1
|
Abalkhail A, AlYami AS, Alrashedi SF, Almushayqih KM, Alslamah T, Alsalamah YA, Elbehiry A. The Prevalence of Multidrug-Resistant Escherichia coli Producing ESBL among Male and Female Patients with Urinary Tract Infections in Riyadh Region, Saudi Arabia. Healthcare (Basel) 2022; 10:1778. [PMID: 36141390 PMCID: PMC9498880 DOI: 10.3390/healthcare10091778] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
The Escherichia coli that produces extended-spectrum lactamases (ESBL-E. coli) can develop resistance to many antibiotics. The control of ESBL-E. coli disorders is challenging due to their restricted therapeutic approaches, so this study aims to determine the prevalence and pattern of the antibiotic resistance of ESBL-E. coli among male and female patients with urinary tract infections in Riyadh, Saudi Arabia. During the period of 2019 to 2020 at King Fahd Medical City, Riyadh, 2250 urine samples from patients with urinary tract infections (UTIs) were collected, and microbial species were cultured and identified using standard biochemical techniques. A double-disc synergy test was used to identify ESBL-producing strains of E. coli, and an in vitro method and the clinical laboratory standard institute (CLSI) criteria were employed to determine the resistance of these strains to antimicrobial drugs. ESBL-E. coli was detected in 510 (33.49%) of the 1523 E. coli isolates, 67.27% of which were recovered from women and 33.7% of which were recovered from men. A total of 284 (55.69%) ESBL-E. coli isolates were found in patients under 50 years of age, and 226 (44.31%) were found in patients over 50 years of age. Nearly all the isolates of ESBL-E. coli were resistant to cephalosporins (ceftriaxone, cefotaxime, cefepime, cefuroxime, and cephalothin) and penicillin (ampicillin), whereas the majority of the isolates were sensitive to several carbapenems (imipenem, meropenem, and ertapenem), aminoglycosides (amikacin), and nitrofurantoins. The development of antibiotic resistance by ESBL-E. coli, the most frequent pathogen linked to urinary tract infections, plays a crucial role in determining which antibiotic therapy is appropriate.
Collapse
Affiliation(s)
- Adil Abalkhail
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
| | - Ahmad S. AlYami
- King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | | | | | - Thamer Alslamah
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
| | - Yasir Ahmed Alsalamah
- General Surgery Department, Unaizah College of Medicine, Qassim University, Unayzah 56453, Saudi Arabia
| | - Ayman Elbehiry
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
| |
Collapse
|
2
|
Antimicrobial Resistance Patterns and ESBL of Uropathogens Isolated from Adult Females in Najran Region of Saudi Arabia. Clin Pract 2021; 11:650-658. [PMID: 34563009 PMCID: PMC8482141 DOI: 10.3390/clinpract11030080] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 01/24/2023] Open
Abstract
Background: To explore the prevalence of urinary tract infections (UTIs) among female patients in the Najran region of Saudi Arabia and determine their antimicrobial resistance pattern. Methods: This study was conducted on 136 urine samples collected from outpatient departments (OPDs) of the different government hospitals in the Najran region of Saudi Arabia. Over one year, the results of susceptibility testing reports of outpatient midstream urine samples from three government hospitals were prospectively evaluated. Results: Of 136 urine samples, only 123 (90.45%) were found to show significant growth for UTIs, from which 23 different uropathogens were identified. Escherichia coli (58.5%) was the most commonly isolated organism, followed by Klebsiella pneumoniae (8.1%). The isolated microorganism showed increased resistance patterns from 3.3% to 62.6%, with an overall resistance of 27.19%. Meropenem was the most effective antimicrobial, followed by amikacin and ertapenem (0.47%, 0.91%, and 1.5% resistance, respectively). At the same time, ampicillin and cephazolin were the least (62.6% and 59.5% resistance, respectively) effective. Overall, eleven (8.94%) uropathogens isolates were ESBLs, among which there were eight (6.5%) Escherichia coli, one (0.81%) Klebsiella pneumoniae, one (0.81%) Klebsiella oxytoca, and one (0.81%) Citrobacter amalonaticus. Conclusions: E. coli remains the most commonly isolated causative uropathogens, followed by Klebsiella species. The prevalence of pathogenic E. coli and Klebsiella species underscores the importance of developing cost-effective, precise, and rapid identification systems to minimize public exposure to uropathogens. Antibiotic susceptibility data revealed that most of the isolates were resistant to the majority of the antibiotics. The patients with UTIs in the Najran region of Saudi Arabia are at a high risk of antibiotic resistance, leading to significant problems in outpatient department (OPD) treatment outcomes and raising the alarm for the physician to change their empiric treatment.
