1
|
Khan MA, Shakeel N. Pediatric Uropathogens and their Antimicrobial Susceptibility Pattern: Experience from an Impoverished District of Karachi, Pakistan. Clin Med Insights Pediatr 2024; 18:11795565241254321. [PMID: 39044848 PMCID: PMC11265240 DOI: 10.1177/11795565241254321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/18/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction Urinary tract infection (UTI) is the most common infection of the pediatric age group. Several factors linked to higher prevalence include poor personal hygiene, improper sanitation, lower socioeconomic status, and malnourishment. In addition to having a worse quality of life, the 1.8 million children who live in Karachi's Korangi district are routinely exposed to such factors. Objectives The study aims to evaluate the frequency of UTI and distribution of uropathogens along with their antimicrobial susceptibility pattern in patients presenting to a pediatric tertiary care center in the Korangi district of Karachi, Pakistan. Design The study employed an observational cross-sectional design. Methods The study was conducted at the Microbiology laboratory of Sindh Institute of Child Health and Neonatology, Karachi, Pakistan from 1st January to 15th August 2023. Urine samples of patients 1 to 16 years of age were collected via midstream clean catch method and of patients from birth up to 1 year were collected in urine collection bags. The samples were cultured on Cystine Lactose Electrolyte Deficient (CLED) agar and antibiotic susceptibility testing was performed using the Kirby-Bauer Disc Diffusion method. Results A total of 457 urine samples were collected, of which 90 (19.7%) were positive for significant uropathogens. With a mean age of 4.6 years, majority of the culture-positive patients were female (n = 72; 80%). Enterobacterales were the most frequently isolated (n = 88; 95.6%), of which Escherichia coli was the most common (73.9%; n = 68). Citrobacter (n = 7; 7.6%), Klebsiella (n = 6; 6.5%), Serratia (n = 4; 4.3%), Proteus (n = 2; 2.2%), Salmonella (n = 2; 2.2%), and Enterobacter (n = 1; 1.1%) were among the other Enterobacterales isolated. Meropenem and imipenem were the most effective in isolates from Enterobacterales (n = 88) followed by amikacin (n = 84), ciprofloxacin (n = 75), and piperacillin-tazobactam (n = 70). Ceftriaxone and cefixime exhibited moderate susceptibility (n = 69 and 52) whereas, amoxicillin-clavulanate was the least susceptible (n = 3). Conclusion We report high frequency of UTI in our pediatric population with uropathogens and associated antimicrobial susceptibility pattern confirming to the existing trends of pediatric UTIs in Pakistan. In addition to valuable insights for treating patients under similar conditions, our study serves as a catalyst for further multi-center research in this area.
Collapse
Affiliation(s)
- Moiz Ahmed Khan
- Section of Microbiology, Clinical Laboratory, Sindh Institute of Child Health and Neonatology, Karachi, Pakistan
- Section of Microbiology, Department of Pathology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Nosheen Shakeel
- Section of Microbiology, Clinical Laboratory, Sindh Institute of Child Health and Neonatology, Karachi, Pakistan
| |
Collapse
|
2
|
Shawkat ND, Yassin NA. The Prevalence of Multidrug-Resistant Uropathogenic Bacterial Profile With Antibiotic Susceptibility Patterns Among the Community and Hospitalized Patients During COVID Waves. Cureus 2024; 16:e60613. [PMID: 38894805 PMCID: PMC11185838 DOI: 10.7759/cureus.60613] [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] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Background and objective Urinary tract infections (UTIs) are a common infectious disease affecting people of various ages and genders and are prevalent in different geographical locations. However, the way Gram-positive and Gram-negative (UTI) germs react to antibiotic treatment varies significantly. The coronavirus disease 2019 (COVID-19) pandemic has increased the frequency of secondary bacterial superinfection, leading to a spike in ongoing recommendations for antibiotic treatment, both therapeutic and preventative. In this study, we aimed to assess uropathogenic bacterial resistance and shed light on how COVID-19 epidemic waves influence the evolution of bacterial resistance. Materials and methods A cross-sectional study was conducted, assessing the different isolates of the uropathogen in all COVID-19 waves by using convenience sampling from August 2020 till the end of 2023. The VITEK-2 compact system employing industry-standard bacteriological tests to identify the bacteria and confirm their antibiotic susceptibility was utilized. Results Of the total 3877 patients, 381 (9.8%) and 3483 (89.8%) had positive and negative microbial growth, respectively. Of the 381 (9.8%) positive cases, 130 (34%) were male and 251 (65%) were female; 138 (43.3%) patients in the age range of 15-40 years developed sporadic UTIs attributed to Gram-negative bacteria. Alternatively, patients over 40 years had the highest prevalence rate (n = 180, 56.6%). The most common strains of Gram-negative and Gram-positive bacteria were Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), with 278 (88.8%) and 13 (20.9%) cases respectively. People with Gram-negative bacteria who were not hospitalized were very resistant to trimethoprim/sulfamethoxazole (n = 219, 69.1%), cefotaxime (n = 193, 60.9%), ampicillin (n = 192, 60.6%), and amoxicillin/clavulanic acid (176, 55.5%). While high sensitivity to meropenem (n = 14, 4.4%) and imipenem (n = 13, 4.1%) was observed, hospitalized individuals had higher levels of resistance and great sensitivity to the same antibiotics. S. aureus and Enterococcus faecalis (E. faecalis) were commonly present. Hospitalized patients were less sensitive to benzylpenicillin, ampicillin, and oxacillin, and there was a big rise in resistance to cefoxitin in the community. Conclusions In this study, Gram-negative germs among females were predominantly observed with extremely high multi-drug resistance (MDR). The most effective antibiotics against Gram-positive germs included linezolid, vancomycin, and nitrofurantin, while those against Gram-negative bacteria were meropenem and amikacin. Clinicians should be regularly updated and informed about antibiotic selection through routine monitoring of uropathogenic bacteria's susceptibility. Moreover, we recommend changes to the local antibiotic policy regarding the selection of UTIs; further multicentric and high-volume studies are required to gain deeper insights into the topic.
Collapse
Affiliation(s)
- Newar D Shawkat
- Department of Nursing, Akre Technical Institute, Akre University For Applied Sciences, Akre, IRQ
- Department of Medical Laboratory Technology, Technical College of Health-Shekhan, Duhok Polytechnic University, Duhok, IRQ
| | - Najim Abdulla Yassin
- Department of Microbiology, College of Medicine, University of Duhok, Duhok, IRQ
| |
Collapse
|
3
|
Baral R, Tuladhar R, Manandhar S, Singh A, Sherchan S. Detection of bla KPC gene among carbapenemase producing Klebsiella pneumoniae isolated from different clinical specimens at tertiary care hospital of Nepal. BMC Microbiol 2024; 24:144. [PMID: 38664608 PMCID: PMC11044503 DOI: 10.1186/s12866-024-03301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae infections have become a major cause of hospital acquired infection worldwide with the increased rate of acquisition of resistance to antibiotics. Carbapenem resistance mainly among Gram negative is an ongoing problem which causes serious outbreaks dramatically limiting treatment options. This prospective cross-sectional study was designed to detect blaKPC gene from carbapenem resistant K. pneumoniae. MATERIALS AND METHODS A totally of 1118 different clinical specimens were screened and confirmed for KPC producing K. pneumoniae phenotypically using Meropenem (10 μg) disc. The blaKPC gene was amplified from the isolates of K. pneumoniae to detect the presence of this gene. RESULT Of the total samples processed, 18.6% (n = 36) were K. pneumoniae and among 36 K. pneumoniae, 61.1% (n = 22/36) were meropenem resistant. This study demonstrated the higher level of MDR 91.7% (n = 33) and KPC production 47.2% (n = 17) among K. pneumoniae isolates. The blaKPC gene was detected in 8.3% (n = 3) of meropenem resistant isolates. CONCLUSION Since the study demonstrates the higher level of MDR and KPC producing K. pneumoniae isolates that has challenged the use of antimicrobial agents, continuous microbiology, and molecular surveillance to assist early detection and minimize the further dissemination of blaKPC should be initiated. We anticipate that the findings of this study will be useful in understanding the prevalence of KPC-producing K. pneumoniae in Nepal.
Collapse
Affiliation(s)
- Rakshya Baral
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal.
- Department of Biology, Morgan State University, Baltimore, USA.
| | - Reshma Tuladhar
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Sarita Manandhar
- Department of Microbiology, Tri-Chandra Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Anjana Singh
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Samendra Sherchan
- Department of Biology, Morgan State University, Baltimore, USA
- Department of Environmental Health Sciences, Tulane University, New Orleans, USA
| |
Collapse
|
4
|
Omar MH, Kilale AM, Rashid HK, Mwakapeje ER, Onoka IM, Gimbi AA. Prevalence and risk factors for extended-spectrum β-lactamase producing antimicrobial-resistant E. coli in urinary tract infections among inpatients in the tertiary hospitals in Zanzibar (Tanzania): a prospective cross-sectional study. Pan Afr Med J 2024; 47:193. [PMID: 39119113 PMCID: PMC11308945 DOI: 10.11604/pamj.2024.47.193.37920] [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: 10/24/2022] [Accepted: 01/14/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Extended-spectrum β-lactamase (ESBL) production among Enterobacteriaceae, such as E. coli, has been increasing worldwide, which causes treatment failure for urinary tract infections. Therefore, this study aimed to determine the prevalence and risk factors for the production of ESBL in E. coli from patients with urinary tract infections (UTI) in Zanzibar. Methods a prospective cross-sectional study was conducted from January 2018 to December 2021 in Zanzibar. Data were retrieved from a routine bacteriological laboratory culture report from urine samples of 4306 patients at the Lancet Laboratory. In addition, the patient's social demographics and clinical data were retrieved by examining the medical records in the respective hospitals. All inpatients older than fifteen years diagnosed with urinary tract infections (UTI) and requested urine culture and sensitivity were included. The Chi-square and Fischer's exact tests were used to compare antibiotic resistance. In addition, a binary logistic regression analysis was used to predict ESBL production risk factors. Results the prevalence of E. coli-producing ESBL was 13.4% (578/4030). Infection of ESBL. E. coli was prevalent in females 52.6% (n=304) compared to male patients, 47.4% (n=274), and the majority 38.8% (n=224), were people of young age, between 16-30 years. The average age of patients was 31.5±10.2 years, with minimum age of 16 years and a maximum age of 72 years. In multivariate analysis, results shown that previously hospitalised patients aOR: 6.35, 95% Cl 3.37-11.92; p=0.001, long hospital stays aOR: 10.34, 95% Cl 3.03-22.29; p <0.001, prior use of penicillin aOR: 7.78, 95% Cl 2.99-29.11; p < 0.001, and prior use of cephalosporin drugs aOR: 4.64, 95% Cl 2.99-9.96; p=0.001, were strongly associated with the emergence of ESBL-producing E. coli in urinary tract infection patients. ESBL E. coli showed high resistance to amoxicillin 99.5% (n=575), ampicillin 97.8.% (n=570), cotrimazaxole 86.2% (n=344), ceftriaxone 73.7% (n=344), ciprofloxacin 73.2% (n=423), and ceftaxime 59.5% (n=426). There was a less resistance to ampicillin -cloxacillin 44.3% (n=256), gentamicin 22.5% (n=22.5), and norfloxacin 18.9% (n=109) respectively. Isolates were shown to be more susceptible to meropenem at 1.6% (n=9). Conclusion the overall prevalence of ESBL-producing E. coli is 13.4%. The risk of emergence ESBL was higher in patients with previous history of hospitalisation, long hospital stay, prior use of penicillin and cephalosporin drugs. High level of antimicrobial resistance observed against most commonly used antibiotics in treatment of urinary tract infections. The clinicians should rely on microbiological diagnosis in treatment of UTIs to reduce risk of treatment failure. Further study should be carried out to assess the prevalence and resistance pattern of other uropathogens and other risk factors.
Collapse
Affiliation(s)
- Muhiddin Hamada Omar
- Department of Preventive Service and Health Education, Ministry of Health, Unguja, Zanzibar, Tanzania
- The Open University of Tanzania, Dar es Salaam, Tanzania
| | - Andrew Martin Kilale
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Huba Khamis Rashid
- Department of Pharmacology, School of Health and Medical Science, State University of Zanzibar, Zanzibar, Tanzania
| | - Elibariki Reuben Mwakapeje
- Food and Agriculture Organization of the United Nations, emergence Center for Transboundary Animal Diseases, Dar es Salaam, Tanzania
| | | | | |
Collapse
|
5
|
Sah RK, Dahal P, Parajuli R, Giri GR, Tuladhar E. Prevalence of blaCTX-M and blaTEM Genes in Cefotaxime-Resistant Escherichia coli Recovered from Tertiary Care at Central Nepal: A Descriptive Cross-Sectional Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:5517662. [PMID: 38226321 PMCID: PMC10789516 DOI: 10.1155/2024/5517662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/17/2024]
Abstract
Urinary tract infections (UTIs) are highly prevalent globally, and various antibiotics are employed for their treatment. However, the emergence of drug-resistant uropathogens towards these antibiotics causes a high rate of morbidity and mortality. This study was conducted at the Microbiology Laboratory of Grande International Hospital from November 2021 to May 2022 and aimed to assess the prevalence of UTI caused by Escherichia coli and their antibiotic susceptibility pattern with a focus on extended-spectrum beta-lactamases (ESBLs) and the prevalence of two genes (blaCTX-M and blaTEM) in cephalosporin-resistant E. coli. Altogether, 1050 urine samples were processed to obtain 165 isolates of E. coli. The isolates were identified by colony morphology and biochemical characteristics. Antimicrobial susceptibility tests (ASTs) were determined by the Kirby-Bauer disk diffusion method, and their ESBL enzymes were estimated by the combined disk method (CDM). Two ESBL genes (blaCTX-M and blaTEM) were investigated by polymerase chain reaction (PCR) in cefotaxime-resistant E. coli. Among the 1050 urine samples that were processed, 335 (31.9%) were culture-positive with 165 (49.2%) identified as E. coli. The age group ≥60 years (30.3%) had greater susceptibility to bacterial infections. AST revealed that meropenem was highly effective (95.7% susceptibility), while ampicillin showed the least sensitivity (42.4%). Among the E. coli isolates, 86 were multidrug resistant (MDR) and 10 were extensively drug resistant (XDR). Of these, 46 MDR (96%) and 2 XDR (4%) were ESBL producers. The prevalence of ESBL genes (blaCTX-M and blaTEM) was 49.3% and 54.8%, respectively. The overall accuracy of CDM as compared to PCR for the detection of the blaCTX-M gene was 55.26%. The prevalence of MDR E. coli harboring the blaCTX-M and blaTEM genes underscores the imperative role of ESBL testing in accurately identifying both beta-lactamase producers and nonproducers.
