{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:12:39Z","timestamp":1789985559927,"version":"4.0.1"},"reference-count":51,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Introduction: Urinary tract infections (UTIs) caused by carbapenem-resistant pathogens are increasingly common and pose serious treatment challenges due to limited antibiotic options and high complication rates. Identifying patients at risk is essential for guiding empirical therapy and improving outcomes. The primary objective of this study was to identify risk factors associated with carbapenem-resistant (CR) UTIs by comparing them with carbapenem-susceptible (CS) UTIs. Secondary objectives included analyzing the types of microorganisms involved in both groups, their antibiotic susceptibility profiles, and the presence of carbapenemase enzymes among CR UTI cases. Method: We conducted a retrospective case-control study involving 127 hospitalized patients with UTIs caused by CR microorganisms and 91 patients with UTIs caused by multidrug-resistant (MDR) strains that retain susceptibility to carbapenems, admitted between 1 October 2023, and 31 March 2025. Results: In univariate analysis, CR UTI patients had significantly higher rates of neoplasia, neurological disorders, urosepsis at admission, septic shock, the presence of urinary catheters at diagnosis, permanent nephrostomy catheters, hospitalizations within the past 180 days, previous antibiotic exposure including carbapenems, and recent urological procedures. Multivariate analysis revealed four independent risk factors for CR UTIs: neoplasia (OR = 2.152; 95% CI: 1.044\u20134.436; p = 0.038), neurological disorders (OR = 7.427; 95% CI: 2.804\u201319.674; p &lt; 0.0001), antibiotic use in the previous 180 days (OR = 2.792; 95% CI: 1.487\u20135.396; p = 0.001), and prior carbapenem treatment OR = 10.313; 95% CI: 1.277\u201383.248; p = 0.029). Most of the isolated organisms belonged to the Enterobacterales genus, with Klebsiella spp. and Pseudomonas aeruginosa being the most common pathogens in CR UTIs, accounting for over 90% of cases. Among patients tested for carbapenemase production, all but one tested positive for at least one carbapenemase. Conclusions: Neoplasia, neurological disorders, recent antibiotic therapy, and prior carbapenem use were significantly associated with increased risk of developing CR UTIs. Klebsiella spp. and Pseudomonas aeruginosa were the predominant causative organisms, with New Delhi metallo-\u03b2-lactamase (NDM) and Klebsiella pneumoniae carbapenemase (KPC) being the most frequently identified resistance mechanisms.<\/jats:p>","DOI":"10.3390\/antibiotics14090918","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T15:10:46Z","timestamp":1757603446000},"page":"918","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Assessment of Factors Contributing to Multidrug Resistance in Urinary Tract Infections: Focus on Carbapenem Resistance"],"prefix":"10.3390","volume":"14","author":[{"given":"Carina Alexandra","family":"Bandac","sequence":"first","affiliation":[{"name":"Department of Urology and Renal Transplantation, \"C.I. Parhon\" University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Ristescu","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, \"C.I. Parhon\" University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4975-3252","authenticated-orcid":false,"given":"Pavel","family":"Onofrei","sequence":"additional","affiliation":[{"name":"Department of Urology, Elytis Hospital, 700010 Iasi, Romania"},{"name":"Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4131-1019","authenticated-orcid":false,"given":"Ionela-Larisa","family":"Miftode","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"\u201cSt Parascheva\u201d Clinical Hospital of Infectious Diseases, 700116 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica","family":"Radu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5825-6189","authenticated-orcid":false,"given":"Vasile Lucian","family":"Boiculese","sequence":"additional","affiliation":[{"name":"Department of Preventive and Interdisciplinarity, Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Maria Raluca","family":"Pauna","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T.Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5860-3696","authenticated-orcid":false,"given":"Theodor Florin","family":"Pantilimonescu","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, \"C.I. Parhon\" University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Ludu\u015fanu","sequence":"additional","affiliation":[{"name":"Department of Morphofunctional Sciences I\u2014Anatomy, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2065-2926","authenticated-orcid":false,"given":"Viorel Drago\u0219","family":"Radu","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, \"C.I. Parhon\" University Hospital, 700115 Iasi, Romania"},{"name":"Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Yang, X., Chen, H., Zheng, Y., Qu, S., Wang, H., and Yi, F. (2022). Disease burden and long-term trends of urinary tract infections: A worldwide report. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.888205"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Topa, A.-E., Ionescu, C., Pinzaru, A., Mocanu, E., Iancu, A.M., Dumea, E., Nitu, B.F., Panculescu, F.G., and Cambrea, S.C. (2025). Challenges in the Treatment of Urinary Tract Infections: Antibiotic Resistance Profiles of Escherichia coli Strains Isolated from Young and Elderly Patients in a Southeastern Romanian Hospital. Biomedicines, 13.","DOI":"10.3390\/biomedicines13051066"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.jiac.2020.01.004","article-title":"The third national Japanese antimicrobial susceptibility pattern surveillance program: Bacterial isolates from complicated urinary tract infection patients","volume":"26","author":"Kobayashi","year":"2020","journal-title":"J. Infect. Chemother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_5","first-page":"64","article-title":"Epidemiological trends of urinary tract infections, urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019. Mil","volume":"8","author":"Zhu","year":"2021","journal-title":"Med. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1093\/infdis\/jiw282","article-title":"The epidemiology of carbapenem-resistant Enterobacteriaceae: The impact and evolution of a global menace","volume":"215","author":"Logan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.3201\/eid1710.110655","article-title":"Global spread of Carbapenemase-producing Enterobacteriaceae","volume":"17","author":"Nordmann","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ji, Y., Yang, H., Li, C., Yang, Z., and Wu, Y. (2023). Evaluation and Analysis of Multidrug Resistance- and Hypervirulence-Associated Genes in Carbapenem-Resistant Pseudomonas aeruginosa Strains among Children in an Area of China for Five Consecutive Years. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1280012"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1128\/CMR.00001-07","article-title":"Carbapenemases: The versatile beta-lactamases","volume":"20","author":"Queenan","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1007\/s10096-021-04288-1","article-title":"Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: An international ID-IRI survey","volume":"40","author":"Uysal","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S521","DOI":"10.1093\/cid\/ciz824","article-title":"Epidemiology and Diagnostics of Carbapenem Resistance in Gram-negative Bacteria","volume":"69","author":"Nordmann","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1093\/jac\/dkz501","article-title":"Comparison between IMP carbapenemase-producing Enterobacteriaceae and non-carbapenemase-producing Enterobacteriaceae: A multicentre prospective study of the clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae","volume":"75","author":"Hayakawa","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jgar.2023.03.013","article-title":"Epidemiology and risk factors for carbapenemase-producing Enterobacteriaceae carriage in the hospital: A population-based nested case-control study","volume":"33","author":"Fan","year":"2023","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_15","first-page":"170","article-title":"Infections by carbapenemase-producing Enterobacteriaceae in a department of urology. A new challenge","volume":"42","year":"2018","journal-title":"Actas. Urol. Esp."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Radu, V.D., Cristian, R.C., Onofrei, P., Miftode, E., Linga, I., Ouatu, R.M., Boiculese, L., Bobeica, R.L., Vasilache, I.T., and Mititiuc, I.L. (2023). Multidrug-Resistant (MDR) Urinary Tract Infections Associated with Gut Microbiota in CoV and Non-Cov Patients in a Urological Clinic during the Pandemic: A Single Center Experience. Antibiotics, 12.","DOI":"10.3390\/antibiotics12060973"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Timler, M., Timler, W., Bednarz, A., Zakonnik, \u0141., Koz\u0142owski, R., Timler, D., and Marczak, M. (2023). Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20031960"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1159\/000488251","article-title":"Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance","volume":"100","year":"2018","journal-title":"Urol. Int."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"de Maio Carrilho, C.M., de Oliveira, L.M., Gaudereto, J., Perozin, J.S., Urbano, M.R., Camargo, C.H., Grion, C.M., Levin, A.S., and Costa, S.F. (2016). A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1979-z"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.3855\/jidc.19499","article-title":"Detection and characterization of carbapenemase-producing Enterobacteriaceae in cancer patients: First Sri Lankan report of blaVIM in Enterobacteriaceae","volume":"18","author":"Chathuranga","year":"2024","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1093\/jac\/dkae367","article-title":"Resistance profiles of carbapenemase-producing Enterobacterales in a large centre in England: Are we already losing cefiderocol?","volume":"80","author":"Baltas","year":"2025","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1556\/030.2024.02297","article-title":"Antimicrobial resistance trends among Klebsiella pneumoniae associated with urinary tract infections in Crete, Greece, 2017\u20132022","volume":"71","author":"Maraki","year":"2024","journal-title":"Acta Microbiol. Immunol. Hung."