This study aimed to evaluate the associated factors for extended-spectrum beta-lactamase (ESBL) production in Enterobacterales isolated from urine cultures of hospitalized elderly patients and to identify independent predictors of ESBL positivity and 28-day mortality.  Methods: A retrospective observational study was conducted at Soma State Hospital involving 261 patients aged 65 years and older hospitalized between January 1, 2025 and January 1, 2026. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK 2 automated system in accordance with EUCAST guidelines. Risk factors for ESBL production and mortality were determined using multivariate logistic regression models.  Results: The median age of the cohort was 81 years, and 64.0% (n = 167) of the isolates were ESBL-positive. While Escherichia coli was the most frequently isolated pathogen overall (48.7%), Klebsiella pneumoniae was the most common organism in the ESBL-positive group (53.3%). Multivariate analysis identified urinary catheter use (aOR = 2.044, 95% CI: 1.178-3.548, p = 0.011) and length of stay (LOS) ≥ 7 days (aOR = 1.905, 95% CI: 1.083-3.352, p = 0.025) as independent risk factors for ESBL positivity. Independent predictors of 28-day mortality included age (aOR= 1.082, p < 0.001), urinary catheter use (aOR = 1.941, p = 0.023) and higher CRP levels (aOR = 1.035, p = 0.036). Notably, ESBL positivity was not significantly associated with mortality (p = 0.076). ESBL-positive isolates exhibited significantly higher resistance rates across nearly all tested antibiotic classes, including ciprofloxacin and trimethoprim-sulfamethoxazole.  Conclusion: The findings highlight that urinary catheterization and prolonged hospitalization are pivotal drivers of ESBL prevalence in the geriatric population. Furthermore, advanced age, catheter use, and CRP levels independently impact mortality, underscoring the necessity of monitoring invasive device use to mitigate resistance development and improve clinical outcomes.

Purpose Acquired urinary fistula is a rare complication. Scientific evidence supporting the right technique of fistula repair is lacking. To predict treatment failure, the aim of this study is to document our experience in management of acquired complex fistula, reporting surgical success of different strategies in relation to fistula type, previous radiotherapy, sex, and patient comorbidities. Methods A retrospective review of all fistula treatments at the University Hospital of Cologne, Germany was performed. Causal interventions and comorbidities were recorded. Only outcomes of complex fistulas, as defined by WHO criteria, were included. Primary outcome was fistula-closure per intervention strategy and fistula type. Secondary outcome was to identify patient characteristics leading to therapy failure and the need for permanent urinary diversion. Results Between November 2014 and February 2021, 45 patients were treated. Patients with vesicosymphyseal (35.6%), vesicovaginal (28.9%), rectovesical (22.2%) and ureterovaginal fistula (13.3%) were observed. A cumulative fistula closure rate of 67.7% was achieved. Conservative management, surgery with primary closure and tissue interposition was successful in 28.6%, 83.3% and 64%. Patients previously treated with radiotherapy scored significantly worse (p=0.013). 12 patients eventually needed permanent urinary diversion. Differences measured in type of interposing tissue, sex and medical comorbidities were not significant. Conclusion Definitive surgical repair is mandatory in most complex urinary fistulas. Treatment should be individualized and tailored to the underlying disease, tissue quality and patients' comorbidities. Oncological status, previous radiation and previous reconstructive surgery should be critically regarded to determine if permanent urinary diversion is required. A treatment algorithm is proposed. Keywords Urinary - rectourinary - genitourinary - vesicovaginal - ureterovaginal - vesicosymphyseal fistula.