Collapse
|
6
|
Sah BK, Dahal P, Mallik SK, Paul AD, Mainali U, Shah C, Dahal P. Uropathogens and their antimicrobial-resistant pattern among suspected urinary tract infections patients in eastern Nepal: A hospital inpatients-based study. SAGE Open Med 2023; 11:20503121231220821. [PMID: 38148764 PMCID: PMC10750547 DOI: 10.1177/20503121231220821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
Background Urinary tract infections are the primary factors that cause mortality and morbidity in patients with underlying comorbid conditions and are responsible for most hospital admissions worldwide. Objectives The study aims to identify the common bacterial uropathogens and determine their antimicrobial susceptibility pattern, including multidrug-resistant/extensively drug-resistant bacteria. Methods The descriptive cross-sectional study was conducted among inpatients provisionally suspected of urinary tract infections in the medical ward of Koshi Hospital, Biratnagar, Nepal. Samples were inoculated in a cystine lysine electrolyte-deficient medium, and pure growth of significant bacteria was further subjected Gram staining, biochemical identification, and antimicrobial susceptibility testing as per laboratory standard procedure and Clinical Laboratory Standards Institute guidelines, respectively. Descriptive and inferential statistical analysis was performed to analyze the outcomes and a p-value < 0.05 was considered statistically significant. Results A total of 305 patients urine specimens were examined, of which 251 (82.29%) samples resulted in significant bacterial growth in the culture. Escherichia coli (62.94%) was the most predominantly isolated organism, followed by Klebsiella pneumoniae (12.35%), Staphylococcus aureus (9.16%), and Pseudomonas aeruginosa (8.76%). Among antimicrobials, colistin had shown absolute susceptibility (100%) toward gram-negative uropathogens followed by carbapenem and aminoglycosides in a majority of uropathogens. Escherichia coli was found to be the leading drug-resistant bacteria (70%) among uropathogens. The presence of multidrug-resistant/extensively drug-resistant bacteria uropathogens was found to be significantly associated with diabetes mellitus and those with combined antimicrobial therapies. Diabetic patients were twice (OR~2) more likely to colonize and develop uropathogens as compared to non-diabetics. Conclusion Escherichia coli was the most common uropathogens followed by Klebsiella pneumoniae in urinary tract infection patients. The polymyxin group (colistin) of antimicrobials was found to be effective in all multidrug-resistant and extensively drug-resistant uropathogens. The study recommends the need of optimized antimicrobial stewardship program to develop effective strategies in the management of urinary tract infections in diverse healthcare settings.
Collapse
Affiliation(s)
- Bikash Kumar Sah
- Purbanchal University School of Health Sciences, Purbanchal University, Gothgaun, Morang, Nepal
| | - Prasanna Dahal
- Purbanchal University School of Health Sciences, Purbanchal University, Gothgaun, Morang, Nepal
| | - Shyam Kumar Mallik
- Purbanchal University School of Health Sciences, Purbanchal University, Gothgaun, Morang, Nepal
| | - A Deevan Paul
- Chettinad School of Pharmaceutical Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, TN, India
| | | | | | | |
Collapse
|
7
|
Raherison RE, Raharinavalona SA, Razanamparany T, Randrianotahiana TN, Randrianomanana TV, Andrianiaina MMA, Rakotomalala ADP, Andrianasolo RL. Urinary tract infection in diabetics hospitalized in Befelatanana Hospital, Antananarivo: Epidemiological, clinical, biological profiles and risk factors for multidrug-resistant bacterial infection. Clin Case Rep 2023; 11:e7867. [PMID: 37675415 PMCID: PMC10477472 DOI: 10.1002/ccr3.7867] [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: 06/12/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Key Clinical Message The main type of urinary tract infection in hospitalized diabetics in Antananarivo is acute pyelonephritis; Escherichia coli is the most isolated uropathogen; imipenem, amikacin, fosfomycin and ceftriaxone are the major antibiotics for which Escherichia coli retain good sensitivity; Type 2 diabetes is predictive factor for infection by multidrug resistant bacteria. Abstract This study aimed to describe the epidemiological-clinical profiles of diabetics hospitalized for bacterial urinary tract infections in the Endocrinology Department of Befelatanana Hospital, to identify the main bacteria responsible, their antibiotic sensitivity profile and the factors associated with multidrug-resistant bacterial infection. A cross-sectional study was conducted between March 2017 and March 2020 involving all diabetics hospitalized for documented community-acquired bacterial urinary tract infection during this period. The hospital prevalence of urinary tract infections was 4.64%. The mean age of the patients was 59.06 ± 14.26 years and the sex ratio was 0.15. The main sign was fever (55.76%). The main clinical form was uncomplicated acute pyelonephritis (38.46%). Fifty-seven bacterial uropathogens were isolated. The most frequent was Escherichia coli (77.19%). Escherichia coli was sensitive to ertapenem and nitrofurantoin in 100% of cases, to Amikacin in 97.5% of cases, to Fosfomycin in 94.4% of cases and to Ceftriaxone in 80.65% of cases. Thirteen patients were infected with multidrug-resistant bacteria, all of them are extended-spectrum beta-lactamase-producing Enterobacteriaceae. Only the type of diabetes was associated with multidrug-resistant bacteria infection. The epidemiological-clinical and biological characteristics of urinary tract infections in our diabetics are similar to those reported in the literature. Compliance with the rules of proper antibiotic use is imperative to limit the emergence and spread of multidrug-resistant bacteria.
Collapse
Affiliation(s)
- Rija Eric Raherison
- Endocrinology DepartmentJoseph Raseta Befelatanana University Hospital CenterAntananarivoMadagascar
| | | | - Thierry Razanamparany
- Endocrinology DepartmentJoseph Raseta Befelatanana University Hospital CenterAntananarivoMadagascar
| | | | | | | | | | | |
Collapse
|
8
|
Chaudhary R, Pradhan M, Bhatta S, Shrestha S, Adhikari N, Singh YI. Multidrug Resistant Escherichia coli among Urinary Samples of Patients with Urinary Tract Infection in the Microbiology Department of a Tertiary Care Center: A Descriptive Cross-Sectional Study. JNMA J Nepal Med Assoc 2023; 61:437-441. [PMID: 37203893 PMCID: PMC10896443 DOI: 10.31729/jnma.8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction Urinary Tract Infection one of the most common and manageable infections still holds its position as a major public health issue worldwide due to an increase in the number of multidrug resistant bacteria. This study aims to find out the prevalence of multidrug resistant Escherichia coli among urinary samples of patients with urinary tract infections in the microbiology Department of a tertiary care center. Methods A descriptive cross-sectional study was carried out at a tertiary care centre from 8 August 2018 to 9 January 2019. Ethical approval was received from the Institutional Review Committee (Reference number: 123/2018). Clinically suspected cases of urinary tract infection were included in this study. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results Among 594 patients with urinary tract infections, the prevalence of multidrug resistant Escherichia coli was 102 (17.17%) (14.14-20.20, 95% Confidence Interval). Out of which, the production of extended-spectrum beta-lactamase and AmpC beta-lactamase were observed in 74 (72.54%), and 28 (27.45%) isolates respectively. The co-production of extended-spectrum beta-lactamases/AmpC was observed in 17 (16.67%). Conclusions The prevalence of multidrug resistant Escherichia coli among patients urinary samples of patient with urinary tract infection was lower as compared to the other studies done in similar settings. Keywords antibiotics; Escherichia coli; urinary tract infection.
Collapse
Affiliation(s)
- Raina Chaudhary
- Department of Microbiology, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Manoj Pradhan
- Department of Microbiology, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Sabita Bhatta
- Department of Microbiology, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Sabnum Shrestha
- Kantipur College of Medical Sciences, Sitapaila, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University Institute of Science and Technology, Kirtipur, Kathmandu, Nepal.
| | - Yengkokpam Ibotomba Singh
- Department of Microbiology, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| |
Collapse
|
9
|
Ghimire K, Banjara MR, Marasini BP, Gyanwali P, Poudel S, Khatri E, Dhimal M. Antibiotics Prescription, Dispensing Practices and Antibiotic Resistance Pattern in Common Pathogens in Nepal: A Narrative Review. Microbiol Insights 2023; 16:11786361231167239. [PMID: 37066121 PMCID: PMC10102948 DOI: 10.1177/11786361231167239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Antimicrobial resistance (AMR) is increasing and it is a serious public health problem worldwide. Nepal is considered as one of the contributors for rising AMR due to the most prevalent irrational use of antibiotics. In this review, we have assessed the practices of antibiotic prescription and dispensing, and antibiotic resistance of commonly encountered bacteria in Nepal. There is exponential increase of therapeutic consumption of antibiotics either without clinician's prescription or irrational prescription. Almost half of the population in Nepal was found to purchase antibiotics easily from the nearby pharmacies without clinician's prescription. Irrational prescription is exceeded in remote areas which could be due to lack of access with health posts and hospitals. The third generation cephalosporins, which are considered as the last resort antibiotics were found to be relatively prescribed and dispensed higher as compared to other classes of antibiotics. Despite the existing limited functional surveillance system, antibiotic resistance among bacteria is increasing in Nepal because of irrational prescription, dispensing and consumption of antibiotics without prescription.
Collapse
Affiliation(s)
- Kalpana Ghimire
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
- Megha Raj Banjara, Central Department of
Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal.
| | | | | | | | | | | |
Collapse
|
10
|
Islam MA, Islam MR, Khan R, Amin MB, Rahman M, Hossain MI, Ahmed D, Asaduzzaman M, Riley LW. Prevalence, etiology and antibiotic resistance patterns of community-acquired urinary tract infections in Dhaka, Bangladesh. PLoS One 2022; 17:e0274423. [PMID: 36107878 PMCID: PMC9477272 DOI: 10.1371/journal.pone.0274423] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infection (UTI) accounts for a significant morbidity and mortality across the world and is a leading cause for antibiotic prescriptions in the community especially in developing countries. Empirical choice of antibiotics for treatment of UTI is often discordant with the drug susceptibility of the etiologic agent. This study aimed to estimate the prevalence of community-acquired UTI caused by antibiotic resistant organisms. This was a cross-sectional study where urine samples were prospectively collected from 4,500 patients at the icddr,b diagnostic clinic in Dhaka, Bangladesh during 2016–2018. Urine samples were analyzed by standard culture method and the isolated bacteria were tested for antibiotic susceptibility by using disc diffusion method and VITEK-2. Descriptive statistics were used to estimate the prevalence of community acquired UTI (CA-UTI) by different age groups, sex, and etiology of infection. Relationship between the etiology of CA-UTI and age and sex of patients was analyzed using binary logistic regression analysis. Seasonal trends in the prevalence of CA-UTI, multi-drug resistant (MDR) pathogens and MDR Escherichia coli were also analyzed. Around 81% of patients were adults (≥18y). Of 3,200 (71%) urine samples with bacterial growth, 920 (29%) had a bacterial count of ≥1.0x105 CFU/ml indicating UTI. Women were more likely to have UTI compared to males (OR: 1.48, CI: 1.24–1.76). E. coli (51.6%) was the predominant causative pathogen followed by Streptococcus spp. (15.7%), Klebsiella spp. (12.1%), Enterococcus spp. (6.4%), Pseudomonas spp. (4.4%), coagulase-negative Staphylococcus spp. (2.0%), and other pathogens (7.8%). Both E. coli and Klebsiella spp. were predominantly resistant to penicillin (85%, 95%, respectively) followed by macrolide (70%, 76%), third-generation cephalosporins (69%, 58%), fluoroquinolones (69%, 53%) and carbapenem (5%, 9%). Around 65% of patients tested positive for multi-drug resistant (MDR) uropathogens. A higher number of male patients tested positive for MDR pathogens compared to the female patients (p = 0.015). Overall, 71% of Gram-negative and 46% of Gram-positive bacteria were MDR. The burden of community-acquired UTI caused by MDR organisms was high among the study population. The findings of the study will guide clinicians to be more selective about their antibiotic choice for empirical treatment of UTI and alleviate misuse/overuse of antibiotics in the community.
Collapse
Affiliation(s)
- Mohammad Aminul Islam
- Paul G. Allen School for Global Health, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Md Rayhanul Islam
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rizwana Khan
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Badrul Amin
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahdia Rahman
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muhammed Iqbal Hossain
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- Clinical Microbiology Laboratory, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muhammad Asaduzzaman
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lee W. Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States of America
| |
Collapse
|
11
|
Shakya S, Edwards J, Gupte HA, Shrestha S, Shakya BM, Parajuli K, Kattel HP, Shrestha PS, Ghimire R, Thekkur P. High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal. Public Health Action 2021; 11:24-31. [PMID: 34778012 PMCID: PMC8575380 DOI: 10.5588/pha.21.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
SETTING: Tribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May–October 2019. OBJECTIVE: 1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing. DESIGN: This was a hospital-based, cross-sectional study using routine laboratory records. RESULTS: Among 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ⩾60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ⩾45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ⩾60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR. CONCLUSION: Urine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.
