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Mohamed AA, Bastug Y, Senol C, Kassim MM, Yusuf AA, Mohamed AH. Antimicrobial resistance pattern and uropathogens distribution in children visiting a referral hospital in Mogadishu. Future Sci OA 2024; 10:FSO978. [PMID: 38817370 PMCID: PMC11137854 DOI: 10.2144/fsoa-2023-0298] [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: 11/26/2023] [Accepted: 02/14/2024] [Indexed: 06/01/2024] Open
Abstract
Aim: Studies concerning epidemiology and drug susceptibility patterns of pediatric urinary tract infection in developing countries are scarce. This study aimed to evaluate the antimicrobial resistance pattern and uropathogens distribution in children. Method: Four-year retrospective study included 840 participants in all pediatric age groups whose urine had been cultured. Results: The prevalence of culture-proven pediatric UTIs was 17.6% (148/840). Escherichia coli was the most common pathogen isolated from the cultures, accounting for (48%, 71/148), followed by Klebsiella pneumoniae (16.2%, 24/148). About 27% of the pathogens had a multidrug-resistant (MDR) pattern. A resistance rate against nitrofurantoin at 24.6%, fosfomycin at 15.2% and trimethoprim-sulfamethoxazole (SMX-TMP) at 79.7% was noted. Conclusion: E. coli and Klebsiella pneumoniae were the most common pathogens isolated.
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Affiliation(s)
- Abdikarin Ahmed Mohamed
- Department of Pediatrics & Child Health, Mogadishu Somalia Turkish Training & Research Hospital, Mogadishu, Somalia
- University of Somalia, Mogadishu, Somalia
| | - Yavuz Bastug
- Department of Pediatrics & Child Health, Mogadishu Somalia Turkish Training & Research Hospital, Mogadishu, Somalia
| | - Cem Senol
- Department of Pediatrics & Child Health, Mogadishu Somalia Turkish Training & Research Hospital, Mogadishu, Somalia
| | - Mohamed Muktar Kassim
- Department of Pediatrics & Child Health, Mogadishu Somalia Turkish Training & Research Hospital, Mogadishu, Somalia
| | - Abdisalam Abdullahi Yusuf
- Department of Pediatrics & Child Health, Mogadishu Somalia Turkish Training & Research Hospital, Mogadishu, Somalia
| | - Abdikarim Hussein Mohamed
- Department of Pediatrics & Child Health, Mogadishu Somalia Turkish Training & Research Hospital, Mogadishu, Somalia
- University of Somalia, Mogadishu, Somalia
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Hou PJ, Lin PY, Lin WL, Hsueh TP. Integrated traditional herbal medicine for recurrent urinary tract infection treatment and follow-up: A meta-analysis of randomized controlled trials. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117491. [PMID: 38012975 DOI: 10.1016/j.jep.2023.117491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Urinary tract infections (UTIs) with pathogenic strain resistance leading to a high recurrence rate affect health quality and have become a high-priority issue due to the economic burden on the health care system. AIM OF THE STUDY This study aimed to investigate the supportive benefits of traditional herbal medicines (THMs) for the treatment and prevention of recurrent UTIs through a meta-analysis of randomized controlled trials. MATERIALS AND METHODS Systematic searches of databases, including PubMed/Medline, the Cochrane Library, and China National Knowledge Infrastructure (CNKI), were conducted to collect eligible studies for meta-analysis. The inclusion criteria were randomized controlled trials that investigated UTI recurrence using THM treatment. RESULTS The results of 22 studies showed that THM treatment led to significantly fewer UTI events in the experimental group than in the control group (OR = 0.348; 95% confidence interval [CI] = 0.257 to 0.473; p < 0.001). Seventeen studies reported UTI events during the follow-up period, and the recurrence rate was lower in the experimental group than in the control group (OR, 0.326; 95% CI, 0.245-0.434; p < 0.01). Subgroup analysis further showed that compared to antibiotics alone, treatment with THM plus antibiotics significantly reduced UTI events in the acute phase (OR = 0.301; 95% CI = 0.201 to 0.431; p < 0.001) as well as in the follow-up period (OR = 0.347; 95% CI = 0.241 to 0.498; p < 0.001). However, THM treatment alone was not superior to antibiotics in the acute treatment phase (OR = 0.540; 95% CI = 0.250 to 1.166; p = 0.117) or in the follow-up period (OR = 0.464; 95% CI = 0.111 to 1.951; p = 0.295). Herbal ingredients for recurrent UTI events also showed benefits compared to placebo treatment in the acute phase (OR = 0.337; 95% CI = 0.158 to 0.717; p = 0.005) and during follow-up (OR = 0.238; 95% CI = 0.139 to 0.409; p < 0.001). CONCLUSIONS THM combined with antibiotics is helpful for people with acute UTIs and for reinfection prevention. THMs alone, although less effective for recurrent UTIs, could be considered a therapeutic alternative to antibiotics.
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Affiliation(s)
- Pei-Ju Hou
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, 83001, Taiwan
| | - Wan-Ling Lin
- Institute of Education, National Sun Yat-Sen University, Kaohsiung, 80424, Taiwan; Department of Traditional Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 81362, Taiwan
| | - Tun-Pin Hsueh
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan; School of Chinese Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan; Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.
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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.
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Thapa TB, Pokhrel S, Lamichhane A, Singh VK, Shrestha O, Sapkota M, Khanal PR. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease. Open Med (Wars) 2023; 18:20230824. [PMID: 37873539 PMCID: PMC10590610 DOI: 10.1515/med-2023-0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 10/25/2023] Open
Abstract
Identifying and appropriately managing urinary tract infections (UTIs) among chronic kidney disease (CKD) patients are essential to reduce further disease complications and economic burden. Hence, this study aims to determine the prevalence of UTIs among CKD patients and study the antibiogram of the bacterial isolates. Four hundred eighty-two clean catch midstream urine samples were collected from CKD patients during the study period. The samples were cultured, and bacteria were isolated using standard microbiological techniques. Antibiotic susceptibility testing was performed by the Kirby-Bauer disc diffusion method following the Clinical and Laboratory Standards Institute guidelines. Of the 482 CKD patients, 15.8% were culture positive, and the majority was elderly aged group population. Most bacterial isolates were Escherichia coli 50%, followed by Pseudomonas aeruginosa 15.80%, Enterococcus species 15.80%, and Klebsiella pneumoniae 11.84%. The majority of bacteria were found to be resistant to beta-lactam antibiotics, ampicillin (94.67%), ceftriaxone (89.04%), cefotaxime (87.5%), and ceftazidime (84.0%), while polymyxin, colistin, vancomycin, meropenem, and imipenem were the most sensitive antibiotics. In our study, higher levels of antibiotic resistance were observed among urinary isolates. Therefore, our findings suggest clinicians to choose better antibiotic options to treat UTIs among CKD patients.
