1
|
Laopaiboonkun S, Chuaychai A, Yommudee K, Puttasiri P, Petchluan S, Thongsutt T. Antibiotic prescribing for acute uncomplicated cystitis among community pharmacists in Thailand. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024:riae047. [PMID: 39226048 DOI: 10.1093/ijpp/riae047] [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: 09/22/2023] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES This study aimed to evaluate the knowledge of community pharmacists toward acute uncomplicated cystitis regarding diagnosis, referral, and conformity to guidelines of the chosen antibiotic and to identify the associated factors with the pharmacist's knowledge. METHODS This was a descriptive cross-sectional survey using a questionnaire. Data was collected from 349 community pharmacies in upper southern Thailand between December 2021 and February 2022. Univariate logistic regression analysis was used to assess factors associated with an inappropriate diagnosis of acute uncomplicated cystitis. The variables with P-value < 0.2 were included in the multivariate model. The statistically significant level was set as P-value < 0.05. KEY FINDINGS Three hundred and forty-nine pharmacists from 349 community pharmacies were included. Approximately 65% and 69% of the participants had the knowledge to identify which patients should be considered for cystitis and which patients should be considered for acute uncomplicated cystitis. Ninety eight percentage of pharmacists could select the appropriate antibiotic for uncomplicated cystitis patients. The most prescribed antibiotics were ciprofloxacin (44.7%), norfloxacin (40.7%), and ofloxacin (10.3%). Inappropriate diagnosis was significantly related to age (P = 0.016) and role in the community pharmacy (P = 0.033). CONCLUSION The majority of participants had misconceptions about the differential diagnosis between complicated and uncomplicated cystitis. These were related to the community pharmacists' advanced age. Continuous pharmacy education should be established to advocate rational antibiotic use, especially in a country where community pharmacists are legally allowed to dispense antimicrobials without a prescription.
Collapse
Affiliation(s)
- Sawitree Laopaiboonkun
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Aungkana Chuaychai
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Drug and Cosmetics Excellence Center, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Kanitin Yommudee
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Polawat Puttasiri
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Siriporn Petchluan
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Tiwaphon Thongsutt
- Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| |
Collapse
|
2
|
Frick-Cheng AE, Shea AE, Roberts JR, Smith SN, Ohi MD, Mobley HLT. Iron limitation induces motility in uropathogenic E. coli CFT073 partially through action of LpdA. mBio 2024; 15:e0104824. [PMID: 38874412 PMCID: PMC11253704 DOI: 10.1128/mbio.01048-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
More than half of women will experience a urinary tract infection (UTI) with most cases caused by uropathogenic Escherichia coli (UPEC). Bacterial swimming motility enhances UPEC pathogenicity, resulting in more severe disease outcomes including kidney infection. Surprisingly, the connection between motility and iron limitation is mostly unexplored despite the lack of free iron available in the host. We sought to investigate a potential connection between iron restriction and regulation of motility in UPEC. We cultured E. coli CFT073, a prototypical UPEC strain, under iron limitation and observed that CFT073 had elevated fliC (flagella) promoter activity, and this iron-specific response was repressed by the addition of exogenous iron. We confirmed increased flagellar expression in CFT073 by measuring fliC transcript, FliC protein, and surface-expressed flagella under iron-limited conditions. Interestingly, known motility regulator flhDC did not have altered transcription under these conditions. To define the regulatory mechanism of this response, we constructed single knockouts of eight master regulators and found the iron-regulated response was lost in crp, arcA, and fis mutants. Thus, we focused on the five genes regulated by all three regulators. Of the five genes knocked out, the iron-regulated motility response was most strongly dysregulated in the lpdA mutant, which also resulted in significantly lowered fitness in the murine model of ascending UTI, both against the WT and a non-motile fliC mutant. Collectively, we demonstrated that iron-mediated motility in CFT073 is partially regulated by lpdA, which contributes to the understanding of how uropathogens differentially regulate motility mechanisms in the iron-restricted host. IMPORTANCE Urinary tract infections (UTIs) are ubiquitous and responsible for over five billion dollars in associated health care costs annually. Both iron acquisition and motility are highly studied virulence factors associated with uropathogenic Escherichia coli (UPEC), the main causative agent of uncomplicated UTI. This work is innovative by providing mechanistic insight into the synergistic relationship between these two critical virulence properties. Here, we demonstrate that iron limitation has pleiotropic effects with consequences that extend beyond metabolism and impact other virulence mechanisms. Indeed, targeting iron acquisition as a therapy may lead to an undesirable enhancement of UPEC pathogenesis through increased motility. It is vital to understand the full breadth of UPEC pathogenesis to adequately respond to this common infection, especially with the increase of antibiotic-resistant pathogens.
Collapse
Affiliation(s)
- A. E. Frick-Cheng
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - A. E. Shea
- Department of Microbiology and Immunology, University of South Alabama Medical School, Mobile, Alabama, USA
| | - J. R. Roberts
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - S. N. Smith
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - M. D. Ohi
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - H. L. T. Mobley
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B, Schubert S, Pilatz A, Veeratterapillay R, Wagenlehner FME, Bausch K, Devlies W, Horváth J, Leitner L, Mantica G, Mezei T, Smith EJ, Bonkat G. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol 2024; 86:27-41. [PMID: 38714379 DOI: 10.1016/j.eururo.2024.03.035] [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: 03/12/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Urological infections significantly impact the wellbeing and quality of life of individuals owing to their widespread occurrence and diverse clinical manifestations. The objective of the guidelines panel was to provide evidence-based guidance on the diagnosis, treatment, and prevention of urinary tract infections (UTIs) and male accessory-gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship. METHODS For the 2024 guidelines on urological infections, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of a thorough medical history and physical examination for patients with urological infections. The guidelines stress the role of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, providing recommendations for antibiotic selection, dosing, and duration on the basis of the latest evidence. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2024 EAU guidelines offers valuable insights into managing urological infections and are designed for effective integration into clinical practice. PATIENT SUMMARY The European Association of Urology has issued an updated guideline on urological infections. The guidelines provide recommendations for diagnosis, treatment, and prevention, with a particular focus on minimising antibiotic use because of the increasing global threat of antimicrobial resistance.
Collapse
Affiliation(s)
- Jennifer Kranz
- Department of Urology and Pediatric Urology, RWTH Aachen University, Aachen, Germany; Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle, Germany.
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, France; Université Francois Rabelais, PRES Centre Val de Loire, Tours, France
| | - Tommaso Cai
- Department of Urology, Santa Chiara, Regional Hospital, Trento, Italy
| | - Suzanne Geerlings
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Sören Schubert
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Kathrin Bausch
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Wout Devlies
- Department of Urology, UZ Leuven, Leuven, Belgium
| | - József Horváth
- BKMK SZTE ÁOK Okt. Kh. Urológiai Osztálya, Kecskemét, Hungary
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Tunde Mezei
- Department of Urology, Telemark Hospital, Skien, Norway
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Gernot Bonkat
- alta Uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University of Basel, Basel, Switzerland
| |
Collapse
|
4
|
Drekonja DM. Urinary Tract Infection in Male Patients: Challenges in Management. Infect Dis Clin North Am 2024; 38:311-323. [PMID: 38575494 DOI: 10.1016/j.idc.2024.03.009] [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] [Indexed: 04/06/2024]
Abstract
Urinary tract infections in male patients share many of the management principles as used in the management of female patients, including the need to accurately define the clinical syndrome, choose empirical therapy based on the severity of illness and the potential for antimicrobial resistance, and consider the need for source control in severely ill patients. The microbiology of the causative organisms is more unpredictable compared to female patients, and data to inform treatment decisions from clinical trials specific to male patients are relatively scarce.
Collapse
Affiliation(s)
- Dimitri M Drekonja
- Infectious Disease Section, Minneapolis VA Health Care System, University of Minnesota, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Mail code 111F, Minneapolis, MN 55417, USA.
| |
Collapse
|
5
|
Calvo CI, Hoy N, Rourke KF. Refining Bacteriuria as a Risk Factor for Complications After Urethroplasty: Identifying the Culprit. Urology 2024; 186:1-6. [PMID: 38354912 DOI: 10.1016/j.urology.2024.01.013] [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: 11/19/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To determine which bacteria are associated with an increased risk of 90-day complications after urethroplasty. Preoperative bacteriuria is associated with an increased risk of complications after urethroplasty. However, it remains unclear which specific micro-organisms are the primary drivers of this morbidity. METHODS A single-institution, 2-surgeon retrospective review was performed on patients undergoing urethroplasty from 08/2003 to 06/2021. Preoperative bacteriuria was considered significant when the patient had a mixed culture with ≥108 CFU/L or an identifiable micro-organism with ≥106 CFU/L. Descriptive statistics were used to summarize the results and chi-square was used to determine the association between 90-day complications (Clavien ≥2) and clinical characteristics/bacteria. RESULTS Out of 1611 patients, 23.2% (373) had significant preoperative bacteriuria. The most common pathogens included coagulase-negative staphylococcus 18.5% (69), mixed growth 15.8% (59), Escherichia coli 10.7% (40), and Enterococcus 14.2% (53). 7.9% (128/1611) experienced a significant 90-day complication (Clavien-Dindo ≥2). Gram-negative bacilli including E coli, Pseudomonas sp, Klebsiella sp, Serratia sp, Citrobacter sp, Achromobacter sp, Stenotrophomonas sp, and Morganella sp were associated with higher rates of postoperative complications (14.2%; P = .01) as well as Enterococcus sp (15.1%; P = .03). However, gram-positive cocci (7.9%; P = .97), gram-positive bacilli (11.8%; P = .47), mixed growth (5.1%; P = .54) and Candida (16.7%; P = .27) were not. Neither escalating concentrations of bacteria (P = .44) or number of strains (P = .08) were associated with increased risk of complications. CONCLUSION The main driver of bacteriuria-related complications after urethroplasty are gram-negative bacilli and Enterococcus sp. Patients with bacteriuria related to other micro-organisms can likely proceed with urethroplasty without increased risk of postoperative complications.
