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Al Kadri HM, El-Metwally AA, Al Sudairy AA, Al-Dahash RA, Al Khateeb BF, Al Johani SM. Antimicrobial resistance among pregnant women with urinary tract infections is on rise: Findings from meta-analysis of observational studies. J Infect Public Health 2024; 17:102467. [PMID: 38850585 DOI: 10.1016/j.jiph.2024.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
Pregnant women have a higher risk of urinary tract infections (UTIs) compared to non-pregnant women, making antibiotics necessary for treatment. However, prescribing antibiotics without culture and sensitivity tests may contribute to antimicrobial resistance. A meta-analysis using R was conducted to determine the prevalence of antibiotic resistance patterns in UTIs among pregnant women. We identified observational studies published in the last 10 years and used a random effects model to calculate the pooled prevalence. The prevalence of Gram-negative organisms causing UTIs in pregnant women was 67 %, while Gram-positive organisms were 22 %. The burden of Gram-positive organisms exhibiting antimicrobial resistance was very high at 95 %, primarily to ampicillin. The most common Gram-negative organisms exhibiting antimicrobial resistance were E. coli, Klebsiella, and Pseudomonas aeruginosa, while the most common Gram-positive organisms resistant to antibiotics were Staphylococcus aureus and coagulase-negative Staphylococcus. Sensitivity and culture testing are recommended for effective treatment in pregnant women with UTIs.
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Affiliation(s)
- Hanan M Al Kadri
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Ashraf A El-Metwally
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Atika A Al Sudairy
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed A Al-Dahash
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Badr F Al Khateeb
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Family Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sameera M Al Johani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
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Papatsoris A, Alba AB, Galán Llopis JA, Musafer MA, Alameedee M, Ather H, Caballero-Romeu JP, Costa-Bauzá A, Dellis A, El Howairis M, Gambaro G, Geavlete B, Halinski A, Hess B, Jaffry S, Kok D, Kouicem H, Llanes L, Lopez Martinez JM, Popov E, Rodgers A, Soria F, Stamatelou K, Trinchieri A, Tuerk C. Management of urinary stones: state of the art and future perspectives by experts in stone disease. Arch Ital Urol Androl 2024; 96:12703. [PMID: 38934520 DOI: 10.4081/aiua.2024.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
AIM To present state of the art on the management of urinary stones from a panel of globally recognized urolithiasis experts who met during the Experts in Stone Disease Congress in Valencia in January 2024. Options of treatment: The surgical treatment modalities of renal and ureteral stones are well defined by the guidelines of international societies, although for some index cases more alternative options are possible. For 1.5 cm renal stones, both m-PCNL and RIRS have proven to be valid treatment alternatives with comparable stone-free rates. The m-PCNL has proven to be more cost effective and requires a shorter operative time, while the RIRS has demonstrated lower morbidity in terms of blood loss and shorter recovery times. SWL has proven to be less effective at least for lower calyceal stones but has the highest safety profile. For a 6mm obstructing stone of the pelviureteric junction (PUJ) stone, SWL should be the first choice for a stone less than 1 cm, due to less invasiveness and lower risk of complications although it has a lower stone free-rate. RIRS has advantages in certain conditions such as anticoagulant treatment, obesity, or body deformity. Technical issues of the surgical procedures for stone removal: In patients receiving antithrombotic therapy, SWL, PCN and open surgery are at elevated risk of hemorrhage or perinephric hematoma. URS, is associated with less morbidity in these cases. An individualized combined evaluation of risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. Pre-interventional urine culture and antibiotic therapy are mandatory although UTI treatment is becoming more challenging due to increasing resistance to routinely applied antibiotics. The use of an intrarenal urine culture and stone culture is recommended to adapt antibiotic therapy in case of postoperative infectious complications. Measurements of temperature and pressure during RIRS are vital for ensuring patient safety and optimizing surgical outcomes although techniques of measurements and methods for data analysis are still to be refined. Ureteral stents were improved by the development of new biomaterials, new coatings, and new stent designs. Topics of current research are the development of drug eluting and bioresorbable stents. Complications of endoscopic treatment: PCNL is considered the most invasive surgical option. Fever and sepsis were observed in 11 and 0.5% and need for transfusion and embolization for bleeding in 7 and 0.4%. Major complications, as colonic, splenic, liver, gall bladder and bowel injuries are quite rare but are associated with significant morbidity. Ureteroscopy causes less complications, although some of them can be severe. They depend on high pressure in the urinary tract (sepsis or renal bleeding) or application of excessive force to the urinary tract (ureteral avulsion or stricture). Diagnostic work up: Genetic testing consents the diagnosis of monogenetic conditions causing stones. It should be carried out in children and in selected adults. In adults, monogenetic diseases can be diagnosed by systematic genetic testing in no more than 4%, when cystinuria, APRT deficiency, and xanthinuria are excluded. A reliable stone analysis by infrared spectroscopy or X-ray diffraction is mandatory and should be associated to examination of the stone under a stereomicroscope. The analysis of digital images of stones by deep convolutional neural networks in dry laboratory or during endoscopic examination could allow the classification of stones based on their color and texture. Scanning electron microscopy (SEM) in association with energy dispersive spectrometry (EDS) is another fundamental research tool for the study of kidney stones. The combination of metagenomic analysis using Next Generation Sequencing (NGS) techniques and the enhanced quantitative urine culture (EQUC) protocol can be used to evaluate the urobiome of renal stone formers. Twenty-four hour urine analysis has a place during patient evaluation together with repeated measurements of urinary pH with a digital pH meter. Urinary supersaturation is the most comprehensive physicochemical risk factor employed in urolithiasis research. Urinary macromolecules can act as both promoters or inhibitors of stone formation depending on the chemical composition of urine in which they are operating. At the moment, there are no clinical applications of macromolecules in stone management or prophylaxis. Patients should be evaluated for the association with systemic pathologies. PROPHYLAXIS Personalized medicine and public health interventions are complementary to prevent stone recurrence. Personalized medicine addresses a small part of stone patients with a high risk of recurrence and systemic complications requiring specific dietary and pharmacological treatment to prevent stone recurrence and complications of associated systemic diseases. The more numerous subjects who form one or a few stones during their entire lifespan should be treated by modifications of diet and lifestyle. Primary prevention by public health interventions is advisable to reduce prevalence of stones in the general population. Renal stone formers at "high-risk" for recurrence need early diagnosis to start specific treatment. Stone analysis allows the identification of most "high-risk" patients forming non-calcium stones: infection stones (struvite), uric acid and urates, cystine and other rare stones (dihydroxyadenine, xanthine). Patients at "high-risk" forming calcium stones require a more difficult diagnosis by clinical and laboratory evaluation. Particularly, patients with cystinuria and primary hyperoxaluria should be actively searched. FUTURE RESEARCH Application of Artificial Intelligence are promising for automated identification of ureteral stones on CT imaging, prediction of stone composition and 24-hour urinary risk factors by demographics and clinical parameters, assessment of stone composition by evaluation of endoscopic images and prediction of outcomes of stone treatments. The synergy between urologists, nephrologists, and scientists in basic kidney stone research will enhance the depth and breadth of investigations, leading to a more comprehensive understanding of kidney stone formation.
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Affiliation(s)
- Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens; U-merge Scientific Office.
| | - Alberto Budia Alba
- Urology Department, La Fe University and Polytechnic Hospital, Valencia.
| | | | | | | | | | | | - Antònia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Illes Balears, Palma de Mallorca.
| | - Athanasios Dellis
- 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens.
| | | | - Giovanni Gambaro
- Division of Nephrology, Department of Medicine, University Hospital of Verona.
| | - Bogdan Geavlete
- "Carol Davila" University of Medicine and Pharmacy & "Saint John" Emergency Clinical Hospital, Bucharest.
| | - Adam Halinski
- Private Medical Center "Klinika Wisniowa" Zielona Gora.
| | - Bernhard Hess
- Internal Medicine & Nephrology, KidneyStoneCenter Zurich, Klinik Im Park, Zurich.
| | | | - Dirk Kok
- Saelo Scientific Support, Oegstgeest.
| | | | - Luis Llanes
- Urology Department, University Hospital of Getafe, Getafe, Madrid.
| | | | - Elenko Popov
- Department of Urology, UMHAT "Tzaritza Yoanna-ISUL", Medical University, Sofia.
| | | | - Federico Soria
- Experimental Surgery Department, Ramón y Cajal University Hospital, Madrid.
| | - Kyriaki Stamatelou
- MESOGEIOS Nephrology Center, Haidari Attica and NEPHROS.EU Private Clinic, Athens.
| | | | - Christian Tuerk
- Urologic Department, Sisters of Charity Hospital and Urologic Praxis, Wien.
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Siddig LA, Bayoumi M, Elhadi N. Sociodemographic distributions and molecular characterization of colonized Enterococcus faecium isolates from locality hospitals in Khartoum, Sudan. PeerJ 2023; 11:e16169. [PMID: 37842047 PMCID: PMC10573385 DOI: 10.7717/peerj.16169] [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: 02/24/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023] Open
Abstract
Background Enterococcus faecium is an opportunistic pathogen of humans with diverse hosts, encompassing animals as well as human beings. In the past twenty years, there has been a rise in the instances of nosocomial infections that are linked to antibiotic-resistant Enterococcus faecium. The acquisition of diverse antimicrobial resistance factors has driven the global development of robust and convergent adaptive mechanisms within the healthcare environment. The presence of microorganisms in hospitalized and non-hospitalized patient populations has been significantly aided by the facilitation of various perturbations within their respective microbiomes. Objective This study aimed to determine the antimicrobial profile, demographic and clinical characteristics, along with the detection of virulence encoding genes, and to find out the clonal genetic relationship among colonized E. faecium strains. Methodology A hospital-based cross-sectional study was carried out between October 2018 and March 2020 at four Khartoum locality hospitals in Sudan. The study comprised a total of 108 strains of E. faecium isolated from patients admitted to four locality hospitals in Khartoum. A self-structured questionnaire was used to gather information on sociodemographic traits. Data were analyzed using chi-square test. In all cases, P value ≤ 0.05 with a corresponding 95% confidence interval was considered statistically significant. Moreover, enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) was utilized to assess the prevalence of clonal relationships, and the gel was analyzed using CLIQS software. Results In this study, the isolation rate of colonized E. faecium strains was 108/170 (63.5%). The colonization of E. faecium and its association with various sociodemographic and clinical features was examined. 73 (67.6%) of patients had multidrug-resistant (MDR), and 22 (20.4%) had extensively drug-resistant (XDR), 73 (67.6%) of patients engaged in self-medication practices. Eighty patients (74.1%) were non-adherence to prescribed antibiotics, while 70 (64.8%) patients reported recent antibiotic usage within the 3 months. The present study suggests that demographic factors may not be significantly associated with the incidence of E. faecium infection except for patients who had a prior history of antibiotic use (P ≤ 0.005). The analysis of virulence genes showed a high prevalence of asa1 gene (22.2%) among strains. In ERIC-PCR the genetic relatedness of E. faecium showed seven identical clusters (A-G) with 100% genetic similarity. This implies clonal propagation in hospitals and communities. Conclusion This study found that the incidence of E. faecium isolated from locality hospitals in Khartoum was likely due to the spread of E. faecium clones, thereby highlighting the need for intensifying infection control measures to prevent the spreading of nosocomial infection.
