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García-Meniño I, García V, Lumbreras-Iglesias P, Fernández J, Mora A. Fluoroquinolone resistance in complicated urinary tract infections: association with the increased occurrence and diversity of Escherichia coli of clonal complex 131, together with ST1193. Front Cell Infect Microbiol 2024; 14:1351618. [PMID: 38510968 PMCID: PMC10953827 DOI: 10.3389/fcimb.2024.1351618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/02/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Urinary tract infections (UTIs) are one of the leading causes of multidrug-resistance (MDR) spread and infection-related deaths. Escherichia coli is by far the main causative agent. We conducted a prospective study on complicated urinary tract infections (cUTIs) i) to monitor the high-risk clones that could be compromising the therapeutic management and ii) to compare the cUTI etiology with uncomplicated infections (uUTIs) occurring in the same period and health area. Methods 154 non-duplicated E. coli recovered from cUTIs in 2020 at the Hospital Universitario Central de Asturias (Spain) constituted the study collection. Results Most cUTI isolates belonged to phylogroup B2 (72.1%) and met the uropathogenic (UPEC) status (69.5%) (≥3 of chuA, fyuA, vat, and yfcV genes). MDR was exhibited by 35.7% of the isolates, similarly to data observed in the uUTI collection. A significant difference observed in cUTI was the higher level of fluoroquinolone resistance (FQR) (47.4%), where the pandemic clonal groups B2-CC131 and B2-ST1193 (CH14-64) comprised 28% of the 154 E. coli, representing 52.1% of the FQR isolates. Other prevalent FQR clones were D-ST69 (CH35-27), D-ST405 (CH37-27), and B2-ST429 (CH40-20) (three isolates each). We uncovered an increased genetic and genomic diversity of the CC131: 10 different virotypes, 8 clonotypes (CH), and 2 STs. The presence of bla CTX-M-15 was determined in 12 (7.8%) isolates (all CC131), which showed 10 different core genome (cg)STs and 2 fimH types (fimH30 and fimH602) but the same set of chromosomal mutations conferring FQR (gyrA p.S83L, gyrA p.D87N, parC p.S80I, parC p.E84V, and parE p.I529L). In addition, the plasmidome analysis revealed 10 different IncF formulae in CC131 genomes. Conclusion We proved here that non-lactose fermenting screening, together with the detection of O25b (rfbO25b), H4 (fliCH4), and H5 (fliCH5) genes, and phylogroup and clonotyping assignation, is a reasonable approach that can be easily implemented for the surveillance of emerging high-risk clones associated with FQR spread in cUTIs, such as the uncommonly reported O25b:H4-B2-ST9126-CC131 (CH1267-30). Since E. coli CC131 and ST1193 are also involved in the community uUTIs of this health area, interventions to eradicate these MDR clones, along with surveillance for other emerging ones, are essential for antibiotic use optimization programs.
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Affiliation(s)
- Isidro García-Meniño
- Laboratorio de Referencia de Escherichia coli (LREC), Dpto. de Microbioloxía e Parasitoloxía, Universidade de Santiago de Compostela (USC), Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Department for Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Vanesa García
- Laboratorio de Referencia de Escherichia coli (LREC), Dpto. de Microbioloxía e Parasitoloxía, Universidade de Santiago de Compostela (USC), Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pilar Lumbreras-Iglesias
- Servicio de Microbiología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Javier Fernández
- Servicio de Microbiología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Research and Innovation, Artificial Intelligence and Statistical Department, Pragmatech AI Solutions, Oviedo, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Spain
| | - Azucena Mora
- Laboratorio de Referencia de Escherichia coli (LREC), Dpto. de Microbioloxía e Parasitoloxía, Universidade de Santiago de Compostela (USC), Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Dean NL, Gras J, Lantz EE, Patterson JP, Inglese G, Goldstine JV, Medina-Rivera M, Bionda N, Strickland AD, Sileika TS. Microbial Transfer by Intermittent Catheters: An In Vitro Evaluation of Microbial Transfer in Catheter With Variable Protective Features. J Wound Ostomy Continence Nurs 2024; 51:66-73. [PMID: 38215300 DOI: 10.1097/won.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of various protective features (eg, catheter cap, introducer tip, and catheter sleeve) of hydrophilic intermittent catheters against contamination with urinary tract infection-associated microorganisms using an in vitro model. DESIGN An in vitro study of microbial transfer. MATERIALS AND METHODS Gloves were contaminated with uropathogenic microorganisms and used to simulate intermittent catheterization of male anatomical models with and without the protective features present in 5 commercially available hydrophilic catheters. Using this contaminated touch transfer method, both the meatus of the sterile male anatomical models and sterile surgical gloves of an operator were inoculated with a high level of microorganisms (107 and 109 colony-forming units [CFU], respectively). The operator then performed catheterization of the anatomical model. The most relevant segments of the catheter were sampled, and the level of microbial transfer and catheter contamination was quantified. Results from experimental and sample replicates from the 3 microbial species and 5 catheters (sleeved and unsleeved) were analyzed by pair-wise t tests and analysis of variance. RESULTS Of the 5 commercially available sleeved intermittent catheters evaluated in this study, use of catheters with multiple protective components (ring cap, introducer tip, and catheter sleeve) resulted in significant improvement in protection against contamination with a 25- to 2500-fold lower level of microbial contamination (C1 segment) across all species as compared to catheters protected with only sleeves or un-sleeved catheters. CONCLUSIONS The combination of a ring cap, protective introducer tip, and protective sleeve provides additional protection when compared to sleeve alone from transferring microbial contamination from the meatus to the advancing catheter. Additional research is needed to determine whether these design features result in fewer urinary tract infections among intermittent catheter users.
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Affiliation(s)
- Nicole L Dean
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - James Gras
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Ellen E Lantz
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jillian P Patterson
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Gary Inglese
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jimena V Goldstine
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Mariely Medina-Rivera
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Nina Bionda
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Aaron D Strickland
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Tadas S Sileika
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
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