Collapse
Affiliation(s)
- Carlos I Calvo
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nathan Hoy
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
6
|
Flores-Oropeza MA, Ochoa SA, Cruz-Córdova A, Chavez-Tepecano R, Martínez-Peñafiel E, Rembao-Bojórquez D, Zavala-Vega S, Hernández-Castro R, Flores-Encarnacion M, Arellano-Galindo J, Vélez D, Xicohtencatl-Cortes J. Comparative genomic analysis of uropathogenic Escherichia coli strains from women with recurrent urinary tract infection. Front Microbiol 2024; 14:1340427. [PMID: 38328583 PMCID: PMC10848155 DOI: 10.3389/fmicb.2023.1340427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Recurrent urinary tract infections (RUTIs) caused by uropathogenic Escherichia coli are costly public health problems impacting patients' quality of life. Aim In this work, a comparative genomics analysis of three clinical RUTI strains isolated from bladder biopsy specimens was performed. Materials and methods One hundred seventy-two whole genomes of urinary tract E. coli strains were selected from the NCBI database. The search for virulence factors, fitness genes, regions of interest, and genetic elements associated with resistance was manually carried out. The phenotypic characterization of antibiotic resistance, haemolysis, motility, and biofilm formation was performed. Moreover, adherence and invasion assays with human bladder HTB-5 cells, and transmission electron microscopy (TEM) were performed. Results The UTI-1_774U and UTI-3_455U/ST1193 strains were associated with the extraintestinal pathotypes, and the UTI-2_245U/ST295 strain was associated with the intestinal pathotype, according to a phylogenetic analysis of 172 E. coli urinary strains. The three RUTI strains were of clinical, epidemiological, and zoonotic relevance. Several resistance genes were found within the plasmids of these strains, and a multidrug resistance phenotype was revealed. Other virulence genes associated with CFT073 were not identified in the three RUTI strains (genes for type 1 and P fimbriae, haemolysin hlyA, and sat toxin). Quantitative adherence analysis showed that UTI-1_774U was significantly (p < 0.0001) more adherent to human bladder HTB-5 cells. Quantitative invasion analysis showed that UTI-2_245U was significantly more invasive than the control strains. No haemolysis or biofilm activity was detected in the three RUTI strains. The TEM micrographs showed the presence of short and thin fimbriae only in the UTI-2_245U strain. Conclusion The high variability and genetic diversity of the RUTI strains indicate that are a mosaic of virulence, resistance, and fitness genes that could promote recurrence in susceptible patients.
Collapse
Affiliation(s)
- Marco A. Flores-Oropeza
- Posgrado en Ciencias Biomédicas, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Sara A. Ochoa
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Ariadnna Cruz-Córdova
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Eva Martínez-Peñafiel
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Daniel Rembao-Bojórquez
- Departamento de Patología, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Zavala-Vega
- Departamento de Patología, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Mexico City, Mexico
- Laboratorio Clínico y Banco de Sangre, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Mexico City, Mexico
| | - Rigoberto Hernández-Castro
- Departmento de Ecología de Agentes Patógenos, Hospital General “Dr. Manuel Gea González”, Mexico City, Mexico
| | - Marcos Flores-Encarnacion
- Laboratorio de Microbiología Molecular y Celular, Biomedicina, Facultad de Medicina, BUAP, Puebla, Mexico
| | - José Arellano-Galindo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Daniel Vélez
- Hospital Militar de Especialidades de la Mujer y Neonatología, Mexico City, Mexico
- Unidad Médica de Alta Especialidad, Hospital de Ginecología y Obstetricia No. 3 IMSS, Mexico City, Mexico
| | - Juan Xicohtencatl-Cortes
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| |
Collapse
|
7
|
Goubet AG, Rouanne M, Derosa L, Kroemer G, Zitvogel L. From mucosal infection to successful cancer immunotherapy. Nat Rev Urol 2023; 20:682-700. [PMID: 37433926 DOI: 10.1038/s41585-023-00784-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/13/2023]
Abstract
The clinical management of advanced malignancies of the upper and lower urinary tract has been revolutionized with the advent of immune checkpoint blockers (ICBs). ICBs reinstate or bolster pre-existing immune responses while creating new T cell specificities. Immunogenic cancers, which tend to benefit more from immunotherapy than cold tumours, harbour tumour-specific neoantigens, often associated with a high tumour mutational burden, as well as CD8+ T cell infiltrates and ectopic lymphoid structures. The identification of beneficial non-self tumour antigens and natural adjuvants is the focus of current investigation. Moreover, growing evidence suggests that urinary or intestinal commensals, BCG and uropathogenic Escherichia coli influence long-term responses in patients with kidney or bladder cancer treated with ICBs. Bacteria infecting urothelium could be a prominent target for T follicular helper cells and B cells, linking innate and cognate CD8+ memory responses. In the urinary tract, commensal flora differ between healthy and tumoural mucosae. Although antibiotics can affect the prognosis of urinary tract malignancies, bacteria can have a major influence on cancer immunosurveillance. Beyond their role as biomarkers, immune responses against uropathogenic commensals could be harnessed for the design of future immunoadjuvants that can be advantageously combined with ICBs.
Collapse
Affiliation(s)
- Anne-Gaëlle Goubet
- Gustave Roussy, Villejuif, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- AGORA Cancer Center, Lausanne, Switzerland
| | - Mathieu Rouanne
- Gustave Roussy, Villejuif, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France
- Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lisa Derosa
- Gustave Roussy, Villejuif, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Kremlin-Bicetre, France
| | - Guido Kroemer
- Gustave Roussy, Villejuif, France
- Equipe labellisée par la Ligue contre le Cancer, Université de Paris Cité, Sorbonne Université, Institut Universitaire de France, Inserm U1138, Centre de Recherche des Cordeliers, Paris, France
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
| | - Laurence Zitvogel
- Gustave Roussy, Villejuif, France.
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France.
- Faculté de Médecine, Université Paris-Saclay, Kremlin-Bicetre, France.
- Center of Clinical Investigations for In Situ Biotherapies of Cancer (BIOTHERIS) INSERM, CIC1428, Villejuif, France.
| |
Collapse
|
8
|
Chelangarimiyandoab F, Mungara P, Batta M, Cordat E. Urinary Tract Infections: Renal Intercalated Cells Protect against Pathogens. J Am Soc Nephrol 2023; 34:1605-1614. [PMID: 37401780 PMCID: PMC10561816 DOI: 10.1681/asn.0000000000000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
Urinary tract infections affect more than 1 in 2 women during their lifetime. Among these, more than 10% of patients carry antibiotic-resistant bacterial strains, highlighting the urgent need to identify alternative treatments. While innate defense mechanisms are well-characterized in the lower urinary tract, it is becoming evident that the collecting duct (CD), the first renal segment encountered by invading uropathogenic bacteria, also contributes to bacterial clearance. However, the role of this segment is beginning to be understood. This review summarizes the current knowledge on CD intercalated cells in urinary tract bacterial clearance. Understanding the innate protective role of the uroepithelium and of the CD offers new opportunities for alternative therapeutic strategies.
Collapse
Affiliation(s)
- Forough Chelangarimiyandoab
- Department of Physiology and Membrane Protein Disease Research Group, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | |
Collapse
|
9
|
Frick-Cheng AE, Shea AE, Roberts JR, Smith SN, Ohi MD, Mobley HLT. Altered motility in response to iron-limitation is regulated by lpdA in uropathogenic E. coli CFT073. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.27.559868. [PMID: 37808639 PMCID: PMC10557643 DOI: 10.1101/2023.09.27.559868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
More than half of all women will experience a urinary tract infection (UTI) in their lifetime with most cases caused by uropathogenic Escherichia coli (UPEC). Bacterial motility enhances UPEC pathogenicity, resulting in more severe disease outcomes including kidney infection. Surprisingly, the connection between motility and iron limitation is mostly unexplored, despite the lack of free iron available in the host. Therefore, we sought to explore the potential connection between iron restriction and regulation of motility in UPEC. We cultured E. coli CFT073, a prototypical UPEC strain, in media containing an iron chelator. Under iron limitation, CFT073 had elevated fliC (flagella) promoter activity, driving motility on the leading edge of the colony. Furthermore, this iron-specific response was repressed by the addition of exogenous iron. We confirmed increased flagella expression in CFT073 by measuring fliC transcript, FliC protein, and surface-expressed flagella under iron-limited conditions. To define the regulatory mechanism, we constructed single knockouts of eight master regulators. The iron-regulated response was lost in crp, arcA, and fis mutants. Thus, we focused on the five genes regulated by all three transcription factors. Of the five genes knocked out, the iron-regulated motility response was most strongly dysregulated in an lpdA mutant, which also resulted in significantly lowered fitness in the murine model of ascending UTI. Collectively, we demonstrated that iron-mediated motility in CFT073 is regulated by lpdA , which contributes to the understanding of how uropathogens differentially regulate motility mechanisms in the iron-restricted host. Importance Urinary tract infections (UTIs) are ubiquitous and responsible for over five billion dollars in associated health care costs annually. Both iron acquisition and motility are highly studied virulence factors associated with uropathogenic E. coli (UPEC), the main causative agent of uncomplicated UTI. This work is innovative by providing mechanistic insight into the synergistic relationship between these two critical virulence properties. Here, we demonstrate that iron limitation has pleiotropic effects with consequences that extend beyond metabolism, and impact other virulence mechanisms. Indeed, targeting iron acquisition as a therapy may lead to an undesirable enhancement of UPEC pathogenesis through increased motility. It is vital to understand the full breadth of UPEC pathogenesis to adequately respond to this common infection, especially with the increase of antibiotic resistant pathogens.
Collapse
|
10
|
Ali S, Ryan L. Antimicrobial susceptibility patterns of community-acquired uropathogenic Escherichia coli, Dublin 2010-2022. Access Microbiol 2023; 5:acmi000633.v3. [PMID: 37691841 PMCID: PMC10484315 DOI: 10.1099/acmi.0.000633.v3] [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: 05/31/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023] Open
Abstract
Background Escherichia coli is a common cause of urinary tract infections. Due to the increase in antimicrobial resistance (AMR) and global differences in antimicrobial susceptibility data, routine assessment of local antimicrobial susceptibility patterns is necessary to guide the selection of appropriate empirical therapy. The aim of this study was to evaluate the antimicrobial susceptibility patterns of community-acquired uropathogenic Escherichia coli within a catchment area in Dublin over a 13 year period, 2010-2022. Methods All mid-stream urine samples received from local general practitioners in which there was significant E. coli bacteriuria during the study period, 2010-2022, were included in the analysis. Antimicrobial susceptibility testing was performed by disc diffusion as per the European Committee on Antimicrobial Susceptibility Testing recommendations. Results An average of 11 407 urine samples per month had significant bacteriuria, with E. coli accounting for an average of 67 % of those. Overall AMR rates were highest for ampicillin (53.9 %), followed by trimethoprim (32.4 %), gentamicin (18.6 %), co-amoxiclav (16.5 %), ciprofloxacin (12.3 %), cephalexin (8.3 %), cefpodoxime (6.8 %) and nitrofurantoin (2 %). While rates appeared grossly static, statistically significant reduced resistance rates were noted for co-amoxiclav (rs=-0.95; P=<0.001), cephalexin prior to 2019 (rs=-0.783; P=0.013) and trimethoprim (rs=-0.639; P=0.019), with a statistically significant increase in non-susceptibility to cefpodoxime (rs=0.802; P=0.001). Conclusions In order to generate efficient empirical antimicrobial prescribing guidelines, knowledge of region-specific contemporaneous antimicrobial susceptibility patterns is pivotal. Our findings support the use of nitrofurantoin or cephalexin as empirical antimicrobial therapy within our setting.