Collapse
Affiliation(s)
- S Shakya
- Central Department of Public Health, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - J Edwards
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - H A Gupte
- Narotam Sekhsaria Foundation, Mumbai, India
| | - S Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu, Nepal
| | - B M Shakya
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - K Parajuli
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - H P Kattel
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - P S Shrestha
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - R Ghimire
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - P Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| |
Collapse
|
12
|
Karki D, Dhungel B, Bhandari S, Kunwar A, Joshi PR, Shrestha B, Rijal KR, Ghimire P, Banjara MR. Antibiotic resistance and detection of plasmid mediated colistin resistance mcr-1 gene among Escherichia coli and Klebsiella pneumoniae isolated from clinical samples. Gut Pathog 2021; 13:45. [PMID: 34225805 PMCID: PMC8256586 DOI: 10.1186/s13099-021-00441-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prevalence of antimicrobial resistance (AMR) among Gram-negative bacteria is alarmingly high. Reintroduction of colistin as last resort treatment in the infections caused by drug-resistant Gram-negative bacteria has led to the emergence and spread of colistin resistance. This study was designed to determine the prevalence of drug-resistance among beta-lactamase-producing strains of Escherichia coli and Klebsiella pneumoniae, isolated from the clinical specimens received at a tertiary care centre of Kathmandu, Nepal during the period of March to August, 2019. METHODS A total of 3216 different clinical samples were processed in the Microbiology laboratory of Kathmandu Model Hospital. Gram-negative isolates (E. coli and K. pneumoniae) were processed for antimicrobial susceptibility test (AST) by using modified Kirby-Bauer disc diffusion method. Drug-resistant isolates were further screened for extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL), carbapenemase and K. pneumoniae carbapenemase (KPC) production tests. All the suspected enzyme producers were processed for phenotypic confirmatory tests. Colistin resistance was determined by minimum inhibitory concentration (MIC) using agar dilution method. Colistin resistant strains were further screened for plasmid-mediated mcr-1 gene using conventional polymerase chain reaction (PCR). RESULTS Among the total samples processed, 16.4% (529/3216) samples had bacterial growth. A total of 583 bacterial isolates were recovered from 529 clinical samples. Among the total isolates, 78.0% (455/583) isolates were Gram-negative bacteria. The most predominant isolate among Gram-negatives was E. coli (66.4%; 302/455) and K. pneumoniae isolates were 9% (41/455). In AST, colistin, polymyxin B and tigecycline were the most effective antibiotics. The overall prevalence of multidrug-resistance (MDR) among both of the isolates was 58.0% (199/343). In the ESBL testing, 41.1% (n = 141) isolates were confirmed as ESBL-producers. The prevalence of ESBL-producing E. coli was 43% (130/302) whereas that of K. pneumoniae was 26.8% (11/41). Similarly, 12.5% (43/343) of the total isolates, 10.9% (33/302) of E. coli and 24.3% of (10/41) K. pneumoniae were resistant to carbapenem. Among 43 carbapenem resistant isolates, 30.2% (13/43) and 60.5% (26/43) were KPC and MBL-producers respectively. KPC-producers isolates of E. coli and K. pneumoniae were 33.3% (11/33) and 20% (2/10) respectively. Similarly, 63.6% (21/33) of the E. coli and 50% (5/10) of the K. pneumoniae were MBL-producers. In MIC assay, 2.2% (4/179) of E. coli and 10% (2/20) of K. pneumoniae isolates were confirmed as colistin resistant (MIC ≥ 4 µg/ml). Overall, the prevalence of colistin resistance was 3.1% (6/199) and acquisition of mcr-1 was 16.6% (3/18) among the E. coli isolates. CONCLUSION High prevalence of drug-resistance in our study is indicative of a deteriorating situation of AMR. Moreover, significant prevalence of resistant enzymes in our study reinforces their roles in the emergence of drug resistance. Resistance to last resort drug (colistin) and the isolation of mcr-1 indicate further urgency in infection management. Therefore, extensive surveillance, formulation and implementation of effective policies, augmentation of diagnostic facilities and incorporation of antibiotic stewardship programs can be some remedies to cope with this global crisis.
Collapse
Affiliation(s)
- Deepa Karki
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Srijana Bhandari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Anil Kunwar
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Basudha Shrestha
- Department of Microbiology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| |
Collapse
|
13
|
Salh KK. Evolution of the Antimicrobial resistance of Bacteria causing Urinary Tract Infections. Comb Chem High Throughput Screen 2021; 25:1219-1229. [PMID: 34161207 DOI: 10.2174/1386207324666210622161325] [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: 12/07/2020] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The bacteria, Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), are the main reasons for urinary tract infections (UTIs). This research aimed to investigate the isolation of etiologic agents from patients with UTI; it also investigates the antibiotic resistance activities and incidence of ESBL genes between different clinical separates of uropathogenic E. coli, determining their association with ESBL genes. METHODS The study enrolled 1000 positive growth isolates. The predominant pathogen associated with urinary tract infection, Gram-negative, were the main isolates from UTI patients, including E. coli, K. pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus and Enterococcus faecalis. RESULTS Among suspicious cases of urinary tract infection, we showed that 15.2% of the patients had UTI, and female patients in the childbearing age group were more affected. 644 E. coli (64.4%) and 322 (32.2%) K. pneumoniae were more isolated. Among 936 (93.6%) ESBL producing bacteria, 614 (61.4 %) E. coli showedhigh resistance to the antibiotics, Cefotaxime (85.7 %), Cefepime (85.7 %), Ciprofloxacin (83.1 %) and Kanamycin (77.9 %). Most ESBL-producing K. pneumoniae were multidrug-resistant (MDR). Nitrofurantoin, gentamycin, and imipenem were the most effective antibiotics for ESBL-producing E. coli isolates. CONCLUSION This study shows that the high rates of MDR Escherichia coli infection in our hospital were frequentative reasons for UTI. Nitrofurantoin and aminoglycosides were the most beneficial first-line drugs to be applied in the cases of UTI. It is recommended to conduct regular investigations on the drug resistance of all isolates and formulate helpful antibiotic treatment policies in China. It is important to determine the prevalence of ESBL in urine E. coli and K. pneumoniae isolates because it has a great influence on the selection of suitable antibacterial agents. In short, more than half of ESBL producers have multiple drug resistance (MDR).
Collapse
Affiliation(s)
- Khonaw Kader Salh
- Basic Science Department, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region. Iraq
| |
Collapse
|
14
|
Multidrug-Resistant and Carbapenemase-Producing Enterobacteriaceae in Addis Ababa, Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9999638. [PMID: 34195291 PMCID: PMC8214486 DOI: 10.1155/2021/9999638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
Background The emergence and spread of multi-drug resistant (MDR) bacteria have become a public health problem in recent years. For the last many years, carbapenem antibiotics have been used successfully to treat infections caused by MDR Enterobacteriaceae. However, recently, Enterobacteriaceae producing carbapenemases have emerged, which confer broad resistance to most β-lactam antibiotics including carbapenems. Therefore, this study is aimed at determining the magnitude of MDR and carbapenemase-producing Enterobacteriaceae (CPE) isolated from various clinical specimens in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted from January to April 2018. A total of 312 Enterobacteriaceae isolates were identified from various clinical specimens. The Phoenix automated system (BD Phoenix100) was used for bacterial identification and antimicrobial susceptibility testing. Potential carbapenemase producers were confirmed by the modified carbapenem inactivation test, and KPC, MBL, and OXA-48 were phenotypically characterized by the disk diffusion method. The data obtained were entered and analyzed using SPSS version 20 software. Descriptive statistics, chi square, bivariate and multivariable logistic regression analyses were performed. P value ≤ 0.05 with corresponding 95% confidence interval was considered for statistical significance. Results A total of 312 Enterobacteriaceae were recovered. Of these isolates, 68.6% were MDR and 2.6% were CPE with different classes including OXA-48 1.6% (5/312), MBL 0.6% (2/312), and KPC and OXA-48 0.3% (1/312). The predominant bacterial isolates were E. coli 72.4% (226/312) followed by K. pneumoniae 13.8% (43/312). The antibiotic resistance rates of CPE isolates were significantly higher than other MDRE including ampicillin (100% versus 77.6%), cefoxitin (75% versus 20.6%), and piperacillin/tazobactam (50% versus 13.1%). Conclusion In this study, a relatively higher prevalence of MDR was observed, and the highest resistance was recorded against ampicillin, amoxicillin with clavulanic acid, and sulfamethoxazole-trimethoprim. Detection of CPE is important for implementing appropriate antimicrobial therapy and in controlling the spread of the infection. Furthermore, continuous screening and investigations, including genotypic characterization of CPE, are required for the prevention and control of the spread of antimicrobial-resistant pathogens.
Collapse
|
15
|
Petca RC, Negoiță S, Mareș C, Petca A, Popescu RI, Chibelean CB. Heterogeneity of Antibiotics Multidrug-Resistance Profile of Uropathogens in Romanian Population. Antibiotics (Basel) 2021; 10:antibiotics10050523. [PMID: 34063317 PMCID: PMC8147389 DOI: 10.3390/antibiotics10050523] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
Urinary tract infections (UTIs) are a leading cause of morbidity for both males and females. The overconsumption of antibiotics in general medicine, veterinary, or agriculture has led to a spike in drug-resistant microorganisms; obtaining standardized results is imposed by standard definitions for various categories of drug-resistant bacteria—such as multiple-drug resistant (MDR), extensive drug-resistant (XDR), and pan drug-resistant (PDR). This retrospective study conducted in three university teaching hospitals in Romania has analyzed urine probes from 15,231 patients, of which 698 (4.58%) presented multidrug-resistant strains. Escherichia coli was the leading uropathogen 283 (40.54%), presenting the highest resistance to quinolones (R = 72.08%) and penicillin (R = 66.78%) with the most important patterns of resistance for penicillin, sulfonamides, and quinolones (12.01%) and aminoglycosides, aztreonam, cephalosporins, and quinolones (9.89%). Klebsiella spp. followed—260 (37.24%) with the highest resistance to amoxicillin-clavulanate (R = 94.61%) and cephalosporins (R = 94.23%); the leading patterns were observed for aminoglycosides, aminopenicillins + β-lactams inhibitor, sulfonamides, and cephalosporins (12.69%) and aminoglycosides, aztreonam, cephalosporins, quinolones (9.23%). The insufficient research of MDR strains on the Romanian population is promoting these findings as an important tool for any clinician treating MDR-UTIs.
Collapse
Affiliation(s)
- Răzvan-Cosmin Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Silvius Negoiță
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Anesthesiology and Critical Care, Elias University Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Cristian Mareș
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
- Correspondence: (C.M.); (A.P.); Tel.: +40-745-383-552 (C.M.); +40-745-787-448 (A.P.)
| | - Aida Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Obstetrics and Gynecology, Elias University Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
- Correspondence: (C.M.); (A.P.); Tel.: +40-745-383-552 (C.M.); +40-745-787-448 (A.P.)
| | - Răzvan-Ionuț Popescu
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Călin Bogdan Chibelean
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, 38 Gheorghe Marinescu Str., 540139 Targu-Mures, Romania;
- Department of Urology, Mureș County Hospital, 1st Gheorghe Marinescu Str., 540136 Targu-Mures, Romania
| |
Collapse
|
16
|
Nji CP, Assob JCN, Akoachere JFTK. Predictors of Urinary Tract Infections in Children and Antibiotic Susceptibility Pattern in the Buea Health District, South West Region, Cameroon. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2176569. [PMID: 33490237 PMCID: PMC7803141 DOI: 10.1155/2020/2176569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/03/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022]
Abstract
Urinary tract infections (UTI) are among the most common pediatric infections and if not promptly diagnosed and treated, it could cause long term complications. Worldwide and in Cameroon, little attention has been paid to this growing problem in the pediatric population. Identification of risk factors will contribute significantly to prevention. A cross-sectional case-control study was carried out in children ≤ 15 years to identify the risk factors of UTI, etiologic agents, and their antibiotic susceptibility. Samples (urine) were collected from in and outpatients with symptoms of UTI attending two health facilities in Buea. Controls were age- and sex-matched children in the community and those visiting these health facilities for unrelated reasons. Samples were analyzed by microscopy, culture, and antibiotic susceptibility of bacteria isolates tested by the disc diffusion technique. Questionnaires were administered to collect sociodemographic, clinical characteristics and data on risk factors. Odds ratios and bivariate and multivariate analyses were used to assess the relationship between predictors (symptoms and risk factors) and UTI. P < 0.05 was considered significant. A total of 405 participants (200 cases and 205 controls) were investigated. UTI prevalence was 12% in cases. From the UTI cases, bacteria was the major cause of infection, with E. coli (39.4%) predominating. Parasitic organisms, Trichomonas vaginalis (0.5%) and Schistosoma spp (0.5%), and yeast (6%) were also detected. Urinary urgency (F = 4.98, P = 0.027) and back pain (F = 12.37, P = 0.001) were associated to UTI following bivariate analysis. These parameters could be used to predict UTI in the pediatric population in the study area. Third generation cephalosporins: ceftriaxone (90.1%) and cefadroxil (85.4%) were the most effective and thus recommended for treatment.