Collapse
|
3
|
Al-Zahrani J, Al Dossari K, Gabr AH, Ahmed AF, Al Shahrani SA, Al-Ghamdi S. Antimicrobial resistance patterns of Uropathogens isolated from adult women with acute uncomplicated cystitis. BMC Microbiol 2019; 19:237. [PMID: 31666014 PMCID: PMC6822473 DOI: 10.1186/s12866-019-1612-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the antibiotic resistance patterns of uropathogens isolated from adult women with acute community-acquired (CA) uncomplicated cystitis. Results Over a one-year period (May 2015–April 2016), the results of susceptibility testing of outpatient midstream urine samples from 5 different laboratories were prospectively evaluated. The study included only adult women with uncomplicated cystitis. The susceptibility testing in all laboratories was performed using the disk diffusion method with the VITEK-2 Compact system. The isolated uropathogens and their resistance to the tested antibiotics were evaluated. Out of 317 adult women with CA uncomplicated cystitis, 179 had a positive culture. The most commonly isolated organism was Escherichia coli (E. coli) (70.4%), followed by Klebsiella (21.2%). The overall resistance rate was highest for ampicillin (85.6%), followed by cefalotin (56.3%), trimethoprim/sulfamethoxazole (54.7%), pipracillin (51.9%), nitrofurantoin (48.8%) and aztreonam (47.4%). Isolated E. coli strains were commonly resistant to ampicillin (80.5%), trimethoprim/sulfamethoxazole (72.2%) and aztreonam (71.4%), followed by cefalotin (55.9%). The overall ciprofloxacin resistance rate was 17.9%, and the resistent was found only with E. coli (25.4%). Conclusions Our results may aid in the selection of proper empiric antibiotic therapy for adult women with acute CA uncomplicated cystitis.
Collapse
Affiliation(s)
- Jamaan Al-Zahrani
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
| | - Khaled Al Dossari
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
| | - Ahmed H Gabr
- Department of Urology, Minia University, Minia, Egypt
| | | | - Saad Abdulrahman Al Shahrani
- Department of Urology, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
| | - Sameer Al-Ghamdi
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj 11942, Saudi Arabia.
| |
Collapse
|
4
|
Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines. J Infect 2017; 76:20-37. [PMID: 29079323 DOI: 10.1016/j.jinf.2017.10.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/03/2017] [Accepted: 10/13/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated. METHODS Literature review of randomised controlled trials (RCT) and observational studies published in years 2006-2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed. RESULTS Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73-1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43-0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20-0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains. CONCLUSIONS The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.
Collapse
|
5
|
Alabsi MS, Ghazal A, Sabry SA, Alasaly MM. Association of some virulence genes with antibiotic resistance among uropathogenic Escherichia coli isolated from urinary tract infection patients in Alexandria, Egypt: A hospital-based study. J Glob Antimicrob Resist 2014; 2:83-86. [PMID: 27873595 DOI: 10.1016/j.jgar.2014.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 01/07/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022] Open
Abstract
Uropathogenic Escherichia coli (UPEC) is the infecting agent most frequently involved in urinary tract infections (UTIs) worldwide. UPEC resistance to commonly used antibiotics represents a major health problem all over the world. Several factors have been associated with UPEC resistance to antibiotics. The present study deployed a molecular approach to explore the association between some UPEC virulence genes and antibiotic resistance among patients with UTI in Alexandria, Egypt. The study revealed a significant association between presence of the pap gene and resistance to gentamicin; however, it was not significantly associated with resistance to β-lactam antibiotics, quinolones, aminoglycosides, nitrofurantoin and trimethoprim/sulfamethoxazole. The genes sfa, aer and cnf1 were not significantly associated with UPEC resistance to any of the tested antibiotics. In conclusion, resistance of UPEC isolates in the present study could be attributed to other virulence factors.