Collapse
Affiliation(s)
- Saied Ali
- Department of Clinical Microbiology, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Laura Ryan
- Department of Clinical Microbiology, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| |
Collapse
|
11
|
Hollestein LM, Ye MYF, Ang K, Forbes H, Mansfield KE, Abuabara K, Smeeth L, Langan SM. The association between atopic eczema and lymphopenia: Results from a UK cohort study with replication in US survey data. J Eur Acad Dermatol Venereol 2023; 37:1190-1198. [PMID: 36606535 PMCID: PMC10947025 DOI: 10.1111/jdv.18841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lymphocyte skin homing in atopic eczema (AE) may induce lymphopenia. OBJECTIVE To determine if AE is associated with lymphopenia. METHODS We used UK primary care electronic health records (Clinical Practice Research Datalink GOLD) for a matched cohort study in adults (18 years+) (1997-2015) with at least one recorded lymphocyte count. We matched people with AE to up to five people without. We used multivariable logistic regression to estimate the association between AE and lymphopenia (two low lymphocyte counts within 3 months) and linear mixed effects regression to estimate the association with absolute lymphocyte counts using all available counts. Cox proportional hazard models were used to investigate the effect of lymphopenia on common infections. We replicated the study using US survey data (National Health and Nutrition Examination Survey [NHANES]). RESULTS Among 71,731 adults with AE and 126,349 adults without AE, we found an adjusted odds ratio (OR) for lymphopenia of 1.16 (95% CI: 1.09-1.23); the strength of association increased with increasing eczema severity. When comparing all recorded lymphocyte counts from adults with AE (n = 1,497,306) to those of people without AE (n = 4,035,870) we saw a lower mean lymphocyte (adjusted mean difference -0.047 × 109 /L [95% CI: -0.051 to -0.043]) in those with AE. The difference was larger for men, with increasing age, and with increasing AE severity and was present among people with AE not treated with immunosuppressive drugs. In NHANES (n = 22,624), the adjusted OR for lymphopenia in adults with AE was 1.30 (95% CI: 0.80-2.11), and the adjusted mean lymphocyte count difference was -0.03 × 109 /L (95% CI: -0.07 to 0.02). Despite having a lower lymphocyte count, adjusting for time with lymphopenia, did not alter risk estimates of infections. CONCLUSION Atopic eczema, including increasing AE severity, is associated with a decreased lymphocyte count, regardless of immunosuppressive drug use. Whether the lower lymphocyte count has wider health implications for people with severe eczema warrants further investigation.
Collapse
Affiliation(s)
- Loes M. Hollestein
- Department of DermatologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of ResearchNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
| | - Morgan Ya Fang Ye
- Department of DermatologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ky‐Leigh Ang
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Harriet Forbes
- Department of Population Health SciencesUniversity of BristolBristolUK
| | - Kathryn E. Mansfield
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Katrina Abuabara
- Department of DermatologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Liam Smeeth
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sinéad M. Langan
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
- Health Data Research UKLondonUK
| |
Collapse
|
12
|
Electro-fulguration for extensive inflammatory bladder lesions in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Int Urogynecol J 2022:10.1007/s00192-022-05360-w. [PMID: 36166061 DOI: 10.1007/s00192-022-05360-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate how women with uncomplicated antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) and extensive inflammatory bladder lesions on office cystoscopy responded to electro-fulguration (EF) to eliminate these chronic bladder sites. METHODS After IRB approval, a retrospective study of non-neurogenic women with RUTIs, inflammatory lesions on cystoscopy, and who underwent EF was performed. Lesions were classified through a simplified staging system based on the extent of bladder wall involvement. Only those with extensive bladder wall involvement (stages 3 and 4) at the time of EF were analyzed in this report. Six months after EF, an office cystoscopy was performed, with endoscopic success defined as no lesions seen. The primary clinical outcome was number of symptomatic UTIs after EF, defined as cure (0/year), improvement (1-2/year), and failure (≥3/year). RESULTS From 2007 to 2019, a total of 57 women met the study criteria, 30 stage 3 and 27 stage 4. Nineteen (63%) were endoscopically successful in stage 3 and 11 (41%) in stage 4. Mean follow-up was 2.9 years (stage 3) and 3.1 years (stage 4). All had at least a 6-month UTI follow-up after the 6 months of office cystoscopy, with 15 patients cured, 37 improved, and 5 failed (all stage 4). CONCLUSIONS Although EF only resulted in 63% complete endoscopic resolution, the majority experienced a decrease in the frequency of UTIs, suggesting that EF can be durably effective even in women with very extensive cystitis lesions.
Collapse
|
13
|
Butler D, Ambite I, Wan MLY, Tran TH, Wullt B, Svanborg C. Immunomodulation therapy offers new molecular strategies to treat UTI. Nat Rev Urol 2022; 19:419-437. [PMID: 35732832 PMCID: PMC9214477 DOI: 10.1038/s41585-022-00602-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 12/13/2022]
Abstract
Innovative solutions are needed for the treatment of bacterial infections, and a range of antibacterial molecules have been explored as alternatives to antibiotics. A different approach is to investigate the immune system of the host for new ways of making the antibacterial defence more efficient. However, the immune system has a dual role as protector and cause of disease: in addition to being protective, increasing evidence shows that innate immune responses can become excessive and cause acute symptoms and tissue pathology during infection. This role of innate immunity in disease suggests that the immune system should be targeted therapeutically, to inhibit over-reactivity. The ultimate goal is to develop therapies that selectively attenuate destructive immune response cascades, while augmenting the protective antimicrobial defence but such treatment options have remained underexplored, owing to the molecular proximity of the protective and destructive effects of the immune response. The concept of innate immunomodulation therapy has been developed successfully in urinary tract infections, based on detailed studies of innate immune activation and disease pathogenesis. Effective, disease-specific, immunomodulatory strategies have been developed by targeting specific immune response regulators including key transcription factors. In acute pyelonephritis, targeting interferon regulatory factor 7 using small interfering RNA or treatment with antimicrobial peptide cathelicidin was protective and, in acute cystitis, targeting overactive effector molecules such as IL-1β, MMP7, COX2, cAMP and the pain-sensing receptor NK1R has been successful in vivo. Furthermore, other UTI treatment strategies, such as inhibiting bacterial adhesion and vaccination, have also shown promise. Hyperactivation of innate immunity is a disease determinant in urinary tract infections (UTIs). Modulation of innate immunity has promise as a therapy for UTIs. In this Review, the authors discuss potential mechanisms and immunomodulatory therapeutic strategies in UTIs. Excessive innate immune responses to infection cause symptoms and pathology in acute pyelonephritis and acute cystitis. Innate immunomodulation therapy is, therefore, a realistic option for treating these conditions. Targeting excessive innate immune responses at the level of transcription has been successful in animal models. Innate immunomodulation therapy reduces excessive inflammation and tissue pathology and accelerates bacterial clearance from infected kidneys and bladders in mice. Innate immunomodulation therapy also accelerates the clearance of antibiotic-resistant bacterial strains.
Collapse
Affiliation(s)
- Daniel Butler
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Ines Ambite
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Murphy Lam Yim Wan
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Thi Hien Tran
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Björn Wullt
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Catharina Svanborg
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden.
| |
Collapse
|
14
|
Monotheca buxifolia Driven Synthesis of Zinc Oxide Nano Material Its Characterization and Biomedical Applications. MICROMACHINES 2022; 13:mi13050668. [PMID: 35630135 PMCID: PMC9146105 DOI: 10.3390/mi13050668] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 01/27/2023]
Abstract
The current study demonstrates a sophisticated and environmentally friendly synthesis of zinc oxide nanoparticles (ZnO-NPs) for a range of biological and environmental applications using Monotheca buxifolia as a bio-source. At the nanometer scale, a simple aqueous extract from Monotheca buxifolia was used to convert Zn into stable elemental zinc (Zn0). With an average size of 45.8 nm and a spherical shape, the NPs were stable and pure. The nanoparticles studied here were tested in vitro for bactericide, fungicide, biocompatibility, leishmaniasis, anti-diabetic effect, antioxidant effect, and anti-Alzheimer’s effect. According to our results, Monotheca buxifolia mediated ZnO-NPs are highly effective against spore-forming fungal strains and MDR bacterial strains. All examined bacterial isolates of UTI (urinary tract infection) were resistant to non-coated antibiotics; however, adding 1% of the produced ZnO-NPs to the treatments increased their bactericidal activity significantly. The NPs also showed dose-dependent cytotoxicity against Leishmania tropica parasites, with an LC50 of 248 μg/mL for promastigote parasites and 251 μg/mL for amastigote parasites. In addition, a significant inhibition of α-glucosidase, α-amylase, butyrylcholinesterase (BChE), and acetylcholinesterase (AChE) was discovered, indicating anti-Alzheimer’s and anti-diabetic effects. The biocompatibility of the particles with human red blood cells was also observed. Due to their environmentally friendly production, biological safety, and exceptional physicochemical properties, ZnO-NPs could be used as a new competitor for several biological and environmental applications.
Collapse
|
15
|
Al-Mnaser A, Dakheel M, Alkandari F, Woodward M. Polyphenolic phytochemicals as natural feed additives to control bacterial pathogens in the chicken gut. Arch Microbiol 2022; 204:253. [PMID: 35412092 PMCID: PMC9001821 DOI: 10.1007/s00203-022-02862-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 01/21/2023]
Abstract
Poultry provides an important protein source consumed globally by human population, and simultaneously, acts as a substantial reservoir of antibiotic resistant bacterial species such as Escherichia coli, Salmonella, Campylobacter, Clostridium perfringens. These bacterial species can include commensal strains with beneficial roles on poultry health and productivity, and pathogenic strains not only to poultry but zoonotically to man. This review paper evaluates the role of phytochemicals as possible alternatives to antibiotics and natural anti-bacterial agents to control antibiotic resistance in poultry. The focus of this paper is on the polyphenolic phytochemicals as they constitute the major group; carvacrol oil (the active ingredient of oregano), thymol oil (the main ingredient of oregano), oregano oil, and tannins oil as feed additives and their mechanism of actions that might enhance avian gut health by controlling antibiotic-resistant bacterial strains spread in poultry.
Collapse
Affiliation(s)
- Afnan Al-Mnaser
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, RG6 6DZ, UK.
- Dasman Diabetes Institute, Dasman, Sharq, Kuwait.
| | - Mohammed Dakheel
- Department of Veterinary Public Health, College of Veterinary Medicine, University of Baghdad, Baghdad, Iraq
| | - Fatemah Alkandari
- Department of Plant Protection, Public Authority of Agriculture Affairs and Fish Resources, Al-Rabia, Kuwait
| | - Martin Woodward
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, RG6 6DZ, UK
- Folium Science, Unit DX, Bristol, BS2 0XJ, UK
| |
Collapse
|
16
|
Kasew D, Desalegn B, Aynalem M, Tila S, Diriba D, Afework B, Getie M, Biset S, Baynes HW. Antimicrobial resistance trend of bacterial uropathogens at the university of Gondar comprehensive specialized hospital, northwest Ethiopia: A 10 years retrospective study. PLoS One 2022; 17:e0266878. [PMID: 35404978 PMCID: PMC9000029 DOI: 10.1371/journal.pone.0266878] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Urinary tract infection and antimicrobial resistance remains the major problem, with significant health and socioeconomic burden, particularly in developing countries. This infection is commonly caused by Gram-negative bacteria, principally by Escherichia coli. So, this study aimed to determine bacterial isolates and antimicrobial resistance trend among patients with urinary tract infection at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A retrospective study was conducted from January 1st to February 28th. A ten years (2010–2019) record of urine culture results, the biochemical test and antimicrobial susceptibility test results of isolates were collected from the medical microbiology laboratory register using a checklist. Data quality was checked, entered, and analyzed using SPSS version 23. We have presented results through descriptive tables and graphs. The overall prevalence of urinary tract infection among 4441 patients was 24.1%. Escherichia coli (37.7%), Klebsiella pneumoniae (11.4%), and Staphylococcus aureus (9.1%) were the predominant uropathogens. The infection rate was nearly similar across both sexes but highest in the age group above 60 years. Above 75% of Gram-negative isolates were resistant to ampicillin (92.5%), amoxicillin-clavulanate (80.1%), tetracycline (79.3%), cefuroxime (79.2%), and Trimethoprim-sulfamethoxazole (78.3%). Over 2/3 of Gram-positive isolates also showed increased resistance to tetracycline (84.8%) and penicillin (71.6%). Moreover, more than 44% of the isolates were multidrug-resistant (MDR). We have seen an inconsistent trend of antimicrobial resistance, with an overall resistance rate of above 50%. In conclusion, the overall prevalence of urinary tract infection was high and elderly patients were most affected. More than 70% of both Gram positive and gram-negative isolates were resistant to penicillin, ampicillin, amoxicillin-clavulanate, tetracycline, cefuroxime, Trimethoprim-sulfamethoxazole. Above than 44% of the isolates were multidrug-resistant (MDR). The increasing rate of antimicrobial resistance calls for routine diagnosis and antimicrobial susceptibility testing. A prospective multicenter study indicating the status of resistance should be encouraged.