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.2147\/IDR.S401807","article-title":"Long Term Characteristics of Clinical Distribution and Resistance Trends of Carbapenem-Resistant and Extended-Spectrum \u03b2-Lactamase Klebsiella pneumoniae Infections: 2014\u20132022","volume":"16","author":"Wang","year":"2023","journal-title":"Infect. Drug. Resist."},{"key":"ref_24","first-page":"450","article-title":"Useful independent factors for distinguish infection and colonization in patients with urinary carbapenemase-producing Enterobacteriaceae isolation","volume":"30","author":"Candel","year":"2017","journal-title":"Rev. Esp. Quimioter."},{"key":"ref_25","first-page":"239","article-title":"Carbapenem-resistant Klebsiella pneumoniae infection outbreak in a tertiary urology clinic: Analysis of influencing factors with a controlled trial","volume":"50","author":"Kizilay","year":"2020","journal-title":"Turk. J. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Radu, V.D., Costache, R.C., Onofrei, P., Miron, A., Bandac, C.-A., Arseni, D., Mironescu, M., Miftode, R.-S., Boiculese, L.V., and Miftode, I.-L. (2024). Urinary Tract Infections with Carbapenem-Resistant Klebsiella pneumoniae in a Urology Clinic\u2014A Case-Control Study. Antibiotics, 13.","DOI":"10.3390\/antibiotics13070583"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"27","DOI":"10.9734\/jpri\/2022\/v34i52B7219","article-title":"A systematic review and meta-analysis of efficacy of carbapenems versus other best available antibiotics in the management of patients with urinary tract infections","volume":"34","author":"Albunayyan","year":"2022","journal-title":"J. Pharm. Res. Int."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Shields, R., Zhou, Y., Kanakamedala, H., and Cai, B. (2021). Burden of illness in US hospitals due to carbapenem-resistant gram-negative urinary tract infections in patients with or without bacteraemia. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06229-x"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ajic.2019.07.006","article-title":"Carbapenem-resistant Enterobacteriaceae: A retrospective review of treatment and outcomes in a long-term acute care hospital","volume":"48","author":"Igbinosa","year":"2020","journal-title":"Am. J. Infect. Control"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Golli, A.-L., Zlatian, O.M., Cara, M.L., and Olteanu, M. (2024). Pre- and Post-COVID-19 Antimicrobial Resistance Pattern of Pathogens in an Intensive Care Unit. Pharmaceuticals, 17.","DOI":"10.20944\/preprints202402.0311.v1"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-015-0054-7","article-title":"Multidrug resistant and carbapenemase producing Enterobacteriaceae among patients with urinary tract infection at referral hospital, northwest Ethiopia","volume":"4","author":"Eshetie","year":"2015","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Marimuthu, K., Ng, O.T., Cherng, B.P.Z., Fong, R.K.C., Pada, S.K., De, P.P., Ooi, S.T., Smitasin, N., Thoon, K.C., and Krishnan, P.U. (2019). Antecedent Carbapenem Exposure as a Risk Factor for Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae and Carbapenemase-Producing Enterobacteriaceae. Antimicrob. Agents. Chemother., 63.","DOI":"10.1128\/AAC.00845-19"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Manolitsis, I., Feretzakis, G., Katsimperis, S., Angelopoulos, P., Loupelis, E., Skarmoutsou, N., Tzelves, L., and Skolarikos, A. (2023). A 2-Year Audit on Antibiotic Resistance Patterns from a Urology Department in Greece. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093180"},{"key":"ref_34","first-page":"20499361241278218","article-title":"Catheter-associated urinary tract infections in critically ill patients with COVID-19: A retrospective cohort study","volume":"11","author":"Bartoszewicz","year":"2024","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Anton, G., Gheorghe, L., Radu, V., Scripcariu, I., Vasilache, I., C\u0103r\u0103uleanu, A., and Socolov, D. (2024). Multidrug-resistant urinary tract infections in pregnant patients and their association with adverse pregnancy outcomes\u2014A retrospective study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226664"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Dahdouh, E., G\u00f3mez-Marcos, L., Ca\u00f1ada-Garc\u00eda, J.E., de Arellano, E.R., S\u00e1nchez-Garc\u00eda, A., S\u00e1nchez-Romero, I., L\u00f3pez-Urrutia, L., de la Iglesia, P., Gonzalez-Praetorius, A., and Sotelo, J. (2024). Characterizing carbapenemase-producing Escherichia coli isolates from Spain: High genetic heterogeneity and wide geographical