Collapse
Affiliation(s)
- Che Pantalius Nji
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, South West Region, Cameroon
| | - Jules Clément Nguedia Assob
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Buea, P. O. Box, 63 Buea, South West Region, Cameroon
| | | |
Collapse
|
17
|
Prevalence of Community Acquired Uropathogens and their Antimicrobial Susceptibility in Patients from the Urology Unit of A Tertiary Care Medical Center. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.40] [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
Urinary tract infections (UTI) are one of the most common community acquired infections and can also present with similar lower urinary tract symptoms (LUTS). Moreover, UTI can be a complication of these urological diseases. Thus, this study was conducted in patients with LUTS to find out the prevalence of uro-pathogens and their antibiotic susceptibility pattern so that appropriate antibiotics can be started on clinical suspicion of UTI. The study was conducted over a period of 12 months. Culture and susceptibility of urine specimen was done as per standard microbiological guidelines. Apart from the growth of common bacteria with their antibiogram, Methicillin-resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) was investigated among Enterococci, and metallo beta-lactamases(MBL) production was production was investigated among gram-negative pathogens. Out of 407 urine samples included in the study, 80 (19.6%) samples showed bacterial growth. The commonest isolate was E. coli 44 (55 %). Majority of the isolates were multidrug resistant with two E.coli strains showing pan-resistance to the first line drugs tested. Carbapenem resistance was seen in 67.2% of all gram negative isolates tested. Metallo beta-lactamases production was found to be highest among the Klebsiella isolates. Among the Enterobacterales, highest susceptibility was noted to Fosfomycin (87.7%) followed by Nitrofurantoin (62.7%). Similarly in gram positive group, highest susceptibility was again to Fosfomycin followed by Nitrofurantoin. Overall the prevalence of MDR is increasing however Fosfomycin or Nitrofurantoin, both oral antibiotics, can be the considered for starting empirical antibiotic therapy.
Collapse
|
18
|
Mohsenzadeh M, Abtahi-Eivary SH, Pirouzi A, Khaledi A, Rahimi M. A systematic review and meta-analysis of urinary tract infection, frequency of IS elements and MDR isolates retrieved from adult patients. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
19
|
Thapa Shrestha U, Shrestha S, Adhikari N, Rijal KR, Shrestha B, Adhikari B, Banjara MR, Ghimire P. Plasmid Profiling and Occurrence of β-Lactamase Enzymes in Multidrug-Resistant Uropathogenic Escherichia coli in Kathmandu, Nepal. Infect Drug Resist 2020; 13:1905-1917. [PMID: 32606839 PMCID: PMC7320882 DOI: 10.2147/idr.s250591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Extended-spectrum β-lactamases (ESBL) among Gram-negative bacteria, predominantly Escherichia coli (E. coli), in Nepal, have been rising. The main objectives of this study were to determine the prevalence of uropathogenic E. coli, antibiotic resistance, ESBLs, ABLs (AmpC type β-lactamases), MBLs (metallo-β-lactamases) and KPCs (Klebsiella pneumoniae carbapenemases) and their correlation with plasmid profiling patterns among patients with urinary tract infections in a tertiary hospital in Kathmandu, Nepal. METHODS The mid-stream urine samples collected from patients were inoculated in cystine-lactose-electrolyte-deficient (CLED) agar plates. E. coli producing ESBLs, ABLs, MBLs/KPC were identified phenotypically using standard microbiological methods. Plasmids were extracted by alkaline lysis method from E. coli isolates and profiled using agarose gel electrophoresis. RESULTS Out of the total 2661 urine samples, E. coli were isolated in 64.34% (507/788), among which 170 (33.53%) were multidrug-resistant (MDR) isolates. All MDR isolates were resistant to amoxicillin and third-generation cephalosporins but were highly sensitive to imipenem (94.12%, 160/170), amikacin (92.94%, 158/170) and nitrofurantoin (86.47%, 147/170). Among 170 MDR isolates, 78.2% (133/170) were ESBLs, 46.3% (50/170) were AmpC, 11.2% (19/170) were MBL and 0.6% (1/170) were KPC producers. Coproduction of β-lactamases was detected in 24.12% (41/170) of isolates. E. coli isolates showed one plasmid (>33.5 kb), which was present in all the isolates. Overall, 44 different plasmid profile groups were identified based on molecular weight and number of plasmids. β-Lactamase producers were relatively resistant to the higher number of antibiotics tested (≤10) than non-producers (≤8), and the number of plasmids were higher in β-lactamase producers (≤7) than those in non-producers (≤5). CONCLUSION The higher prevalence of the ESBLs, AmpCs, KPCs and MBLs along with their coproduction in E. coli isolates highlights the importance of routine surveillance of ESBLs, AmpCs, KPCs and MBLs in microbiology laboratories using various phenotypic methods.
Collapse
Affiliation(s)
- Upendra Thapa Shrestha
- Kantipur College of Medical Science, Tribhuvan University, Sitapaila, Kathmandu, Nepal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Sabnum Shrestha
- Kantipur College of Medical Science, Tribhuvan University, Sitapaila, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Kantipur College of Medical Science, Tribhuvan University, Sitapaila, Kathmandu, Nepal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Basudha Shrestha
- Department of Microbiology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| |
Collapse
|
20
|
Bandyopadhyay D, Mukherjee M. Reactive oxygen species and uspA overexpession: an alternative bacterial response toward selection and maintenance of multidrug resistance in clinical isolates of uropathogenic E. coli. Eur J Clin Microbiol Infect Dis 2020; 39:1753-1760. [PMID: 32399681 DOI: 10.1007/s10096-020-03903-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022]
Abstract
Emergence of multidrug resistance (MDR) in uropathogenic E. coli (UPEC) demands alternative therapeutic interventions. Bactericidal antibiotics at their sub-inhibitory concentration stimulate production of reactive oxygen species (ROS) that results in oxidative stress, generates mutations, and alters transcription of different genes. Sub-inhibitory concentration of antibiotics facilitates selection of highly resistant population. Universal stress protein A (uspA) overexpression in MDR-UPEC at sub-inhibitory bactericidal antibiotics concentration was investigated to explore alternative survival strategy against them. Fifty clinical UPEC isolates were screened. Minimum inhibitory concentration (MIC) against three different bactericidal antibiotics (ciprofloxacin, CIP; ceftazidime, CAZ; gentamycin, GEN) was determined by broth dilution method; ROS production by DCFDA and overexpression of uspA by real-time PCR were determined at the sub-inhibitory concentration of antibiotics. DNA ladder formation and SEM studies were performed with drug untreated and treated samples. Statistical analysis was done by Student's t test and Pearson's correlation analysis; 25 out of 50 UPEC exhibited high MIC against CIP (> 200 μg/ml), CAZ (> 500 μg/ml), GEN (> 500 μg/ml), with varied ROS production (p ≤ 0.001) in treated than untreated controls. DNA ladder formation confirmed ROS production in drug-treated samples. SEM analysis revealed unaltered cell morphology in both untreated and drug-treated bacteria. uspA was universally overexpressed in all 25 UPEC. A significant correlation (p ≤ 0.001) between ROS production and uspA overexpression was observed in 19 out of 25 MDR isolates at sub-inhibitory doses of the bactericidal antibiotics. Therefore, this study highlights an alternative strategy that the MDR isolates may acquire when exposed to sub-inhibitory drug concentration for their survival.
Collapse
Affiliation(s)
- Debojyoty Bandyopadhyay
- Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, 700073, India
| | - Mandira Mukherjee
- Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, 700073, India.
| |
Collapse
|
21
|
Extended-Spectrum β-Lactamase (ESBL) Genotypes among Multidrug-Resistant Uropathogenic Escherichia coli Clinical Isolates from a Teaching Hospital of Nepal. Interdiscip Perspect Infect Dis 2020; 2020:6525826. [PMID: 32377184 PMCID: PMC7181012 DOI: 10.1155/2020/6525826] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infections (UTI) represent the most common bacterial infections among patients visiting outpatient clinics of healthcare centers in Nepal. However, treatment of such infections is compounded by emergence and spread of multidrug-resistant uropathogens associated with extended-spectrum β-lactamases (ESBLs). In this study, we aimed to investigate the burden of antimicrobial resistance and occurrence of ESBL genes among clinical isolates of uropathogenic Escherichia coli at a tertiary care teaching hospital of Nepal. During the study period, we processed a total of 1,626 urinary tract specimens, isolated significant bacterial pathogens, and investigated their antimicrobial susceptibilities. Escherichia coli (n = 154), the predominant pathogen associated with UTI, was further investigated for the existence of ESBL enzymes by using conventional phenotypic as well as molecular approaches. Among suspected cases of UTI, we found that 15.2% were having UTI and female patients of the reproductive age group were more affected (p < 0.05). Escherichia coli (154, 62.1%) was the key uropathogen, and majority (∼64.9%) of them were multidrug resistant (MDR). Among MDR E. coli isolates, 40.3% were producing extended-spectrum β-lactamases (ESBLs). bla-TEM (83.8%), bla-CTX-M (66.1%), and bla-SHV (4.8%) were common ESBL genotypes. Nitrofurantoin, gentamycin, and imipenem were the most effective antibiotics for ESBL-producing Escherichia coli isolates. It indicates that the high rates of multidrug-resistant Escherichia coli are frequent causes of UTI in our hospital. Nitrofurantoin and aminoglycosides are the most useful first-line drugs to be used in the cases of UTI. We recommend the regular investigation of drug resistance among all isolates and develop a useful antibiotic prescription policy in our country.
Collapse
|
22
|
Faujdar SS, Bisht D, Sharma A. Antibacterial activity of Syzygium aromaticum (clove) against uropathogens producing ESBL, MBL, and AmpC beta-lactamase: Are we close to getting a new antibacterial agent? J Family Med Prim Care 2020; 9:180-186. [PMID: 32110587 PMCID: PMC7014883 DOI: 10.4103/jfmpc.jfmpc_908_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction The present study was done to access the antibacterial activity of clove (Syzygium aromaticum) against extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL), and AmpC beta-lactamase-producing gram-negative bacteria causing urinary tract infection. Methods A total of 221 gram-negative uropathogens were isolated and screened for beta-lactamase (ESBL, MBL, and AmpC) production and further tested against ethanolic extract of clove (S. aromaticum) for its antibacterial activity. Results Clove was effective against all gram-negative isolates but the best antibacterial activity was shown against Proteus species with 19 mm zone of inhibition, 0.39 mg/ml minimum inhibitory concentration (MIC) and 0.19 mg/ml minimum bactericidal concentration (MBC). Conclusions Clove extract showed different antibacterial potential against all gram-negative uropathogens. Clove activity for particular strain was found to be similar between isolates producing beta-lactamase and non beta-lactamase.
Collapse
Affiliation(s)
- Sameer S Faujdar
- Department of Microbiology, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Dakshina Bisht
- Department of Microbiology, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Amisha Sharma
- Department of Microbiology, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India
| |
Collapse
|
23
|
Coexistence of β-Lactamases in Community-Acquired Infections in a Tertiary Care Hospital in India. Int J Microbiol 2019; 2019:7019578. [PMID: 31885596 PMCID: PMC6927026 DOI: 10.1155/2019/7019578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/03/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The trends of β-lactamases producing Enterobacteriaceae is ever increasing, and limited studies have reported investigating coexistence of β lactamases in Enterobacteriaceae. A cross-sectional study after approval from the Institutional Ethical committee was conducted between June 2014 and May 2016 in community-acquired infections due to multidrug-resistant organisms in our tertiary care. Nonrepetitive clinical samples from the out-patient department (OPD) were processed for bacteriological culture and identification of Enterobacteriaceae. An antibiotic susceptibility test, screening, and phenotypic confirmation for ESBLs and carbapenemases and AmpC producers were performed to check for coexistence of these enzymes. Results Nonrepetitive clinical specimens processed for culture and identification in our hospital revealed 417 positive isolates in community acquired infections which were multidrug-resistant organisms, and on screening for β-lactamases, 293 isolates were positive for one of the three beta lactamases, ESBL, AmpC, or carbapnemases. Coproduction of ESBL and MBL was seen in 5 isolates, 35 isolates showed coproduction of ESBL and AmpC enzymes, and AmpC and MBL coproduction was exhibited in only in 5 isolates. Conclusions Coexistence of ESBLs, AmpC producers, and carbapenemases has been described. Continuous monitoring and surveillance and proper infection control and prevention practices will limit the further spread of these superbugs within the hospital and beyond.
Collapse
|
24
|
Nepal A, Hendrie D, Robinson S, Selvey LA. Knowledge, attitudes and practices relating to antibiotic use among community members of the Rupandehi District in Nepal. BMC Public Health 2019; 19:1558. [PMID: 31771595 PMCID: PMC6880381 DOI: 10.1186/s12889-019-7924-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/08/2019] [Indexed: 11/23/2022] Open
Abstract
Background The development of antibiotic resistance is one of the biggest threats to global public health. Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. The aim of this study was to explore the knowledge, attitudes and practices (KAP) towards antibiotic use among adults in Nepal. Methods A quantitative survey was conducted with 220 community members of the Rupandehi district of Nepal, with cluster sampling techniques applied to select households. Interviews were carried out face-to-face using a structured questionnaire. Responses were presented using descriptive analysis, with chi-squared tests and regression analysis applied to identify factors associated with KAP about antibiotic use and the Spearman’s rank order correlation coefficient calculated to examine the relationship between responses to the KAP questions. Results The sample comprised more females (54%) than males, the average age of respondents was 38.5 years and almost 60% of respondents lived in rural areas. Respondents had relatively good knowledge about aspects of antibiotic use other than identifying antibiotics. The concept of antibiotic resistance was well known but imperfectly understood. Half of respondents (50.9%) were unsure whether skipping doses would contribute to the development of antibiotic resistance, 88.2% indicated they would go to another doctor if not prescribed an antibiotic when they thought one was needed and nearly half (47.7%) believed antibiotics helped them get better more quickly if they had a fever. Most respondents reported correct practices accessing and using antibiotics, however, 84.6% at least sometimes preferred an antibiotic when they have a cough and sore throat. Logistic regression showed respondents with higher levels of education tended to have better knowledge, more appropriate attitudes and better practices about antibiotic use. Rural respondents were less likely to have better knowledge about antibiotic use, while females were more likely to report better practices. Conclusion The study provides baseline evidence about the knowledge, attitudes and practices regarding antibiotic use among the population of the Rupandehl district. Its findings will be useful in designing effective and targeted interventions to decrease misconceptions about antibiotic use and to increase awareness about the risks of inappropriate use of antibiotics in the community.