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Affiliation(s)
- Loai Abdelati Siddig
- Microbiology Department, Faculty of Medical Laboratory Sciences, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Magdi Bayoumi
- Microbiology Department, Faculty of Medicine, University of Medical Sciences and Technology (UMST), Khartoum, Sudan
| | - Nasreldin Elhadi
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Omulo S, Ita T, Mugoh R, Ayodo C, Luvsansharav U, Bollinger S, Styczynski A, Ramay BM, Caudell MA, Palmer GH, Kariuki S, Call DR, Smith RM. Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant and Carbapenem-Resistant Enterobacterales Among Hospitalized Patients in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S97-S103. [PMID: 37406042 DOI: 10.1093/cid/ciad258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) represents a significant global public health threat. We identified putative risk factors for ESCrE and CRE colonization among patients in 1 urban and 3 rural hospitals in Kenya. METHODS During a January 2019 and March 2020 cross-sectional study, stool samples were collected from randomized inpatients and tested for ESCrE and CRE. The Vitek2 instrument was used for isolate confirmation and antibiotic susceptibility testing, and least absolute shrinkage and selection operator (LASSO) regression models were used to identify colonization risk factors while varying antibiotic use measures. RESULTS Most (76%) of the 840 enrolled participants received ≥1 antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%), metronidazole (28%), or benzylpenicillin-gentamycin (23%). For LASSO models that included ceftriaxone administration, ESCrE colonization odds were higher among patients hospitalized for ≥3 days (odds ratio, 2.32 [95% confidence interval, 1.6-3.37]; P < .001), intubated patients (1.73 [1.03-2.91]; P = .009), and persons living with human immunodeficiency virus (1.70 [1.03-2.8]; P = .029). CRE colonization odds were higher among patients receiving ceftriaxone (odds ratio, 2.23 [95% confidence interval, 1.14-4.38]; P = .025) and for every additional day of antibiotic use (1.08 [1.03-1.13]; P = .002). CONCLUSIONS While CRE colonization was strongly associated with ceftriaxone use and duration of antibiotic use, the odds of ESCrE colonization increased with exposure to the hospital setting and invasive medical devices, which may reflect nosocomial transmission. These data suggest several areas where hospitals can intervene to prevent colonization among hospitalized patients, both through robust infection prevention and control practices and antibiotic stewardship programs.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Teresa Ita
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Robert Mugoh
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Charchil Ayodo
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Ulzii Luvsansharav
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Styczynski
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brooke M Ramay
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Mark A Caudell
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | | | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Radu VD, Costache RC, Onofrei P, Miftode E, Linga I, Ouatu RM, Boiculese L, Bobeica RL, Tanasa Vasilache I, Mititiuc IL. 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 (Basel) 2023; 12:973. [PMID: 37370292 DOI: 10.3390/antibiotics12060973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of the study was to compare the profile of COVID-19 (CoV)-infected patients with non-COVID-19 (non-CoV) patients who presented with a multidrug-resistant urinary tract infection (MDR UTI) associated with gut microbiota, as well as analyze the risk factors for their occurrence, the types of bacteria involved, and their spectrum of sensitivity. METHODS We conducted a case-control study on patients admitted to the urology clinic of the "Parhon" Teaching Hospital in Iasi, Romania, between March 2020 and August 2022. The study group consisted of 22 CoV patients with MDR urinary infections associated with gut microbiota. For the control group, 66 non-CoV patients who developed MDR urinary infections associated with gut microbiota were selected. Electronic medical records were analyzed to determine demographics, characteristics, and risk factors. The types of urinary tract bacteria involved in the occurrence of MDR urinary infections and their sensitivity spectrum were also analyzed. RESULTS Patients in both groups studied were over 60 years of age, with no differences in gender, environment of origin, and rate of comorbidities. Patients in the CoV group had a higher percentage of urosepsis (54.5% versus 21.2%, p < 0.05) and more hospitalization days (9.27 versus 6.09, p < 0.05). Regarding risk factors, the two groups had similar percentages of previous urologic interventions (95.45% versus 96.97%, p > 0.05), antibiotic therapy (77.3% versus 87.9%, p > 0.05), and the presence of permanent urinary catheters (77.27% versus 84.85%, p > 0.05). Escherichia coli (31.8% versus 42.4%, p > 0.05), Klebsiella spp. (22.7% versus 34.8%, p > 0.05), and Pseudomonas aeruginosa (27.3% versus 9.1%, p > 0.05) were the most common urinary tract bacteria found in the etiology of MDR urinary infections in CoV and non-CoV patients. A high percentage of the involved MDR urinary tract bacteria were resistant to quinolones (71.4-76.2% versus 80.3-82%, p > 0.05) and cephalosporins (61.9-81% versus 63.9-83.6%, p > 0.05), both in CoV and non-CoV patients. CONCLUSIONS Patients with urological interventions who remain on indwelling urinary catheters are at an increased risk of developing MDR urinary infections associated with gut microbiota resistant to quinolones and cephalosporins. Patients with MDR UTIs who have CoV-associated symptoms seem to have a higher rate of urosepsis and a longer hospitalization length.
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Affiliation(s)
- Viorel Dragos Radu
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Radu Cristian Costache
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Pavel Onofrei
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Egidia Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Iacov Linga
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Radu Mihaita Ouatu
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Lucian Boiculese
- Department of Preventive and Interdisciplinarity, Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Razvan Lucian Bobeica
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Ingrid Tanasa Vasilache
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Irina Luanda Mititiuc
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
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Madrazo M, López-Cruz I, Piles L, Viñola S, Alberola J, Eiros JM, Artero A. Risk Factors and the Impact of Multidrug-Resistant Bacteria on Community-Acquired Urinary Sepsis. Microorganisms 2023; 11:1278. [PMID: 37317252 DOI: 10.3390/microorganisms11051278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023] Open
Abstract
Risk factors for multidrug-resistant bacteria (MDRB) in nosocomial urinary tract infection (UTI) have been widely studied. However, these risk factors have not been analyzed in community-acquired urinary sepsis (US), nor have its outcomes been studied. The aim of our study is to determine risk factors for MDRB in community-acquired US and its influence on outcomes. Prospective observational study of patients with community-acquired US admitted to a university hospital. We compared epidemiological and clinical variables and outcomes of US due to MDRB and non-MDRB. Independent risk factors for MDRB were analyzed using logistic regression. A total of 193 patients were included, 33.7% of them with US due to MDRB. The median age of patients was 82 years. Hospital mortality was 17.6%, with no difference between the MDRB and non-MDRB groups. The length of hospital stay was 5 (4-8) days, with a non-significant tendency to longer hospital stays in the MDRB group (6 (4-10) vs. 5 (4-8) days, p = 0.051). Healthcare-associated US was found to be an independent risk factor for MDR bacteria by multivariate analysis. In conclusion, the impact of MDR bacteria on the outcomes of community-acquired urinary sepsis was mild. Healthcare-associated US was an independent risk factor for MDR bacteria.
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Affiliation(s)
- Manuel Madrazo
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain
| | - Ian López-Cruz
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain
| | - Laura Piles
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain
| | - Sofía Viñola
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain
| | - Juan Alberola
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain
| | | | - Arturo Artero
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain
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Arafi V, Hasani A, Sadeghi J, Varshochi M, Poortahmasebi V, Hasani A, Hasani R. Uropathogenic Escherichia coli endeavors: an insight into the characteristic features, resistance mechanism, and treatment choice. Arch Microbiol 2023; 205:226. [PMID: 37156886 DOI: 10.1007/s00203-023-03553-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
Uropathogenic Escherichia coli (UPEC) are the strains diverted from the intestinal status and account mainly for uropathogenicity. This pathotype has gained specifications in structure and virulence to turn into a competent uropathogenic organism. Biofilm formation and antibiotic resistance play an important role in the organism's persistence in the urinary tract. Increased consumption of carbapenem prescribed for multidrug-resistant (MDR) and Extended-spectrum-beta lactamase (ESBL)-producing UPECs, has added to the expansion of resistance. The World Health Organization (WHO) and Centre for Disease Control (CDC) placed the Carbapenem-resistant Enterobacteriaceae (CRE) on their treatment priority lists. Understanding both patterns of pathogenicity, and multiple drug resistance may provide guidance for the rational use of anti-bacterial agents in the clinic. Developing an effective vaccine, adherence-inhibiting compounds, cranberry juice, and probiotics are non-antibiotical approaches proposed for the treatment of drug-resistant UTIs. We aimed to review the distinguishing characteristics, current therapeutic options and promising non-antibiotical approaches against ESBL-producing and CRE UPECs.
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Affiliation(s)
- Vahid Arafi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alka Hasani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Clinical Research Development Unit, Sina Educational, Research and Treatment Centre, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Javid Sadeghi
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojtaba Varshochi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahdat Poortahmasebi
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Hasani
- Department of Clinical Biochemistry and Laboratory Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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McAteer J, Lee JH, Cosgrove SE, Dzintars K, Fiawoo S, Heil EL, Kendall RE, Louie T, Malani AN, Nori P, Percival KM, Tamma PD. Defining the Optimal Duration of Therapy for Hospitalized Patients With Complicated Urinary Tract Infections and Associated Bacteremia. Clin Infect Dis 2023; 76:1604-1612. [PMID: 36633559 PMCID: PMC10411929 DOI: 10.1093/cid/ciad009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTIs). METHODS We conducted an observational study of patients ≥18 years at 24 US hospitals to identify the optimal treatment duration for patients with cUTI. To increase the likelihood patients experienced true infection, eligibility was limited to those with associated bacteremia. Propensity scores were generated for an inverse probability of treatment weighted analysis. The primary outcome was recurrent infection with the same species ≤30 days of completing therapy. RESULTS 1099 patients met eligibility criteria and received 7 (n = 265), 10 (n = 382), or 14 (n = 452) days of therapy. There was no difference in the odds of recurrent infection for patients receiving 10 days and those receiving 14 days of therapy (aOR: .99; 95% CI: .52-1.87). Increased odds of recurrence was observed in patients receiving 7 days versus 14 days of treatment (aOR: 2.54; 95% CI: 1.40-4.60). When limiting the 7-day versus 14-day analysis to the 627 patients who remained on intravenous beta-lactam therapy or were transitioned to highly bioavailable oral agents, differences in outcomes no longer persisted (aOR: .76; 95% CI: .38-1.52). Of 76 patients with recurrent infections, 2 (11%), 2 (10%), and 10 (36%) in the 7-, 10-, and 14-day groups, respectively, had drug-resistant infections (P = .10). CONCLUSIONS Seven days of antibiotics appears effective for hospitalized patients with cUTI when antibiotics with comparable intravenous and oral bioavailability are administered; 10 days may be needed for all other patients.
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Affiliation(s)
- John McAteer
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jae Hyoung Lee
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Dzintars
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Suiyini Fiawoo
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily L Heil
- Department of Practice, Science, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Ronald E Kendall
- Department of Pharmacy, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ted Louie
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Anurag N Malani
- Department of Medicine, Trinity Health St. Joseph Mercy, Ann Arbor, Michigan, USA
| | - Priya Nori
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kelly M Percival
- Department of Pharmaceutical Care, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Machado IC, Nunes T, Maximino M, Malato J, Tavares L, Almeida V, Sepúlveda N, Gil S. Epidemiologic Factors Supporting Triage of Infected Dog Patients Admitted to a Veterinary Hospital Biological Isolation and Containment Unit. Vet Sci 2023; 10:vetsci10030186. [PMID: 36977225 PMCID: PMC10057909 DOI: 10.3390/vetsci10030186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
The teaching hospital of the Faculty of Veterinary Medicine at the University of Lisbon hosts a Biological Isolation and Containment Unit (BICU) for the hospitalization of both confirmed and suspected animals of an infectious disease. This study targets the BICU dog population to identify and characterize the most frequent infectious diseases recorded in a 7-year period. Several epidemiologic factors were analyzed for their significance to triage infected cases. During the study period, 534 dogs were admitted, of which 263 (49.3%) had a confirmed infectious disease diagnosis: parvovirosis (49.4%; n = 130); leptospirosis (21.7%; n = 57); multidrug-resistant (MDR) bacterial infection; (10.6%; n = 28), and canine distemper (9.9%; n = 26). Several potential risk factors for these diseases were identified: age under 2 years old (p < 0.001), incomplete vaccination for parvovirosis (p < 0.001), age ≥ 10 years old (p < 0.001), and the presence of concomitant disorders for MDR-infected cases (p = 0.03). Logistic regression models were constructed to classify cases and controls. The sensitivity and specificity estimates were very high (>0.83) for parvovirosis, MDR, and distemper infections. A lower sensitivity (0.77) was obtained for identifying cases with leptospirosis. In conclusion, infectious diseases are frequent, hence, it is essential to decrease their occurrence through effective preventive measures such as vaccination. The constructed logistic models can also help in triaging admitted dogs with a potential infectious disease.
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Affiliation(s)
- Inês Cunha Machado
- Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal
| | - Telmo Nunes
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal
| | - Miguel Maximino
- Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - João Malato
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
| | - Luís Tavares
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal
| | - Virgilio Almeida
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal
| | - Nuno Sepúlveda
- Centro de Estatística e Aplicações da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 75, 00-662 Warsaw, Poland
| | - Solange Gil
- Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av. Universidade Técnica, 1300-477 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal
- Correspondence: ; Tel.: +48-351213652800
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10
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AbuSara A, Tayyeb N, Matalka L, Almomani B, Abaza H, Nazer L. Prevalence and Predictors of Multi-Drug Resistant Organisms Among Ambulatory Cancer Patients with Urinary Tract Infections. Infect Drug Resist 2023; 16:747-753. [PMID: 36760782 PMCID: PMC9904220 DOI: 10.2147/idr.s388680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose Urinary tract infections (UTIs) are among the most common community-acquired infections in patients with cancer. Though the prevalence of multi-drug resistant organisms (MDROs) has increased, there are limited studies on MDROs among ambulatory cancer patients with UTIs. Therefore, we aimed to evaluate the prevalence and predictors of MDROs in this patient population. Patients and Methods A retrospective study of adult cancer patients treated for bacterial UTIs in the ambulatory setting at King Hussein Cancer Center. The medical laboratory's system was used to identify positive urine cultures taken in the ambulatory setting, between Aug 2020 and March 2021. UTIs were defined as a positive urine culture along with the initiation of antibiotics empirically or as definitive therapy. Patient characteristics, as well as the type and sensitivity of the bacterial organisms, were recorded. MDROs were defined as intrinsic or acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Logistic regression was used to identify predictors that were independently associated with MDROs. Results A total of 376 patients had UTIs that met the inclusion criteria; mean age 60.5±15.1 (SD) years and 330 (87.8%) had solid tumors. Gram-negative bacteria was recorded in the majority of UTIs (n = 368, 97.9%), the most common being Escherichia-coli (n = 220, 59.8%) and Klebsiella-pneumonia (n = 68, 18.5%). MDROs were recorded in 226 (60.1%) of urine cultures, with the majority being extended-spectrum-beta-lactamase producing organisms (n = 142, 62.8%). The only significant predictor was having had a UTI with MDRO within the past 6 months (OR 5.6, 95% CI 2.1-15.2). Conclusion More than half of the positive urine cultures of cancer patients treated for UTIs in the ambulatory setting were MDROs. A subsequent UTI due to MDROs is more likely to occur in patients who had a UTI with an MDRO within the past 6 months.