spread. Front. Cell Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1390966"},{"key":"ref_37","first-page":"274","article-title":"Carbapenemase-producing Enterobacteriaceae isolates resistant to last-line antibiotics in an Italian general hospital","volume":"41","author":"Ferranti","year":"2018","journal-title":"New. Microbiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.pedneo.2023.04.021","article-title":"The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum \u03b2-lactamases-producing pathogens in pediatric urinary tract infection","volume":"65","author":"He","year":"2024","journal-title":"Pediatr. Neonatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"748","DOI":"10.3892\/etm.2021.10180","article-title":"Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania","volume":"22","author":"Duicu","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mare\u0219, C., Petca, R.-C., Popescu, R.-I., Petca, A., Mul\u021bescu, R., Bulai, C.A., Ene, C.V., Geavlete, P.A., Geavlete, B.F., and Jinga, V. (2024). Update on Urinary Tract Infection Antibiotic Resistance\u2014A Retrospective Study in Females in Conjunction with Clinical Data. Life, 14.","DOI":"10.3390\/life14010106"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Petca, R.-C., Mare\u0219, C., Petca, A., Negoi\u021b\u0103, S., Popescu, R.-I., Bo\u021b, M., Barab\u00e1s, E., and Chibelean, C.B. (2020). Spectrum and Antibiotic Resistance of Uropathogens in Romanian Females. Antibiotics, 9.","DOI":"10.3390\/antibiotics9080472"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Borcan, A.M., Radu, G., Simoiu, M., Costea, E.L., and Rafila, A. (2024). A Five-Year Analysis of Antibiotic Resistance Trends among Bacteria Identified in Positive Urine Samples in a Tertiary Care Hospital from Bucharest, Romania. Antibiotics, 13.","DOI":"10.3390\/antibiotics13020160"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Luchian, N., Dabija, M.G., Eva, L., Marcu, C., Popescu, M.R., Scutariu, M.M., Bogdan Goroftei, E.R., Gu\u021bu, C., Popa, F., and Duceac, L.D. (2024). Antimicrobial Resistance to Klebsiella pneumoniae in a North Eastern Romanian Hospital: A Descriptive Study. Rom. J. Oral. Rehabil., 16.","DOI":"10.62610\/RJOR.2024.1.16.19"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ghenea, A.E., Cioboat\u0103, R., Droca\u015f, A.I., \u021aieranu, E.N., Vasile, C.M., Moro\u015fanu, A., \u021aieranu, C.G., Salan, A.-I., Popescu, M., and Turculeanu, A. (2021). Prevalence and Antimicrobial Resistance of Klebsiella Strains Isolated from a County Hospital in Romania. Antibiotics, 10.","DOI":"10.3390\/antibiotics10070868"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.3892\/etm.2021.10520","article-title":"Insights into Multidrug-Resistant Klebsiella pneumoniae Urinary Tract Infections: From Susceptibility to Mortality","volume":"22","author":"Miftode","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Filev, R., Bogov, B., Lyubomirova, M., and Rostaing, L. (2025). From Pandemic to Resistance: Addressing Multidrug-Resistant Urinary Tract Infections in the Balkans. Antibiotics, 14.","DOI":"10.3390\/antibiotics14090849"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ijid.2014.08.018","article-title":"Efficacy of empirical therapy with non-carbapenems for urinary tract infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae","volume":"29","author":"Asakura","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_48","first-page":"123","article-title":"Carbapenem de-escalation as an antimicrobial stewardship strategy: A narrative review","volume":"80","author":"Gardner","year":"2025","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Abuelshayeb, L., Abu Farha, R., Abu Hammour, K., and Zawiah, M. (2025). Prevalence and Outcomes of Carbapenem De-escalation in Hospitalized Patients with Urinary Tract Infections: A Retrospective Cohort Study. BMC. Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10962-y"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"ofac034","DOI":"10.1093\/ofid\/ofac034","article-title":"Efficacy of noncarbapenem \u03b2-lactams compared to carbapenems for extended-spectrum \u03b2-lactamase\u2013producing Enterobacterales urinary tract infections","volume":"9","author":"Anderson","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_51","unstructured":"Bonkat, G., Bartoletti, R., Bruy\u00e8re, F., Cai, T., Geerlings, S.E., K\u00f6ves, B., Pilatz, A., Pradere, B., and Wagenlehner, F.M.E. (2025, July 14). EAU Guidelines on Urological Infections 2024. Available online: https:\/\/uroweb.org\/guidelines\/urological-infections."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/918\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:44:09Z","timestamp":1760035449000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/918"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":51,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["antibiotics14090918"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14090918","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,11]]}}}