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Affiliation(s)
- Tika Bahadur Thapa
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu, Nepal
- Department of Pathology, Sumeru Hospital Pvt Ltd, Dhapakhel, Lalitpur, Nepal
| | - Sushant Pokhrel
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu, Nepal
| | - Anit Lamichhane
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu, Nepal
- Department of Pathology, Sumeru Hospital Pvt Ltd, Dhapakhel, Lalitpur, Nepal
| | - Vinay Kumar Singh
- Department of Pathology, Sumeru Hospital Pvt Ltd, Dhapakhel, Lalitpur, Nepal
| | - Ojaswee Shrestha
- Department of Pathology, Sumeru Hospital Pvt Ltd, Dhapakhel, Lalitpur, Nepal
| | - Manisha Sapkota
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Soalteemode, Kathmandu, Nepal
| | - Puspa Raj Khanal
- Department of Pathology, Sumeru Hospital Pvt Ltd, Dhapakhel, Lalitpur, Nepal
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Weng X, Liu Y, Hu H, Wang M, Huang X. Changes of microbiota level in urinary tract infections: A meta-analysis. Open Med (Wars) 2023; 18:20230702. [PMID: 37251539 PMCID: PMC10224615 DOI: 10.1515/med-2023-0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 05/31/2023] Open
Abstract
No consensus has been reached on the dysbiosis signs of microbiota in patients with urinary tract infections (UTIs). This meta-analysis aimed to verify the relationship between microbiota levels and UTIs. PubMed, Web of Science, and Embase databases were retrieved for related articles published from inception until October 20, 2021. The standardized mean difference (SMD) and its related 95% confidence intervals (CIs) of the microbiota diversity and abundance were pooled under a random-effects model. Twelve studies were included in this meta-analysis. The pooled analysis revealed that the microbiota diversity was lower in patients with UTIs than in healthy individuals (SMD = -0.655, 95% CI = -1.290, -0.021, I 2 = 81.0%, P = 0.043). The abundance of specific bacteria was higher in UTI subjects compared with healthy control individuals (SMD = 0.41, 95% CI = 0.07-0.74, P = 0.017), especially in North America patients with UTIs. Similar results were also found in studies with the total sample size being greater than 30. Importantly, Escherichia coli levels were increased in patients with UTI, whereas Lactobacillus levels decreased. E. coli and Lactobacilli have huge prospects as potential microbiota markers in the treatment of UTIs.
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Affiliation(s)
- Xia Weng
- Urology Department, Zhejiang Hospital, Hangzhou310013, Zhejiang Province, China
| | - Yajun Liu
- Neurosurgery Department, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Haiping Hu
- Urology Department, Zhejiang Hospital, Hangzhou310013, Zhejiang Province, China
| | - Meichai Wang
- Urology Department, Zhejiang Hospital, Hangzhou310013, Zhejiang Province, China
| | - Xiaoqin Huang
- Orthopedics Department, Zhejiang Hospital, No. 1229, Gudun Road, Hangzhou 310013, Zhejiang Province, China
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Antibiotic Drug Resistance Pattern of Uropathogens in Pediatric Patients in Pakistani Population. Antibiotics (Basel) 2023; 12:antibiotics12020395. [PMID: 36830305 PMCID: PMC9952681 DOI: 10.3390/antibiotics12020395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
The common prevalent diseases in the age of 0 to 6 are related to urinary tract infections. If not properly diagnosed, they will lead to urological and nephrological complications. Uropathogens are developing resistance against most drugs and are harder to treat. A study was done on the inpatients and outpatients of the two hospitals located in Lahore. A total of 39,750 samples that were both male and female were collected. Escherichia and Klebsiella were found in 234 samples based on biochemical characterization, growth on CLED agar, and white blood cell/pus cell (WBC) microscopy. In comparison to males, female samples had a higher number of uropathogens (1:1.29). From the samples of Shaikh Zayed Hospital (SZH), the ratio of Klebsiella to Escherichia (1:1.93) was reported, while this ratio was 1.84:1 from the Children Hospital (CH). The incidence of UTI was higher in the month of September. Randomly selected Escherichia and Klebsiella were verified via a 16S rRNA sequence. Antibiotic resistance profiling of isolated bacterial strains was done against 23 antibiotics. The most efficient antibiotics against Klebsiella and Escherichia were colistin sulphate (100% sensitivity against bacteria from CH; 99.3% against strains from SZH) and polymyxin B (100% sensitivity against strains from SZH; 98.8% against strains from CH). Sensitivity of the total tested strains against meropenem (74%, SZH; 70% CH), Fosfomycin (68%, SZH; 73% CH strains), amikacin (74% SZH; 55% CH), and nitrofurantoin (71% SZH;67% CH) was found, Amoxicillin, ampicillin, and cefuroxime showed 100 to ≥90% resistance and are the least effective.
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Kraszewska Z, Skowron K, Kwiecińska-Piróg J, Grudlewska-Buda K, Przekwas J, Wiktorczyk-Kapischke N, Wałecka-Zacharska E, Gospodarek-Komkowska E. Antibiotic Resistance of Enterococcus spp. Isolated from the Urine of Patients Hospitalized in the University Hospital in North-Central Poland, 2016-2021. Antibiotics (Basel) 2022; 11:antibiotics11121749. [PMID: 36551406 PMCID: PMC9774570 DOI: 10.3390/antibiotics11121749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Urinary Tract Infections (UTIs) are common outpatient and inpatient infections, often treated with empirical therapy. Enterococcus spp. is responsible for about 10% of UTIs. This study aimed to determine the necessity of changing the empirical treatment of UTIs caused by Enterococcus spp. The evaluation was performed for 542 Enterococcus strains isolated from urine samples in the years 2016-2021. We identified three Enterococcus species that were found: E. faecalis (389, 71.8%), E. faecium (151, 27.8%) and E. gallinarum (2, 0.4%). E. faecalis was the dominant species every year. Among E. faecalis, the most prevalent was resistance to norfloxacin (51.4%). Almost all E. faecium strains (150, 99.3%) were resistant to beta-lactams and norfloxacin. Eighty-three strains (55.0%) were resistant to vancomycin and 72 (47.7%) to teicoplanin. E. faecium strains showed a significantly higher percentage of resistance mechanisms GRE (Glicopeptide-Resistant Enterococcus) (72, 48.7%) and VRE (Vancomycin-Resistant Enterococcus) (11, 7.3%), while only five strains of E. feacalis showed a VRE mechanism (1.3%). In the therapy of E. faecalis UTIs, ampicillin and imipenem still remain effective. However, the above-mentioned antibiotics, as well as fluoroquinolones, are not recommended in the treatment of UTIs of E. faecium etiology.