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Affiliation(s)
- Aseel AbuSara
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan,Correspondence: Aseel AbuSara, Department of Pharmacy, King Hussein Cancer Center, Queen Rania Al-Abdallah Street, P.O.Box 1269, Amman, 1191, Jordan, Tel + 962-6 5300460, Email
| | - Nabiha Tayyeb
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Lujain Matalka
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Bayan Almomani
- Department of Microbiology, King Hussein Cancer Center, Amman, Jordan
| | - Haneen Abaza
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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11
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Asamoah B, Labi AK, Gupte HA, Davtyan H, Peprah GM, Adu-Gyan F, Nair D, Muradyan K, Jessani NS, Sekyere-Nyantakyi P. High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16556. [PMID: 36554436 PMCID: PMC9779193 DOI: 10.3390/ijerph192416556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Management of urinary tract infections is challenged by increasing antimicrobial resistance (AMR) worldwide. In this study, we describe the trends in antimicrobial resistance of uropathogens isolated from the largest private sector laboratory in Ghana over a five-year period. We reviewed positive urine cultures at the MDS Lancet Laboratories from 2017 to 2021. The proportions of uropathogens with antimicrobial resistance to oral and parenteral antimicrobials recommended by the Ghana standard treatment guidelines were determined. The proportion of multi-drug resistant isolates, ESBL and carbapenemase-producing phenotypes were determined. Of 94,134 urine specimens submitted for culture, 20,010 (22.1%) were culture positive. Enterobacterales was the most common group of organisms, E. coli (70.6%) being the most common isolate and Enterococcus spp. the most common gram-positive (1.3%) organisms. Among oral antimicrobials, the highest resistance was observed to ciprofloxacin (62.3%) and cefuroxime (60.2%) and the least resistance to fosfomycin (1.9%). The least resistance among parenteral antimicrobials was to meropenem (0.3%). The highest multi-drug resistance levels were observed among Klebsiella spp. (68.6%) and E. coli (64.0%). Extended-spectrum beta-lactamase (ESBL) positivity was highest in Klebsiella spp. (58.6%) and E. coli (50.0%). There may be a need to review the Ghana standard treatment guidelines to reflect increased resistance among uropathogens to recommended antimicrobials.
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Affiliation(s)
| | | | | | - Hayk Davtyan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | | | | | - Divya Nair
- International Union Against TB and Lung Disease (The Union), 75006 Paris, France
| | - Karlos Muradyan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | - Nasreen S. Jessani
- Centre for Evidence based Health Care, Department of Global Health, Stellenbosch University, Cape Town 800, South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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12
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Prospects and Challenges of Electrospun Cell and Drug Delivery Vehicles to Correct Urethral Stricture. Int J Mol Sci 2022; 23:ijms231810519. [PMID: 36142432 PMCID: PMC9502833 DOI: 10.3390/ijms231810519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Current therapeutic modalities to treat urethral strictures are associated with several challenges and shortcomings. Therefore, significant strides have been made to develop strategies with minimal side effects and the highest therapeutic potential. In this framework, electrospun scaffolds incorporated with various cells or bioactive agents have provided promising vistas to repair urethral defects. Due to the biomimetic nature of these constructs, they can efficiently mimic the native cells’ niches and provide essential microenvironmental cues for the safe transplantation of multiple cell types. Furthermore, these scaffolds are versatile platforms for delivering various drug molecules, growth factors, and nucleic acids. This review discusses the recent progress, applications, and challenges of electrospun scaffolds to deliver cells or bioactive agents during the urethral defect repair process. First, the current status of electrospinning in urethral tissue engineering is presented. Then, the principles of electrospinning in drug and cell delivery applications are reviewed. Finally, the recent preclinical studies are summarized and the current challenges are discussed.
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13
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Faine BA, Rech MA, Vakkalanka P, Gross A, Brown C, Harding SJ, Slocum G, Zimmerman D, Zepeski A, Rewitzer S, Howington GT, Campbell M, Dawson J, Treu CN, Nelson L, Jones M, Flack T, Porter B, Sarangarm P, Mattson AE, Bailey A, Kelly G, Talan DA. High prevalence of fluoroquinolone-resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018-2020. Acad Emerg Med 2022; 29:1096-1105. [PMID: 35652493 PMCID: PMC9543902 DOI: 10.1111/acem.14545] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Uropathogen resistance, fluoroquinolone-resistance (FQR), and extended spectrum beta-lactamase (ESBL), has been observed to be emerging worldwide with prevalences above recommended thresholds for routine empirical treatment. The primary aim of our study was to determine the prevalence of FQR from a geographically diverse sample of United States emergency departments (EDs). METHODS We conducted a multi-center, observational cohort study using a network of 15 geographically diverse US EDs. All patients ≥18 years of age with the primary or secondary diagnosis of urinary tract infection (UTI) in the ED identified using International Classification of Diseases (ICD-10) diagnosis code of cystitis, pyelonephritis, or UTI from 2018 to 2020 were included. We calculated descriptive statistics for uropathogens and susceptibilities. Logistic regression analysis was used to identify antimicrobial resistance risk factors associated with FQR Escherichia coli. RESULTS Among 3779 patients who met inclusion criteria, median age was 62.9 years (interquartile range [IQR]: 41-77.6) and 76.3% were female. The most common diagnoses were complicated (41.2%) and uncomplicated cystitis (40.3%). E. coli was the most common pathogen (63.2%), followed by Klebsiella pneumoniae (13.2%) and Enterococcus species (5.8%). Across all sites, overall E. coli FQ-resistance prevalence was 22.1%, ranging from 10.5 to 29.7% by site. The prevalence of ESBL-producing uropathogen was 7.4%, ranging from 3.6% to 11.6% by site. Previous IV or oral antimicrobial use in the past 90-days and history of a multi-drug resistant pathogen were associated with FQ-resistant E. coli (odds ratio [OR] 2.68, 95% confidence interval [CI]: 2.04-3.51, and OR 6.93, 95% CI: 4.95-9.70, respectively). Of the patients who had FQ-resistant E. coli or an ESBL-producing uropathogen isolated, 116 (37.1%) and 61 (36.7%) did not have any documented risk factors for resistance. CONCLUSION FQ-resistant E. coli is widely prevalent across US sites highlighting the need for ongoing monitoring of antimicrobial resistance and, at some locations, modification of empirical treatments.
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Affiliation(s)
- Brett A. Faine
- Department of Emergency Medicine and PharmacyUniversity of Iowa Hospitals and ClinicsHawkinsIowaUSA
| | - Megan A. Rech
- Department of Emergency MedicineLoyola University Medical CenterMaywoodIllinoisUSA
| | | | - Alan Gross
- University of Illinois at Chicago College of PharmacyChicagoIllinoisUSA
| | - Caitlin Brown
- Assistant Professor of Pharmacy and Emergency MedicineMayo Clinic School of Medicine and ScienceRochesterMinnesotaUSA
| | - Stephanie J. Harding
- Infectious Diseases Clinical Pharmacy SpecialistWesley Medical CenterWichitaKansasUSA
| | - Giles Slocum
- Emergency Medicine Clinical Pharmacy Specialist, Assistant Professor, Department of Pharmacy Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - David Zimmerman
- Associate Professor of Pharmacy at Duquesne University School of PharmacyEmergency Medicine Pharmacist at University of Pittsburgh Medical Center‐ Mercy HospitalPittsburghPennsylvaniaUSA
| | - Anne Zepeski
- Emergency Medicine Clinical PharmacistUniversity of IowaIowa CityIowaUSA
| | | | - Gavin T. Howington
- Department of Pharmacy Practice and ScienceUniversity of Kentucky College of PharmacyEmergency Medicine Clinical Pharmacy SpecialistLexingtonKentuckyUSA
| | - Matt Campbell
- Emergency Medicine Clinical Coordinator, Department of PharmacyCleveland ClinicClevelandOhioUSA
| | - Jordan Dawson
- Emergency Medicine and Critical CareDenver Health Medical CenterDenverColoradoUSA
| | - Cierra N. Treu
- New York‐Presbyterian Brooklyn Methodist HospitalBrooklynNew YorkUSA
| | - Lucas Nelson
- Emergency Center Pharmacist LeadPark Nicollet, Methodist HospitalSaint Louis ParkMinnesotaUSA
| | - Mandy Jones
- Emergency Medicine Clinical Pharmacy SpecialistUK HealthCare, Fellow, Center for Interprofessional Healthcare Education, University of KentuckyLexingtonKentuckyUSA
| | - Tara Flack
- Emergency Medicine Clinical PharmacistIndiana University Health Methodist HospitalIndianapolisIndianaUSA
| | - Blake Porter
- Emergency Medicine Pharmacist ClinicianUniversity of Vermont Medical CenterBurlingtonVermontUSA
| | | | - Alicia E. Mattson
- Emergency Medicine Clinical PharmacistInstructor of Pharmacy, Mayo ClinicRochesterMinnesotaUSA
| | - Abby Bailey
- Emergency Medicine University of Kentucky HealthCareLexingtonKentuckyUSA
| | - Gregory Kelly
- Rutgers Ernest Mario College of Pharmacy, Emergency Medicine Clinical Pharmacy SpecialistRobert Wood Johnson University Hospital‐New BrunswickNew BrunswickNew JerseyUSA
| | - David A. Talan
- The David Geffen School of Medicine at UCLA, Chairman Emeritus, Dept. of Emergency Medicine, Faculty, Division of Infectious DiseasesOlive View‐UCLA Medical CenterSylmarCaliforniaUSA
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Barré SL, Weeda ER, Matuskowitz AJ, Hall GA, Weant KA. Risk Factors for Antibiotic Resistant Urinary Pathogens in Patients Discharged From the Emergency Department. Hosp Pharm 2022; 57:462-468. [PMID: 35898246 PMCID: PMC9310312 DOI: 10.1177/00185787211046851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Purpose: Urinary tract infections (UTIs) are one of the most common indications for antimicrobial use in the emergency department (ED). Appropriate empiric selection is crucial to ensure optimal care while limiting broad-spectrum antibiotic use. The primary objective of this study was to evaluate the relationship between patient-specific risk factors and drug resistant urinary pathogens in patients discharged from the ED and followed by Emergency Medicine Pharmacists (EMPs). Methods: This was a single-center, retrospective chart review of adult (≥18 years old) patients with positive urine cultures discharged from the ED. The association between risk factors and pathogen resistance to ≥1 classes of antibiotics was evaluated using multivariate logistic regression. Risk factors included the following: hospitalization within the previous 30 days, intravenous antibiotic use within 90 days, diabetes, clinical atherosclerotic cardiovascular disease, psychiatric disorder, dementia, current antibiotic use for any indication, previous lifetime history of UTIs, indwelling or intermittent catheterization, hemodialysis, previous lifetime history of a urologic procedure, urinary tract abnormality, immunosuppressive disease or medications, current residence in a nursing or rehabilitation facility, and history of a multidrug resistant organism (MDRO). Results: A total of 1018 patients were included. There was an increase in the odds of antibiotic resistance in patients with cystitis and ≥2 risk factors (Odds Ratio [OR] = 1.70, 95% CI = 1.24-2.32). In those with pyelonephritis, there was a non-significant increase in the odds of resistance for those with ≥2 risk factors (OR = 1.83, 95% CI = 0.98-3.42). Patients with pyelonephritis discharged on inappropriate antibiotics were more likely to return to the ED within 30 days (P = .03). Conclusions: For patients with cystitis discharged from the ED, those with ≥2 patient-specific risk factors had significantly increased odds of antibiotic resistance. Patients with pyelonephritis, but not cystitis, who were discharged on inappropriate antibiotics were more likely to return to the ED within 30 days. In conjunction with an EMP culture follow-up program, the identification of risk factors for antimicrobial resistance can be used to design more patient-specific empiric antibiotic selections.
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Affiliation(s)
- Stephanie L. Barré
- Department of Pharmacy, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Erin R. Weeda
- Medical University of South Carolina College of Pharmacy, Charleston, SC, USA
| | - Andrew J. Matuskowitz
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Gregory A. Hall
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kyle A. Weant
- Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
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Mohammed EJ, Hasan KC, Allami M. Phylogenetic groups, serogroups and virulence factors of uropathogenic Escherichia coli isolated from patients with urinary tract infection in Baghdad, Iraq. IRANIAN JOURNAL OF MICROBIOLOGY 2022; 14:445-457. [PMID: 36721510 PMCID: PMC9867636 DOI: 10.18502/ijm.v14i4.10230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background and Objectives Uropathogenic Escherichia coli (UPEC) is divided into different phylogenetic groups that differ in their antibiotic resistance patterns, serogroups and pathogenicity. This study aimed to investigate the prevalence of phylogenetic groups of UPEC isolates and their relationship with serogroups and virulence factors in patients with UTIs. Materials and Methods Of the 412 urine samples tested a total of 150 UPEC were isolated and confirmed with PCR using 16S rRNA gene. Antibiotic resistance of the isolates was tested using disk diffusion method and the isolates were divided into phylogenetic groups by the quadruplex PCR method. The prevalence of serogroups and virulence genes were investigated using multiplex PCR. Results 87 (58%) of the isolates belonged to phylogroup B2. Virulence genes fimH (95.3%), aer (49.3%) and serogroups O8 (22.3%), O25 (21.5%) showed the highest prevalence. The lowest drug resistance was observed against imipenem (4.6%) and meropenem (3.3%). The prevalence of multidrug-resistant and extended-spectrum beta-lactamases isolates were 60% and 61.3%, respectively. We also found a significant relationship between phylogenetic groups, serogroups and virulence factors among our isolates. Conclusion The high abundance of phylogenetic group B2, serogroups O8 and O25, and virulence genes fimH and aer indicate their importance in the pathogenesis of UPEC in this country.