Collapse
Affiliation(s)
- Desie Kasew
- Department of Medical Microbiology, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail: ,
| | - Blen Desalegn
- Department of Medical Laboratory Science, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Mihret Aynalem
- Department of Medical Laboratory Science, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Sosina Tila
- Department of Medical Laboratory Science, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Dureti Diriba
- Department of Medical Laboratory Science, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Beimnet Afework
- Department of Medical Laboratory Science, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Michael Getie
- Microbiology Laboratory, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Sirak Biset
- Department of Medical Microbiology, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Wondifraw Baynes
- Department of Clinical Chemistry, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
17
|
Isolation, Identification, Characterization, and Plasmid Profile of Urinary Tract Infectious Escherichia coli from Clinical Samples. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7234586. [PMID: 35356239 PMCID: PMC8958076 DOI: 10.1155/2022/7234586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 12/04/2022]
Abstract
Objective In recent times, urinary tract infection (UTI) is one of the most widely recognized bacterial diseases all over the planet. UTI influences individuals of any age and gender. The target of this study is to concentrate on the recurrence of uropathogens, the antimicrobial susceptibility pattern of the isolates, and the plasmid profile of people from the government clinics of Karaikudi. Methods From July 2017 to December 2017, 100 urine tests were gathered and handled for the isolation of pathogenic microbes. In total, 89 isolates were found from the samples collected. Results Escherichia coli was discovered as the most common bacterial isolate screened from the UTI-infected people, accounting for 28.09 percent of all isolates. E. coli was seen to be the highest prevalent bacterium for UTI in all age groups and demonstrated resistance to routinely used medications, especially cefpodoxime and novobiocin, which have been 100 percent resistant. The E. coli isolates screened were positive for beta-lactamase and film generation, and they have strong antimicrobial resistance. As a result, the E. coli strains with the highest prevalence of virulence determinants have become more resistant to many medications because they support the microorganism in overcoming the host's defense and colonizing or entering the urinary system. The amplified 16S rRNA product was analyzed, and phylogenetic relationships were determined. The presence of TEM (56 percent), CTX-M (64 percent), SHV (40 percent), and OXA (60 percent) was discovered. Among E. coli isolates, CTX-M was the most common extended spectrum-beta lactamase (ESBL). Multiplex PCR was also used to identify the existence of CTX-M subgroups in E. coli isolates. Conclusion Finally, we urge that antibiotic selection should be predicated on the awareness of the specific prevalence and that novel antimicrobial medicines for urinary infections be developed to combat the overuse of antibiotics.
Collapse
|
18
|
Choi JHK, Duong HA, Williams S, Lee J, Oh M, Rosen C, Lee YP, Bhatia N. The efficacy of bactrim in reducing surgical site infections after spine surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 9:100095. [PMID: 35141659 PMCID: PMC8820075 DOI: 10.1016/j.xnsj.2021.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Previous studies show an increasing incidence of gram-negative organisms in surgical site infections after spine surgery. This study is looking for the association of the post-operative prophylactic use of Bactrim and the gram-negative surgical site infection after lumbar spine surgery. METHODS Patients who underwent lumbar spine surgery between August 2010 and December 2019 at the institution were retrospectively reviewed. RESULTS There were 11 infections out of 511 cases where no oral antibiotics were given (2.2%). There were 2 infections out of 84 cases where Bactrim was given (2.4%). This was not statistically significant (P=0.89). The organisms cultured from the no oral antibiotic group were 8 cases of methicillin sensitive Staphylococcus aureus (MSSA), 1 case of E. coli, 1 case of Pseudomonas aeruginosa, 1 case of MRSA. The organisms cultured from the Bactrim group were 1 case of MRSA, and 1 case of combined Citrobacter freundii and methicillin sensitive Staphylococcus aureus (MSSA). CONCLUSION There was no statistically significant difference in SSIs when Bactrim was given for two weeks after surgery. However, two subjects who developed infection from the Bactrim group were paradoxically affected by gram-negative and antibiotic resistant organisms. So, clinicians should be judicious in their use of oral antibiotics after spine surgery. Level of Evidence: III.
Collapse
Affiliation(s)
- Jeffrey Hyun-Kyu Choi
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Huy Alex Duong
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Sean Williams
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Joshua Lee
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Michael Oh
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Charles Rosen
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| |
Collapse
|
19
|
|
20
|
Urinary Tract Infections. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
21
|
Addis T, Mekonnen Y, Ayenew Z, Fentaw S, Biazin H. Bacterial uropathogens and burden of antimicrobial resistance pattern in urine specimens referred to Ethiopian Public Health Institute. PLoS One 2021; 16:e0259602. [PMID: 34767605 PMCID: PMC8589166 DOI: 10.1371/journal.pone.0259602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are the leading causes of morbidity in the general population, and is the second most common infectious disease after respiratory infections. Appropriate antibiotic therapy is essential to achieving good therapeutic results. Therefore, the purpose of this study was to investigate the profile of pathogens cultured from urinary tract infections and to determine their resistance profiles to commonly prescribed antibiotics. METHOD A cross-sectional study was carried out at the National Referral Laboratory of the Ethiopian Institute of Public Health from January 2017 to December 2018. All positive cultures were characterized by colony morphology, Gram stain, and standard biochemical tests. The antimicrobial susceptibility test of the isolate was performed using the Kirby- Bauer disk diffusion test on Muller-Hinton agar. In addition, bacterial identification, antimicrobial susceptibility testing and phenotypic detection of MDR were performed with VITEK 2 Compact according to the manufacturer's instructions. RESULT Out of 1012 cultured urine specimens, 325 (32.1%) was showed significant bacteriuria. The overall prevalence of UTIs was 325(32.1%) and the highest prevalence rate was obtained from 21-30 years age group 73(22.5%). Among UTIs patients, 583(57.6%) were females and 429(42.4%) were males. The UTIs of 179 (55%) women is relatively higher than that of men 146 (45%). Among 325 isolates, Gram-negative bacteria (GNB) appeared more frequently 252 (51.7%) than Gram-positive bacteria 63 (19.4%). In GNB, E. coli 168(66.7%), Klebsiella species 32(12.7%), and Enterobacter species 13 (5.2%) were dominated isolates whereas in GPB accounted for coagulase-negative staphylococcus (CoNS) 33(52.4%), Enterococcus species 16(25.4%), and Staphylococcus aureus 10(15.9%). Major of the isolates showed high levels of antibiotic resistance to commonly prescribed antimicrobials. Imipenem, Amikacin, and Nitrofurantoin were the most sensitive antibiotics for Gram-negative isolates while Nitrofurantoin, clindamycin, and Gentamycin were effective against gram-positive uropathogens. Overall, 156/256(60.9%), 56/256(22.4%), 10/256(4%) of gram-negative isolates were MDR, XDR, and PDR respectively while among the GPB isolates, 34/63(53.1%), 10/63(15.8%), and 1/63(1.6%) were MDR, XDR, and PDR isolates respectively. Among the tested bacterial strains, 190/319 (59.5%) were MDR, 66/319 (20.7%) strains were XDR, and 11/319 (3.45%) were PDR isolated. CONCLUSION The prevalence of urinary tract infection was high, and Gram-negative organisms were the most common causes of UTIs in this study. It was found that the resistance to commonly used antibiotics is very high. Early detection and close monitoring of MDR, XDR, or even PDR bacterial strains must be started by all clinical microbiology laboratories to reduce the menace of antimicrobial resistance that is now a global problem.
Collapse
Affiliation(s)
- Tesfa Addis
- Department of Clinical bacteriology and Mycology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Mekonnen
- Department of Clinical bacteriology and Mycology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zeleke Ayenew
- Department of Clinical bacteriology and Mycology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Surafel Fentaw
- Department of Clinical bacteriology and Mycology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Habtamu Biazin
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
22
|
Blondeau JM, Fitch SD. In Vitro Killing of Canine Urinary Tract Infection Pathogens by Ampicillin, Cephalexin, Marbofloxacin, Pradofloxacin, and Trimethoprim/Sulfamethoxazole. Microorganisms 2021; 9:2279. [PMID: 34835405 PMCID: PMC8619264 DOI: 10.3390/microorganisms9112279] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/24/2022] Open
Abstract
Urinary tract infections are common in dogs, necessitating antimicrobial therapy. We determined the speed and extent of in vitro killing of canine urinary tract infection pathogens by five antimicrobial agents (ampicillin, cephalexin, marbofloxacin, pradofloxacin, and trimethoprim/sulfamethoxazole) following the first 3 h of drug exposure. Minimum inhibitory and mutant prevention drug concentrations were determined for each strain. In vitro killing was determined by exposing bacteria to clinically relevant drug concentrations and recording the log10 reduction and percent kill in viable cells at timed intervals. Marbofloxacin and pradofloxacin killed more bacterial cells, and faster than other agents, depending on the time of sampling and drug concentration. Significant differences were seen between drugs for killing Escherichia coli, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus pseudintermedius strains. At the maximum urine drug concentrations, significantly more E. coli cells were killed by marbofloxacin than by ampicillin (p < 0.0001), cephalexin (p < 0.0001), and TMP/SMX (p < 0.0001) and by pradofloxacin than by cephalexin (p < 0.0001) and TMP/SMX (p < 0.0001), following 5 min of drug exposure. Rapid killing of bacteria should inform thinking on drug selection for short course therapy for uncomplicated UTIs, without compromising patient care, and is consistent with appropriate antimicrobial use and stewardship principles.