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Affiliation(s)
- Zuzanna Kraszewska
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Krzysztof Skowron
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-512-210-245
| | - Joanna Kwiecińska-Piróg
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Katarzyna Grudlewska-Buda
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Jana Przekwas
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Natalia Wiktorczyk-Kapischke
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Ewa Wałecka-Zacharska
- Department of Food Hygiene and Consumer Health, Wrocław University of Environmental and Life Sciences, 50-375 Wrocław, Poland
| | - Eugenia Gospodarek-Komkowska
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
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DEGER I, ERTUĞRUL S, YOLBAŞ I, TEKIN R. Evaluation of urinary tract infections in neonatal indirect hyperbilirubinemia. Minerva Pediatr (Torino) 2022; 74:562-567. [DOI: 10.23736/s2724-5276.21.06295-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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DEĞİRMENCİ H, VURAL S, YALÇIN S. Determination of Bacterial Species and their Antibiotic Susceptibility Profiles Isolated from Patients with Urinary Tract Infection in a Private Hospital in Istanbul. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1123454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: One of the most common bacterial infections in humans in the community and hospital settings is urinary tract infections. It is seen in the second frequency, with a rate of 25% among all infectious diseases. Urinary tract infections are caused by microorganisms that cause an inflammatory response in the urinary tract epithelium, more than 95% of which are bacterial agents. The aim of this study is to retrospectively examine and evaluate the bacteria isolated and their resistance/sensitivity to antibiotics as a result of microbiological analyzes of urine samples taken from patients who came to different services and polyclinics and inpatients with signs of urinary tract infection of a private hospital in Istanbul between 2017-2021 with the complaint of urinary tract infection.Method: In the study, 772 urine samples sent to the microbiology laboratory of the hospital between 2017-2021 were analyzed retrospectively in terms of isolated bacteria and their resistance/sensitivity to antibiotics. Data analysis was performed with SPSS Statistics version 26. Categorical variables were calculated as numbers and percentages. The difference between categorical variables was analyzed using the chi-square test.Results: In the study, microbiological culture/antibiogram results of urine samples of 772 patients, 572 of whom were female (74%) and 200 were male (26%), were examined. When the age distributions of the patients are examined; 6% are 0-15 years old, 5.9% are 15-24 years old, 33.9% are 25-49 years old and 54.2% are 49 years old and over. A total of 32 different bacterial species were isolated from urine samples, and the most isolated bacterial species were respectively; Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. Among the antibiotics to which Escherichia coli isolates are most sensitive; amikacin (97.2%), meropenem (95.3%), imipenem (95.1%), colistin (94.7%), ertapenem (92%), tazobactam-piperacillin (88.6%), nitrofurantoin (87.7%), gentamicin (84.3%), ticarcillin-clavulanate (83.1%), and cefoxitin (82.9%). The antibiotics with the highest resistance development are respectively; ampicillin (71.3%), ampicillin-sulbactam (69.9%) and amoxicillin-clavulonic acid (49.4%). The antibiotics with the highest sensitivity in Klebsiella pneumoniae isolates are, respectively; colistin (70.4%) and amikacin (69.8%) were most resistant to ampicillin (94.9%), ampicillin - sulbactam (93.5%) and cefazolin (69.6%). In isolated Proteus mirabilis, the highest sensitivity was found to tazobactam-piperacillin (78.8%), aztreonam (78.6%) and meropenem (75%), while the antibiotics with the highest resistance development were nitrofurantoin (72.7%) and colistin (81.5%).Conclusion: Widespread use of antibiotics against UTI pathogens has led to the emergence of antibiotic-resistant strains. The most important reason for the formation of antibacterial resistance is the use of antibiotics for a long time and in insufficient doses. In addition, the wrong choice of antibiotics leads to the development of resistance. This situation affects the treatment process and reveals the need to determine the right chemotherapeutic options for an effective treatment. The antimicrobial resistance distributions of bacteria causing urinary tract infections show differences according to time and region. Because the antibiogram test results take time, patients who apply to clinics and hospitals with the complaint of UTI are usually treated with empirical antibiotics. In the selection of empirical preparations, first of all, the most frequently isolated agent and the antimicrobial agent with the lowest resistance rate should be taken into consideration, and if possible, urine samples should be delivered to the laboratory for agent isolation and antibiogram evaluation before starting antibiotic therapy.
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Clinical Epidemiology Characteristics and Antibiotic Resistance Associated with Urinary Tract Infections Caused by E. coli. Int J Nephrol 2022; 2022:2552990. [PMID: 35265377 PMCID: PMC8901359 DOI: 10.1155/2022/2552990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/24/2021] [Accepted: 01/13/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction In individuals with urinary tract infections, Escherichia coli (E. coli) is an ubiquitous causative agent and antibiotic resistance is on the rise throughout the world. Therefore, early diagnosis and appropriate choice of antimicrobials are essential. The purpose of our study is to describe some of the clinical and epidemiological characteristics and the laboratory test results of children treated in our hospital for urinary tract infections caused by E. coli. Methods The study included 128 patients from 2 months to 15 years of age with urinary tract infections caused by E. coli and treated at the Haiphong Children's Hospital during the periods of 2011–2013 and 2018–2020. Results During the two study periods, 57 and 71 cases, respectively, were included. The most common clinical symptom was fever in 40 and 46 cases, respectively. The proportion of E. coli's resistance to ampicillin increased from 85.3% in 2011–2013 to 97.1% in 2018–2020. In 2011–2013, 70.5% of E. coli isolates were resistant to cotrimoxazole, which increased to 81.4% during 2018–2020. During both periods, E. coli was highly sensitive to amikacin, at 87% and 95.5%, respectively. In 2018–2020, carbapenems (meropenem and imipenem) and piperacillin were also effective against E. coli. Conclusion Our study revealed that high fever was the most prevalent clinical characteristic in urinary tract infections caused by E. coli in children and E. coli was mostly resistant to ampicillin, nalidixic acid, and cotrimoxazole but was highly sensitive to ciprofloxacin, amikacin, piperacillin, meropenem, and imipenem.