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Affiliation(s)
- Eman Jassim Mohammed
- Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq
| | - Kadhim Ch. Hasan
- Department of Surgery, Babil Medical College, University of Babylon, Babil, Iraq
| | - Mohammed Allami
- Department of Dentistry, Al-Manara College for Medical Sciences, Maysan, Iraq,Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran,Corresponding author: Mohammed Allami, MSc, Department of Dentistry, Al-Manara College for Medical Sciences, Maysan, Iraq; Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran. Tel: +964-7712640070
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16
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Kikuchi JY, Banaag A, Koehlmoos TP. Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System. JAMA Netw Open 2022; 5:e2225730. [PMID: 35925603 PMCID: PMC9353594 DOI: 10.1001/jamanetworkopen.2022.25730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Urinary tract infections (UTIs) are one of the most commonly diagnosed infections, and prior studies have reported discordance in antibiotic treatment with the Infectious Diseases Society of America (IDSA) guidelines. OBJECTIVE To assess IDSA guideline concordance rates for women with uncomplicated UTIs treated with antibiotics, and compare concordance rates between different specialty field. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional study of health care claims data from the US Military Health System Data Repository, which contains comprehensive health care encounter and claims data for all military beneficiaries. Participants were adult women between the ages of 18 to 50 years with uncomplicated UTIs from October 1, 2017, to September 30, 2019. Data extraction and analysis were performed in 2022. Patients with diagnosis of UTI in the preceding 6 months, current pregnancy, history of pyelonephritis, history of diabetes, history of organ transplant, history of human immunodeficiency virus, immunosuppression, renal insufficiency, urinary tract abnormalities, or history of urologic procedures were excluded. EXPOSURES Antibiotic treatment for uncomplicated UTIs. Only antibiotics received within 1 day after the diagnosis were analyzed. The IDSA recommends the following antibiotics as first-line therapy: nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, pivmecillinam. MAIN OUTCOMES AND MEASURES The IDSA guideline concordance rates were calculated as the number of patients receiving first-line antibiotic therapy divided by the total number of cases for uncomplicated UTIs. RESULTS A total of 46 793 adult women (67.3% [31 475 of 46 793] aged 18-34 years; 38.2% [31 475 of 46 793] of White race) were diagnosed with uncomplicated UTIs with 91.0% receiving guideline-concordant antibiotic treatment. In comparison with obstetrics and gynecology, IDSA guideline-concordant treatment was more likely in internal medicine (adjusted odds ratio [aOR], 2.87; 95% CI, 2.73-3.03), family medicine (aOR, 1.81; 95% CI, 1.76-1.87), surgery (aOR, 1.51; 95% CI, 1.36-1.67), and emergency medicine (aOR, 1.36; 95% CI, 1.32-1.39) and less likely in urology (aOR, 0.40; 95% CI, 0.38-0.43). Compared with direct military care, private sector care had lower concordance rates (aOR, 0.63; 95% CI, 0.62-0.64). CONCLUSIONS AND RELEVANCE In this cross-sectional study of antibiotic treatments for uncomplicated UTIs in a universally insured population, the IDSA guideline-concordance rate was high at 91.0% with higher rates in direct military care compared with private sector care. There were higher rates in general medical specialties, surgery, and emergency medicine and lower rates in urology and obstetrics and gynecology. These results further enhance the literature on current antibiotic prescribing practices for uncomplicated UTIs in adult women.
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Affiliation(s)
- Jacqueline Y. Kikuchi
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda Banaag
- Department of Preventative Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Tracey P. Koehlmoos
- Department of Preventative Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland
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Alhomayani FK, Alazwari NM, Alshhrani MS, Alkhudaydi AS, Basaba AS, Alharthi TM, Alghamdi MM, Aljuaid AS, Alosimi NM, Alqethami AM. The prevalence of multiple drug resistant urinary tract infections: A single-centered, observational retrospective study in King Abdulaziz Specialized Hospital, Taif, Saudi Arabia. Saudi Med J 2022; 43:927-932. [PMID: 35964957 PMCID: PMC9749674 DOI: 10.15537/smj.2022.43.8.20220238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the prevalence and patterns of antibiotic resistance, risk factors, and appropriate empiric therapy for multidrug-resistant Enterococcus (MDRE) urinary tract infections (UTIs) at King Abdulaziz Specialist Hospital (KAASH), Taif, Saudi Arabia. METHODS All patients attending KAASH with MDRE UTIs between January 2018 and December 2020 were enrolled in the study. After ethical approval, data were analyzed. RESULTS The most common causative organisms were Gram-negative and anaerobes, and the most sensitive antibiotics were ciprofloxacin and ceftriaxone. CONCLUSION Based on our analyses, regular culture and sensitivity should be made routine to gather information regarding susceptibility patterns, thereby reducing drug resistance in our setups.
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Affiliation(s)
- Faisal K. Alhomayani
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Naif M. Alazwari
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
- Address correspondence and reprint request to: Dr. Naif M. Alazwari, Internal Medicine Department, King Abdul Aziz Specialist Hospital, Taif, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-1140-5842
| | - Mohammed S. Alshhrani
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Ali S. Alkhudaydi
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Abdullah S. Basaba
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Tariq M. Alharthi
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Muhanad M. Alghamdi
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Abdulaziz S. Aljuaid
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Nasser M. Alosimi
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
| | - Abdulmajeed M. Alqethami
- From the Department of Nephrology and Kidney Transplant (Alhomayani); from the Department of Internal Medicine (Aljuaid, Alqethami), College of Medicine, Taif University; and from the Department of Internal Medicine (Alazwari, Alshhrani, Alkhudaydi, Basaba, Alharthi, Alghamdi, Alosimi), King Abdulaziz Specialist Hospital, Taif, Kingdom of Saudi Arabia
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Trześniewska-Ofiara Z, Mendrycka M, Cudo A, Szmulik M, Woźniak-Kosek A. Hospital Urinary Tract Infections in Healthcare Units on the Example of Mazovian Specialist Hospital Ltd. Front Cell Infect Microbiol 2022; 12:891796. [PMID: 35899043 PMCID: PMC9309389 DOI: 10.3389/fcimb.2022.891796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Microbiological diagnostics is of great importance in limiting the spread of nosocomial infections. The information on etiological agents of infections and their susceptibility to antibiotics enables a quick response in the case of a suspected epidemic outbreak. The aim of this study is to analyze the incidence of nosocomial urinary tract infections among patients hospitalized in hospital wards over a period of 2 years and to determine the predominant etiological agent depending on the method of clinical specimen collection. Data from the Mazovian Specialist Hospital (MSH) in Radom constitute the material for the preparation of this study. Urine was collected using two methods. The first one was the method of collecting urine from the central stream, while the second method was urine collected from patients with a urinary catheter in place. The statistical calculations were conducted using the statistical software. Based on hospital data, it was shown that 5,870 urine tests were performed during the period under review, of which 2,070 were positive. The number of positive results in 2021 decreased by 2.84% compared to that in 2020. On the basis of the statistical analysis, differences in the occurrence of multiple strains were observed between catheter-based and midstream urine collection. Differences were observed especially for Acinetobacter baumannii, Candida albicans, Escherichia coli, and Pseudomonas aeruginosa. A. baumannii, C. albicans, and P. aeruginosa were significantly more frequently found in urine samples collected through the catheter than from the midstream. Furthermore, E. coli (51.56%) and Enterococcus species (25.46%) were more frequent when collected from the middle stream than when urine was collected through a catheter. However, for the strain K. pneumoniae, the results were comparable when urine was collected from catheterized patients (13.83%) and from midstream (13.35%). Urinary tract infection among hospitalized patients of the Mazovian Specialist Hospital in Radom was diagnosed quite frequently. In 2021, 32 more urine cultures were performed than in 2020. In the analyzed period, among all ordered urine cultures, 35.27% of samples were positive.
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Affiliation(s)
- Zuzanna Trześniewska-Ofiara
- Department of Laboratory Diagnostics, Mazovian Specialist Hospital Ltd, Radom, Poland
- *Correspondence: Zuzanna Trześniewska-Ofiara, ; Mariola Mendrycka,
| | - Mariola Mendrycka
- Department of Nursing, Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, Radom, Poland
- *Correspondence: Zuzanna Trześniewska-Ofiara, ; Mariola Mendrycka,
| | - Andrzej Cudo
- Department of Experimental Psychology, Institute of Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Magdalena Szmulik
- Sysmex Poland Ltd, scientific aspect prepared in cooperation with Department of Laboratory Diagnostics, Military Institute of Medicine, Warsaw, Poland
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Miftode IL, Pasare MA, Miftode RS, Nastase E, Plesca CE, Lunca C, Miftode EG, Timpau AS, Iancu LS, Dorneanu OS. What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe. Antibiotics (Basel) 2022; 11:antibiotics11050548. [PMID: 35625192 PMCID: PMC9137815 DOI: 10.3390/antibiotics11050548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The evolution of bacterial resistance to antibiotics is one of the factors that make infectious pathology an extremely dynamic field, also inducing a significant burden on public health systems; therefore, continuous updates on the bacterial resistance to antibiotics and their particular regional patterns is crucial for the adequate approach of various infectious diseases. (2) Methods: We retrospectively analyzed 354 patients with Enterobacterales urinary tract infections (UTIs), determined their antibiotic resistance pattern, thus aiming to correlate them with the outcome and other specific markers of poor prognosis. (3) Results: The most frequent causative agent was Escherichia coli, representing 64.6% of all UTIs. We identified 154 patients resistant to multiple antibiotic classes, of which 126 were multidrug-resistant (MDR), 17 were extensive drug-resistant (XDR) and 11 were pandrug-resistant (PDR). Moreover, 25 isolates were resistant to carbapenems (CRE), 25 were difficult-to-treat (DTR), and 84 were extended-spectrum cephalosporin-resistant (ESC), with only 95 isolates susceptible to all tested antibiotics. Mortality ranged from 1% for UTIs caused by isolates susceptible to all tested antibiotics, to 24% for the ones caused by DTR or CRE isolates. Other significant risk factors associated with mortality were: prolonged hospital stay (p = 0.0001), Charlson comorbidity index ≥ 3 (p = 0.02), urinary catheterization (p = 0.001), associated respiratory pathologies (p = 0.004), obesity (p = 0.047), a history of previous hospitalizations (p = 0.007), inappropriate empiric antibiotic regimen (p = 0.001), or hyper inflammatory status (p = 0.006). Basically, we observed that a multiple regression model comprising urinary catheterization, inappropriate empiric anti-biotherapy, obesity, and respiratory comorbidities exhibits the best correlation with mortality rate in patients with UTI (R = 0.347, R2 = 0.12). (4) Conclusions: By focusing on the novel resistance patterns, our study provides complementary evidence concerning the resistance profiles found in an Eastern European region, as well as their prognostic implications in patients with UTI.
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Affiliation(s)
- Ionela-Larisa Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Maria-Antoanela Pasare
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Radu-Stefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania;
- Correspondence: (R.-S.M.); (E.-G.M.); Tel.: +40-742067839 (R.-S.M.); +40-744118866 (E.-G.M.)
| | - Eduard Nastase
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Claudia Elena Plesca
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Catalina Lunca
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
| | - Egidia-Gabriela Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
- Correspondence: (R.-S.M.); (E.-G.M.); Tel.: +40-742067839 (R.-S.M.); +40-744118866 (E.-G.M.)
| | - Amalia-Stefana Timpau
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania;
| | - Luminita Smaranda Iancu
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
| | - Olivia Simona Dorneanu
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
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Wesolek JL, Wu JY, Smalley CM, Wang L, Campbell MJ. Risk factors for trimethoprim and sulfamethoxazole-resistant Escherichia coli in emergency department patients with urinary tract infections. Am J Emerg Med 2022; 56:178-182. [PMID: 35405469 DOI: 10.1016/j.ajem.2022.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND While trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs). METHODS This multicenter, retrospective study included adult patients who were discharged from 12 emergency departments (EDs) with a urine culture positive for E. coli between January 1, 2019 and December 31, 2019. Logistic regression was used to assess the relationship between potential risk factors and TMP-SMX resistance. The overall institutional antimicrobial resistance rates for E. coli were compared to the rates seen in the study population of ED urinary isolates. RESULTS Among 427 patients included from a randomized sample of 500 with a urine culture positive for E. coli, 107 (25.1%) were resistant to TMP-SMX. Three predictors of TMP-SMX resistance were identified: recurrent UTI (OR 2.27 [95% CI 1.27-3.99]), genitourinary abnormalities (OR 2.31 [95% CI 1.17-4.49]), and TMP-SMX use within 90 days (OR 8.77 [95% CI 3.19-28.12]). When the antibiotic susceptibilities for this ED cohort were compared to the institutional antibiogram, the TMP-SMX resistance rate was found to be higher in the ED population (25.1% vs 20%). CONCLUSIONS TMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.
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Affiliation(s)
- Jessica L Wesolek
- Department of Pharmacy, Cleveland Clinic Health System, Cleveland, OH, United States of America.
| | - Janet Y Wu
- Department of Pharmacy, Cleveland Clinic Health System, Cleveland, OH, United States of America.
| | - Courtney M Smalley
- Emergency Services Institute, Cleveland Clinic Health System, Cleveland, OH, United States of America; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States of America.
| | - Lu Wang
- Quantitative Health Sciences, Cleveland Clinic Health System, Cleveland, OH, United States of America.
| | - Matthew J Campbell
- Department of Pharmacy, Cleveland Clinic Health System, Cleveland, OH, United States of America.