Collapse
Affiliation(s)
- Anant Nepal
- School of Public Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia.
| | - Delia Hendrie
- School of Public Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia
| | - Suzanne Robinson
- School of Public Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia
| | - Linda A Selvey
- School of Public Health, The University of Queensland, Herston Rd, Herston, Qld, 4006, Australia
| |
Collapse
|
25
|
Donkor ES, Horlortu PZ, Dayie NTKD, Obeng-Nkrumah N, Labi AK. Community acquired urinary tract infections among adults in Accra, Ghana. Infect Drug Resist 2019; 12:2059-2067. [PMID: 31372013 PMCID: PMC6628945 DOI: 10.2147/idr.s204880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Urinary tract infection (UTI) is one of the most common bacterial infectious diseases encountered in clinical practice, and accounts for significant morbidity and high medical costs. To reduce its public health burden, there is the need for local research data to address aspects of prevention and management of UTI. The aim of this study was to investigate community-acquired UTI among adults in Accra, Ghana, including the risk factors, etiological agents, and antibiotic resistance. Methods: This was a cross-sectional study involving 307 patients clinically diagnosed with UTI at the Korle Bu and Mamprobi polyclinics in Accra. Urine specimens were collected from the study participants and analyzed by culture, microscopy, and dipstick. The bacterial isolates were identified using standard microbiological methods and tested against a spectrum of antibiotics by the Kirby Bauer method. Multidrug resistant Enterobacteriaceae isolates were screened for Extended Spectrum β-lactamase (ESBL) production by the double disc method, and isolates that tested positive were analyzed by Polymerase Chain Reaction for ESBL genes. Demographic information and clinical history of study participants were collected. Results: Based on the criteria for laboratory confirmed UTI, 31 (10.1%) of the 307 specimens were positive and the main risk factor of UTI among the study participants was pregnancy (P=0.02, OR=2.43). The most common uropathogen isolated was Escherichia coli (48.9%), followed by Klebseilla sp. (16.1%). Prevalence of resistance was highest for Piperacillin (87.1%) and Amoxicillin+Clavulanic Acid (87.1%) and lowest for Amikacin (12.9%). Prevalence of multidrug resistance among the uropathogens was 80.1% (25) and the most common ESBL gene detected was CTX-M-15. Conclusion: Pregnant women constitute the key risk population of UTI in Accra, while Amikacin remains a suitable drug for the treatment of febrile UTI. The high prevalence of multidrug resistance among the uropathogens highlights the need for surveillance of antimicrobial resistance among these pathogens.
Collapse
Affiliation(s)
- Eric S Donkor
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences University of Ghana, Accra, Ghana
| | - Prince Z Horlortu
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences University of Ghana, Accra, Ghana
| | - Nicholas TKD Dayie
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences University of Ghana, Accra, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Science, School of Biomedical and Allied Health Sciences University of Ghana, Accra, Ghana
| | | |
Collapse
|
26
|
DEHBANIPOUR R, KHANAHMAD H, SEDIGHI M, BIALVAEI AZAHEDI, FAGHRI J. High prevalence of fluoroquinolone-resistant Escherichia coli strains isolated from urine clinical samples. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E25-E30. [PMID: 31041407 PMCID: PMC6477561 DOI: 10.15167/2421-4248/jpmh2019.60.1.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022]
Abstract
Background Fluoroquinolone resistant Escherichia coli isolates have become an important challenge in healthcare settings in Iran. In this study, we have determined Fluoroquinolone resistant E. coli isolates (from both outpatients and inpatients) and evaluated mutations of gyrA and parC within the quinolone resistance-determining regions (QRDR) of these clinical isolates. Materials and methods Clinical isolates were recovered from the urine sample of patients with urinary tract infections admitted at Alzahra hospital, Iran, between September and February 2013. We assessed antimicrobial susceptibility of all isolates and determined mutations in QRDR of gyrA and parC genes from 13 fluoroquinolone-resistant isolates by DNA sequencing. Results A total of 135 E. coli strains were obtained from 135 patients (91 outpatients and 44 inpatients). The resistance rate of fluoroquinolones (Ciprofloxacin, Norfloxacin and Ofloxacin) among our strains was 45.2%. Two E. coli isolates were shown just a single mutation, but other isolates possessed 2-5 mutations in gyrA and parC genes. Mutations in the QRDR regions of gyrA were at positions Ser83 and Asp87 and parC at positions Ser80, Glu84, Gly78. Conclusions Ciprofloxacin is the most common antimicrobial agent used for treating urinary tract infections (UTIs) in healthcare settings in Iran. Accumulation of different substitutions in the QRDR regions of gyrA and parC confers high-level resistance of fluoroquinolones in clinical isolates.
Collapse
Affiliation(s)
- R. DEHBANIPOUR
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H. KHANAHMAD
- Department of Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M. SEDIGHI
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - A. ZAHEDI BIALVAEI
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - J. FAGHRI
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Jamshid Faghri, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran - Tel/Fax +983137922421 - E-mail:
| |
Collapse
|
27
|
Dynamics of Resistance Plasmids in Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae during Postinfection Colonization. Antimicrob Agents Chemother 2019; 63:AAC.02201-18. [PMID: 30745391 DOI: 10.1128/aac.02201-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/05/2019] [Indexed: 01/01/2023] Open
Abstract
Extended-spectrum β-lactamase-producing Enterobacteriaceae (EPE) are a major cause of bloodstream infections, and the colonization rate of EPE in the gut microbiota of individuals lacking prior hospitalization or comorbidities is increasing. In this study, we performed an in-depth investigation of the temporal dynamics of EPE and their plasmids during one year by collecting fecal samples from three patients initially seeking medical care for urinary tract infections. In two of the patients, the same strain that caused the urinary tract infection (UTI) was found at all consecutive samplings from the gut microbiota, and no other EPEs were detected, while in the third patient the UTI strain was only found in the initial UTI sample. Instead, this patient presented a complex situation where a mixed microbiota of different EPE strain types, including three different E. coli ST131 variants, as well as different bacterial species, was identified over the course of the study. Different plasmid dynamics were displayed in each of the patients, including the spread of plasmids between different strain types over time and the transposition of bla CTX-M-15 from the chromosome to a plasmid, followed by subsequent loss through homologous recombination. Small cryptic plasmids were found in all isolates from all patients, and they appear to move frequently between different strains in the microbiota. In conclusion, we could demonstrate an extensive variation of EPE strain types, plasmid composition, rearrangements, and horizontal gene transfer of genetic material illustrating the high dynamics nature and interactive environment of the gut microbiota during post-UTI carriage.
Collapse
|
28
|
Shrestha LB, Baral R, Poudel P, Khanal B. Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal. BMC Pediatr 2019; 19:36. [PMID: 30696410 PMCID: PMC6350346 DOI: 10.1186/s12887-019-1410-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background Urinary tract infection (UTI) is one of most common pediatric infections. The study was designed to assess the clinical profile, common bacterial microorganisms causing UTI and their antimicrobial susceptibility patterns at B. P. Koirala Institute of Health Sciences (BPKIHS) hospital. Methods This is a prospective cross-sectional study conducted at Department of Microbiology and Infectious Diseases for 6 months (January to June 2018). A total of 1962 non-repetitive urine specimens (midstream, nappy pad, catheter aspirated) of pediatric patients (0–14 years age) suspected of UTI were obtained in the Microbiology laboratory. Clinical data was obtained from requisition form and hospital software. Culture and bacterial identification was done by using standard microbiological guidelines. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method following clinical and laboratory standards institute (CLSI) guidelines. Resistance to methicillin and vancomycin were confirmed by calculating minimum inhibitory concentration using broth dilution method. Results Among 1962 samples, 314 (16%) were positive for bacterial infection. Fever, irritability and poor feeding was the most common symptoms in neonates while older children presented with fever and urinary symptoms. E. coli was reported the most common etiological agent (53%), followed by Enterococcus faecalis (22%), Klebsiella pneumoniae (7%) and Staphylococcus aureus (7%). Multidrug resistant (MDR) isolates accounted for 32% of isolates, while 5% were extensively drug resistant (XDR). Fourty percentage of gram-negative bacilli were ESBL producer, 38% of S. aureus were methicillin resistant Staphylococcus aureus (MRSA) and 5% E. faecalis were vacomycin resistant enterococci (VRE). E coli was highly resistant to Ampicillin (87%), Ceftriaxone (62%) and Ofloxacin (62%). Amikacin (11% resistance) and Nitrofurantoin (5% resistance) are the most effective drugs for gram-negative bacilli (GNB) while vancomycin and linezolid are functional against gram-positive cocci. Conclusions High-level antimicrobial resistance was observed in pediatric UTI with alarming incidence superbugs like MDR, XDR, ESBL and MRSA. Regular surveillance should be carried out to determine the local prevalence of organisms and antimicrobial susceptibilities in order to guide the proper management of children.
Collapse
Affiliation(s)
- Lok Bahadur Shrestha
- Department of Microbiology and Infectious Diseases, B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700, Nepal.
| | - Ratna Baral
- Department of Microbiology and Infectious Diseases, B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700, Nepal
| | - Prakash Poudel
- Department of Pediatrics and Adolescent Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700, Nepal
| | - Basudha Khanal
- Department of Microbiology and Infectious Diseases, B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, 56700, Nepal
| |
Collapse
|
29
|
Gashe F, Mulisa E, Mekonnen M, Zeleke G. Antimicrobial Resistance Profile of Different Clinical Isolates against Third-Generation Cephalosporins. JOURNAL OF PHARMACEUTICS 2018; 2018:5070742. [PMID: 30271652 PMCID: PMC6151245 DOI: 10.1155/2018/5070742] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/19/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug resistant microorganisms lead to an increase in morbidity and mortality as they boost the risk of inappropriate therapy. Hence, data on antimicrobial resistance help define the best possible treatment for individual patients. Therefore, this study aimed to screen the antimicrobial resistant profile of 3rd generation cephalosporin drugs in Jimma University Specialized Teaching Hospital. METHODS A hospital based prospective cross-sectional study was conducted in Jimma University Specialized Hospital (JUSH) from April to August 2016. The clinical samples such as wound swab, urine, sputum, and stool were collected from hospitalized patients. Then, bacterial species were isolated and identified as per the standard microbiological methods. Antimicrobial susceptibility tests were carried out using various antimicrobial discs by Kirby-Bauer disc diffusion method. RESULTS Totally, 248 bacterial isolates were obtained from 154 (62.1%) male and 94 (37.9%) female patients. Escherichia coli (25.4%) and Staphylococcus aureus (19.0 %) were the predominant organisms isolated from specimens. About 140 (56.5%) and 149 (60.1%) of the total bacterial isolates were found to be resistant to ceftriaxone and ceftazidime, respectively. The majority of Escherichia coli isolates 46 (73%) were resistant to ceftriaxone and 41 (65%) of them were resistant to ceftazidime. Staphylococcus aureus, which accounted 19% of the total bacterial isolates, showed 23.4% and 34% resistance to ceftriaxone and ceftazidime, respectively. Among the bacterial strains revealing resistant to ceftriazone and ceftazidime, about 109 (44%) and 108 (43.5%) of them were resistant to two, three, or four other drugs, respectively. CONCLUSION Bacterial resistance towards third-generation cephalosporin (ceftriaxone and ceftazidime) is escalating as more than half of the isolated strains demonstrated resistance to these drugs. Moreover, these strains also revealed multidrug resistance mainly against clinically used drugs which could render therapy unsuccessful. Therefore, in clinical use appropriate medications should be selected based on the data obtained from antimicrobial susceptibility tests.
Collapse
Affiliation(s)
- Fanta Gashe
- School of Pharmacy, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Eshetu Mulisa
- School of Pharmacy, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Mekidim Mekonnen
- School of Laboratory Sciences, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Gemechu Zeleke
- School of Pharmacy, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| |
Collapse
|
30
|
Margulieux KR, Srijan A, Ruekit S, Nobthai P, Poramathikul K, Pandey P, Serichantalergs O, Shrestha SK, Bodhidatta L, Swierczewski BE. Extended-spectrum β-lactamase prevalence and virulence factor characterization of enterotoxigenic Escherichia coli responsible for acute diarrhea in Nepal from 2001 to 2016. Antimicrob Resist Infect Control 2018; 7:87. [PMID: 30038780 PMCID: PMC6053774 DOI: 10.1186/s13756-018-0377-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/06/2018] [Indexed: 02/02/2023] Open
Abstract
Background Multidrug-resistant (MDR) Gram-negative bacterial species are an increasingly dangerous public health threat, and are now endemic in many areas of South Asia. However, there are a lack of comprehensive data from many countries in this region determining historic and current MDR prevalence. Enterotoxigenic Escherichia coli (ETEC) is a leading cause of both acute infant diarrhea and traveler’s diarrhea in Nepal. The MDR prevalence and associated resistance mechanisms of ETEC isolates responsible for enteric infections in Nepal are largely unknown. Methods A total of 265 ETEC isolates were obtained from acute diarrheal samples (263/265) or patient control samples (2/265) at traveler’s clinics or regional hospitals in Nepal from 2001 to 2016. Isolates were screened for antibiotic resistance, to include extended spectrum beta-lactamase (ESBL) production, via the Microscan Automated Microbiology System. ETEC virulence factors, specifically enterotoxins and colonization factors (CFs), were detected using multiplex PCR, and prevalence in the total isolate population was compared to ESBL-positive isolates. ESBL-positive isolates were assessed using multiplex PCR for genetic markers potentially responsible for observed resistance. Results A total of 118/265 (44.5%) ETEC isolates demonstrated resistance to ≥2 antibiotics. ESBL-positive phenotypes were detected in 40/265 isolates, with isolates from 2008, 2013, 2014, and 2016 demonstrating ESBL prevalence rates of 1.5, 34.5, 31.2, and 35.0% respectively. No difference was observed in overall enterotoxin characterization between the total ETEC and ESBL-positive populations. The CFs CS2 (13.6%), CS3 (25.3%), CS6 (30.2%), and CS21 (62.6%) were the most prevalent in the total ETEC population. The ESBL-positive ETEC isolates exhibited a higher association trend with the CFs CS2 (37.5%), CS3 (35%), CS6 (42.5%), and CS21 (67.5%). The primary ESBL gene identified was blaCTX-M-15 (80%), followed by blaSHV-12 (20%) and blaCTX-M-14 (2.5%). The beta-lactamase genes blaTEM-1 (40%) and blaCMY-2 (2.5%) were also identified. It was determined that 42.5% of the ESBL-positive isolates carried multiple resistance genes. Conclusion Over 30% of ETEC isolates collected post-2013 and evaluated in this study demonstrated ESBL resistance. Persistent surveillance and characterization of enteric ETEC isolates are vital for tracking the community presence of MDR bacterial species in order to recommend effective treatment strategies and help mitigate the spread of resistant pathogens.