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Prevalence of Multidrug-Resistant Klebsiella pneumoniae Clinical Isolates in Nepal. J Trop Med 2022; 2022:5309350. [PMID: 35242192 PMCID: PMC8888090 DOI: 10.1155/2022/5309350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 12/19/2022] Open
Abstract
Background Multidrug-resistant Klebsiella pneumoniae (MDR-KP) are becoming increasingly common over the world. The focus of this research was to get a quantitative assessment of K. pneumoniae and their multidrug resistance (MDR) profile in Nepal. Methods Three electronic databases: PubMed, Google Scholar, and Research4Life were used to search publications specifying K. pneumoniae infections and/or their MDR status from January 2015 to October 2021. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was followed for the review, and R language 4.1.1 was used for analysis. Depending upon heterogeneity of data, we used random model for pooled data to examine the prevalence of the organism and the multidrug resistance. Results Evaluation included 16 studies, and the pooled estimation of K. pneumoniae in total clinical samples was 3% (95% CI; 0.01–0.05). In the meta-analysis, 14 studies were combined for determining the prevalence of K. pneumoniae in total positive clinical isolates which was 16% (95% CI: 0.11–0.20), while from 12 research studies, MDR status in the pathogen was found to be 64% (95% CI, 0.53–0.74). Conclusion The MDR status of K. pneumoniae as well as the prevalence of the bacteria in Nepal was analyzed which showed alarming situation about administration of antibiotics and indicated choosing and developing reliable antibiotic strategies.
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Mahmoudi A, Moghadami M, Shirazi B, Tabari P, Moosavi M. What Left for Us for Urinary Tract Infection Treatment? An Experience from the South of Iran. Adv Biomed Res 2022; 10:52. [PMID: 35127579 PMCID: PMC8781903 DOI: 10.4103/abr.abr_255_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 09/21/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of the study is to define the prevalence and antimicrobial susceptibility pattern of bacteria from cases of urinary tract infections (UTIs). Materials and Methods: A retrospective analysis of urinary pathogens and their antimicrobial susceptibility was done on urine cultures at Shiraz University Laboratory from 2015 to 2017. Antimicrobial susceptibility tests have done using the disk-diffusion technique as per the standard of CSLI. Results: During 2 years of study, 3489 samples were culture positive. Escherichia coli was the dominant isolate (84%), followed by Klebsiella spp. (10.7%) and Enterococci spp. (2,2%). The overall resistance rates to trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin were 56.1%, 47.2%, and 37%, respectively. The most frequently isolated bacteria were E. coli, which had resistance rates of 58.6%, 49.1% to TMP-STX, and cefixime, also sensitivity rates of 95.1% to nitrofurantoin (FM). Conclusions: In the study area, resistance rates to fluoroquinolones and cephalosporins were high. Because most isolates were sensitive to FM and aminoglycoside, they are suggested as appropriate antimicrobials for empirical treatment of UTIs before available urine culture results.
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Affiliation(s)
- Ali Mahmoudi
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Moghadami
- The Department of Internal Medicine, Shiraz University of Medical Sciences, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Shirazi
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parinaz Tabari
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Moosavi
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ben Hassena A, Guermazi-Toumi S, Gdoura-Ben Amor M, Saidani M, Tlili S, Khannous L, Gdoura R, Siala-Trigui M. Detection of AmpC and ESBL-producing Enterobacterales isolated from urinary tract infections in Tunisia. Acta Microbiol Immunol Hung 2022; 69:46-55. [PMID: 35037898 DOI: 10.1556/030.2022.01630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/03/2022] [Indexed: 01/18/2023]
Abstract
Urinary tract infections (UTIs) are the most frequent human infections in community and hospitals. This study aimed to determine the distribution of bacterial uropathogens among urinary tract infections diagnosed within the regional hospital Houcine Bouzaiene (Gafsa, South West Tunisia) during a survey of 54 days from the 8th of November to the 31st of December 2017. Enterobacterales strains were tested for antimicrobial resistance by disk diffusion method and extended-spectrum β-lactamase (ESBL) production was tested by double-disc synergy test. Strains were further subjected to a molecular assessment of ESBL and AmpC β-lactamase production by PCR. Overall, 173 bacterial isolates were studied, out of which 91.3% were Enterobacterales. Escherichia coli was the dominant pathogen, followed by Klebsiella pneumoniae. High to moderate resistance rates were observed, ranging from 66% to 90.7% for penicillins, from 6.7% to 18.6% for cephalosporins and from 16.2% to 25.4% for fluoroquinolones. Enterobacterales with decreased susceptibility to third-generation cephalosporins (3rd GC) carried several resistance genes: blaCTX-M group 1 and group 9, and ACC and FOX AmpC β-lactamase genes. Overall, ESBLs and AmpC β-lactamases were detected in 57% and 14% of the 3rd GC-resistant isolates, respectively. This study proved the high potential of K. pneumaniae species to develop resistance against commonly used antibiotics. Thus, rigorous monitoring of the antibiotic resistance of clinical pathogens have to be implemented in Tunisia. Our results are very relevant to evaluate efficiency of the Tunisian therapeutic strategies against UTIs and adapt them to the emerging problem of antimicrobial resistance.
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Affiliation(s)
- Amal Ben Hassena
- 1 Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences of Sfax, University of Sfax, Tunisia
| | - Sonda Guermazi-Toumi
- 1 Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences of Sfax, University of Sfax, Tunisia
- 2 Department of Biotechnology and Health, Higher Institute of Biotechnology of Sfax, University of Sfax, Tunisia
| | - Maroua Gdoura-Ben Amor
- 1 Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences of Sfax, University of Sfax, Tunisia
| | | | - Sonia Tlili
- 3 Regional Hospital Houcine Bouzaeine, Gafsa, Tunisia
| | - Lamia Khannous
- 1 Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences of Sfax, University of Sfax, Tunisia
| | - Radhouane Gdoura
- 1 Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences of Sfax, University of Sfax, Tunisia
| | - Mariam Siala-Trigui
- 1 Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences of Sfax, University of Sfax, Tunisia
- 4 Department of Biology, Preparatory Institute for Engineering Studies of Sfax, Universiy of Sfax, Tunisia
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Lu J, Liu X, Wei Y, Yu C, Zhao J, Wang L, Hu Y, Wei G, Wu S. Clinical and Microbial Etiology Characteristics in Pediatric Urinary Tract Infection. Front Pediatr 2022; 10:844797. [PMID: 35463882 PMCID: PMC9021593 DOI: 10.3389/fped.2022.844797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is a common occurrence in children. UTI and urological malformations are intimately linked. However, whether urinary tract malformations affect the clinical features of pediatric UTI remains unclear. The purpose of this study was to characterize the clinical features and microbial etiology of UTI in children. METHODS We retrospectively reviewed the records of 741 patients with UTI treated at the Chongqing Medical University Affiliated Children's Hospital between 2015 and 2020. Patients with and without urological malformations were compared using propensity score matching (PSM). RESULTS Escherichia coli was the most common causative microorganism of UTI, accounting for 40.5% of infections. One hundred twenty-two patients (16.5%) had urological malformations. PSM identified 122 matched pairs of patients with or without urological malformations. The proportion of patients with UTI caused by atypical microorganisms was significantly higher in patients with urological malformations (P = 0.048). Children with urological malformations showed longer duration of intravenous antibiotic treatment (P = 0.010), higher cost of treatment (P < 0.001), and higher prevalence of recurrence (23.8 vs. 10.7%, P < 0.001), compared with the normal group. CONCLUSION Children with urological malformations are more likely to develop UTI with atypical microorganisms. Appropriate imaging examination and urine culture are strongly recommended for the diagnosis and management of pediatric UTI.