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Ndomba ALM, Laisser RM, Silago V, Kidenya BR, Mwanga J, Seni J, Mshana SE. Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania. Microorganisms 2022; 10:microorganisms10020473. [PMID: 35208927 PMCID: PMC8879566 DOI: 10.3390/microorganisms10020473] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient's well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p < 0.001). Older age (OR: 1.3, (95%CI: 1.1-1.5), p < 0.001), level of education (OR: 1.8, (95%CI: 1.1-3.1), p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1-5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2-3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2-0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2-0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC.
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Affiliation(s)
- Asteria L. M. Ndomba
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
- Correspondence:
| | - Rose M. Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Joseph Mwanga
- Department of Biostatistics, Epidemiology and Behavioral Sciences, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
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Sheikh RY, Murdeshwar S, Maheshwari TK, Chacko S. Microbiological Spectrum and Antibiogram of Urinary Tract Infection in a Tertiary Care Center from the Kingdom of Bahrain. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:S53-S60. [PMID: 37102524 DOI: 10.4103/1319-2442.374382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Urinary tract infection is the second-most common after respiratory infections. This is a single-center retrospective study conducted in Bahrain Specialist Hospital, Bahrain. Urine culture data from November 2011 until December 2020 was obtained from the hospital database. Out of 28082, 4849 (17.3%) cultures were positive. One hundred and thirty-four (2.8%) showed the growth of multiple organisms. The male-to-female ratio was 3.7. Most of the patients [1872 (39.7%)] were 20-40 years. Men and women were 53.84 ± 25.85 and 43.41 ± 23.89 years, respectively; P <0.001. 4118/4715 (87.3%) were Gram-negative. Five hundred and sixty-four (11.9 %) and 33 (0.7%) were Gram-positive cocci and fungi, respectively. Escherichia coli (E. coli) was the most common and Klebsiella species were second-most common, accounting for 2916 (61.8%) and 586 (12.4%), respectively. 30.2% of all E. coli and 130 (22.2%) of all Klebsiella species were extended-spectrum beta-lactamase (ESBL) producers. ESBL Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis were present more in inpatients (P <0.001). P. aeruginosa was found more in women (P <0.001). E. coli was resistant to cotrimoxazole, ciprofloxacin, and levofloxacin in 28%, 17.3%, and 18.1%, respectively. ESBL E. coli and ESBL K. pneumoniae were resistant to amoxicillin-clavulanate, cotrimoxazole, ciprofloxacin, and levofloxacin in 73.8%, 62.3%, 62.4%, 58.4% and 68.2%, 62.6%, 55.7%, and 41.8% respectively. There is a high incidence of ESBL E. coli and ESBL K. pneumoniae. There is alarmingly increased resistance of P. aeruginosa to carbapenems. Amoxicillin-clavulanate, cefixime, and cefuroxime are suitable oral antibiotics for empirical treatment. For sick patients, piperacillin-tazobactam, aminoglycosides, and carbapenems should be considered. Antibiotic stewardship is the need of an hour.
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Affiliation(s)
| | - Soni Murdeshwar
- Department of Microbiology, Bahrain Specialist Hospital, Manama, Bahrain
| | | | - Saramma Chacko
- Department of Microbiology, Bahrain Specialist Hospital, Manama, Bahrain
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Liu H, Qiu S, Chen M, Lyu J, Yu G, Xue L. A clinical prediction tool for extended-spectrum β-lactamase-producing Enterobacteriaceae urinary tract infection. BMC Infect Dis 2022; 22:50. [PMID: 35027010 PMCID: PMC8756698 DOI: 10.1186/s12879-022-07040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prevalence of extended-spectrum beta-lactamase-producing-Enterobacteriaceae (ESBL-E) has risen in patients with urinary tract infections. The objective of this study was to determine explore the risk factors of ESBL-E infection in hospitalized patients and establish a predictive model. Methods This retrospective study included all patients with an Enterobacteriaceae-positive urine sample at the first affiliated hospital of Jinan university from January 2018 to December 2019. Antimicrobial susceptibility patterns of ESBL-E were analyzed, and multivariate analysis of related factors was performed. From these, a nomogram was established to predict the possibility of ESBL-E infection. Simultaneously, susceptibility testing of a broad array of carbapenem antibiotics was performed on ESBL-E cultures to explore possible alternative treatment options. Results Of the total 874 patients with urinary tract infections (UTIs), 272 (31.1%) were ESBL-E positive. In the predictive analysis, five variables were identified as independent risk factors for ESBL-E infection: male gender (OR = 1.607, 95% CI 1.066–2.416), older age (OR = 4.100, 95% CI 1.678–12.343), a hospital stay in preceding 3 months (OR = 1.872, 95% CI 1.141–3.067), invasive urological procedure (OR = 1.810, 95% CI 1.197–2.729), and antibiotic use within the previous 3 months (OR = 1.833, 95% CI 1.055–3.188). In multivariate analysis, the data set was divided into a training set of 611 patients and a validation set of 263 patients The model developed to predict ESBL-E infection was effective, with the AuROC of 0.650 (95% CI 0.577–0.725). Among the antibiotics tested, several showed very high effectiveness against ESBL-E: amikacin (85.7%), carbapenems (83.8%), tigecycline (97.1%) and polymyxin (98.2%). Conclusions The nomogram is useful for estimating a UTI patient’s likelihood of infection with ESBL-E. It could improve clinical decision making and enable more efficient empirical treatment. Empirical treatment may be informed by the results of the antibiotic susceptibility testing.
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Pathogen profile of urinary tract infections in Nephrology Unit. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2021. [DOI: 10.2478/cipms-2021-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Urinary tract infection (UTI) is one of the most common types of infection in both hospitalized and outpatient settings. The etiology is mostly bacterial, and the typical causative agent is uropathogenic Escherichia coli. There is a noticeable increase in drug resistance of pathogenic microorganisms.
The aim of the study was retrospective analyses of etiological agents of UTI and their antibiotic resistance patterns in Nephrology Unit patients.
Material and methods. An infection was diagnosed based on the patient’s symptoms and positive results of urine culture, carried out over 26 months. The clinical material was tested by using the VITEK system, the drug susceptibility of the emerged pathogens was identified.
Results. The most common etiological agents of UTI were Gram-negative rods: Escherichia coli (51.23%), Klebsiella spp. (19.3%) and Proteus spp. (13.68%). The analysis of drug resistance profiles of these pathogens showed a high percentage of strains resistant to broad-spectrum penicillins and fluoroquinolones. At the same time, it seems that E. coli isolates presented the most favorable pattern of drug susceptibility in this comparison.
Conclusions. The alarming tendency of increasing drug resistance among pathogens causing UTIs to antibiotics such as penicillins or fluoroquinolones prompts a careful choice of drugs in empirical therapies. The most appropriate practice in this regard seems to be meticulous control of nosocomial infections and making therapeutic decisions based on the knowledge of local microbiological data.
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Madrazo M, Esparcia A, López-Cruz I, Alberola J, Piles L, Viana A, Eiros JM, Artero A. Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection. BMC Infect Dis 2021; 21:1232. [PMID: 34876045 PMCID: PMC8653523 DOI: 10.1186/s12879-021-06939-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Previous studies have described some risk factors for multidrug-resistant (MDR) bacteria in urinary tract infection (UTI). However, the clinical impact of MDR bacteria on older hospitalized patients with community-acquired UTI has not been broadly analyzed. We conducted a study in older adults with community-acquired UTI in order to identify risk factors for MDR bacteria and to know their clinical impact. Methods Cohort prospective observational study of patients of 65 years or older, consecutively admitted to a university hospital, diagnosed with community-acquired UTI. We compared epidemiological and clinical variables and outcomes, from UTI due to MDR and non-MDR bacteria. Independent risk factors for MDR bacteria were analyzed using logistic regression. Results 348 patients were included, 41.4% of them with UTI due to MDR bacteria. Median age was 81 years. Hospital mortality was 8.6%, with no difference between the MDR and non-MDR bacteria groups. Median length of stay was 5 [4–8] days, with a longer stay in the MDR group (6 [4–8] vs. 5 [4–7] days, p = 0.029). Inadequate empirical antimicrobial therapy (IEAT) was 23.3%, with statistically significant differences between groups (33.3% vs. 16.2%, p < 0.001). Healthcare-associated UTI variables, in particular previous antimicrobial therapy and residence in a nursing home, were found to be independent risk factors for MDR bacteria. Conclusions The clinical impact of MDR bacteria was moderate. MDR bacteria cases had higher IEAT and longer hospital stay, although mortality was not higher. Previous antimicrobial therapy and residence in a nursing home were independent risk factors for MDR bacteria.
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Affiliation(s)
- Manuel Madrazo
- Internal Medicine Department, Doctor Peset University Hospital, Avda. Gaspar Aguilar, n 90, 46017, Valencia, Spain
| | - Ana Esparcia
- Internal Medicine Department, Doctor Peset University Hospital, Avda. Gaspar Aguilar, n 90, 46017, Valencia, Spain
| | - Ian López-Cruz
- Internal Medicine Department, Doctor Peset University Hospital, Avda. Gaspar Aguilar, n 90, 46017, Valencia, Spain
| | - Juan Alberola
- Microbiology Department, Doctor Peset University Hospital, Avda. Gaspar Aguilar, n 90, 46017, Valencia, Spain. .,Universitat de València, Avda. Blasco Ibañez, n 17, 46010, Valencia, Spain.
| | - Laura Piles
- Internal Medicine Department, Doctor Peset University Hospital, Avda. Gaspar Aguilar, n 90, 46017, Valencia, Spain
| | - Alba Viana
- Internal Medicine Department, Doctor Peset University Hospital, Avda. Gaspar Aguilar, n 90, 46017, Valencia, Spain
| | - José María Eiros
- Department of Microbiology and Parasitology, Rio Hortega University Hospital, University of Valladolid, C/ Dulzaina, 2, 47012, Valladolid, Spain
| | - Arturo Artero
- Internal Medicine Department, Doctor Peset University Hospital, Avda. Gaspar Aguilar, n 90, 46017, Valencia, Spain.,Universitat de València, Avda. Blasco Ibañez, n 17, 46010, Valencia, Spain
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Shakya S, Edwards J, Gupte HA, Shrestha S, Shakya BM, Parajuli K, Kattel HP, Shrestha PS, Ghimire R, Thekkur P. High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal. Public Health Action 2021; 11:24-31. [PMID: 34778012 PMCID: PMC8575380 DOI: 10.5588/pha.21.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
SETTING: Tribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May–October 2019. OBJECTIVE: 1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing. DESIGN: This was a hospital-based, cross-sectional study using routine laboratory records. RESULTS: Among 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ⩾60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ⩾45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ⩾60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR. CONCLUSION: Urine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.
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Affiliation(s)
- S Shakya
- Central Department of Public Health, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - J Edwards
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - H A Gupte
- Narotam Sekhsaria Foundation, Mumbai, India
| | - S Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu, Nepal
| | - B M Shakya
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - K Parajuli
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - H P Kattel
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - P S Shrestha
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - R Ghimire
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - P Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
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Lodise TP, Henriksen AS, Hadley T, Patel N. US-Focused Conceptual Health Care Decision-Analytic Models Examining the Value of Pivmecillinam Relative to Current Standard-of-Care Agents Among Adult Patients With Uncomplicated Urinary Tract Infections due to Enterobacterales. Open Forum Infect Dis 2021; 8:ofab380. [PMID: 34660834 PMCID: PMC8516593 DOI: 10.1093/ofid/ofab380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background Pivmecillinam is approved for the treatment of adults with uncomplicated urinary tract infection (uUTI) in Canada and Europe and is pending United States (US) Food and Drug Administration submission for consideration for approval. US-focused health care decision-analytics were developed to define the value of an agent like pivmecillinam relative to current standard-of-care (SOC) agents among adult patients with Enterobacterales uUTIs based on its improved microbiologic activity against common Enterobacterales. Methods The model population was 100 theoretical adult outpatients with Enterobacterales uUTIs under 4 different uUTI first-line empiric treatment scenarios (ie, pivmecillinam, nitrofurantoin, trimethoprim-sulfamethoxazole [SXT], or fluoroquinolones). The total mean uUTI-related 30-day costs, including inappropriate treatment costs, were calculated for each regimen. The range of pivmecillinam regimen costs that conferred cost savings relative to the current SOC agents based on its potentially improved microbiologic activity against common Enterobacterales was determined. Results The 30-day uUTI-related costs associated with nitrofurantoin, SXT, and fluoroquinolones were $655.61, $687.57, and $659.69, respectively. The pivmecillinam neutral regimen cost thresholds that resulted in the same uUTI-related 30-day per-patient costs for nitrofurantoin, SXT, and fluoroquinolones were $83.50, $115.45, and $87.58, respectively. The overall antimicrobial susceptibility improvement required with pivmecillinam fixed at $200/regimen, for it to be cost savings relative to SOC agents, was 28%. Conclusions The analyses suggests that an agent like pivmecillinam, if approved in the US, has the potential to reduce the economic burden associated with inappropriate treatment of adult outpatients with uUTIs, especially in patients at high risk for an Enterobacterales uUTI that is resistant to SOC agents.