Collapse
Affiliation(s)
- Katie R Margulieux
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand
| | - Apichai Srijan
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand
| | - Sirigade Ruekit
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand
| | - Panida Nobthai
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand
| | - Kamonporn Poramathikul
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand
| | - Prativa Pandey
- CIWEC Hospital and Travel Medicine Clinic, Kathmandu, Nepal
| | - Oralak Serichantalergs
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand
| | | | - Ladaporn Bodhidatta
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand
| | - Brett E Swierczewski
- 1Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithee Road, Bangkok, 10400 Thailand.,4Present Address: Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD USA
| |
Collapse
|
31
|
Herindrainy P, Rabenandrasana MAN, Andrianirina ZZ, Rakotoarimanana FMJ, Padget M, de Lauzanne A, Ndir A, Kermorvant-Duchemin E, Garin B, Piola P, Collard JM, Guillemot D, Huynh BT, Delarocque-Astagneau E. Acquisition of extended spectrum beta-lactamase-producing enterobacteriaceae in neonates: A community based cohort in Madagascar. PLoS One 2018; 13:e0193325. [PMID: 29494706 PMCID: PMC5832238 DOI: 10.1371/journal.pone.0193325] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/08/2018] [Indexed: 01/09/2023] Open
Abstract
In low and middle income countries (LMICs), where the burden of neonatal sepsis is the highest, the spread of extended spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE) in the community, potentially contributing to the neonatal mortality, is a public health concern. Data regarding the acquisition of ESBL-PE during the neonatal period are scarce. The routes of transmission are not well defined and particularly the possible key role played by pregnant women. This study aimed to understand the neonatal acquisition of ESBL-PE in the community in Madagascar. The study was conducted in urban and semi-rural areas. Newborns were included at birth and followed-up during their first month of life. Maternal stool samples at delivery and six stool samples in each infant were collected to screen for ESBL-PE. A Cox proportional hazards model was performed to identify factors associated with the first ESBL-PE acquisition. The incidence rate of ESBL-PE acquisition was 10.4 cases/1000 newborn-days [95% CI: 8.0–13.4 cases per 1000 newborn-days]. Of the 83 ESBL-PE isolates identified, Escherichia coli was the most frequent species (n = 28, 34.1%), followed by Klebsiella pneumoniae (n = 20, 24.4%). Cox multivariate analysis showed that independent risk factors for ESBL-PE acquisition were low birth weight (adjusted Hazard-ratio (aHR) = 2.7, 95% CI [1.2; 5.9]), cesarean-section, (aHR = 3.4, 95% CI [1.7; 7.1]) and maternal use of antibiotics at delivery (aHR = 2.2, 95% CI [1.1; 4.5]). Our results confirm that mothers play a significant role in the neonatal acquisition of ESBL-PE. In LMICs, public health interventions during pregnancy should be reinforced to avoid unnecessary caesarean section, unnecessary antibiotic use at delivery and low birth weight newborns.
Collapse
Affiliation(s)
| | | | | | | | - Michael Padget
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
| | - Agathe de Lauzanne
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Awa Ndir
- Epidemiology and Infectious Diseases Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Elsa Kermorvant-Duchemin
- Paris Descartes University and AP-HP, Necker-Enfants Malades University Hospital, Department of Neonatology, Paris, France
| | - Benoit Garin
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Jean-Marc Collard
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
| | - Bich-Tram Huynh
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
- * E-mail:
| | - Elisabeth Delarocque-Astagneau
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
| | | |
Collapse
|
32
|
Nepal K, Pant ND, Neupane B, Belbase A, Baidhya R, Shrestha RK, Lekhak B, Bhatta DR, Jha B. Extended spectrum beta-lactamase and metallo beta-lactamase production among Escherichia coli and Klebsiella pneumoniae isolated from different clinical samples in a tertiary care hospital in Kathmandu, Nepal. Ann Clin Microbiol Antimicrob 2017; 16:62. [PMID: 28927454 PMCID: PMC5605977 DOI: 10.1186/s12941-017-0236-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background Extended spectrum beta-lactamase (ESBL) and metallo beta-lactamase (MBL) production in Klebsiella pneumoniae and Escherichia coli are the commonest modes of drug resistance among these commonly isolated bacteria from clinical specimens. So the main purpose of our study was to determine the burden of ESBL and MBL production in E. coli and K. pneumoniae isolated from clinical samples. Further, the antimicrobial susceptibility patterns of E. coli and K. pneumoniae were also determined. Methods A cross-sectional study was conducted at Om Hospital and Research Centre, Kathmandu, Nepal by using the E. coli and K. pneumoniae isolated from different clinical samples (urine, pus, body fluids, sputum, blood) from May 2015 to December 2015. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion technique. Extended spectrum beta-lactamase production was detected by combined disc method using ceftazidime and ceftazidime/clavulanic acid discs and cefotaxime and cefotaxime/clavulanic acid discs. Similarly, metallo beta-lactamase production was detected by combined disc assay using imipenem and imipenem/ethylenediaminetetracetate discs. Bacteria showing resistance to at least three different classes of antibiotics were considered multidrug resistant (MDR). Results Of total 1568 different clinical samples processed, 268 (17.1%) samples were culture positive. Among which, E. coli and K. pneumoniae were isolated from 138 (51.5%) and 39 (14.6%) samples respectively. Of the total isolates 61 (34.5%) were ESBL producers and 7 (4%) isolates were found to be MBL producers. High rates of ESBL production (35.9%) was noted among the clinical isolates from outpatients, however no MBL producing strains were isolated from outpatients. Among 138 E. coli and 39 K. pneumoniae, 73 (52.9%) E. coli and 23 (59%) K. pneumoniae were multidrug resistant. The lowest rates of resistance was seen toward imipenem followed by piperacillin/tazobactam, amikacin and cefoperazone/sulbactam. Conclusions High rate of ESBL production was found in the E. coli and K. pneumoniae isolated from outpatients suggesting the dissemination of ESBL producing isolates in community. This is very serious issue and can’t be neglected. Regular monitoring of rates of ESBL and MBL production along with multidrug resistance among clinical isolates is very necessary.
Collapse
Affiliation(s)
- Krishus Nepal
- Department of Microbiology, GoldenGate International College, Battisputali, Kathmandu, Nepal
| | - Narayan Dutt Pant
- Department of Microbiology, Grande International Hospital, Dhapasi, Kathmandu, Nepal.
| | - Bibhusan Neupane
- Department of Microbiology, GoldenGate International College, Battisputali, Kathmandu, Nepal
| | - Ankit Belbase
- Department of Microbiology, GoldenGate International College, Battisputali, Kathmandu, Nepal
| | - Rikesh Baidhya
- Department of Microbiology, GoldenGate International College, Battisputali, Kathmandu, Nepal
| | - Ram Krishna Shrestha
- Department of Laboratory Medicine, OM Hospital and Research Center, Chabahil, Kathmandu, Nepal
| | - Binod Lekhak
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Dwij Raj Bhatta
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bharat Jha
- Department of Laboratory Medicine, OM Hospital and Research Center, Chabahil, Kathmandu, Nepal
| |
Collapse
|
33
|
Gona F, Caio C, Iannolo G, Monaco F, Di Mento G, Cuscino N, Fontana I, Panarello G, Maugeri G, Mezzatesta ML, Stefani S, Conaldi PG. Detection of the IncX3 plasmid carrying blaKPC-3 in a Serratia marcescens strain isolated from a kidney-liver transplanted patient. J Med Microbiol 2017; 66:1454-1456. [PMID: 28920846 DOI: 10.1099/jmm.0.000592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Dissemination of resistance to carbapenems among Enterobacteriaceae through plasmids is an increasingly important concern in health care worldwide. Here we report the first description of an IncX3 plasmid carrying the blaKPC-3 gene in a strain of Serratia marcescens isolated from a kidney-liver transplanted patient at the transplantation centre ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy). To localize the transposable element containing the resistance-associated gene Next-Generation Sequencing of the bacterial DNA was performed. S. marcescens was positive for blaKPC-3 and blaSHV-11 genes. The molecular analysis demonstrated that the blaKPC-3 gene of this bacterial strain was located in one copy of the Tn-3-like element Tn4401-a carried in a plasmid that is 53 392 bp in size and showed the typical IncX3 scaffold. Our data demonstrated the presence of a new blaKPC-3 harbouring the IncX3 plasmid in S. marcescens. The possible dissemination among Enterobacteriaceae of this type of plasmid should be monitored and evaluated in terms of clinical risk.
Collapse
Affiliation(s)
- Floriana Gona
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Carla Caio
- Fondazione Ri.MED, Regenerative Medicine and Biomedical Technologies Unit, Palermo, Italy
| | - Gioacchin Iannolo
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Francesco Monaco
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Giuseppina Di Mento
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Nicola Cuscino
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Ignazio Fontana
- Institute of Biosciences and Bioresources, National Research Council (IBBR-CNR), Palermo, Italy
| | | | - Gaetano Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Italy
| | - Maria Lina Mezzatesta
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Italy
| | - Pier Giulio Conaldi
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy.,Fondazione Ri.MED, Regenerative Medicine and Biomedical Technologies Unit, Palermo, Italy
| |
Collapse
|
34
|
Shakya P, Shrestha D, Maharjan E, Sharma VK, Paudyal R. ESBL Production Among E. coli and Klebsiella spp. Causing Urinary Tract Infection: A Hospital Based Study. Open Microbiol J 2017; 11:23-30. [PMID: 28553414 PMCID: PMC5427687 DOI: 10.2174/1874285801711010023] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/26/2017] [Accepted: 02/08/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction: Increase in extended-spectrum β-lactamases (ESBL) producing microbes in recent years has led to limitations of treatment options. This study aimed to assess the prevalence of ESBL producing E. coli and Klebsiella spp. at a tertiary hospital in Nepal. Methods: A total of 2209 non-repetitive mid-stream urine (MSU) samples were collected during the study period (March to September 2014). Identification of the isolates was done by Gram's staining followed by biochemical tests. Antibiotic susceptibility testing was done by modified Kirby-Bauer disc diffusion method and interpretation was done following Clinical and Laboratory Standard Institute (CLSI) guidelines, 2013. ESBL screening among E. coli and Klebsiella spp. isolates were done using ceftriaxone, cefotaxime, ceftazidime and cefpodoxime. The confirmation was done by phenotypic disc diffusion test (combined disc method) using ceftazidime (30µg) and ceftazidime plus clavulanic acid (30/10µg), and cefotaxime (30µg) and cefotaxime plus clavulanic acid (30/10µg) disc as per CLSI guidelines. Results: A total of 451 samples showed significant bacteriuria with 365 (80.9%) E. coli, 17 (3.8%) Klebsiella pneumoniae and 3 (0.7%) Klebsiella oxytoca. Of 451 isolates, 236 (52.3%) were found MDR strains. By combined disk test, 33 (91.7%) E. coli and 3 (8.3%) Klebsiella spp. were found ESBL producers. Conclusion: Higher prevalence of ESBL producing E. coli and Klebsiella spp. was observed warranting prompt need of surveillance for effective management of such MDR strains.
Collapse
Affiliation(s)
- Pooja Shakya
- Department of Microbiology, Kathmandu College of Science and Technology, Kathmandu, Nepal
| | - Dhiraj Shrestha
- Department of Microbiology, Tri-Chandra Multiple College, Ghantaghar, Kathmandu, Nepal
| | - Elina Maharjan
- Department of Microbiology, Kathmandu College of Science and Technology, Kathmandu, Nepal
| | - Vijay K Sharma
- Department of Biochemistry, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Rabin Paudyal
- Department of Microbiology, Tri-Chandra Multiple College, Ghantaghar, Kathmandu, Nepal
| |
Collapse
|
35
|
Muzslay M, Moore G, Alhussaini N, Wilson A. ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections. J Hosp Infect 2017; 95:59-64. [DOI: 10.1016/j.jhin.2016.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/03/2016] [Indexed: 10/21/2022]
|
36
|
Ansari S, Dhital R, Shrestha S, Thapa S, Puri R, Chaudhary N, Khatiwada S, Gautam R. Growing Menace of Antibacterial Resistance in Clinical Isolates of Pseudomonas aeruginosa in Nepal: An Insight of Beta-Lactamase Production. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6437208. [PMID: 27642599 PMCID: PMC5011509 DOI: 10.1155/2016/6437208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 07/17/2016] [Indexed: 01/13/2023]
Abstract
Introduction. Pseudomonas aeruginosa is the most frequently isolated organism as it acts as the opportunistic pathogen and can cause infections in immunosuppressed patients. The production of different types of beta-lactamases renders this organism resistant to many commonly used antimicrobials. Therefore, the aim of this study was to document the antibiotic resistance rate in Pseudomonas aeruginosa isolated from different clinical specimens. Methods. Pseudomonas aeruginosa recovered was identified by standard microbiological methods. Antibiotic susceptibility testing was performed by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines and all the suspected isolates were tested for the production of ESBLs, MBLs, and AmpC. Results. Out of total (178) isolates, 83.1% were recovered from the inpatient department (IPD). Majority of the isolates mediated resistance towards the beta-lactam antibiotics, while nearly half of the isolates were resistant to ciprofloxacin. Most of the aminoglycosides used showed resistance rate up to 75% but amikacin proved to be better option. No resistance to polymyxin was observed. ESBLs, MBLs, and AmpC mediated resistance was seen in 33.1%, 30.9%, and 15.7% isolates, respectively. Conclusions. Antibiotic resistance rate and beta-lactamase mediated resistance were high. Thus, regular surveillance of drug resistance is of utmost importance.