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Affiliation(s)
- Jiandong Lu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wei
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chengjun Yu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Zhao
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Wang
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Hu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guanghui Wei
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shengde Wu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
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Shakya S, Edwards J, Gupte HA, Shrestha S, Shakya BM, Parajuli K, Kattel HP, Shrestha PS, Ghimire R, Thekkur P. High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal. Public Health Action 2021; 11:24-31. [PMID: 34778012 PMCID: PMC8575380 DOI: 10.5588/pha.21.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
SETTING: Tribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May–October 2019. OBJECTIVE: 1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing. DESIGN: This was a hospital-based, cross-sectional study using routine laboratory records. RESULTS: Among 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ⩾60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ⩾45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ⩾60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR. CONCLUSION: Urine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.
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Affiliation(s)
- S Shakya
- Central Department of Public Health, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - J Edwards
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - H A Gupte
- Narotam Sekhsaria Foundation, Mumbai, India
| | - S Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu, Nepal
| | - B M Shakya
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - K Parajuli
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - H P Kattel
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - P S Shrestha
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - R Ghimire
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - P Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
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Mohanty S, Purohit G, Rath S, Seth RK, Mohanty RR. Urinary tract infection due to Group B Streptococcus: A case series from Eastern India. Clin Case Rep 2021; 9:e04885. [PMID: 34631070 PMCID: PMC8489396 DOI: 10.1002/ccr3.4885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/01/2021] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
Group B Streptococcus (GBS) or Streptococcus agalactiae is an uncommon causative agent of urinary tract infection (UTI). We present a series of seven cases of UTI due to GBS from a tertiary care hospital of Eastern India, highlighting its emerging role in a hitherto less commonly described clinical entity.
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Affiliation(s)
- Srujana Mohanty
- Department of Microbiology All India Institute of Medical Sciences Bhubaneswar India
| | - Geetarani Purohit
- Department of Microbiology All India Institute of Medical Sciences Bhubaneswar India
| | - Sutapa Rath
- Department of Microbiology All India Institute of Medical Sciences Bhubaneswar India
| | - Rajeev Kumar Seth
- Department of Microbiology All India Institute of Medical Sciences Bhubaneswar India
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17
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Gurung R, Adhikari S, Adhikari N, Sapkota S, Rana JC, Dhungel B, Thapa Shrestha U, Banjara MR, Ghimire P, Rijal KR. Efficacy of Urine Dipstick Test in Diagnosing Urinary Tract Infection and Detection of the blaCTX-M Gene among ESBL-Producing Escherichia coli. Diseases 2021; 9:diseases9030059. [PMID: 34562966 PMCID: PMC8482205 DOI: 10.3390/diseases9030059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/24/2023] Open
Abstract
A urine dipstick test used for prompt diagnosis of urinary tract infection (UTI) is a rapid and cost-effective method. The main objective of this study was to compare the efficacy of the urine dipstick test with culture methods in screening for UTIs along with the detection of the blaCTX-M gene in extended spectrum β-lactamase (ESBL)-producing Escherichia coli. A total of 217 mid-stream urine samples were collected from UTI-suspected patients attending Bharatpur Hospital, Chitwan, and tested by dipstick test strip (COMBI-10SL, Germany) prior to the culture. E. coli isolates were identified by standard microbiological procedures and subjected to antimicrobial susceptibility testing by Kirby Bauer disc diffusion method following CLSI guideline. Primary screening of ESBL-producing E. coli isolates was conducted using ceftriaxone, cefotaxime and ceftazidime discs and phenotypically confirmed by combined disk diffusion test. Plasmid DNA of ESBL-producing strains was extracted by phenol-chloroform method and subjected to PCR for detection of the blaCTX-M gene. Out of 217 urine samples, 48 (22.12%) showed significant bacteriuria. Among 46 (21.20%) Gram negative bacteria recovered, the predominant one was E. coli 37 (77.08%) of which 33 (89.19%) were multidrug resistant (MDR). E. coli isolates showed a higher degree of resistance towards cefazolin (62.16%) while 81.08% of the isolates were sensitive towards amikacin followed by nitrofurantoin (70.27%). Among 14 (37.84%) phenotypically confirmed ESBL isolates, only eight (21.62%) isolates carried the blaCTX-M gene. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of urine dipstick test were 43.75%, 77.51%, 35.59% and 82.91%, respectively. Besides, the use of dipstick test strip for screening UTI was associated with many false positive and negative results as compared to the gold standard culture method. Hence, dipstick nitrite test alone should not be used as sole method for screening UTIs.