Collapse
Affiliation(s)
- Mogeeb S Alabsi
- Department of Microbiology, Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen.
| | - Abeer Ghazal
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Soraya A Sabry
- Department of Microbiology, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Monasr M Alasaly
- Department of public health, Faculty of medicine and health science, Hodaiedah University, Hodaiedah, Yemen
| |
Collapse
|
6
|
Antibiotic-resistant Escherichia coli in women with acute cystitis in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:143-9. [PMID: 24421825 DOI: 10.1155/2013/547848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Trimethoprim-sulfamethoxazole (TMP-SMX) has been a traditional first-line antibiotic treatment for acute cystitis; however, guidelines do not recommend TMP-SMX in regions where Escherichia coli resistance exceeds 20%. While resistance is increasing, there are no recent Canadian estimates from a primary care setting to guide prescribing decisions. METHODS A total of 330 family physicians assessed 752 women with suspected acute cystitis between 2009 and 2011. Physicians documented clinical features and collected urine for cultures for 430 (57.2%) women. The proportion of resistant isolates of E coli and exact binomial 95% CIs were estimated nationally, and compared regionally and demographically. These estimates were compared with those from a 2002 national study. RESULTS The proportion of TMP-SMX-resistant E coli was 16.0% nationally (95% CI 11.3% to 21.8%). This was not statistically higher than 2002 (10.9% [P=0.14]). TMP-SMX resistance was increased in women ≤50 years of age (21.4%) compared with older women (10.7% [P=0.037]). In women with no antibiotic exposure in the previous three months, TMP-SMX-resistant E coli remained more prevalent in younger women (21.8%) compared with older women (4.4% [P=0.003]). The proportion of ciprofloxacin-resistant E coli was 5.5% nationally (95% CI 2.7% to 9.9%), and was increased compared with 2002 (1.1% [P=0.036]). Ciprofloxacin resistance was highest in British Columbia (17.7%) compared with other regions (2.7% [P=0.003]), and was increased compared with 2002 levels in this province (0.0% [P=0.025]). Nitrofurantoin-resistant E coli levels were low (0.5% [95% CI 0.01% to 2.7%). DISCUSSION The proportion of TMP-SMX-resistant E coli causing acute cystitis in women in Canada remains below 20% nationally, but may exceed this level in premenopausal women. Ciprofloxacin resistance has increased, notably in British Columbia. Nitrofurantoin resistance levels are low across the country. These observations indicate that TMP-SMX and nitrofurantoin remain appropriate empirical antibiotic agents for treating cystitis in primary care settings in Canada.
Collapse
|
7
|
Nicolle LE. Antimicrobial resistance in community-acquired Escherichia coli isolated from urinary infection: Good news or bad? THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2013; 24:123-124. [PMID: 24421821 PMCID: PMC3852447 DOI: 10.1155/2013/182615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Lindsay E Nicolle
- Correspondence: Dr Lindsay E Nicolle, Department of Internal Medicine and Medical Microbiology, University of Manitoba, Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9. Telephone 204-787-7029, fax 204-787-4826, e-mail
| |
Collapse
|
8
|
The management of acute uncomplicated cystitis in adult women by family physicians in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 19:287-93. [PMID: 19436509 DOI: 10.1155/2008/404939] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 05/26/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross-Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first-line antibiotic choices. METHODS A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms. Physicians completed a standardized checklist of symptoms and signs, indicated their diagnosis and antibiotics prescribed. A urine sample for culture was obtained. RESULTS Of the 418 responding physicians, 246 (58.6%) completed the study and assessed 446 women between April 2002 and March 2003. Most women (412 of 420, for whom clinical information about antibiotic prescriptions was available) reported either frequency, urgency or painful urination. Physicians would have usually ordered a urine culture for 77.0% of the women (95% CI 72.7 to 80.8) and prescribed an antibiotic for 86.9% of the women (95% CI 83.3 to 90.0). The urine culture was negative for 32.8% of these prescriptions. The most commonly prescribed antibiotic was trimethoprim/sulfamethoxazole (40.8%; 95% CI 35.7 to 46.1), followed by fluoroquinolones (27.4%; 95% CI 22.9 to 32.3) and nitrofurantoin (26.6%; 95% CI 22.1 to 31.4). CONCLUSION Empirical antibiotic prescribing is standard practice in the community, but is associated with high levels of unnecessary antibiotic use. While trimethoprim/sulfamethoxazole is the first-line empirical antibiotic choice, fluoroquinolone antibiotics have become the second most commonly prescribed empirical antibiotic for acute cystitis. The effect of current prescribing patterns on community levels of quinolone-resistant Escherichia coli may need to be monitored.