Collapse
Affiliation(s)
- Joseph M. Blondeau
- Departments of Microbiology and Immunology, Pathology and Laboratory Medicine and Ophthalmology, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
- Department of Clinical Microbiology, Royal University Hospital and Saskatchewan Health Authority, Saskatoon, SK S7N 0W8, Canada;
| | - Shantelle D. Fitch
- Department of Clinical Microbiology, Royal University Hospital and Saskatchewan Health Authority, Saskatoon, SK S7N 0W8, Canada;
| |
Collapse
|
23
|
A Proteomics Approach to Identify Possible Biomarkers of Early and Late Stages of E. coli-induced Urinary Tract Infections. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.3.47] [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
As one of the most common bacterial infections globally, urinary tract infections (UTI)s affect the bladder and kidneys of many the bladders and kidneys of many. Along with gram-negative bacteria, Escherichia coli (E. coli) causes nearly 40% of nosocomial UTIs, 25% of recurrent infections, and between 80 to 90% of community-acquired infections. Proteomics, commonly used to study changes in protein expression of organisms, can be used to explore candidate biomarkers useful for the diagnosis of pathological conditions. Here, protein profiles of samples from patients diagnosed with E. coli-induced UTI were compared to identify distinctive proteins. Extracted proteins from bacteria from patients’ urine samples were separated into excisable spots using 2D-gel electrophoresis. The gels were then analyzed using Progenesis SameSpot software to select uniquely expressed protein spots, excised, and analyzed by LC/MS. The results were then compared against a database of known proteins. We identified two proteins, outer membrane protein A (OmpA) and RNA polymerase-binding transcription factor (DksA), involved in the survival of E. coli in the harsh environment of the host. We suggest their use as a part of a battery of possible biomarkers proteins for E. coli-induced UTI, and suggest that their overexpression is possibly associated with the stage of infection, early or late.
Collapse
|
24
|
Cai T. Recurrent uncomplicated urinary tract infections: definitions and risk factors. GMS INFECTIOUS DISEASES 2021; 9:Doc03. [PMID: 34113535 PMCID: PMC8167371 DOI: 10.3205/id000072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Recurrent uncomplicated urinary tract infections (UTI) have a high impact on patients’ quality of life and high direct and indirect costs for public health. Therefore, optimal management should be of high priority. Methods: Current international guidelines were reviewed, and a systematic literature search was performed in Medline, Cochrane, and Embase. Results: Several risks factors have been identified and used in everyday clinical practice to plan the correct strategy for recurrence prevention. Among all factors, the most important are: sexual intercourse, spermicide use, having a new sex partner, having a mother with a history of UTI, having had UTI during childhood, and asymptomatic bacteriuria treatment. Moreover, other risk factors such as reduced fluid intake, habitual and post-coital delayed urination, wiping from back to front after defecation, douching and wearing occlusive underwear, as well as irregular bowel function should be taken into account. Conclusions: Recurrent UTI show a high impact on clinical practice. Risk factors are generally related to both virulence of pathogens and patient’s behavior or condition. A recently developed nomogram can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy.
Collapse
Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| |
Collapse
|
25
|
A New Gold Rush: A Review of Current and Developing Diagnostic Tools for Urinary Tract Infections. Diagnostics (Basel) 2021; 11:diagnostics11030479. [PMID: 33803202 PMCID: PMC7998255 DOI: 10.3390/diagnostics11030479] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
Urinary tract infections (UTIs) are one of the most common infections in the United States and consequently are responsible for significant healthcare expenditure. The standard urine culture is the current gold standard for diagnosing urinary tract infections, however there are limitations of the test that directly contribute to increased healthcare costs. As a result, new and innovative techniques have been developed to address the inefficiencies of the current standard-it remains to be seen whether these tests should be performed adjunctly to, or perhaps even replace the urine culture. This review aims to analyze the advantages and disadvantages of the newer and emerging diagnostic techniques such as PCR, expanded quantitative urine culture (EQUC), and next generation sequencing (NGS).
Collapse
|
26
|
Kumar M, Sarma DK, Shubham S, Kumawat M, Verma V, Nina PB, JP D, Kumar S, Singh B, Tiwari RR. Futuristic Non-antibiotic Therapies to Combat Antibiotic Resistance: A Review. Front Microbiol 2021; 12:609459. [PMID: 33574807 PMCID: PMC7870489 DOI: 10.3389/fmicb.2021.609459] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022] Open
Abstract
The looming problem of resistance to antibiotics in microorganisms is a global health concern. The drug-resistant microorganisms originating from anthropogenic sources and commercial livestock farming have posed serious environmental and health challenges. Antibiotic-resistant genes constituting the environmental "resistome" get transferred to human and veterinary pathogens. Hence, deciphering the origin, mechanism and extreme of transfer of these genetic factors into pathogens is extremely important to develop not only the therapeutic interventions to curtail the infections, but also the strategies to avert the menace of microbial drug-resistance. Clinicians, researchers and policymakers should jointly come up to develop the strategies to prevent superfluous exposure of pathogens to antibiotics in non-clinical settings. This article highlights the present scenario of increasing antimicrobial-resistance in pathogenic bacteria and the clinical importance of unconventional or non-antibiotic therapies to thwart the infectious pathogenic microorganisms.
Collapse
Affiliation(s)
- Manoj Kumar
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | | | - Swasti Shubham
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | - Manoj Kumawat
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | - Vinod Verma
- Stem Cell Research Centre, Department of Hematology, SGPGIMS, Lucknow, India
| | | | - Devraj JP
- ICMR- National Institute of Nutrition, Hyderabad, India
| | - Santosh Kumar
- ICMR- National Institute of Nutrition, Hyderabad, India
| | - Birbal Singh
- ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, India
| | | |
Collapse
|
27
|
Alidjanov JF, Naber KG, Pilatz A, Wagenlehner FM. Validation of the American English Acute Cystitis Symptom Score. Antibiotics (Basel) 2020; 9:antibiotics9120929. [PMID: 33352734 PMCID: PMC7766804 DOI: 10.3390/antibiotics9120929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023] Open
Abstract
The diagnosis of acute uncomplicated cystitis (UC) is usually based on clinical symptoms. The study aims to develop and validate the American-English Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for diagnosis and patient-reported outcome in women with acute uncomplicated cystitis (UC). After certified translation into American-English and cognitive assessment, the clinical validation of the ACSS was performed embedded in a US phase-II trial. 167 female patients with typical symptoms of UC were included in the study following US Food and Drug Administration (FDA) guidance. At Day 1 (diagnosis), the mean (SD) sum score of the six ACSS typical symptoms reached 10.60 (2.51). Of 100 patients followed-up last time on Day 5 or 6 (End-of-treatment, EoT), 91 patients showed clinical success according to the favored ACSS criteria (sum score of typical symptoms 0.98 (1.94)). There was no correlation between the severity of symptoms on Day 1 or between clinical success rate at EoT and level of bacteriuria on Day 1. The American-English ACSS showed high predictive ability and responsiveness and excellent levels of reliability and validity. It can now be recommended as the new master version in clinical and epidemiological studies, in clinical practice, or for self-diagnosis of women with symptoms of UC.
Collapse
Affiliation(s)
- Jakhongir F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
- Correspondence: ; Tel.: +49-176-5806-8639
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 81675 Munich, Germany;
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
| | - Florian M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
| |
Collapse
|
28
|
Saad D, Gameel S, Ahmed S, Basha E, Osman M, Khalil E. Etiological Agents of Urinary Tract Infection and 7 Years Trend of Antibiotic Resistance of Bacterial Uropathogens in Sudan. Open Microbiol J 2020. [DOI: 10.2174/1874434602014010312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Bacterial infections of the urinary tract represent a major cause of outpatient visits as well as hospital-acquired infections. As the prevalence of multidrug-resistant uropathogens is increasing, updated knowledge of the commonest bacterial causes and their susceptibility patterns is crucial for the proper selection and use of antimicrobial drugs and the development of effective local prescribing guidelines.
Methods:
Handling of urine samples, identification of organisms and antimicrobial susceptibility testing were made according to guidelines in Monica Cheesbrough 2000, 2006. The prevalence of resistance of the pathogens against each antibiotic was calculated as the proportion of resistant isolates over the entire tested isolates. Data were analyzed using Epi info; the chi-square test and Fisher exact test were used to assess the statistical significance of results.
Results:
In this study, 774 samples were cultured from patients with suspected urinary tract infection (UTI), 705 (91%) urinary isolates showed significant growth (>105 CFU /L) while the other 69 samples showed no significant growth. 431 (61%) of the patients were female, while the other 274 (39%) were males. 13 types of pathogens were identified in 705 urinary isolates. E.Coli was the main bacterial uropathogen identified. Microbiological susceptibility of a total of 28 antibiotics was tested; for each urinary isolate, different sets of these antibiotics were used. 601(96%) of the bacteria were resistant to at least one antibiotic. 17 antibiotics were found to have a bacterial resistance rate of more than 50%, including all B lactams (except cefuroxime), Nalidixic acid, Ciprofloxacin, Norfloxacin, Clindamycin, Co-Trimoxazole and Tetracyclines(Tetracycline and Doxycycline). Other antibiotics were found to have resistance rates of less than 50%. Amikacin & Imipenem had the highest susceptibility rates. Throughout the 7 years, resistance to most of the antibiotics showed an incremental pattern.
Conclusion:
Current empirical antibiotic therapy for UTI should be modified, and new guidelines should be established based on local resistance rates. This study comes up with precious regional data for evidence-based empirical antibiotic treatment, but a national sentinel surveillance system and regional antibiograms should be established to track the bacterial susceptibility profiles in Sudan.
Collapse
|
29
|
Lau WK, Dharmasena D, Horsley H, Jafari NV, Malone-Lee J, Stride E, Edirisinghe M, Rohn JL. Novel antibiotic-loaded particles conferring eradication of deep tissue bacterial reservoirs for the treatment of chronic urinary tract infection. J Control Release 2020; 328:490-502. [PMID: 32882271 DOI: 10.1016/j.jconrel.2020.08.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/09/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
A significant proportion of urinary tract infection (UTI) patients experience recurrent episodes, due to deep tissue infection and treatment-resistant bacterial reservoirs. Direct bladder instillation of antibiotics has proved disappointing in treating UTI, likely due to the failure of infused antibiotics to penetrate the bladder epithelium and accumulate to high enough levels to kill intracellular bacteria. This work investigates the use of nitrofurantoin loaded poly(lactic-co-glycolic acid) (PLGA) particles to improve delivery to intracellular targets for the treatment of chronic UTI. Using electrohydrodynamic atomisation, we produced particles with an average diameter of 2.8 μm. In broth culture experiments, the biodegradable particles were effective against a number of UTI-relevant bacterial strains. Dye-loaded particles demonstrated that intracellular delivery was achieved in all cells in 2D cultures of a human bladder epithelial progenitor cell line in a dose-dependent manner, achieving far higher efficiency and concentration than equivalent quantities of free drug. Time-lapse video microscopy confirmed that delivery occurred within 30 min of administration, to 100% of cells. Moreover, the particles were able to deliver the drug to cells through multiple layers of a 3D human bladder organoid model causing minimal cell toxicity, displaying superior killing of bacterial reservoirs harboured within bladder cells compared with unencapsulated drug. The particles were also able to kill bacterial biofilms more effectively than the free drug. These results illustrate the potential for using antibiotic-loaded microparticles to effectively treat chronic UTIs. Such a delivery method could be extrapolated to other clinical indications where robust intracellular delivery is required, such as oncology and gene therapy.