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Affiliation(s)
- Rubina Gurung
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Sanjib Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Sanjeep Sapkota
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur 44200, Chitwan, Nepal;
| | - Jid Chani Rana
- Department of Microbiology, Bharatpur Hospital, Bharatpur 44200, Chitwan, Nepal;
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Upendra Thapa Shrestha
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
- Correspondence: or
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Ahmed O, Mohamed H, Salem W, Afifi M, Song Y. Efficacy of Ethanolic Extract of Syzygium aromaticum in the Treatment of Multidrug-Resistant Pseudomonas aeruginosa Clinical Isolates Associated with Urinary Tract Infections. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6612058. [PMID: 34221080 PMCID: PMC8221855 DOI: 10.1155/2021/6612058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
Pseudomonas aeruginosa is an organism commonly found in the environment and one of the most common causes of human urinary tract infections in developed and developing countries. The present study aimed to investigate the effect of five medicinal plant extracts on the isolated drug-resistant P. aeruginosa clinical isolates. A total of 100 urine samples were collected from Nagaa Hammadi and Qena General Hospitals and private medical analysis laboratories in Qena governorate, Upper Egypt. Samples were screened for the prevalence of UTI pathogens by biochemical tests, antibiotics sensitivity, detection of virulence, and antibiotic-resistant genes by using multiplex PCR. P. aeruginosa is by far the subdominant causative agent with a percentage of 14%. Clinical isolates were multidrug-resistant, containing bla TEM, bla SHV, toxA, lasB, pslA, and fliC resistant and virulence genes. Based on bioactivity, the ethanolic extract of clove (Syzygium aromaticum) was the most active extract among tested medicinal plants and had the maximum zone of inhibition sized 23 mm against tested bacteria. The results of the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) showed a high decrease of inhibition within a concentration range of (10 to 121.25 mg/mL and 20 to 30 mg/mL, respectively). Further, major compounds of oleic acid (27.22%), guanosine (8.91%), indole (6.83%), 1-eicosene (6.30%), and cis-10-nonadecenoic acid (5.37%) were determined among 12 bioactive compounds in the ethanolic extract of S. aromaticum using gas chromatography-mass spectrometry (GC-MS). These results indicated that the ethanolic extract of S. aromaticum is a promising antibacterial agent for further studies aiming to control bacterial infections including MDR bacteria and develop novel therapeutic alternatives for the treatment of UTI.
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Affiliation(s)
- Osama Ahmed
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
| | - Hassan Mohamed
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
- Colin Ratledge Center for Microbial Lipids, School of Agricultural Engineering and Food Science, Shandong University of Technology, Zibo 255000, China
| | - Wesam Salem
- Department of Botany and Microbiology, Faculty of Science, South Valley University, Qena 83523, Egypt
| | - Magdy Afifi
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
| | - Yuanda Song
- Colin Ratledge Center for Microbial Lipids, School of Agricultural Engineering and Food Science, Shandong University of Technology, Zibo 255000, China
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Abstract
PURPOSE OF REVIEW Urinary tract infection (UTI) is one of the most common pediatric infections worldwide. Recently introduced 16S rRNA sequencing allows detailed identification of bacteria involved in UTI on a species-based level. The urogenital microbiome in children is scarcely investigated, with underlying conditions differing from adults. Improvement in diagnostic and therapeutic approaches can help to minimize unnecessary antibiotic treatments, thereby protecting the physiological microbiome. RECENT FINDINGS Healthy bladders of children display a distinct microbiome than those of adults. UTI is characterized by changes in bacterial composition, with a high prevalence of Enterobacterales. There is a correlation between bacterial species and the pH of the urine, so a characteristic age-related pathogen pattern can be found due to the acidic urine in infants and more alkaline urine in older children. Recently, new methods were proposed to overcome the suboptimal diagnostic performance of urine cultures and urine dipstick test. This allows precise treatment decisions and helps to prevent chronification of UTI, related voiding dysfunctions and renal scaring, systemic abiosis, and the development of antibiotic resistance. SUMMARY Uropathogens involved in UTIs in children should be identified with precision to allow targeted therapeutic decisions. This can also help preventing the destruction of the microbiome homeostasis, which could result in a life-long dysbiosis. New treatment approaches and recolonization with probiotics are necessary due to increasing intrinsic antibiotic resistance of bacteria.
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Tryphena C, Sahni RD, John S, Jeyapaul S, George A, Helan J. A retrospective study on the microbial spectrum and antibiogram of uropathogens in children in a secondary care hospital in Rural Vellore, South India. J Family Med Prim Care 2021; 10:1706-1711. [PMID: 34123916 PMCID: PMC8144762 DOI: 10.4103/jfmpc.jfmpc_2090_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/02/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Urinary tract infection (UTI) is common among children. Empiric antibiotics have to be started as early as possible or it may lead to an irreversible renal parenchymal damage and renal scarring in children. The objectives were to determine the prevalence and microbial profile of paediatric UTI and to determine the antimicrobial susceptibility pattern. Methodology: This is a retrospective study which looked at urine cultures of children below 15 years that were sent during the study period. Results: Among the total urine cultures sent only 21.2% showed significant growth of organisms. The most common organism isolated was E. coli (75.5%). E. coli was least sensitive to cefpodoxime and co-trimoxazole, whereas highly sensitive to nitrofurantoin. Of the total children who had significant growth, 46% had ESBL. Discussion: The prevalence of culture-proven UTI among children was found to be 21.2%. The most common organism isolated among the study population was E. coli (75.5%) followed by Enterococcus species (19.0%) and Klebsiella species (14.5%). It was also found that E. coli was least sensitive to cefpodoxime (31.6%) and co-trimoxazole (26.3%), moderately to amoxicillin-clavulanate (52.4%), whereas highly sensitive to nitrofurantoin (82.9%). This was similar with the studies done at other secondary care hospitals, in Oman and Oddanchathram, South India. Conclusions: With the increasing resistance, cephalosporins should not be used in treating paediatric UTI, whereas nitrofurantoin can be started as an empiric antibiotic, which can later be changed according to the susceptibility pattern.
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Affiliation(s)
- Cherryl Tryphena
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rani Diana Sahni
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sushil John
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shalini Jeyapaul
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anne George
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jasmine Helan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
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Sugianli AK, Ginting F, Parwati I, de Jong MD, van Leth F, Schultsz C. Antimicrobial resistance among uropathogens in the Asia-Pacific region: a systematic review. JAC Antimicrob Resist 2021; 3:dlab003. [PMID: 34223081 PMCID: PMC8210283 DOI: 10.1093/jacamr/dlab003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) in urinary tract infections (UTI) is a global public health problem. However, estimates of the prevalence of AMR, required for empirical treatment guidelines, are lacking for many regions. OBJECTIVES To perform a systematic review and summarize the available information about AMR prevalence among urinary Escherichia coli and Klebsiella pneumoniae, the two priority uropathogens, in the Asia-Pacific region (APAC). METHODS PubMed, EBSCO and Web of Science databases were searched for articles (2008-20), following PRISMA guidelines. The prevalence of resistance was calculated and reported as point estimate with 95% CI for antimicrobial drugs recommended in WHO treatment guidelines. Data were stratified by country and surveillance approach (laboratory- or population-based surveillance). The quality of included articles was assessed using a modified Newcastle-Ottawa Quality Assessment Scale. RESULTS Out of 2400 identified articles, 24 studies, reporting on 11 (26.8%) of the 41 APAC countries, met the inclusion criteria. Prevalence of resistance against trimethoprim/sulfamethoxazole, ciprofloxacin, and ceftriaxone ranged between 33% and 90%, with highest prevalence reported from Bangladesh, India, Sri Lanka and Indonesia. Resistance against nitrofurantoin ranged between 2.7% and 31.4%. Two studies reported data on fosfomycin resistance (1.8% and 1.7%). Quality of reporting was moderate. CONCLUSIONS We show very high prevalence estimates of AMR against antibiotics commonly used for the empirical treatment of UTI, in the limited number of countries in the APAC for which data are available. Novel feasible and affordable approaches that facilitate population-based AMR surveillance are needed to increase knowledge on AMR prevalence across the region.