Collapse
Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Rabindra Dhital
- Department of Laboratory Medicine, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Sony Shrestha
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Sangita Thapa
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Ram Puri
- Department of Laboratory Medicine, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Niraj Chaudhary
- Department of Laboratory Medicine, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Suresh Khatiwada
- Department of Laboratory Medicine, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Rajendra Gautam
- Department of Microbiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| |
Collapse
|
37
|
Bhandari R, Pant ND, Poudel A, Sharma M. Assessment of the effectiveness of three different cephalosporin/clavulanate combinations for the phenotypic confirmation of extended-spectrum beta-lactamase producing bacteria isolated from urine samples at National Public Health Laboratory, Kathmandu, Nepal. BMC Res Notes 2016; 9:390. [PMID: 27488224 PMCID: PMC4972983 DOI: 10.1186/s13104-016-2192-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/28/2016] [Indexed: 12/05/2022] Open
Abstract
Background The extended-spectrum β-lactamase (ESBL) producing bacteria are present as the serious public health problems due to their resistance to large number of antibiotics. The main aims of this study were to determine the prevalence and antibiotic resistance patterns of bacteria producing extended-spectrum β-lactamases (ESBLs) and to find the suitable cephalosporin/clavulanate combination for phenotypic confirmation of ESBL production. Methods During the study period from April 2013 to November 2013, a total of 1003 urine samples from the patients visiting National Public Health Laboratory, Kathmandu, Nepal were collected and processed. The isolates were identified with the help of colony characteristics, gram stain and conventional biochemical tests. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method. ESBL production screening was done by using ceftriaxone, while ESBL production confirmation was done by using three different 3rd generation cephalosporin/clavulanate combinations. Results Of the 138 isolates, Escherichia coli was the most predominant with 88 (63.8 %) isolates. Among the antibiotics tested for gram negative bacteria, highest susceptibility was seen toward imipenem followed by amikacin. Of the total isolates, 68 (49.3 %) were suspected as ESBL producers. Of these, 44 (64.7 %) were phenotypically confirmed to be ESBL producers. The majority of ESBL producers were E. coli with 34 (72.3 %) isolates. Of the three different 3rd generation cephalosporin/clavulanate combinations used, ceftazidime/clavulanate combination was found to be most effective for phenotypic confirmation of ESBL producers and was statistically highly significant (P < 0.01). Conclusion Based on the findings of our study, we recommend to use ceftazidime/clavulanate combination for phenotypic confirmation of ESBL producers. Routine ESBL testing for uropathogens along with conventional antibiogram would be useful for proper early management of all the cases of urinary tract infections.
Collapse
Affiliation(s)
- Raju Bhandari
- Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal
| | - Narayan Dutt Pant
- Department of Microbiology, Grande International Hospital, Dhapasi, Kathmandu, Nepal.
| | - Asia Poudel
- Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal
| | - Mukunda Sharma
- National Public Health Laboratory, Teku, Kathmandu, Nepal
| |
Collapse
|
38
|
Amraei S, Hashemi Karouei SM, Babakhani S, Kazemi MJ. Serotyping and Antibiotic Susceptibility Pattern of Common Bacterial Uropathogens in Urinary Tract Infections in Koohdasht, Lorestan Province. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2016. [DOI: 10.17795/ijep.34824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
39
|
Leski TA, Taitt CR, Bangura U, Stockelman MG, Ansumana R, Cooper WH, Stenger DA, Vora GJ. High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone. BMC Infect Dis 2016; 16:167. [PMID: 27090787 PMCID: PMC4836052 DOI: 10.1186/s12879-016-1495-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 04/06/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rising level of antimicrobial resistance among bacterial pathogens is one of the most significant public health problems globally. While the antibiotic resistance of clinically important bacteria is closely tracked in many developed countries, the types and levels of resistance and multidrug resistance (MDR) among pathogens currently circulating in most countries of sub-Saharan Africa are virtually unknown. METHODS From December 2013 to April 2014, we collected 93 urine specimens from all outpatients showing symptoms of urinary tract infection (UTI) and 189 fomite swabs from a small hospital in Bo, Sierra Leone. Culture on chromogenic agar combined with biochemical and DNA sequence-based assays was used to detect and identify the bacterial isolates. Their antimicrobial susceptibilities were determined using a panel of 11 antibiotics or antibiotic combinations. RESULTS The 70 Enterobacteriaceae urine isolates were identified as Citrobacter freundii (n = 22), Klebsiella pneumoniae (n = 15), Enterobacter cloacae (n = 15), Escherichia coli (n = 13), Enterobacter sp./Leclercia sp. (n = 4) and Escherichia hermannii (n = 1). Antimicrobial susceptibility testing demonstrated that 85.7 % of these isolates were MDR while 64.3 % produced an extended-spectrum ß-lactamase (ESBL). The most notable observations included widespread resistance to sulphonamides (91.4 %), chloramphenicol (72.9 %), gentamycin (72.9 %), ampicillin with sulbactam (51.4 %) and ciprofloxacin (47.1 %) with C. freundii exhibiting the highest and E. coli the lowest prevalence of multidrug resistance. The environmental cultures resulted in only five Enterobacteriaceae isolates out of 189 collected with lower overall antibiotic resistance. CONCLUSIONS The surprisingly high proportion of C. freundii found in urine of patients with suspected UTI supports earlier findings of the growing role of this pathogen in UTIs in low-resource countries. The isolates of all analyzed species showed worryingly high levels of resistance to both first- and second-line antibiotics as well as a high frequency of MDR and ESBL phenotypes, which likely resulted from the lack of consistent antibiotic stewardship policies in Sierra Leone. Analysis of hospital environmental isolates however suggested that fomites in this naturally ventilated hospital were not a major reservoir for Enterobacteriaceae or antibiotic resistance determinants.
Collapse
Affiliation(s)
- Tomasz A Leski
- Naval Research Laboratory, Code 6910, 4555 Overlook Avenue SW, Washington, DC, 20375, USA.
| | - Chris R Taitt
- Naval Research Laboratory, Code 6910, 4555 Overlook Avenue SW, Washington, DC, 20375, USA
| | - Umaru Bangura
- Mercy Hospital Research Laboratory, Bo, Sierra Leone.,Njala University, Bo, Sierra Leone
| | - Michael G Stockelman
- Naval Research Laboratory, Code 6910, 4555 Overlook Avenue SW, Washington, DC, 20375, USA
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Bo, Sierra Leone.,Liverpool School of Tropical Medicine, Liverpool, UK.,Njala University, Bo, Sierra Leone
| | | | - David A Stenger
- Naval Research Laboratory, Code 6910, 4555 Overlook Avenue SW, Washington, DC, 20375, USA
| | - Gary J Vora
- Naval Research Laboratory, Code 6910, 4555 Overlook Avenue SW, Washington, DC, 20375, USA
| |
Collapse
|
40
|
Arana DM, Rubio M, Alós JI. Evolution of antibiotic multiresistance in Escherichia coli and Klebsiella pneumoniae isolates from urinary tract infections: A 12-year analysis (2003-2014). Enferm Infecc Microbiol Clin 2016; 35:293-298. [PMID: 27056582 DOI: 10.1016/j.eimc.2016.02.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/31/2016] [Accepted: 02/20/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The aim of this study was to identify multi-drug resistance (MDR) in the main enterobacteriaceae implicated in urinary tract infections (Escherichia coli and Klebsiella pneumoniae) from both, community and hospitalized patients and to analyze the evolution over a 12-year period. METHODS Microb Dynamic software was used to analyze the microbiology laboratory database and a chi square test was applied to compare differences in group proportions and to determine the linear trend over 12 years in three different periods: 2003-2006, 2007-2010, 2011-2014. We chose amoxicillin, gentamicin, ciprofloxacin and trimethoprim-sulphamethoxazole as MDR markers. RESULTS A total of 39,980 positive urine samples were analyzed, 34,564 (3786 from hospitalized patients and 30,778 from non-hospitalized patients) E. coli isolates, and 5,422 (774 from hospitalized patients and 4,648 from non-hospitalized patients) K. pneumoniae isolates. The prevalence of UTI due to MDR E. coli and MDR K. pneumoniae significantly increased in the period studied, both in hospitalized and outpatients. A higher percentage of MDR E. coli (5.89% in 2007-2010 versus 8.18% in 2011-2014) and MDR K. pneumoniae (2.38% in 2007-2010 versus 9.35% in 2011-2014) was evident and maintained constant over time in hospitalized patients in comparison to non-hospitalized ones. Infection due to MDR ESBL-producing E. coli and K. pneumoniae increased significantly during the last 8 years in both, hospitalized (20% versus 38% and 66.8% versus 82.6%, respectively) and non-hospitalized patients (18.2% versus 23.6% and 51% versus 74.6%, respectively). CONCLUSIONS This study includes data of a large sample size of urinary strains isolated over a 12 year period and demonstrates that MDR is an increasing phenomenon of particular importance in the main UTI-causing species.
Collapse
Affiliation(s)
- David M Arana
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Margarita Rubio
- Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Juan-Ignacio Alós
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
| |
Collapse
|
41
|
Hadifar S, Moghoofei M, Nematollahi S, Ramazanzadeh R, Sedighi M, Salehi-Abargouei A, Miri A. Epidemiology of Multidrug Resistant Uropathogenic Escherichia coli in Iran: a Systematic Review and Meta-Analysis. Jpn J Infect Dis 2016; 70:19-25. [PMID: 27000462 DOI: 10.7883/yoken.jjid.2015.652] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Urinary tract infection (UTI) is one of the most common infections in humans. It is primarily caused by uropathogenic Escherichia coli (UPEC), which has a high multidrug resistance (MDR). In consideration of the prevalence of MDR-UPEC strains, the aims of the present study were to systematically review the published data about the prevalence rate of MDR-UPEC from different parts of Iran and to establish the overall relative frequency (RF) of these strains in Iran. We searched several databases including PubMed, ISI Web of Science, Scopus, Google Scholar, IranMedex, and Iranian Scientific Information Database by using the following keywords: "Escherichia coli", "multidrug resistant", "MDR", "urinary tract infections", "UTI", "uropathogenic". and "Iran". Articles or abstracts that reported the prevalence of MDR-UPEC were included in this review. We found 15 articles suitable for inclusion in this study. A pooled estimation of 10,247 UPEC strains showed that 49.4% (95% confidence interval = 48.0-50.7%) of the stranis were MDR positive. The RF of MDR-UPEC in different studies varied from 10.5% to 79.2% in the Kashan and Hamedan provinces, respectively. According to the results of the present study, the RF of MDR-UPEC in Iran is high. Thus, measures should be taken to keep the emergence and transmission of these strains to a minimum.
Collapse
Affiliation(s)
- Shima Hadifar
- Department of Microbiology, Pasteur Institute of Tehran
| | | | | | | | | | | | | |
Collapse
|
42
|
Dehbanipour R, Rastaghi S, Sedighi M, Maleki N, Faghri J. High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran. J Nat Sci Biol Med 2016; 7:22-6. [PMID: 27003964 PMCID: PMC4780161 DOI: 10.4103/0976-9668.175020] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Urinary tract infection (UTI) is one of the most frequent infectious diseases and can occur in all age groups. Escherichia coli is the main cause of this infection. Multiple resistances to antimicrobial agents are increasing quickly in E. coli isolates and may complicate therapeutic strategies for UTI. The aim of this study was to determine the antibiotic resistance pattern and the multidrug-resistance (MDR) phenotypes in uropathogenic E. coli (UPEC). MATERIALS AND METHODS A total of 135 UPEC isolates were collected from both outpatients (91 isolates) and inpatients (44 isolates) between September, 2012 and February, 2013. In order to determine the MDR among UPEC isolates, we have tested 15 antimicrobial agents and antibiotic susceptibility was done by Kirby-Bauer disk diffusion method. RESULTS The percentage of MDR isolates (resistant to at least three drug classes such as aminoglycosides, fluoroquinolones, penicillins, cephalosporins, or carbapenems) was 68% in the inpatients and 61% in the outpatients. Antibiotic resistance to ampicillin, ceftazidim, nalidixic acid, and trimethoprim/sulfamethoxazole were higher than 50%. Amikacin, nitrofurantoin, and gentamicin showed markedly greater activity (89.1%, 85.9%, and 82.4% sensitivity, respectively) than other antimicrobial agents. Resistance to meropenem did show either in outpatients or in inpatients. INTERPRETATION AND CONCLUSIONS The high prevalence of drug resistance among UTI patients calls for continuous monitoring of the incidence of drug resistance for appropriate empiric selection of antibiotic therapy. Empirical treatment of UTIs should be relied on susceptibility patterns from local studies.
Collapse
Affiliation(s)
- Razieh Dehbanipour
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedighe Rastaghi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Tehran, Iran
| | - Mansour Sedighi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Maleki
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Faghri
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
43
|
Abstract
ABSTRACT
Antimicrobial agents of various types have important bearing on the outcomes of microbial infections. These agents may be bacteriostatic or –cidal, exert their impact via various means, originate from a living organism or a laboratory, and appropriately be used in or on living tissue or not. Though the primary focus of this chapter is on resistance to the antimicrobial agents used to treat uropathogenic
Escherichia coli
(UPEC)-caused urinary tract infections (UTIs), some attention will be given to UPEC’s resistance to silver-containing antiseptics, which may be incorporated into catheters to prevent foreign body-associated UTIs.