Collapse
Affiliation(s)
- Wai K Lau
- Department of Mechanical Engineering, University College London, London, UK
| | - Dhanuson Dharmasena
- Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - Harry Horsley
- Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - Nazila V Jafari
- Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - James Malone-Lee
- Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - Eleanor Stride
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Mohan Edirisinghe
- Department of Mechanical Engineering, University College London, London, UK
| | - Jennifer L Rohn
- Department of Renal Medicine, Division of Medicine, University College London, London, UK.
| |
Collapse
|
30
|
Petronio Petronio G, Cutuli MA, Magnifico I, Venditti N, Pietrangelo L, Vergalito F, Pane A, Scapagnini G, Di Marco R. In Vitro and In Vivo Biological Activity of Berberine Chloride against Uropathogenic E. coli Strains Using Galleria mellonella as a Host Model. Molecules 2020; 25:E5010. [PMID: 33137930 PMCID: PMC7662377 DOI: 10.3390/molecules25215010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Berberine is an alkaloid of the protoberberine type used in traditional oriental medicine. Its biological activities include documented antibacterial properties against a wide variety of microorganisms; nonetheless, its use against Escherichia coli strains isolated from urinary infections has not yet been widely investigated in vivo. The emergence of antimicrobial resistance requires new therapeutic approaches to ensure the continued effectiveness of antibiotics for the treatment and prevention of urinary infections. Moreover, uropathogenic Escherichia coli (UPEC) has developed several virulence factors and resistance to routine antibiotic therapy. To this end, several in vitro and in vivo tests were conducted to assess the activity of berberine on uropathogenic E. coli strains. Galleria mellonella as an infection model was employed to confirm the in vivo translatability of in vitro data on berberine activity and its influence on adhesion and invasion proprieties of E. coli on human bladder cells. In vitro pre-treatment with berberine was able to decrease the adhesive and invasive UPEC ability. In vivo treatment increased the larvae survival infected with UPEC strains and reduced the number of circulating pathogens in larvae hemolymph. These preliminary findings demonstrated the efficacy and reliability of G. mellonella as in vivo model for pre-clinical studies of natural substances.
Collapse
Affiliation(s)
- Giulio Petronio Petronio
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Marco Alfio Cutuli
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Irene Magnifico
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Noemi Venditti
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Laura Pietrangelo
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Franca Vergalito
- Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, Via De Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso, Italy;
| | - Antonella Pane
- Department of Agricultural, Food and Environment, University of Catania, Via S. Sofia, 100, 95123 Catania, Italy;
| | - Giovanni Scapagnini
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Roberto Di Marco
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| |
Collapse
|
31
|
Reappraisal of the treatment duration of antibiotic regimens for acute uncomplicated cystitis in adult women: a systematic review and network meta-analysis of 61 randomised clinical trials. THE LANCET. INFECTIOUS DISEASES 2020; 20:1080-1088. [DOI: 10.1016/s1473-3099(20)30121-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/23/2022]
|
32
|
Batzlaff C, Koroscil M. Nitrofurantoin-Induced Pulmonary Toxicity: Always Review the Medication List. Cureus 2020; 12:e9807. [PMID: 32953319 PMCID: PMC7494418 DOI: 10.7759/cureus.9807] [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] [Indexed: 11/06/2022] Open
Abstract
Use of nitrofurantoin for uncomplicated cystitis and recurrent urinary tract infections is common practice. While the majority of patients tolerate this medication without issue, it is important to be cognizant of adverse reactions, as these can impact patient’s quality of life. Nitrofurantoin-induced pulmonary toxicity is a rare side effect that can present with various clinical manifestations, imaging abnormalities, and pathologic findings. We describe a case of chronic pneumonitis in a patient on suppressive nitrofurantoin therapy presenting with dyspnea and hypoxemia.
Collapse
Affiliation(s)
- Caitlin Batzlaff
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Matt Koroscil
- Department of Pulmonary and Critical Care Medicine, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam Houston, USA
| |
Collapse
|
33
|
Phase 2a Pharmacokinetic, Safety, and Exploratory Efficacy Evaluation of Oral Gepotidacin (GSK2140944) in Female Participants with Uncomplicated Urinary Tract Infection (Acute Uncomplicated Cystitis). Antimicrob Agents Chemother 2020; 64:AAC.00199-20. [PMID: 32284384 PMCID: PMC7318048 DOI: 10.1128/aac.00199-20] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/04/2020] [Indexed: 11/20/2022] Open
Abstract
Gepotidacin, a triazaacenaphthylene bacterial type II topoisomerase inhibitor, is in development for treatment of uncomplicated urinary tract infection (uUTI). This phase 2a study in female participants with uUTI evaluated the pharmacokinetics (primary objective), safety, and exploratory efficacy of gepotidacin. Eligible participants (n = 22) were confined to the clinic at baseline, received oral gepotidacin at 1,500 mg twice daily for 5 days (on-therapy period; days 1 to 5), and returned to the clinic for test-of-cure (days 10 to 13) and follow-up (day 28 ± 3) visits. Gepotidacin, a triazaacenaphthylene bacterial type II topoisomerase inhibitor, is in development for treatment of uncomplicated urinary tract infection (uUTI). This phase 2a study in female participants with uUTI evaluated the pharmacokinetics (primary objective), safety, and exploratory efficacy of gepotidacin. Eligible participants (n = 22) were confined to the clinic at baseline, received oral gepotidacin at 1,500 mg twice daily for 5 days (on-therapy period; days 1 to 5), and returned to the clinic for test-of-cure (days 10 to 13) and follow-up (day 28 ± 3) visits. Pharmacokinetic, safety, clinical, and microbiological assessments were performed. Maximum plasma concentrations were observed approximately 1.5 to 2 h postdose. Steady state was attained by day 3. Urinary exposure over the dosing interval increased from 3,742 μg·h/ml (day 1) to 5,973 μg·h/ml (day 4), with trough concentrations of 322 to 352 μg/ml from day 3 onward. Gepotidacin had an acceptable safety-risk profile with no treatment-limiting adverse events and no clinically relevant safety trends. Clinical success was achieved in 19 (86%) and 18 (82%) of 22 participants at test-of-cure and follow-up visits, respectively. Eight participants had a qualifying baseline uropathogen (growth; ≥105 CFU/ml). A therapeutic (combined clinical and microbiological [no growth; <103 CFU/ml]) successful response was achieved in 6 (75%) and 5 (63%) of 8 participants at test-of-cure and follow-up visits, respectively. Plasma area under the free-drug concentration-time curve over 24 h at steady state divided by the MIC (fAUC0–24/MIC) and urine AUC0–24/MIC ranged from 6.99 to 90.5 and 1,292 to 121,698, respectively. Further evaluation of gepotidacin in uUTI is warranted. (This study has been registered in ClinicalTrials.gov under identifier NCT03568942.)
Collapse
|
34
|
Efficacy of A Poly(MeOEGMA) Brush on the Prevention of Escherichia coli Biofilm Formation and Susceptibility. Antibiotics (Basel) 2020; 9:antibiotics9050216. [PMID: 32365462 PMCID: PMC7277157 DOI: 10.3390/antibiotics9050216] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
Urinary tract infections are one of the most common hospital-acquired infections, and they are often associated with biofilm formation in indwelling medical devices such as catheters and stents. This study aims to investigate the antibiofilm performance of a polymer brush—poly[oligo(ethylene glycol) methyl ether methacrylate], poly(MeOEGMA)—and evaluate its effect on the antimicrobial susceptibility of Escherichia coli biofilms formed on that surface. Biofilms were formed in a parallel plate flow chamber (PPFC) for 24 h under the hydrodynamic conditions prevailing in urinary catheters and stents and challenged with ampicillin. Results obtained with the brush were compared to those obtained with two control surfaces, polydimethylsiloxane (PDMS) and glass. The polymer brush reduced by 57% the surface area covered by E. coli after 24 h, as well as the number of total adhered cells. The antibiotic treatment potentiated cell death and removal, and the total cell number was reduced by 88%. Biofilms adapted their architecture, and cell morphology changed to a more elongated form during that period. This work suggests that the poly(MeOEGMA) brush has potential to prevent bacterial adhesion in urinary tract devices like ureteral stents and catheters, as well as in eradicating biofilms developed in these biomedical devices.
Collapse
|
35
|
Management of Urinary Tract Infections in Direct to Consumer Telemedicine. J Gen Intern Med 2020; 35:643-648. [PMID: 31667749 PMCID: PMC7080949 DOI: 10.1007/s11606-019-05415-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urinary tract infections (UTI) are a common reason for seeking care via direct to consumer (DTC) telemedicine, yet patterns of care, including antibiotic prescribing, have not been reported. OBJECTIVE To describe management of UTI in a large nationwide DTC telemedicine platform. DESIGN Cross-sectional observational study. PARTICIPANTS Patients seeking care for or diagnosed with UTI via DTC telemedicine between July 2016 and July 2018. MAIN MEASURES Patient measures included age, sex, geographic region, satisfaction with care, and patient-reported call reason. High-risk patients were defined as males, patients over 65 years, or those diagnosed with pyelonephritis. Physician measures included specialty and geographic region. Antibiotic prescription was assessed overall and by antibiotic type. Variation in antibiotic prescriptions was assessed by patient and physician factors, including geographic region of both parties. KEY RESULTS Of the 20,600 patients diagnosed with a UTI during the study period, 96% were female. Most (84%) stated their call reason was a UTI. Overall, 94% of UTI patients received an antibiotic; 56% got nitrofurantoin, 29% got trimethoprim-sulfamethoxazole, and 10% got a quinolone. Receipt of an antibiotic was associated with higher satisfaction with care (p < 0.001). While nitrofurantoin was the most common antibiotic for all physician regions, antibiotic type varied by physician region. Of the 6% of the study population defined as high risk, 69% received an antibiotic: 72% of males, 91% of women over 65, and 21% of patients diagnosed with pyelonephritis. CONCLUSIONS Management of UTI via DTC telemedicine appears to be appropriate for average-risk patients, and most are able to self-diagnose. Most patients received guideline-concordant care, but over half of high-risk patients received antibiotics. DTC telemedicine offers convenient, low-cost care that is generally appropriate. Efforts should be made to ensure high-risk patients get proper follow-up.
Collapse
|
36
|
Ippoliti R, Allievi I, Rocchetti A. UF-5000 flow cytometer: A new technology to support microbiologists' interpretation of suspected urinary tract infections. Microbiologyopen 2020; 9:e987. [PMID: 31908145 PMCID: PMC7066453 DOI: 10.1002/mbo3.987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
This case study aims to describe the adoption of an innovative flow cytometer (i.e., UF-5000), which can support the microbiologists' process of diagnosing suspected urinary tract infections (UTIs). The new clinical information provided can be used to improve the identification of both contamination and colonization, thus reducing inappropriate antibiotic prescriptions. In July and August 2017, the Microbiology Laboratory of Alessandria (Italy) conducted a retrospective monocentric study analyzing data about 1,295 urine specimens from inpatients and outpatients with symptoms of UTIs. The results of this study show that the innovative technology can successfully support the diagnostic process in microbiology laboratories and, consequently, the supply of sustainable treatments by hospitals.