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Affiliation(s)
- Adhi Kristianto Sugianli
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Franciscus Ginting
- Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik General Hospital, Medan, Indonesia
| | - Ida Parwati
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Medical Microbiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Tewawong N, Kowaboot S, Pimainog Y, Watanagul N, Thongmee T, Poovorawan Y. Distribution of phylogenetic groups, adhesin genes, biofilm formation, and antimicrobial resistance of uropathogenic Escherichia coli isolated from hospitalized patients in Thailand. PeerJ 2020; 8:e10453. [PMID: 33344087 PMCID: PMC7718785 DOI: 10.7717/peerj.10453] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Urinary tract infections (UTIs) are the most common bacterial infections and are often caused by uropathogenic Escherichia coli (UPEC). We investigated the distribution of phylogenetic groups, adhesin genes, antimicrobial resistance, and biofilm formation in E. coli isolated from patients with UTIs. Methods In the present study, 208 UPEC isolated from Thai patients were classified into phylogenetic groups and adhesin genes were detected using multiplex PCR. Antimicrobial susceptibility testing was performed using agar disk diffusion. The Congo red agar method was used to determine the ability of the UPEC to form biofilm. Results The most prevalent UPEC strains in this study belonged to phylogenetic group B2 (58.7%), followed by group C (12.5%), group E (12.0%), and the other groups (16.8%). Among adhesin genes, the prevalence of fimH (91.8%) was highest, followed by pap (79.3%), sfa (12.0%), and afa (7.7%). The rates of resistance to fluoroquinolones, trimethoprim-sulfamethoxazole, and amoxicillin-clavulanate were 65%, 54.3%, and 36.5%, respectively. The presence of adhesin genes and antibiotic resistance were more frequent in groups B2 and C compared to the other groups. Of the 129 multidrug-resistant UPEC strains, 54% were biofilm producers. Our findings further indicated that biofilm production was significantly correlated with the pap adhesin gene (p ≤ 0.05). Conclusion These findings provide molecular epidemiologic data, antibiotic resistance profiles, and the potential for biofilm formation among UPEC strains that can inform further development of the appropriate prevention and control strategies for UTIs in this region.
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Affiliation(s)
- Nipaporn Tewawong
- Faculty of Medical Technology, Rangsit University, Muang, Pathumthani, Thailand
| | - Siriporn Kowaboot
- Faculty of Medical Technology, Rangsit University, Muang, Pathumthani, Thailand
| | - Yaowaluk Pimainog
- Faculty of Medical Technology, Rangsit University, Muang, Pathumthani, Thailand
| | - Naiyana Watanagul
- Department of Microbiology, Nopparat Rajathanee Hospital, Khannayao, Bangkok, Thailand
| | - Thanunrat Thongmee
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
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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.
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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
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Petronio Petronio G, Cutuli MA, Magnifico I, Venditti N, Pietrangelo L, Vergalito F, Pane A, Scapagnini G, Di Marco R. In Vitro and In Vivo Biological Activity of Berberine Chloride against Uropathogenic E. coli Strains Using Galleria mellonella as a Host Model. Molecules 2020; 25:E5010. [PMID: 33137930 PMCID: PMC7662377 DOI: 10.3390/molecules25215010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Berberine is an alkaloid of the protoberberine type used in traditional oriental medicine. Its biological activities include documented antibacterial properties against a wide variety of microorganisms; nonetheless, its use against Escherichia coli strains isolated from urinary infections has not yet been widely investigated in vivo. The emergence of antimicrobial resistance requires new therapeutic approaches to ensure the continued effectiveness of antibiotics for the treatment and prevention of urinary infections. Moreover, uropathogenic Escherichia coli (UPEC) has developed several virulence factors and resistance to routine antibiotic therapy. To this end, several in vitro and in vivo tests were conducted to assess the activity of berberine on uropathogenic E. coli strains. Galleria mellonella as an infection model was employed to confirm the in vivo translatability of in vitro data on berberine activity and its influence on adhesion and invasion proprieties of E. coli on human bladder cells. In vitro pre-treatment with berberine was able to decrease the adhesive and invasive UPEC ability. In vivo treatment increased the larvae survival infected with UPEC strains and reduced the number of circulating pathogens in larvae hemolymph. These preliminary findings demonstrated the efficacy and reliability of G. mellonella as in vivo model for pre-clinical studies of natural substances.
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Affiliation(s)
- Giulio Petronio Petronio
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Marco Alfio Cutuli
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Irene Magnifico
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Noemi Venditti
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Laura Pietrangelo
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Franca Vergalito
- Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, Via De Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso, Italy;
| | - Antonella Pane
- Department of Agricultural, Food and Environment, University of Catania, Via S. Sofia, 100, 95123 Catania, Italy;
| | - Giovanni Scapagnini
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
| | - Roberto Di Marco
- Department of Health and Medical Sciences “V. Tiberio”, University of Molise Via de Sanctis 3, III Ed. Polifunzionale, 86100 Campobasso (CB) Molise, Italy; (G.P.P.); (I.M.); (N.V.); (L.P.); (G.S.); (R.D.M.)
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Ramrakhia S, Raja K, Dev K, Kumar A, Kumar V, Kumar B. Comparison of Incidence of Urinary Tract Infection in Diabetic vs Non-Diabetic and Associated Pathogens. Cureus 2020; 12:e10500. [PMID: 33094044 PMCID: PMC7571591 DOI: 10.7759/cureus.10500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction Urinary tract infections (UTIs) are common in low socioeconomic country like Pakistan. There are various factors responsible for UTI, one major factor being diabetes. This study aims to compare diabetic and non-diabetic patients, for gender association, symptoms, and organisms, with UTI. Methods This cross-sectional study was conducted in the medicine ward of tertiary care hospital in Pakistan from January 2019 to December 2019. For urine analysis, freshly voided 5-10 ml of clean midstream urine specimens was collected in a sterile container. Samples were sent to the lab immediately, A colony count of ≥105 CFU/ml was considered for the diagnosis of UTI. Culture was done if UTI was diagnosed. Results The overall incidence of UTI in participants of the diabetic group was significantly higher than those in the non-diabetic group (13.67% vs 6.40%; P=0.004). Escherichia coli was the most common organism in both the diabetic and non-diabetic groups (60% vs 72%; P=0.73). Frequency of Klebsiella was considerably higher in the participants of diabetes but it was not significant (23.3% vs 11.1%; P=0.29). Conclusion UTI was significantly higher in the diabetic population compared to the non-diabetic population. Since diabetes is prevalent in Pakistan, care of diabetes should include reducing the risk factors for UTI.