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Affiliation(s)
- Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | | | | | - Nimish Patel
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
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Current prescribing practices and guideline concordance for the treatment of uncomplicated urinary tract infections in women. Am J Obstet Gynecol 2021; 225:272.e1-272.e11. [PMID: 33848538 DOI: 10.1016/j.ajog.2021.04.218] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Uncomplicated urinary tract infections are one of the most common bacterial infections in the United States. Clinical practice guidelines from the Infectious Diseases Society of America recommend nitrofurantoin, trimethoprim-sulfamethoxazole, and Fosfomycin as first-line antibiotic treatments and discourage the use of fluoroquinolone antibiotic agents. US Food and Drug Administration released several black box warnings about fluoroquinolones over the past decade owing to antibiotic resistance and a high burden of adverse events. Historically, uncomplicated urinary tract infections have high rates of guideline-discordant treatment with past studies noting substantial use of fluoroquinolones, directly contradicting clinical practice guidelines. OBJECTIVE This study aimed to assess the current concordance of physician prescribing practices with Infectious Diseases Society of America guidelines for the treatment of uncomplicated urinary tract infections in women and identify patient and physician predictors of guideline concordance. STUDY DESIGN A retrospective observational secondary analysis was conducted using a series of cross-sectional data extracted from the IQVIA (Plymouth Meeting, Pennsylvania) National Disease and Therapeutic Index from 2015 to 2019. An estimated 44.9 million women with uncomplicated urinary tract infections at the age of 18 to 75 years were treated as outpatients. This population was selected to lack relevant comorbidities or urological abnormalities so that it matched the Infectious Diseases Society of America guidelines. The proportion of prescriptions for each antibiotic drug class were reported with 95% confidence intervals and compared with the Infectious Diseases Society of America guidelines. Patient and physician characteristics were included in a multivariate logistic regression model to identify independent predictors of antibiotic selection and thereby guideline concordance. RESULTS Of the visits that resulted in antibiotic treatment, the overall concordance rate was 58.4% (26.2 million visits of 44.9 million visits) and increased from 48.2% (3.9 million visits of 8.1 million visits) in 2015 to 64.6% (6.3 million visits of 9.8 million visits) in 2019. The most commonly prescribed antibiotic agents were fluoroquinolones (36.4%, 16.3 million visits of 44.9 million visits), nitrofurantoin (31.8%, 14.3 million visits of 44.9 million visits), and trimethoprim-sulfamethoxazole (26.3%, 11.8 million visits of 44.9 million visits). From 2015 to 2019, fluoroquinolone use decreased whereas nitrofurantoin and beta-lactam use increased. Based on the logistic regression, patients aged 18 to 29 years (odds ratio, 1.60; 95% confidence interval, 1.36-1.88; P<.001) and 30 to 44 years (odds ratio, 1.21; 95% confidence interval, 1.03-1.42; P=.020) had a statistically significantly higher likelihood of receiving guideline-concordant treatment than patients aged 45 to 75 years (reference group). Obstetricians-gynecologists (odds ratio, 3.56; 95% confidence interval, 2.91-4.37; P<.001) and urologists (odds ratio, 3.51; 95% confidence interval, 2.45-5.13; P<.001) had a statistically significantly higher likelihood of concordant treatment than all other specialties combined (reference group). CONCLUSION Guideline discordance continues in the treatment of uncomplicated urinary tract infections with the overuse of fluoroquinolones and the underuse of first-line antibiotic agents. Although improving, continued misuse of antibiotic agents may contribute to the growing rates of antibiotic resistance. Actions such as educating physicians about antibiotic resistance and clinical practice guidelines and providing feedback on prescription habits are needed to increase guideline concordance and therefore reduce the use of fluoroquinolones, especially for physicians in family and internal medicine.
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Molecular studies and characterization of genes associated in drug resistance of uro-pathogens in central India. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance. Sci Rep 2021; 11:11927. [PMID: 34099754 PMCID: PMC8184807 DOI: 10.1038/s41598-021-90949-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/17/2021] [Indexed: 02/05/2023] Open
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.
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Petca RC, Negoiță S, Mareș C, Petca A, Popescu RI, Chibelean CB. Heterogeneity of Antibiotics Multidrug-Resistance Profile of Uropathogens in Romanian Population. Antibiotics (Basel) 2021; 10:antibiotics10050523. [PMID: 34063317 PMCID: PMC8147389 DOI: 10.3390/antibiotics10050523] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
Urinary tract infections (UTIs) are a leading cause of morbidity for both males and females. The overconsumption of antibiotics in general medicine, veterinary, or agriculture has led to a spike in drug-resistant microorganisms; obtaining standardized results is imposed by standard definitions for various categories of drug-resistant bacteria—such as multiple-drug resistant (MDR), extensive drug-resistant (XDR), and pan drug-resistant (PDR). This retrospective study conducted in three university teaching hospitals in Romania has analyzed urine probes from 15,231 patients, of which 698 (4.58%) presented multidrug-resistant strains. Escherichia coli was the leading uropathogen 283 (40.54%), presenting the highest resistance to quinolones (R = 72.08%) and penicillin (R = 66.78%) with the most important patterns of resistance for penicillin, sulfonamides, and quinolones (12.01%) and aminoglycosides, aztreonam, cephalosporins, and quinolones (9.89%). Klebsiella spp. followed—260 (37.24%) with the highest resistance to amoxicillin-clavulanate (R = 94.61%) and cephalosporins (R = 94.23%); the leading patterns were observed for aminoglycosides, aminopenicillins + β-lactams inhibitor, sulfonamides, and cephalosporins (12.69%) and aminoglycosides, aztreonam, cephalosporins, quinolones (9.23%). The insufficient research of MDR strains on the Romanian population is promoting these findings as an important tool for any clinician treating MDR-UTIs.
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Affiliation(s)
- Răzvan-Cosmin Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Silvius Negoiță
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Anesthesiology and Critical Care, Elias University Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Cristian Mareș
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
- Correspondence: (C.M.); (A.P.); Tel.: +40-745-383-552 (C.M.); +40-745-787-448 (A.P.)
| | - Aida Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Obstetrics and Gynecology, Elias University Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
- Correspondence: (C.M.); (A.P.); Tel.: +40-745-383-552 (C.M.); +40-745-787-448 (A.P.)
| | - Răzvan-Ionuț Popescu
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Călin Bogdan Chibelean
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, 38 Gheorghe Marinescu Str., 540139 Targu-Mures, Romania;
- Department of Urology, Mureș County Hospital, 1st Gheorghe Marinescu Str., 540136 Targu-Mures, Romania
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Antimicrobial Resistance Patterns and Dynamics of Extended-Spectrum β-Lactamase-Producing Uropathogenic Escherichia coli in Cusco, Peru. Antibiotics (Basel) 2021; 10:antibiotics10050485. [PMID: 33922269 PMCID: PMC8146470 DOI: 10.3390/antibiotics10050485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022] Open
Abstract
Urinary tract infections (UTIs) are a common human infection. Antibiotic resistance in extended-spectrum β-lactamase (ESBL)-producing uropathogenic E. coli (UPEC) is a major therapeutic challenge due to limited treatment alternatives. The aim was to characterize the antimicrobial resistance (AMR) and dynamics of ESBL-producing UPEC isolates from UTI cases seen at a local hospital in Cusco, Peru. Ninety-nine isolates from respective patients were characterized against 18 different antibiotics. Latent class analysis (LCA) was used to evaluate the dynamics across the study time according to resistance patterns. The median age of patients was 51 years old, and nearly half were women. ESBL-producing UPEC isolates were slightly more frequent in outpatient services than emergency rooms, and there were higher resistance rates in males compared to females. Half of the ESBL producers were resistant to aminoglycosides and nitrofurantoin. Cefoxitin and fosfomycin resistance was 29.3% and 14.1%, respectively. Resistance to carbapenems was not observed. All isolates were multidrug-resistant bacteria, and 16.2% (16/99) were also classified as extensively drug-resistant bacteria. The resistance patterns varied across the study time and differed regarding sex and healthcare service. The study revealed high levels of AMR to commonly used antimicrobials and a dynamic circulation of ESBL-producing UPEC isolates with varying resistance patterns.
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Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020. Antibiotics (Basel) 2021; 10:antibiotics10040447. [PMID: 33923389 PMCID: PMC8071495 DOI: 10.3390/antibiotics10040447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to determine antibiotic resistance patterns and the prevalence of uropathogenes causing urinary tract infections (UTIs) in patients hospitalized in January–June 2020 in central Poland. Antimicrobial susceptibility testing was performed using the disk-diffusion method. Escherichia coli (52.2%), Klebsiella pneumoniae (13.7%), Enterococcus faecalis (9.3%), E. faecium (6.2%), and Proteus mirabilis (4,3%) were most commonly isolated from urine samples. E. coli was significantly more frequent in women (58.6%) (p = 0.0089) and in the age group 0–18, while K. pneumoniae was more frequent in men (24.4%) (p = 0.0119) and in individuals aged 40–60 and >60. Gram-negative species showed resistance to ampicillin. K. pneumoniae were resistant to amoxicillin plus clavulanic acid (75.0%), piperacillin plus tazobactam (76.2%), cefotaxime (76.2%), cefuroxime (81.0%), ciprofloxacin (81.0%), and trimethoprim plus sulphamethoxazole (81.0%). Carbapenems were effective against all E. coli and P. mirabilis. Some K. pneumoniae (13.6%) produced metallo-β-lactamases (MBLs). E. coli (22.6%), K. pneumoniae (81.8%), and all E. faecium were multidrug-resistant (MDR). Some E. coli (26.2%), K. pneumoniae (63.6%), and P. mirabilis (14.3%) isolates produced extended-spectrum beta-lactamases (ESBL). Vancomycin-resistant E. faecium was also found. This study showed that the possibilities of UTIs therapy using available antibiotics become limited due to the increasing number of antibiotic-resistant uropathogens.
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Frisbie L, Weissman SJ, Kapoor H, D'Angeli M, Salm A, Radcliff J, Rabinowitz P. Antimicrobial Resistance Patterns of Urinary Escherichia coli Among Outpatients in Washington State, 2013-2017: Associations with Age and Sex. Clin Infect Dis 2021; 73:1066-1074. [PMID: 33768228 DOI: 10.1093/cid/ciab250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Management of acute, uncomplicated cystitis in outpatients benefits from knowledge of drug resistance patterns in the population. However, antibiograms are often not available for the outpatient setting, and the role of host factors such as sex and age in assessing the likelihood of resistance are not well understood. We investigated whether antibiotic resistance patterns of outpatient urinary Escherichia coli (EC) isolates vary by age group and sex in a large database of antibiotic susceptibility test (AST) results from Washington State. METHODS We retrospectively analyzed AST data for outpatient urinary EC isolates in Washington State tested at a clinical reference laboratory from 2013 - 2017. In logistic regression models stratified by sex, we tested the associations of antibiotic resistance with patient age. RESULTS We found females >50 years had greater odds than females younger than 19 for resistance to amoxicillin-clavulanate (odds ratio [OR], 1.43; 95% CI, 1.22-1.69), ciprofloxacin (OR, 3.04; 95% CI, 2.48-3.74), ceftriaxone (OR, 2.58; 95% CI, 1.77-3.92), and gentamicin (OR, 1.62; 95% CI, 1.27-2.08) (all p<0.001). Compared to males younger than 19, males >50 years had greater odds of resistance to ciprofloxacin (OR, 2.59; 95% CI, 1.18-5.69) and lower odds of resistance to amoxicillin-clavulanate (OR, 0.56; 95% CI, 0.34-0.96) (all p<0.05). CONCLUSION These findings demonstrate that age and sex are associated with variability in antibiotic resistance patterns in the outpatient setting. Availability of outpatient antibiotic resistance data based on sex and age may be useful to inform empiric prescribing for outpatient UTIs and to support antibiotic stewardship efforts.
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Affiliation(s)
- Lauren Frisbie
- Department of Environmental and Occupational Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle WA, USA
| | - Scott J Weissman
- Infectious Diseases Department, Seattle Children's Hospital, Seattle WA, USA
| | - Hema Kapoor
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus NJ, USA
| | | | - Ann Salm
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus NJ, USA
| | - Jeff Radcliff
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus NJ, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle WA, USA
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The Antibacterial Activity of Human Amniotic Membrane against Multidrug-Resistant Bacteria Associated with Urinary Tract Infections: New Insights from Normal and Cancerous Urothelial Models. Biomedicines 2021; 9:biomedicines9020218. [PMID: 33672670 PMCID: PMC7924402 DOI: 10.3390/biomedicines9020218] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
Urinary tract infections (UTIs) represent a serious global health issue, especially due to emerging multidrug-resistant UTI-causing bacteria. Recently, we showed that the human amniotic membrane (hAM) could be a candidate for treatments and prevention of UPEC and Staphylococcus aureus infections. However, its role against multidrug-resistant bacteria, namely methicillin-resistant S. aureus (MRSA), extended-spectrum beta-lactamases (ESBL) producing Escherichia coli and Klebsiella pneumoniae, vancomycin-resistant Enterococci (VRE), carbapenem-resistant Acinetobacter baumannii, and Pseudomonas aeruginosa has not yet been thoroughly explored. Here, we demonstrate for the first time that the hAM homogenate had antibacterial activity against 7 out of 11 tested multidrug-resistant strains, the greatest effect was on MRSA. Using novel approaches, its activity against MRSA was further evaluated in a complex microenvironment of normal and cancerous urinary bladder urothelia. Even short-term incubation in hAM homogenate significantly decreased the number of bacteria in MRSA-infected urothelial models, while it did not affect the viability, number, and ultrastructure of urothelial cells. The hAM patches had no antibacterial activity against any of the tested strains, which further exposes the importance of the hAM preparation. Our study substantially contributes to basic knowledge on the antibacterial activity of hAM and reveals its potential to be used as an antibacterial agent against multidrug-resistant bacteria.