Collapse
Affiliation(s)
- Roberto Ippoliti
- Faculty of Business Administration and Economics, University of Bielefeld, Germany
| | - Isabella Allievi
- Microbiologia, Azienda Ospedaliera SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Andrea Rocchetti
- Microbiologia, Azienda Ospedaliera SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy
| |
Collapse
|
37
|
Urinary Tract Infections. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
38
|
Latin American consensus on uncomplicated recurrent urinary tract infection-2018. Int Urogynecol J 2019; 31:35-44. [PMID: 31494690 DOI: 10.1007/s00192-019-04079-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022]
Abstract
An estimated 20-30% of adult women who experience an initial urinary tract infection (UTI) will have recurrent infection. In these patients, prophylaxis may be considered to improve their quality of life and control overuse of antibiotics. Despite this need, there is currently no Latin American consensus on the treatment and prophylaxis of recurrent UTIs. This consensus, signed by a panel of regional and international experts on UTI management, aims to address this need and is the first step toward a Latin American consensus on a number of urogynecological conditions. The panel agrees that antibiotics should be considered the primary treatment option for symptomatic UTI, taking into account local pathogen resistance patterns. Regarding prophylaxis, immunoactive therapy with the bacterial lysate OM-89 received a grade A recommendation and local estrogen in postmenopausal women grade B recommendation. Lower-grade recommendations include behavior modification and D-mannose; probiotics (Lactobacilli), cranberries, and hyaluronic acid (and derivatives) received limited recommendations; their use should be discussed with the patient. Though considered effective and receiving grade A recommendation, antimicrobial prophylaxis should be considered only following prophylaxis with effective non-antimicrobial measures that were not successful and chosen based on the frequency of sexual intercourse and local pathogen resistance patterns.
Collapse
|
39
|
Fayed A, Rahman Tohamy IA, Kahla H, Elsayed NM, El Ansary M, Saadi G. Urinary podocyte-associated mRNA profile in Egyptian patients with diabetic nephropathy. Diabetes Metab Syndr 2019; 13:2849-2854. [PMID: 31425946 DOI: 10.1016/j.dsx.2019.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Podocyte injury and subsequent excretion in urine play a crucial role in the pathogenesis and progression of diabetic nephropathy (DN). Quantification of messenger RNA expression in urinary sediment by real-time PCR is emerging as a noninvasive method of screening DN-associated biomarkers. We aimed to study the expression of podocyte-associated genes in urinary sediment and their relation to disease severity in type 2 diabetic Egyptian patients with diabetic nephropathy. METHOD ology: Sixty patients with type 2 diabetes mellitus were recruited in addition to twenty non diabetic healthy volunteers. Relative mRNA abundance of nephrin, podocalyxin, and podocin were quantified, and correlations between target mRNAs and clinical parameters were examined. RESULTS The urinary mRNA levels of all genes studied were significantly higher in diabetics compared with controls (p < 0.001), and mRNA levels increased with DN progression. Urinary mRNA levels of all target genes positively correlated with both UAE and HbA1c. The expression of nephrin, podocalyxin, and podocin mRNA correlated with serum creatinine {(r = 0.397, p value = 0.002), (r = 0.431, p value = 0.001), (r = 0.433, p value = 0.001) respectively}. CONCLUSION The urinary mRNA profiles of nephrin, podocalyxin, and podocin were found to increase with the progression of DN, which suggested that quantification of podocyte-associated molecules will be useful biomarkers of DN.
Collapse
Affiliation(s)
- Ahmed Fayed
- Nephrology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt.
| | | | - Hala Kahla
- Endocrinology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
| | - Naglaa M Elsayed
- Endocrinology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
| | - Mervat El Ansary
- Clinical Pathology Department, School of Medicine, Cairo University, Egypt
| | - Gamal Saadi
- Nephrology unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
| |
Collapse
|
40
|
Interaction between Antibiotic Resistance, Resistance Genes, and Treatment Response for Urinary Tract Infections in Primary Care. J Clin Microbiol 2019; 57:JCM.00143-19. [PMID: 31243084 PMCID: PMC6711900 DOI: 10.1128/jcm.00143-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/12/2019] [Indexed: 01/11/2023] Open
Abstract
Given increasing antimicrobial resistance, we aimed to determine antibiotic susceptibility and presence of resistance genes in uropathogens in primary care, factors associated with resistance to commonly prescribed antibiotics, and effect of treatment on early symptom resolution. We conducted a prospective study of primary care patients with urinary tract infection (UTI) symptoms and culture-confirmed UTI in Singapore from 2015 to 2016. Cohort characteristics and antimicrobial susceptibility of cultured isolates were analyzed. Among Enterobacteriaceae isolates, early symptom resolution (within 3 days) according to antibiotic prescribed and isolate susceptibility and factors associated with antibiotic resistance were evaluated. Of 695 symptomatic patients, 299 were urine culture positive; of these 299 patients, 259 (87%) were female. Escherichia coli was the most common uropathogen (76%). Enterobacteriaceae isolates (n = 283) were highly susceptible to amoxicillin-clavulanate (86%), nitrofurantoin (87%), and fosfomycin (98%), but >20% were resistant to ciprofloxacin and co-trimoxazole. Isolates resistant to appropriate indicator antibiotics were further tested to determine proportions positive for bla CTX-M (14/26, 54%), plasmid-mediated ampC (12/24, 50%), qnr (7/69, 10%), and fos (1/6, 17%) resistance genes. A total of 67% of patients given antibiotics with susceptible isolates reported early resolution versus 45% given antibiotics with nonsusceptible isolates (P = 0.001) and 27% not treated (P = 0.018). On multivariable analysis, Indian ethnicity and diabetes mellitus were associated with amoxicillin-clavulanate resistance. Genitourinary abnormalities, UTI in the past 12 months, and hospitalization in the past 6 months were associated with ciprofloxacin and co-trimoxazole resistance. Patients given active empirical antibiotics were most likely to report early symptom resolution, but correlation with in vitro susceptibility was imperfect. Factors associated with resistance may guide the decision to obtain initial urine culture.
Collapse
|
41
|
Abstract
Urinary tract infection (UTI) affects patients of all ages and is a diagnosis that emergency physicians might make multiple times per shift. This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients.
Collapse
|
42
|
Pezeshki Najafabadi M, Dagoohian A, Rajaie S, Zarkesh-Esfahani SH, Edalati M. Common microbial causes of significant bacteriuria and their antibiotic resistance pattern in the Isfahan Province of Iran. J Chemother 2019; 30:348-353. [PMID: 30663554 DOI: 10.1080/1120009x.2018.1525120] [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: 12/21/2022]
Abstract
Urinary tract infections (UTIs) are considered the most common community-acquired infections worldwide, which have possible complications along with significant economic impact on national healthcare systems. The aim of this study was to identify the most common causes of significant bacteriuria and to assess their antimicrobial resistance pattern in the Isfahan province of Iran. In this cross-sectional study, 11,678 urine samples of the patients referred to Mahdieh Medical Diagnostic Centre Charity were examined over a period of 10 months (from September 2015 to June 2016). Among the cases, 6.85% were positive for bacteriuria (F/M = 11.3). Escherichia coli (62%) was the most frequently isolated bacteria, followed by Staphylococcus epidermidis (13.9%) and Staphylococcus aureus (6.8%). E. coli was more prevalent among patients with diabetes mellitus. E. coli isolates showed the highest resistance to nalidixic acid, Trimethoprim/Sulfamethoxazole and Cefixime. Our results revealed that broad-spectrum antibiotic resistance is frequent among isolated uropathogens in Isfahan, Iran.
Collapse
Affiliation(s)
| | | | | | | | - Masoud Edalati
- c Department of Pathology , Medical School, Isfahan University of Medical Sciences , Isfahan , Iran
| |
Collapse
|
43
|
Shaheen G, Akram M, Jabeen F, Ali Shah SM, Munir N, Daniyal M, Riaz M, Tahir IM, Ghauri AO, Sultana S, Zainab R, Khan M. Therapeutic potential of medicinal plants for the management of urinary tract infection: A systematic review. Clin Exp Pharmacol Physiol 2019; 46:613-624. [PMID: 30932202 DOI: 10.1111/1440-1681.13092] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/21/2023]
Abstract
Urinary tract infection (UTI) is one of the most severe public health problem affecting both sexes but females are more susceptible due to the differences in urogenital and reproductive anatomy, physiology and lifestyle. As in UTI, different parts of the urinary tract are affected and morbidity due to UTI is more common in women of all ages and older men. Due to multi-drug resistant strains and high recurrence rate, UTI has become a major socioeconomic burden. The current review article was aimed to describe the natural therapeutic strategies to manage and cure the UTI. For this purpose, different databases including Google Scholar, Cochrane database, and PubMed etc. were explored. Inclusion criteria were any research article investigating the current therapy of UTI. It was found that microbial infections including Escherichia coli, Enterococcus faecalis and Klebsiella species are the major causes of UTI with different signs and symptoms including painful urination or dysuria, hematuria, urinary urgency, burning micturition, frequent urination, nausea, and vomiting. Antibiotics like trimethoprim, sulfamethoxazole, quinolone etc. as the first choice of the drug are used worldwide. However, due to microbial resistance, several life-threatening side effects, repeated high doses, high cost and low efficacy of these antibiotics motivated the researchers to explore natural remedies for the treatment of UTI. Herbal medicines are effective to combat bacterial resistance with high efficacy, and easy availability with minimal or no side effects. For these reasons it has attained the attention of researchers wanting to explore the herbal treatment of UTI. Vaccinium macrocarpon, Tribulus terrestris, Trachyspermum copticum, Cinnamomum verum and Hybanthusenn easpermus are some common medicinal plants reported to have therapeutic potential for the management and cure of the UTI. Although herbal medicines have more potential over conventional medicine but more discoveries are required to explore the phytoconstituents and their mechanism of action responsible for the management and cure of UTI.