Collapse
|
44
|
Saha S, Rahman S, Hassan FMN, Sarkar S, Islam K, Saha P, Alam B, Sultana N, Rahman KMT, Sumi SS, Islam F, Hasan S. Antimicrobial Resistance in Uropathogen Isolates from Patients with Urinary Tract Infections. BIOMEDICAL RESEARCH AND THERAPY 2015. [DOI: 10.7603/s40730-015-0011-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
45
|
Ansari S, Nepal HP, Gautam R, Shrestha S, Neopane P, Gurung G, Chapagain ML. Community acquired multi-drug resistant clinical isolates of Escherichia coli in a tertiary care center of Nepal. Antimicrob Resist Infect Control 2015; 4:15. [PMID: 25937923 PMCID: PMC4416386 DOI: 10.1186/s13756-015-0059-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 04/16/2015] [Indexed: 11/24/2022] Open
Abstract
Background Multi-drug resistance (MDR) in Gram-negative organisms is an alarming problem in the world. MDR and extensively-drug resistance (XDR) is in increasing trend due to the production of different types of beta (β)-lactamases. Thus the aim of this study was to document the incidence of MDR and XDR in clinical isolates of Escherichia coli and also to find out the enzymatic mechanisms of β-lactam antibiotics resistance. Methods Two hundred clinical isolates of Escherichia coli (E. coli) identified by standard laboratory methods were studied. Antibiotic susceptibility profile was performed for all the isolates and the suspected isolates were phenotypically tested for the production of extended spectrum β-lactamase (ESBL), metallo β-lactamase (MBL) and AmpC β-lactamase (AmpC) by recommended methods. Results Around three-fourth (78%) of the total isolates were multi-drug resistant. ESBL, MBL and AmpC production was found in 24%, 15% and 9% of isolates respectively. Amikacin, chloramphenicol and colistin were found to be the most effective antibiotics. Conclusions High percentage of MDR was observed. β-lactamase mediated resistance was also high. Thus, regular surveillance of drug resistance due to β-lactamases production and infection control policy are of utmost importance to minimize the spread of resistant strains.
Collapse
Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal
| | - Hari Prasad Nepal
- Department of Microbiology, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal
| | - Rajendra Gautam
- Department of Microbiology, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal
| | - Sony Shrestha
- Department of Microbiology, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal
| | - Puja Neopane
- Department of Microbiology, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal
| | - Ganga Gurung
- College of Nursing, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal
| | - Moti Lal Chapagain
- Department of Microbiology, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal
| |
Collapse
|
46
|
Hamdan HZ, Kubbara E, Adam AM, Hassan OS, Suliman SO, Adam I. Urinary tract infections and antimicrobial sensitivity among diabetic patients at Khartoum, Sudan. Ann Clin Microbiol Antimicrob 2015; 14:26. [PMID: 25896611 PMCID: PMC4406170 DOI: 10.1186/s12941-015-0082-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/23/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patients with diabetes mellitus (DM) are more susceptible to urinary tract infection (UTI) than non-diabetics. Due to the emergence of multidrug resistant (MDR) uropathogenic strains, the choice of antimicrobial agent is restricted. This study investigated the epidemiology of UTI, antimicrobial susceptibility, and resistance patterns of bacterial isolates from adult diabetic patients. METHODS A cross-sectional study was conducted at Khartoum Hospital, Sudan during the period of March - September 2013. Consecutive patients (men and women) were approached to participate in the study, irrespective of UTI symptoms. Socio-demographic and clinical data were obtained from each participant using pre-tested questionnaires. Clean-catch, midstream urine samples were collected and cultured for UTI diagnosis and antimicrobial susceptibility. Symptomatic bacteriuria was defined as a positive urine culture (≥10(5) colony-forming units [CFU]/mL of a single bacterial species) from patients with symptoms associated with UTI; asymptomatic bacteriuria was defined as a positive urine culture from patients without symptoms associated with UTI. RESULTS A total of 200 diabetic patients were enrolled, 121 (60.5%) men and 79 (39.5%) women; 193 (96.5%) had type II DM. The overall prevalence of UTI was 39 (19.5%). Among the total population, 17.1% and 20.9% had symptomatic and asymptomatic bacteriuria, respectively. According to multivariate logistic regression, none of the investigated factors (age, sex, type of DM and duration) were associated with UTI. The predominant isolates were Escherichia coli (22, [56.4%]), and Klebsiella pneumoniae, [9, (23%)]. Eight of 22 E. coli, four of nine K. pneumoniae and one of five Enterococcus faecalis isolates originated from symptomatic patients. Six, four, three, and two of 22 E. coli isolates showed resistance to ampicillin, co-trimoxazole, nitrofurantoin, and amoxicillin-clavulanic acid, respectively. Two, two, one and one of nine K. pneumoniae isolates were resistant to ampicillin, co-trimoxazole, cephalexin, and amoxicillin-clavulanic acid. All 22 E. coli isolates were sensitive (100%) to gentamicin and cephalexin. All nine K. pneumoniae were sensitive to gentamicin (100%) and 88.8% were sensitive to cephalexin. CONCLUSION In Sudan, about one-fifth of diabetic patients have UTI. E. coli is the most frequent isolate followed by K. pneumoniae.
Collapse
Affiliation(s)
- Hamdan Z Hamdan
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box 12702, Khartoum, Sudan.
| | - Eman Kubbara
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box 12702, Khartoum, Sudan.
| | - Amar M Adam
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, P.O. Box 12702, Khartoum, Sudan.
| | - Onab S Hassan
- Faculty of Pharmacy, Al-Yarmouk University College, Khartoum, Sudan.
| | - Sarah O Suliman
- Faculty of Medical Laboratory, Omdurman Al-Ahlia University, Omdurman, Sudan.
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khartoum University, P.O. Box 102, Khartoum, Sudan.
| |
Collapse
|
47
|
Eshetie S, Unakal C, Gelaw A, Ayelign B, Endris M, Moges F. Multidrug resistant and carbapenemase producing Enterobacteriaceae among patients with urinary tract infection at referral Hospital, Northwest Ethiopia. Antimicrob Resist Infect Control 2015; 4:12. [PMID: 25908966 PMCID: PMC4407313 DOI: 10.1186/s13756-015-0054-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Updates on the epidemiology of antibiotic resistance bacterial pathogens is important. This is because the spread of multidrug resistant enterobacteriaceae (MDRE) and recently carbapenemase producing enterobacteriaceae (CPE) have emerged as a major public health concern in patients with urinary tract infections (UTIs). This study is therefore, aimed to assess the prevalence and associated risk factors of MDR and CPE among patients with UTIs. METHODS A cross sectional study was conducted among 442 symptomatic UTI suspected patients. Data on socio-demographic characteristics, clinical information and possible risk factors were collected using structured questionnaire. Early morning mid-stream urine samples were collected and processed to characterize bacterial isolates. Disk diffusion method was used to determine the antibiotic susceptibility patterns of isolates. Carbapenemase producing strains were detected using CHROMagar KPC medium. Data were entered and analyzed using SPSS version 20. P-value <0.05 was considered as statistical significant. RESULTS Among 442 patients enrolled a total of 183 Enterobacteriaceae were recovered. Of these isolates; 160 (87.4%) were MDRE; the most common isolates were K. pneumoniae and E.coli. Five (2.73%) of the isolates were found to be carbapenemase producers and all of CPE strains were 100% ESBL producers. Significant drug resistances were observed among CPE compared to other MDRE, low resistance rates were noted to ciprofloxacin (20%). Being female (OR 4.46; P = 0.018), age (OR 1.08; P = 0.001), hospitalization (OR 5.23; P = 0.006), and prior antibiotic use (OR 3.98; P = 0.04) were associated risk factors for MDRE. CONCLUSION AND RECOMMENDATION High rates of MDR (87.4%) were observed among enterobacteriaceae uropathogens; K. pneumoniae and E.coli were the principal MDR isolates. Overall prevalence of CPE was 2.73% and all of these strains were 100% ESBL producer. Attributing risk factors for MDR UTIs were found to be sex (female), age, hospitalization, and history of antibiotic therapy. Therefore, efforts should be made to reduce patient hospital stay and maximize rational use of drugs. Additional and vigorous investigation especially on CPE should be encouraged.
Collapse
Affiliation(s)
- Setegn Eshetie
- Department of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | | | - Aschalew Gelaw
- Department of Microbiology, University of Gondar, Gondar, Ethiopia
| | | | - Mengistu Endris
- Department of Microbiology, University of Gondar, Gondar, Ethiopia
| | - Feleke Moges
- Department of Microbiology, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
48
|
Incidence and diversity of antimicrobial multidrug resistance profiles of uropathogenic bacteria. BIOMED RESEARCH INTERNATIONAL 2015; 2015:354084. [PMID: 25834814 PMCID: PMC4365316 DOI: 10.1155/2015/354084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/23/2015] [Indexed: 01/05/2023]
Abstract
The aim of this study was to assess the most frequent multidrug resistant (MDR) profiles of the main bacteria implicated in community-acquired urinary tract infections (UTI). Only the MDR profiles observed in, at least, 5% of the MDR isolates were considered. A quarter of the bacteria were MDR and the most common MDR profile, including resistance to penicillins, quinolones, and sulfonamides (antibiotics with different mechanisms of action, all mainly recommended by the European Association of Urology for empirical therapy of uncomplicated UTI), was observed, alone or in association with resistance to other antimicrobial classes, in the main bacteria implicated in UTI. The penicillin class was included in all the frequent MDR profiles observed in the ten main bacteria and was the antibiotic with the highest prescription during the study period. The sulfonamides class, included in five of the six more frequent MDR profiles, was avoided between 2000 and 2009. The results suggest that the high MDR percentage and the high diversity of MDR profiles result from a high prescription of antibiotics but also from antibiotic-resistant genes transmitted with other resistance determinants on mobile genetic elements and that the UTI standard treatment guidelines must be adjusted for the community of Aveiro District.
Collapse
|
49
|
Molecular characterization of Escherichia coli isolates from patients with urinary tract infections in Palestine. J Med Microbiol 2014; 63:229-234. [DOI: 10.1099/jmm.0.067140-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Antibiotic resistance of Escherichia coli isolated from urinary tract infections (UTIs) is increasing worldwide. A total of 41 E. coli isolates were obtained from urine samples from hospitalized patients with a UTI in three hospitals in the northern districts of the West Bank, Palestine during March and June 2011. Resistance rates were: erythromycin (95 %), trimethoprim–sulfamethoxazole (59 %), ciprofloxacin (56 %), gentamicin (27 %), imipenem (22 %), amoxicillin (93 %), amoxicillin–clavulanic acid (32 %), ceftazidime (66 %) and cefotaxime (71 %). No meropenem-resistant isolates were identified in this study. Among the isolates, phylogenetic group B2 was observed in 13 isolates, D in 12 isolates, A in 11 isolates and B1 in five isolates. Thirty-five of the isolates were positive for an extended-spectrum β-lactamase phenotype. Among these isolates, the bla
CTX-M gene was detected in 25, and eight harboured the bla
TEM gene. None of the isolates contained the bla
SHV gene. Transformation experiments indicated that some of the β-lactamase genes (i.e. bla
CTX-M and bla
TEM) with co-resistance to erythromycin and gentamicin were plasmid encoded and transmissible. Apart from this, enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) revealed that the 41 isolates were genetically diverse and comprised a heterogeneous population with 11 ERIC-PCR profiles at a 60 % similarity level.
Collapse
|
50
|
Chander A, Shrestha CD. Prevalence of extended spectrum beta lactamase producing Escherichia coli and Klebsiella pneumoniae urinary isolates in a tertiary care hospital in Kathmandu, Nepal. BMC Res Notes 2013; 6:487. [PMID: 24274894 PMCID: PMC4222089 DOI: 10.1186/1756-0500-6-487] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Escherichia coli and Klebsiella pneumoniae are the major bacterial pathogens being isolated and reported from mid stream urine (MSU) specimens, globally. These uropathogens are mostly implicated as the major extended spectrum beta-lactamase (ESBL) producers, severely limiting the therapeutic management in cases of urinary tract infections. Limited studies had been reported from Nepal investigating the ESBL producers among uropathogens. This study was designed to assess the prevalence of ESBL producing E.coli and K. pneumoniae in urinary isolates at a centrally located major tertiary care hospital in Kathmandu valley, Nepal. METHODS Between September 2011 and May 2012, during the nine months period, 6308 MSU specimens were collected aseptically from the same number of clinically suspected patients of urinary tract infections. The samples were cultured on MacConkey agar and blood agar. The isolates with significant bacteriuria (105 CFU / ml) were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs alongwith ceftriaxone on E.coli and K. pneumoniae isolates by Kirby Bauer disc diffusion method as per the recommendations of CLSI. On initial screening with ceftriaxone (30 μg) disc showing resistance was then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 ug) and ceftazidime + clavulanic acid (30 μg + 10ug) disc as per guidelines of CLSI (2011). RESULTS Out of a total of 6308 MSU specimens investigated for significant bacteriuria, E.coli isolates were 444 (7.04%) and K.pneuminiae were 145 (2.3%) making a total of 589 (9.34%). Initial screening with ceftriaxone disc revealed 155 isolates of E.coli and 70 isolates of K.pneumoniae to be resistant. Further testing by PCDDT method showed 60/444 (=13.51%) of E. coli and 24/145 (=16.55%) of K. pneumoniae isolates to be confirmed ESBL producers. These ESBL - producer uropathogens showed high degree of resistance to ceftriaxone (100.0%), amoxycillin, fluoroquinolones and co-trimoxazole. CONCLUSION An emerging and moderately high prevalence of ESBL-producing E. coli and K. pneumoniae was observed and confirmed in the urinary isolates investigated. It is essential to have a regular and routine monitoring of ESBL producing clinical isolates in laboratory practice.
Collapse
Affiliation(s)
- Anil Chander
- Department of Microbiology, Kathmandu Medical College Teaching Hospital Sinamangal / Duwakot, Kathmandu, Nepal.
| | | |
Collapse
|