Prevalence and impact of multidrug resistance in a cohort of patients admitted to emergency department for urinary tract-infections: The UTILY study, a prospective multicentre study

•UTIs are among the most common community- and hospital-acquired infections.•We assessed prevalence and risk factors for MDR infections among community-acquired UTI.•39.1 % of patients admitted to emergency department with UTI presented and MDR pathogen.•Male gender and previous hospitalization resulted independent predictors of MDR infection.•MDR aetiology and presence of sepsis resulted independently associated to 30-day mortality. The aim of the present study was to evaluate the prevalence and to identify the independent predictors of multi-drug resistance among a cohort of patients admitted to emergency department for urinary tract infections (UTI), and to assess the impact of antimicrobial resistance on the clinical outcomes. We conducted a prospective multicentre study enrolling all adult patients admitted to one of the eight emergency departments participating in the study with a microbiologically confirmed diagnosis of UTI from February 2023 to July 2024. The primary outcome evaluated was 30-day mortality; secondary outcomes included 7-day mortality and clinical response. During the study period, 681 patients were admitted to one of the 8 participating facilities with signs and symptoms consistent with UTI, 327 of which presented a positive urine culture and were included in the study. A total of 128 out of 327 patients (39.1 %) had an isolation of an MDR organism. At multivariate analysis, male gender (OR 1.79, 95 % CI 1.08–2.97, p = 0.024) and hospital admission during the previous 90 days (OR 4.28, 95 % CI 1.86–9.83, p = 0,001) resulted independently associated with the isolation of an MDR pathogen. Regarding clinical outcomes, the presence of sepsis or septic shock (OR 6.25, 95 % CI 1.36–28.73, p = 0.019), and being infected with an MDR pathogen (OR 2.65, 95 % CI 1.01–6.97, p = 0.048) resulted the only variables independently associated with 30-day mortality. Our study has reported a 39.1 % prevalence of MDR pathogens in patients admitted to emergency departments for UTI, with a 21 % prevalence among patients without any known risk factor.