Collapse
Affiliation(s)
- Ghazala Shaheen
- University College of Conventional Medicine, Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine, Directorate of Medical Sciences, Government College University-Faisalabad, Faisalabad, Pakistan
| | - Farhat Jabeen
- Department of Zoology, Government College University-Faisalabad, Faisalabad, Pakistan
| | - Syed Muhammad Ali Shah
- Department of Eastern Medicine, Directorate of Medical Sciences, Government College University-Faisalabad, Faisalabad, Pakistan
| | - Naveed Munir
- College of Allied Health Professional, Directorate of Medical Sciences, Government College University-Faisalabad, Faisalabad, Pakistan.,Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Daniyal
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Muhammad Riaz
- Department of Allied Health Sciences, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan
| | - Imtiaz Mahmood Tahir
- College of Allied Health Professional, Directorate of Medical Sciences, Government College University-Faisalabad, Faisalabad, Pakistan
| | - Aymen Owais Ghauri
- Faculty of pharmacy, Rayaz College of Eastern Medicine, Jinnah University for Women, Karachi, Pakistan
| | - Sabira Sultana
- Department of Eastern Medicine, Directorate of Medical Sciences, Government College University-Faisalabad, Faisalabad, Pakistan
| | - Rida Zainab
- Department of Eastern Medicine, Directorate of Medical Sciences, Government College University-Faisalabad, Faisalabad, Pakistan
| | - Muslim Khan
- Department of Chemistry, Kohat University of Science and Technology, Kohat, Pakistan
| |
Collapse
|
44
|
M Y, Chawla K, Bankapur A, Acharya M, D’Souza JS, Chidangil S. A micro-Raman and chemometric study of urinary tract infection-causing bacterial pathogens in mixed cultures. Anal Bioanal Chem 2019; 411:3165-3177. [DOI: 10.1007/s00216-019-01784-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/07/2019] [Accepted: 03/15/2019] [Indexed: 01/30/2023]
|
45
|
Second nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by Japanese Surveillance Committee from 2015 to 2016: antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus. J Infect Chemother 2019; 25:413-422. [PMID: 30905628 DOI: 10.1016/j.jiac.2019.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 11/20/2022]
Abstract
The Japanese Surveillance Committee conducted a second nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for acute uncomplicated cystitis (AUC) in premenopausal patients aged 16-40 years old at 31 hospitals throughout Japan from March 2015 to February 2016. In this study, the susceptibility of causative bacteria (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus) for various antimicrobial agents was investigated by isolation and culturing of organisms obtained from urine samples. In total, 324 strains were isolated from 361 patients, including E. coli (n = 220, 67.9%), S. saprophyticus (n = 36, 11.1%), and K. pneumoniae (n = 7, 2.2%). The minimum inhibitory concentrations (MICs) of 20 antibacterial agents for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. At least 93% of the E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, whereas 100% of the S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 6.4% (13/220) and 4.1% (9/220), respectively. The antimicrobial susceptibility of K. pneumoniae was retained during the surveillance period, while no multidrug-resistant strains were identified. In summary, antimicrobial susceptibility results of our second nationwide surveillance did not differ significantly from those of the first surveillance. Especially the numbers of fluoroquinolone-resistant and ESBL-producing E. coli strains were not increased in premenopausal patients with AUC in Japan.
Collapse
|
46
|
Li F, Macdonald NP, Guijt RM, Breadmore MC. Multimaterial 3D Printed Fluidic Device for Measuring Pharmaceuticals in Biological Fluids. Anal Chem 2018; 91:1758-1763. [PMID: 30513198 DOI: 10.1021/acs.analchem.8b03772] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multimaterial 3D printing provides a unique capability for the creation of highly complex integrated devices where complementary functionality is realized using differences in material properties. Using a single and automated print process, microfluidic devices were fabricated containing (i) an optically transparent structure for fluorescence detection, (ii) electrodes for electrokinetic transport, (iii) a primary membrane to remove particulates and macromolecules including proteins, and (iv) a secondary membrane to concentrate small molecule targets. The device was used for the simultaneous extraction and concentration of small molecule pharmaceuticals from urine, which was followed by an on-chip electrophoretic separation of the concentrated targets for quantitative analysis. Owing to the high level of functional integration inside the device, manual handling was minimal and restricted to the introduction of the sample and buffer solutions. The 3D printed sample-in/answer-out device allowed the direct quantification of ampicillin-a small molecule pharmaceutical-in untreated urine within 3 min, down to 2 ppm. These results demonstrate the potential of 3D printing for on-demand fabrication of disposable, functionally integrated devices for low-cost point-of-collection (POC) diagnostics.
Collapse
Affiliation(s)
- Feng Li
- Australian Centre for Research on Separation Science, School of Chemistry , University of Tasmania , Private Bag 75 , Hobart , Tasmania 7001 , Australia
| | - Niall P Macdonald
- Analytical-Chemistry Group, van't Hoff Institute for Molecular Sciences , University of Amsterdam , Science Park 904 , 1098 XH Amsterdam , The Netherlands.,Division of BioAnalytical Chemistry , Vrije Universiteit Amsterdam , De Boelelaan 1108 , 1081 HZ Amsterdam , The Netherlands
| | - Rosanne M Guijt
- Centre for Rural and Regional Futures, Geelong , Deakin University , Private Bag 20000 , 3220 Geelong , Australia
| | - Michael C Breadmore
- Australian Centre for Research on Separation Science, School of Chemistry , University of Tasmania , Private Bag 75 , Hobart , Tasmania 7001 , Australia
| |
Collapse
|
47
|
Fatima S, Muhammad IN, Usman S, Jamil S, Khan MN, Khan SI. Incidence of multidrug resistance and extended-spectrum beta-lactamase expression in community-acquired urinary tract infection among different age groups of patients. Indian J Pharmacol 2018; 50:69-74. [PMID: 30100654 PMCID: PMC6044131 DOI: 10.4103/ijp.ijp_200_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Urinary tract infection (UTI) is a frequent disorder and depends on age and gender. Ineffective empiric treatment of UTI is common when associated with extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. The aim of the study was to investigate the prevalence of Gram-negative uropathogens of E. coli and K. pneumoniae in different age groups along with the identification of ESBL-producing uropathogens and antimicrobial susceptibility profiles. MATERIALS AND METHODS A total of 247 uropathogens of E. coli and K. pneumoniae were collected over a period of 1 year (January-December 2015) from various diagnostic centers of Karachi city (Pakistan). Antimicrobial susceptibility analysis was performed by disc diffusion method, and identification of ESBL was performed by double disc synergy test. Categorical data of ESBL and non-ESBL uropathogens were analyzed by Pearson's Chi-square test. RESULTS The study of 247 patients with community-acquired UTI comprised 72% females and 28% males, illustrating an increased prevalence of UTIs among females. It was also revealed that 90% belonged to the age group of 16-30 years whereas 78% related to the age group of 46-60 years. ESBL was found positive in 33.5% (63/188) of E. coli and 15.25% (9/59) in K. pneumonia, with a significant association i.e., (p =0.007). Amikacin, fosfomycin, imipenem, and tazobactam/piperacillin were found to be the effective treatment options. A significant association was found between ESBL-producing uropathogens against ciprofloxacin, enoxacin, and amoxicillin/clavulanic acid resistance (P < 0.05). CONCLUSIONS It was concluded that for effective treatment of UTIs, appropriate screening of ESBL and culture sensitivity must be employed instead of empiric treatment.
Collapse
Affiliation(s)
- Sakina Fatima
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Iyad Neeam Muhammad
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Shahnaz Usman
- Department of Pharmaceutics, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Subia Jamil
- Department of Pharmacology, Faculty of Pharmacy, Jinnah University For Women, Karachi, Pakistan
| | - Muhammad Naseem Khan
- Microbiology section, FMRRC, PCSIR Laboratories Complex Karachi, Karachi, Pakistan
| | - Seema Ismat Khan
- Microbiology section, FMRRC, PCSIR Laboratories Complex Karachi, Karachi, Pakistan
| |
Collapse
|
48
|
Zhang C, Chen MJ, Tong ZQ. Efficacy of Chinese herbal medicine in a case of geriatric urinary tract infections with pain of episiotomy scar inflammation. Medicine (Baltimore) 2018; 97:e13695. [PMID: 30593139 PMCID: PMC6314673 DOI: 10.1097/md.0000000000013695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Urinary tract infections (UTIs) are common infectious diseases in women. The management of patients with UTI after menopause is commonly combined with antibiotics and external application of estrogen, which could also cause drug resistance and result in poor curative effect. This study reports a case of UTI with pain of episiotomy scar inflammation for 10 years, which was successfully cured under traditional Chinese medicine (TCM) and showed no recurrence for 5 years. PATIENT CONCERNS A female patient, aged 71 years, experienced UTIs with pain of episiotomy scar inflammation for 10 years. Under antibiotics and external application of estrogen therapy, the patient still had no significant curative effect. Therefore, he was admitted to treatment with TCM for complementary therapy. DIAGNOSIS UTIs with pain of episiotomy scar inflammation. INTERVENTIONS This patient was treated with Chinese herbal medicine (CHM) treatment 2 times a day for 1 year. After 1 month of CHM treatment, the patient could tolerate pain of episiotomy scar inflammation. OUTCOMES After 2 months of CHM treatment, the follow-up urinalysis leukocyte, red blood cell, and pH showed great improvements in examination. Late follow-up was continued to November 2017, and the patient recovered stable condition without recurrence. LESSONS In this case, successful treatment by only applying the prescription of CHM is achieved in 1 elderly woman with UTI and pain of episiotomy scar inflammation in 1 year. It is suggested that the CHM formula has a potential effect on UTI and pain from episiotomy scar inflammation when usage of antibiotics and hormones meets with poor response.
Collapse
Affiliation(s)
- Chen Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin
| | - Ming-jun Chen
- Department of Traditional Chinese Medicine and Acupuncture, Chinese People Liberation Army General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Zhan-Qi Tong
- Department of Traditional Chinese Medicine and Acupuncture, Chinese People Liberation Army General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| |
Collapse
|
49
|
Recurrent Urinary Tract Infections are Associated With Frailty in Older Adults. Urology 2018; 123:24-27. [PMID: 30296501 DOI: 10.1016/j.urology.2018.09.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/27/2018] [Accepted: 09/24/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To understand the relationship between frailty, age, and recurrent urinary tract infections (rUTIs). MATERIALS AND METHODS The Timed Up and Go Test (TUGT), a measure of frailty, was administered to all adults aged ≥65 presenting to an academic nononcologic urology practice from December 2015 to January 2018. TUGT was categorized as fast (≤10 seconds), intermediate (11-14 seconds) or slow (≥15 seconds). The TUGT and other clinical data were abstracted from the medical record using direct queries supplemented with chart review. Logistic regression was used to determine the relationship between frailty, age, and the diagnosis of rUTIs in our clinic population. RESULTS There were 136 americans adults with and 2824 americans adults without a diagnosis of rUTIs. Individuals with rUTIs had slower TUGT times (13.8 ± 10.4 seconds compared to 10.8 ± 4.52 seconds, P <.01) and were more likely to be classified as slow, or "frail" (27.2% vs 10.8%). In multivariate analysis, slow TUGT times were associated with a diagnosis of rUTIs (adjusted OR 2.0, 95% CI 1.2-3.3), while age was not a statistically significant predictor of this diagnosis (adjusted OR 1.3, 95% CI 0.7-2.2 for aged ≥81 years). CONCLUSION Older adults with a diagnosis of rUTIs are significantly more frail compared to those with other nononcologic urologic diagnoses. Frailty (adjusted for age), was significantly associated with rUTIs, while age (adjusted for frailty) was not. Furthermore, frailty (rather than age) may be important to consider when caring for and treating americans adults with rUTIs.
Collapse
|
50
|
Long B, Koyfman A. The Emergency Department Diagnosis and Management of Urinary Tract Infection. Emerg Med Clin North Am 2018; 36:685-710. [PMID: 30296999 DOI: 10.1016/j.emc.2018.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Urinary tract infection (UTI) is a common infection seen in the emergency department. The spectrum of UTI includes simple versus complicated infection and lower versus upper UTI. No one history or examination finding is definitive for diagnosis. Testing often includes urinalysis and/or urine dipstick, and several pitfalls may occur in interpretation. Urine cultures should be obtained in complicated or upper UTIs but not simple and lower tract UTIs, unless a patient is pregnant. Imaging often is not required. Most patients with simple cystitis and pyelonephritis are treated as outpatients. A variety of potentially dangerous conditions may mimic UTI and pyelonephritis.
Collapse
Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| |
Collapse
|