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Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital. Antibiotics (Basel) 2021; 10:antibiotics10010064. [PMID: 33440660 PMCID: PMC7826794 DOI: 10.3390/antibiotics10010064] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/03/2021] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
The incidence of bacteremia caused by Enterococcus faecium, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of E. faecium infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis (E. faecalis (n = 88) and E. faecium (n = 94)) showed poor overall survival in the E. faecium group (HR: 1.92; 95% confidence interval: 1.01–3.66; p = 0.048). The median daily antibiotic cost per patient in the E. faecium group was significantly higher than that in the E. faecalis group ($23 ($13–$34) vs. $34 ($22–$58), p < 0.001). E. faecium strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, p < 0.001) and carbapenems (OR = 3.33, p = 0.003). Bacteremia from an unknown source (OR = 2.79, p = 0.025) and acute kidney injury (OR = 4.51, p = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs.
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Taktak S, Gall Z, Dyer J. Bacteriuria resistance patterns and the suitability of urinalysis as an initial diagnostic tool in a post-antibiotic era. Ther Adv Urol 2021; 13:17562872211018004. [PMID: 34276811 PMCID: PMC8255551 DOI: 10.1177/17562872211018004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS Urinalysis is used as a first-line investigation throughout healthcare to indicate bacteriuria and guide treatment of potential urinary tract infections. In light of rising bacterial multi-resistance, we aim to analyse its diagnostic accuracy, determine its usefulness in a present-day setting and evaluate current antibiotic resistance patterns across a Trust population. METHODS A retrospective case series of 712 paired urinalysis and urine culture results was obtained over a 1-month period. Sensitivity, specificity and diagnostic accuracy were calculated, and resistance profiles of commonly used Trust antibiotics assessed using statistical analysis. RESULTS A high false negative rate of nitrites on urinalysis, with sensitivity of 38.4%, was found. Leucocyte sensitivity was 87.6% and specificity 39.7%, with no improvement in diagnostic accuracy seen when combining both. Positive urine culture growth demonstrated a substantial resistance pattern to trimethoprim of 48%, compounded by a statistically significant correlation with gentamicin resistance (p < 0.0001). CONCLUSION Our study has highlighted a reduced accuracy of urinalysis compared with previous literature, questioning its usefulness in the real world. We have consolidated growing published trends doubting the efficacy of trimethoprim, revealing co-existing resistance patterns between commonly used antibiotics. This will have implications for future antibiotic-prescribing protocols and requires further research to ensure guidelines are progressive in consciously managing this growing concern in modern-day healthcare.
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Affiliation(s)
- Samih Taktak
- Department of Urology, Stepping Hill Hospital, Poplar Grove, Manchester, SK2 7JE, UK
| | - Zara Gall
- Department of Urology, Stepping Hill Hospital, UK
| | - James Dyer
- Department of Urology, Stepping Hill Hospital, UK
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Torres EL, Cantu JR, Bazan DZ, Verduzco RA, Hernández-Muñoz JJ. Travel to Mexico and uropathogen-antibiotic susceptibility mismatch in the emergency department. Am J Emerg Med 2020; 46:619-624. [PMID: 33298347 DOI: 10.1016/j.ajem.2020.11.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/21/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION International travel results in an increased risk of colonization and infection with multidrug-resistant organisms. This study aimed to determine if recent travel to Mexico affects the rate of uropathogen-antibiotic susceptibility mismatch (UASM) in outpatients treated for urinary tract infection (UTI) in a South Texas emergency department (ED). METHODS A retrospective cohort of adult patients presenting to the ED and treated outpatient for UTI from October 1, 2014, to February 25, 2020, was conducted at a community hospital located within approximately 15 miles of the United States-Mexico border. Rates of UASM were compared between patients with a history of recent travel to Mexico and those who have not recently traveled. RESULTS A total of 192 patients were included, with 64 in the travel to Mexico group and 128 in the no travel group. UASM was significantly higher in the recent travel to Mexico group when compared to the no travel group (RR 1.49, 95% CI 1.03-2.13). Antibiotics most commonly associated with UASM included fluoroquinolones, cephalexin, and sulfamethoxazole-trimethoprim. There was no significant difference between the rates of resistance to first-line agents for the treatment of UTI among the two groups. CONCLUSION In addition to known antibiotic resistance risk factors, recent travel to Mexico may increase the risk of UASM for ED patients with UTI. Considering the potential consequences of UTI treatment failure, antimicrobial stewardship services in the ED should include screening for antibiotic resistance risk factors and urine culture follow-up to ensure appropriate outpatient antibiotic therapy, especially among patients with recent international travel.
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Affiliation(s)
- Erica L Torres
- Pharmacy Department, DHR Health, 5501 South McColl Road, Edinburg, TX 78539, United States.
| | - Jonathon R Cantu
- Pharmacy Department, DHR Health, 5501 South McColl Road, Edinburg, TX 78539, United States
| | - Daniela Z Bazan
- Pharmacy Department, DHR Health, 5501 South McColl Road, Edinburg, TX 78539, United States; Department of Pharmacy Practice, Texas A&M University Irma Lerma Rangel College of Pharmacy, 1010 West Avenue B, Kingsville, TX 78363, United States
| | - Rene A Verduzco
- Pharmacy Department, DHR Health, 5501 South McColl Road, Edinburg, TX 78539, United States; Department of Pharmacy Practice, Texas A&M University Irma Lerma Rangel College of Pharmacy, 1010 West Avenue B, Kingsville, TX 78363, United States
| | - José J Hernández-Muñoz
- Department of Pharmaceutical Sciences, Texas A&M University Irma Lerma Rangel College of Pharmacy, Mail Stop 1114, 159 Reynolds Medical Building, College Station, TX 77843, United States
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Larramendy S, Deglaire V, Dusollier P, Fournier JP, Caillon J, Beaudeau F, Moret L. Risk Factors of Extended-Spectrum Beta-Lactamases-Producing Escherichia coli Community Acquired Urinary Tract Infections: A Systematic Review. Infect Drug Resist 2020; 13:3945-3955. [PMID: 33177845 PMCID: PMC7650195 DOI: 10.2147/idr.s269033] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) has been increasing worldwide since the early 2000s. E. coli is found in 70–90% of community-acquired urinary tract infections (CA-UTIs). We performed a systematic literature review to determine the risk factors for CA-UTI caused by ESBL-EC. Methods We searched the MEDLINE, Cochrane Library, Embase and Web of Science databases without language or date restriction up to March 2019. Two independent reviewers selected studies with quantified risk factors for CA-UTI due to ESBL-EC, and assessed their quality using the Newcastle-Ottawa Scale. Results Among the 5,597 studies identified, 16 observational studies (n=12,138 patients) met the eligibility criteria. The included studies were performed in various countries, and 14/16 were published after 2012. The most relevant risk factors for CA-UTI due to ESBL-EC identified were prior use of antibiotics (odds ratio (OR) from 2.2 to 21.4), previous hospitalization (OR: 1.7 to 3.9), and UTI history (OR: 1.3 to 3.8). Two risk factors were related to environmental contamination: travelling abroad, and swimming in freshwater. Conclusion Our findings could allow adapting empiric antibiotic treatments according to the patient profile. Further studies are needed to quantify the relationships between CA-UTI due to ESBL-EC and the environment.
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Affiliation(s)
- Stéphanie Larramendy
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Valentine Deglaire
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Paul Dusollier
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Jean-Pascal Fournier
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Jocelyne Caillon
- IRS 2 Laboratoire de Thérapeutique Expérimentale et Clinique des Infections, EA3826, University of Nantes, Nantes 44400, France
| | | | - Leïla Moret
- Public Health Department, CHU Nantes, Saint-Jacques Hospital, Nantes 44093, France.,UMR 1246 INSERM SPHERE "MethodS in Patients-Centered Outcomes and HEalth ResEarch", University of Nantes and Tours, Nantes 44200, France
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Vasudevan S, Thamil Selvan G, Bhaskaran S, Hari N, Solomon AP. Reciprocal Cooperation of Type A Procyanidin and Nitrofurantoin Against Multi-Drug Resistant (MDR) UPEC: A pH-Dependent Study. Front Cell Infect Microbiol 2020; 10:421. [PMID: 32850505 PMCID: PMC7431559 DOI: 10.3389/fcimb.2020.00421] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/08/2020] [Indexed: 01/05/2023] Open
Abstract
Uropathogenic Escherichia coli (UPEC) accounts for the majority of complicated and uncomplicated urinary tract infections. The use of phytomolecules in the treatment of UTI is fast gaining attention. The current report identifies a multidrug-resistant strain (QSLUPEC7), which is a strong biofilm producer, among the considered clinical isolates. The antimicrobial and antibiofilm activity was evaluated for the phytomolecule, Type A procyanidin (TAP) from Cinnamomum zeylanicum against QSLUPEC7. TAP treatment did not affect the growth of the MDR strain but affected the biofilm formation (~70% inhibition). The confocal microscopic examination reveals the biofilm inhibition and the live cells in the biofilm corroborates the antimicrobial results. Further, the synergy studies of TAP and nitrofurantoin (NIT) were carried out at different pH. TAP acts synergistically with nitrofurantoin at different pH considered. A closer look in the results reveals that at pH 5.8, maximum growth inhibition is recorded. The gene expression analysis shows that TAP alone and in combination with NIT downregulates the major fimbriae adhesins of UPEC. The results conclude that the TAP has an antibiofilm activity against the multidrug-resistant strain of UPEC, without affecting the growth. Also, TAP reciprocally cooperates with nitrofurantoin at different pH by downregulating the adhesins of UPEC.
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Affiliation(s)
- Sahana Vasudevan
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Gopalakrishnan Thamil Selvan
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Sunil Bhaskaran
- Department of Scientific Affairs, Indus Biotech Private Limited, Pune, India
| | - Natarajan Hari
- Nuclear Magnetic Resonance Laboratory, School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Adline Princy Solomon
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
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Raya GB, Dhoubhadel BG, Shrestha D, Raya S, Laghu U, Shah A, Raya BB, Kafle R, Parry CM, Ariyoshi K. Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal. Trop Med Health 2020; 48:65. [PMID: 32774128 PMCID: PMC7397599 DOI: 10.1186/s41182-020-00251-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens has complicated the treatment of urinary tract infections (UTI). Paediatric UTI is a common illness, which if not treated properly, may lead to acute and long-term complications, such as renal abscess, septicaemia, and renal scarring. This study aimed to determine the prevalence of MDR and ESBL-producing uropathogens among children. Methods During the study period (April 2017–April 2018), midstream urine samples were collected following aseptic procedures from children < 16 years in Siddhi Memorial Hospital. Standard culture and biochemical tests were performed to identify uropathogens and antimicrobial susceptibility test was done by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL-producing uropathogens were screened by ceftazidime (30 μg) and cefotaxime (30 μg) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 μg) or cefotaxime + clavulanic acid (30/10 μg) as recommended by CLSI. Results We processed 5545 non-repeated urine samples from the children with symptoms of UTI. A significant growth of uropathogens was observed in 203 samples (3.7%). The median age of the children was 24 months (interquartile range (IQR), 12–53 months). Escherichia coli (n = 158, 77.8%) and Klebsiella pneumoniae (n = 30, 14.8%) were common among the uropathogens. Among them, 80.3% were resistant to amoxycillin and 51.2% were resistant to cotrimoxazole. Most of them were susceptible to amikacin, nitrofurantoin, and ofloxacin. MDR was detected in 34.5% (n = 70/203) and ESBL producers in 24.6% (n = 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (n = 59/153, 38.6%) than children ≥ 5 years (n = 11/50, 22%) (P = 0.03). Conclusions Nitrofurantoin, ofloxacin, and amikacin can be used for the empirical treatment for UTI in children in Bhaktapur, Nepal. MDR and ESBL-producing uropathogens are prevalent; this warrants a continuous surveillance of antimicrobial resistance.
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Affiliation(s)
| | - Bhim Gopal Dhoubhadel
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan.,School of Tropical Medicine and Global Health (TMGH), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
| | | | | | | | - Ashok Shah
- Siddhi Memorial Hospital, Bhaktapur, Nepal
| | | | - Rita Kafle
- Kathmandu Medical College, Kathmandu, Nepal
| | - Christopher M Parry
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan.,School of Tropical Medicine and Global Health (TMGH), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
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Moussa M, Abou Chakra M, Dellis A, Moussa Y, Papatsoris A. Pharmacotherapeutic advances for recurrent urinary tract infections in women. Expert Opin Pharmacother 2020; 21:2011-2026. [PMID: 32717156 DOI: 10.1080/14656566.2020.1795128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment of recurrent Urinary tract infections (UTIs) has become challenging because of the dramatic increase in the rates of recurrent infection andof multidrug-resistant (MDR) infections. AREAS COVERED The authors review recurrent UTIs(rUTI) management in women. EXPERT OPINION Continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment has all been demonstrated to be effective in managing rUTIs in women. Intravaginal estrogen therapy , shows potential toward preventing rUTI. Oral vaccine Uro-Vaxom seems to reduce the number of UTIs. There is evidence that other therapies (e.g. cranberry, Methenamine hippurate, oral D-mannose) may decrease the number of symptomatic UTIs. The treatment of CRE-UTIs is focused on a colistin backbone. Carbapenems are considered first-line agents for UTIs caused by ESBL, but their use is associated with increased MDR. The usage of non-carbapenem for the treatment of ESBL UTIs is necessary. Cefepime, Piperacillin-Tazobactam, Ceftolozane-Tazobactam, and Ceftazidime-Avibactam are justified options. Oral therapy with Pivmecillinam, Fosfomycin, and Nitrofurantoin can be used against uncomplicated UTIs due to ESBL infection.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Athanasios Dellis
- Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens , Athens, Greece.,2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
| | - Yasmin Moussa
- Clinic of Dermatology, Dr Brinkmann, Schult & Samini-Fard , Gladbeck, Germany
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
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Harding C, Rantell A, Cardozo L, Jacobson SK, Anding R, Kirschner-Hermanns R, Greenwell T, Swamy S, Malde S, Abrams P. How can we improve investigation, prevention and treatment for recurrent urinary tract infections - ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S90-S97. [PMID: 31821632 DOI: 10.1002/nau.24021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recurrent urinary tract infection (rUTI) is a chronic condition and has a significant impact on health-related quality of life. The commonly used definition for rUTI is greater than three episodes in a year or more than two in 6 months. Current diagnostic methods have been used worldwide for over five decades, despite well evidenced criticism. Enhanced culture techniques demonstrate that the microbiome of the bladder is far more complex than previously thought and begs a reappraisal of our current testing. Treatment of rUTI is based on a small number of antibiotic trials with some evidence showing a reduction in the number of positive cultures, but one must be cautious in interpreting the results and weigh against the risk of generation of antimicrobial resistance (AMR). AIM The International Consultation on Incontinence-Research Society think tank reviewed the literature with a view to improving investigation, prevention and treatment of rUTI. METHODS A multidisciplinary team of experts were invited to present evidence regarding the current diagnostic methods, recent advances related to bladder biome mapping and current treatment strategies, including antibiotic and nonantibiotic options. Current guidelines regarding antibiotic stewardship and concerns regarding AMR were discussed. DISCUSSION Outcome of the think tank discussions are summarised with a set of recommendations to inform future research. Particular consideration is given to bacterial survival in the bladder after treatment as well as defects in urothelial barrier function which may play a significant part in the failure to eradicate UTI.