Collapse
|
9
|
Community-acquired antibiotic resistance in urinary isolates from adult women in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 17:337-40. [PMID: 18382648 DOI: 10.1155/2006/791313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 06/08/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are currently limited data regarding the prevalence of antimicrobial-resistant organisms causing community-acquired urinary tract infections among adult women in Canada. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line empirical antibiotic treatment, unless resistance of Escherichia coli to TMP-SMX exceeds 20%. OBJECTIVE To assess current levels of TMP-SMX-resistant E coli in community-acquired cases of urinary tract infection in adult women. METHOD Assessment of urine culture reports obtained from 21 laboratories across Canada, submitted by family physicians for women aged 16 years and older. RESULTS In 2199 adult women with a positive urine culture, 1079 (49.1%) of pathogens isolated were resistant to at least one antibiotic and 660 (30.0%) were multidrug-resistant (resistant to two or more antibiotics). TMP-SMX resistance was seen in 245 of 1613 (15.2%) E coli isolates (95% CI 13.5 to 17.0). This proportion was higher in women 50 years of age and older (155 of 863 isolates [18.0%]; P=0.001), in British Columbia (70 of 342 isolates [20.5%]) and in Ontario (62 of 370 isolates [16.8%]) when compared with eastern provinces (65 of 572 isolates [11.4%]; P=0.001). Fluoroquinolone-resistant E coli occurred in 107 of 1557 (6.9%) isolates (95% CI 5.7 to 8.2), with the highest level found in British Columbia (54 of 341 isolates [15.8%]; P=0.001). CONCLUSION TMP-SMX continues to be appropriate as first-line empirical treatment of acute cystitis in adult women in Canada, as resistance remains below 20%. However, TMP-SMX resistance is higher in older women and in some provinces. The level of fluoroquinolone-resistant E coli is highest in British Columbia.
Collapse
|
10
|
den Heijer CDJ, Donker GA, Maes J, Stobberingh EE. Antibiotic susceptibility of unselected uropathogenic Escherichia coli from female Dutch general practice patients: a comparison of two surveys with a 5 year interval. J Antimicrob Chemother 2010; 65:2128-33. [DOI: 10.1093/jac/dkq286] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
11
|
Nicolle L, Anderson PAM, Conly J, Mainprize TC, Meuser J, Nickel JC, Senikas VM, Zhanel GG. Uncomplicated urinary tract infection in women. Current practice and the effect of antibiotic resistance on empiric treatment. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2006; 52:612-8. [PMID: 16739835 PMCID: PMC1531733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To review treatment recommendations for empiric therapy of uncomplicated urinary tract infection (uUTI) in light of evolving antibiotic resistance and to consider use of guidelines to promote optimal practice. QUALITY OF EVIDENCE PubMed was searched and additional relevant references were identified by reviewing articles found in the search. Guidelines were identified through discussion with family practitioners. Level of evidence was assessed for recommendations. MAIN MESSAGE Many women have uUTIs. The treatment approach is usually empiric antimicrobial therapy without obtaining pretherapy cultures. Trimethoprim-sulfamethoxazole is standard first-line empiric treatment. While resistance to this drug is increasing, it remains only about 10% in community-acquired Escherichia coli in Canada. Concerns about increased resistance have contributed to greater use of fluoroquinolones, but widespread empiric use of this class of medications might promote resistance to fluoroquinolones. Hence, fluoroquinolones should not be considered first-line therapy. While guidelines for treatment of uUTIs have been developed, their usefulness is compromised by their conflicting recommendations. CONCLUSION Trimethoprim-sulfamethoxazole and nitrofurantoin remain first-choice empiric therapy for uUTIs. Development of guidelines relevant to family physicians and community education programs that incorporate local susceptibility patterns are important strategies for promoting optimal practice.
Collapse
|
12
|
Conly JM. Antimicrobial resistance - Judicious use is the key. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2004; 15:249-51. [PMID: 18159499 PMCID: PMC2094982 DOI: 10.1155/2004/680349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John M Conly
- Departments of Pathology and Laboratory Medicine, Medicine, and Microbiology and Infectious Diseases, Centre for Antimicrobial Resistance, University of Calgary, Calgary, Alberta
| |
Collapse
|