Wilk, Kolmogorov–Smirnov, and χ2 Pirson criteria. The values of p≤0,05 were considered as statistically significant.

Results. Specimen culturing revealed Escherichia coli – 24.8%, Klebsiella pneumoniae – 18.3%, Pseudomanas aeruginosa – 11%. Staphylococcus spp., and Enterococcus spp. were most important among gram-positive pathogens (total 26.6% of cases). The sensitivity of the detected infectious agents to basic antibacterial drugs turned out to be sharply reduced. It is noteworthy that 65% of P. aeruginosa strains were sensitive to meropenem.

Conclusion. In patients with recurrent urolithiasis combined with CHD, the proportion of gram-positive coccas was increased on the background of calculous pyelonephritis with a simultaneous decrease in the proportion of poly-resistant gram-negative infectious agents (nosocomial strains of E. coli and K. pneumoniae).

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