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Affiliation(s)
- Chris Harding
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Susan Kim Jacobson
- Infection Sciences, Severn Pathology, North Bristol NHS Trust, Bristol, UK
| | - Ralf Anding
- Department of Neuro-Urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V, Bonn, Germany
| | - Ruth Kirschner-Hermanns
- Department of Neuro-Urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V, Bonn, Germany
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Sheela Swamy
- Division of Medicine, University College London, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Abrams
- Southmead Hospital, Bristol Urological Institute, Bristol, UK
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Koguchi D, Murakami Y, Ikeda M, Dobashi M, Ishii J. Cefaclor as a first-line treatment for acute uncomplicated cystitis: a retrospective single-center study. BMC Urol 2020; 20:38. [PMID: 32252747 PMCID: PMC7137291 DOI: 10.1186/s12894-020-00605-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC. Methods We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy. Results Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n = 160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n = 19; 8.1% and n = 18; 7.7%). Overall success rate was 94.0% (n = 219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P < 0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n = 24) or 93.3% (n = 14). The rate in patients with resistance to both antibiotics was 60.0% (n = 9), and the pathogens in the other 40.0% (n = 6) of patients with treatment failure were E. coli-ESBL. Conclusion Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.
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Affiliation(s)
- Dai Koguchi
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan.
| | - Yasukiyo Murakami
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
| | - Masaomi Ikeda
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
| | - Masato Dobashi
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
| | - Junichiro Ishii
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
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Soucy JPR, Schmidt AM, Quach C, Buckeridge DL. Fluoroquinolone Use and Seasonal Patterns of Ciprofloxacin Resistance in Community-Acquired Urinary Escherichia coli Infection in a Large Urban Center. Am J Epidemiol 2020; 189:215-223. [PMID: 31665215 DOI: 10.1093/aje/kwz239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 11/14/2022] Open
Abstract
Urinary tract infections caused by the bacterium Escherichia coli are among the most frequently encountered infections and are a common reason for antimicrobial prescriptions. Resistance to fluoroquinolone antimicrobial agents, particularly ciprofloxacin, has increased in recent decades. It is intuitive that variation in fluoroquinolone resistance is driven by changes in antimicrobial use, but careful study of this association requires the use of time-series methods. Between April 2010 and December 2014, we studied seasonal variation in resistance to ciprofloxacin, trimethoprim-sulfamethoxazole, and ampicillin in community-acquired urinary E. coli isolates in Montreal, Quebec, Canada. Using dynamic linear models, we investigated whether seasonal variation in resistance could be explained by seasonal variation in community antimicrobial use. We found a positive association between total fluoroquinolone use lagged by 1 and 2 months and the proportion of isolates resistant to ciprofloxacin. Our results suggest that resistance to ciprofloxacin is responsive to short-term variation in antimicrobial use. Thus, antimicrobial stewardship campaigns to reduce fluoroquinolone use, particularly in the winter when use is highest, are likely to be a valuable tool in the struggle against antimicrobial resistance.
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Salloum S, Tawk M, Tayyara L. Bacterial resistance to antibiotics and associated factors in two hospital centers in Lebanon from January 2017 to June 2017. Infect Prev Pract 2020; 2:100043. [PMID: 34368694 PMCID: PMC8335911 DOI: 10.1016/j.infpip.2020.100043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/05/2020] [Indexed: 12/05/2022] Open
Abstract
General presentation Resistance of bacteria to antibiotics is a universal problem. With the increase in the rate of resistance, knowledge of susceptibility patterns is essential to guide antimicrobial therapy. In Lebanon, many studies investigated this subject. Objectives Determine the rate of multidrug and extremely drug-resistant bacteria as well as the patterns of resistance and the factors associated with this resistance. Materials and methods A cross-sectional study was performed using the cultures from the labs of two university hospitals in Lebanon. Bacteria were divided into four groups: sensitive, multidrug-, extremely- and pan-drug resistant. Patient information was obtained from the medical records. Using the SPSS software for Windows, version 20 (IBM, Armonk, USA), the frequency of the bacteria, their susceptibilities and the association of resistance with seven potential factors (age, gender, diabetes mellitus, cancer, chronic kidney disease, dialysis, previous hospitalization) were studied. Results The frequency of resistance was 53.7% (39.9% multidrug-resistant and 13.8% extremely drug-resistant). Escherichia coli strains were mostly susceptible to carbapenems and tigecycline; and nitrofurantoine and fosfomycin in urine. Pseudomonas and Acinetobacter species were mostly sensitive to colistin. Klebsiella species were mostly susceptible to amikacin and carbapenems. MRSA rates were 34.8%. Association was seen between the resistant bacteria and older age, chronic kidney disease, dialysis, and previous hospitalization. Conclusion Resistance of bacteria to drugs in Lebanon is increasing. Significant association is seen between these bacteria and older age, chronic kidney disease, dialysis, and previous hospitalization.
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Affiliation(s)
- Salim Salloum
- Internal Medicine Resident, Lebanese University, Lebanon
| | - Michel Tawk
- Internal Medicine Resident, Lebanese University, Rouphael Abou Jawde Street, Anwar Sello Building, Third Floor, Zalka, Lebanon
| | - Loubna Tayyara
- Doctor of Internal and Pulmonary Medicine, Master Degree in Epidemiology and Biostatistics, Research Carried Out in Lebanese Hospital Geitaoui, Makassed General Hospital, Lebanon
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47
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Etta P. Urinary tract infections in kidney transplantation: An emerging crisis of drug resistance. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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48
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Rothe K, Wantia N, Spinner CD, Schneider J, Lahmer T, Waschulzik B, Schmid RM, Busch DH, Katchanov J. Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013-2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations. BMC Infect Dis 2019; 19:1091. [PMID: 31888581 PMCID: PMC6937826 DOI: 10.1186/s12879-019-4721-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/22/2019] [Indexed: 12/21/2022] Open
Abstract
Background This study investigated predominant microorganisms causing community-onset bacteraemia at the medical emergency department (ED) of a tertiary-care university hospital in Germany from 2013 to 2018 and their antimicrobial susceptibility patterns. Methods Antimicrobial resistance patterns in patients with positive blood cultures presenting to an internal medicine ED were retrospectively analysed. Results Blood cultures were obtained at 5191 of 66,879 ED encounters, with 1013 (19.5%) positive results, and true positive results at 740 encounters (diagnostic yield, 14.3%). The most frequently isolated relevant microorganisms were Enterobacterales (n = 439, 59.3%), Staphylococcus aureus (n = 92, 12.4%), Streptococcus pneumoniae (n = 34, 4.6%), Pseudomonas aeruginosa (n = 32, 4.3%), Streptococcus pyogenes (n = 16, 2.2%), Enterococcus faecalis (n = 18, 2.4%), and Enterococcus faecium (n = 12, 1.6%). Antimicrobial susceptibility testing revealed a high proportion of resistance against ampicillin-sulbactam in Enterobacterales (42.2%). The rate of methicillin-resistant Staphylococcus aureus was low (0.4%). Piperacillin-tazobactam therapy provided coverage for 83.2% of all relevant pathogens using conventional breakpoints. Application of the new European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations increased the percentage of susceptible isolates to high-dose piperacillin-tazobactam to 92.8% (p < 0.001). Broad-spectrum carbapenems would only cover an additional 4.8%. The addition of vancomycin or linezolid extended coverage by just 1.7%. Conclusions Using an ureidopenicillin-beta-lactamase inhibitor combination at the high dose suggested by the new EUCAST recommendations provided nearly 93% coverage for relevant pathogens in patients with suspected bloodstream infection in our cohort. This might offer a safe option to reduce the empiric use of carbapenems. Our data support the absence of a general need for glycopeptides or oxazolidinones in empiric treatment.
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Affiliation(s)
- Kathrin Rothe
- Technical University of Munich, School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Trogerstr. 30, 81675, Munich, Germany. .,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
| | - Nina Wantia
- Technical University of Munich, School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Trogerstr. 30, 81675, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Christoph D Spinner
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Jochen Schneider
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Tobias Lahmer
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Birgit Waschulzik
- Institute of Medical Informatics, Statistics, and Epidemiology, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Dirk H Busch
- Technical University of Munich, School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Trogerstr. 30, 81675, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Juri Katchanov
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
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49
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Petrosillo N, Granata G, Boyle B, Doyle MM, Pinchera B, Taglietti F. Preventing sepsis development in complicated urinary tract infections. Expert Rev Anti Infect Ther 2019; 18:47-61. [PMID: 31795788 DOI: 10.1080/14787210.2020.1700794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Urinary tract infections (UTIs) are the most prevalent infections in the community and the most common reason for antimicrobial prescribing in ambulatory care. A UTI is defined as complicated when urinary tract anatomical abnormalities or urinary devices are present, when it is recurrent and when associated with immunodeficiency. Complicated UTIs (cUTIs) have a higher risk of treatment failure and often require longer antimicrobial treatment courses. cUTIs, especially those which are healthcare-associated, are often due to multidrug resistant organisms (MDROs).Areas covered: This article will review the available evidence in relation to prevention of sepsis in cUTI, evaluating the risk factors associated with sepsis development. Published articles from January 2005 to September 2019 on UTIs and sepsis prevention in complicated UTIs were identified by using MEDLINE (National Library of Medicine Bethesda MD) and by reviewing the references of retrieved articles.Expert opinion: Prevention of sepsis relies on prompt and timely diagnosis of cUTI, early identification of the causative organism, removal of obstructions and source control, proper and adequate empirical/targeted antimicrobial treatment. In particular, source control, i.e. removal of urinary obstructions, infected stents, urinary catheters, nephrostomies, and drainage of hydronephrosis/abscess, is essential for preventing the development and progression of sepsis.
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Affiliation(s)
- Nicola Petrosillo
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Guido Granata
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Breida Boyle
- Department of Clinical Microbiology, St. James Hospital, Dublin, Ireland and Trinity College Dublin, Ireland
| | - Maeve M Doyle
- Consultant Microbiologist, University Hospital Waterford, Waterford, Ireland.,Ireland and Royal College of Surgeons, University College Cork, Cork, Ireland
| | - Biagio Pinchera
- Clinic of Infectious Diseases, University "Federico II", Naples, Italy
| | - Fabrizio Taglietti
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
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50
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Kot B. Antibiotic Resistance Among Uropathogenic Escherichia coli. Pol J Microbiol 2019; 68:403-415. [PMID: 31880885 PMCID: PMC7260639 DOI: 10.33073/pjm-2019-048] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/09/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections. A main etiological factor of UTIs is uropathogenic Escherichia coli (UPEC). This review describes the current state of knowledge on the resistance of UPEC to antibiotics recommended for the treatment of UTIs based on the available literature data. Nitrofurantoin and fosfomycin are recommended as first-line therapy in the treatment of uncomplicated cystitis, and the resistance to these antimicrobial agents remains low between UPEC. Recently, in many countries, the increasing resistance is observed to trimethoprim-sulfamethoxazole, which is widely used as the first-line antimicrobial in the treatment of uncomplicated UTIs. In European countries, the resistance of UPEC to this antimicrobial agent ranges from 14.6% to 60%. The widespread use of fluoroquinolones (FQs), especially ciprofloxacin, in the outpatients is the cause of a continuous increase in resistance to these drugs. The resistance of UPEC to FQs is significantly higher in developing countries (55.5–85.5%) than in developed countries (5.1–32.0%). Amoxicillin-clavulanic acid is recommended as first line-therapy for pyelonephritis or complicated UTI. Resistance rates of UPEC to amoxicillin-clavulanic acid are regionally variable. In European countries the level of resistance to this antimicrobial ranges from 5.3% (Germany) to 37.6% (France). Increasing rates of UPEC resistance to antimicrobials indicate that careful monitoring of their use for UTI treatment is necessary.
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Affiliation(s)
- Barbara Kot
- Department of Microbiology, Faculty of Natural Sciences, Siedlce University of Natural Sciences and Humanities , Siedlce , Poland
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