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Affiliation(s)
- Sonam Ramrakhia
- Medicine, Liaquat University of Medical and Health Sciences, Sukkur, PAK.,Medicine, Mustafai Trust Central Hospital, Sukkur, PAK
| | - Kunal Raja
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Kapeel Dev
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Ajay Kumar
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Vinesh Kumar
- Internal Medicine, Ghulam Mohammad Mahar Medical College, Sukkur, PAK
| | - Besham Kumar
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Gurung S, Kafle S, Dhungel B, Adhikari N, Thapa Shrestha U, Adhikari B, Banjara MR, Rijal KR, Ghimire P. Detection of OXA-48 Gene in Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae from Urine Samples. Infect Drug Resist 2020; 13:2311-2321. [PMID: 32765007 PMCID: PMC7369300 DOI: 10.2147/idr.s259967] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/24/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Resistance to carbapenem in Gram-negative bacteria is attributable to their ability to produce carbapenemase enzymes. The main objective of this study was to detect the presence of blaOXA-48 genes in carbapenem-resistant uropathogenic Escherichia coli and Klebsiella pneumoniae isolated from urine samples from patients attending Alka Hospital, Jawalakhel, Lalitpur, Nepal. METHODS A total of 1013 mid-stream urine samples were collected from patients with suspected urinary tract infection (UTI) between April and September 2018. The identified isolates underwent antibiotic susceptibility testing using the modified Kirby-Bauer disc-diffusion method. Phenotypic carbapenemase production was confirmed by the modified Hodge test, and the blaOXA-48 gene was detected using conventional polymerase chain reaction. RESULTS Out of 1013 urine samples, 15.2% (154/1013) had bacterial growth. Among the isolates, 91.5% (141/154) were Gram-negative bacteria, and E. coli was the most common bacterial isolate (62.9%; 97/154), followed by K. pneumoniae 15.6% (24/154). Among 121 bacterial isolates (97 E. coli isolates and 24 K. pneumoniae isolates), 70.3% (52/121) were multidrug-resistant E. coli and 29.7% (22/121) were multidrug-resistant K. pneumoniae. In addition, 9.1% (11/121) were carbapenem resistant (both imipenem and meropenem resistant). Development of multidrug resistance and development of carbapenem resistance were significantly associated (p<0.05). Of the 11 carbapenem-resistant isolates, only seven were carbapenemase producers; of these, 28.6% (2/7) were E. coli, 72.4% (5/7) were K. pneumoniae and 42.8% (3/7) had the blaOXA-48 gene. Of the three bacterial isolates with the blaOXA-48 gene, 33.3% (1/3) were E. coli and 66.7% (2/3) were K. pneumoniae. CONCLUSION One in ten isolates of E. coli and K. pneumoniae were carbapenem resistant. Among carbapenem-resistant isolates, one-third of E. coli and two-thirds of K. pneumoniae had the blaOXA-48 gene. OXA-48 serves as a potential agent to map the distribution of resistance among clinical isolates.
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Affiliation(s)
- Sushma Gurung
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, 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, Kirtipur, 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
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Wang Z, Xia Z. What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): a case-control study. Ital J Pediatr 2020; 46:17. [PMID: 32033572 PMCID: PMC7007655 DOI: 10.1186/s13052-019-0769-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022] Open
Abstract
Background The risk factors for multi-drug resistant infection (MDRI) in the pediatric intensive care unit (PICU) remain unclear. It’s necessary to evaluate the epidemiological characteristics and risk factors for MDRI in PICU, to provide insights into the prophylaxis of MDRI clinically. Methods Clinical data of 79 PICU children with MDRI were identified, and 80 children in PICU without MDRI in the same period were selected as control group. The related children’s characteristics, clinical care, microbiologic data, treatments provided, and outcomes of the patients with were reviewed and collected. Univariate and multivariate logistic regression analyses were performed to identify the potential risks of MDRI in PICU. Results Of the diagnosed 79 cases of MDRI, there were28 cases of CR-AB, 24 cases of MRSA, 22 cases of PDR-PA,3 cases of VRE and 2 cases of CRE respectively. Univariate analyses indicated that the length of PICU stay, the duration of mechanical ventilation > 5 days, parenteral nutrition, coma, urinary catheter indwelling, invasive operation, 2 or more antibiotics use were associated with MDRIs (all p < 0.05); The logistic multiple regression analyses indicated that coma, parenteral nutrition, 2 or more antibiotics use and the duration of mechanical ventilation > 5 days were independent risk factors associated with MDRI (all p < 0.05). Conclusions This present study has identified several potentially modifiable risk factors for MDRI in PICU, it’s conducive to take appropriate measures targeting risk factors of MDRI for health care providers to reduce MDRI.
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Affiliation(s)
- Zaihua Wang
- Nursing Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Zhongfang Xia
- Otolaryngology Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No 100, Xianggang Road, Wuhan, Hubei province, China.
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Sharma D, Preston SE, Hage R. Emerging Antibiotic Resistance to Bacterial Isolates from Human Urinary Tract Infections in Grenada. Cureus 2019; 11:e5752. [PMID: 31700763 PMCID: PMC6822554 DOI: 10.7759/cureus.5752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A urinary tract infection (UTI) in humans is one of the most common ailments in developing countries. The treatment of UTI is becoming difficult because of the increasing drug resistance against the common bacteria associated with UTI. This research aimed to determine the bacteria, and their antimicrobial drug resistance, associated with UTI in the Grenada population. A retrospective study of data (2015 through 2017) from the microbiology laboratory of the Grenada General Hospital was analyzed. Bacteria were isolated from 1289 (33.3%) urine cultures of 3867 UTI suspected urine samples. Both Gram-positive (Staphylococcus aureus 5.0%; Enterococci group D 43.2%) and Gram-negative bacteria (Escherichia coli 51%; Klebsiella pneumoniae20.0%; Proteus mirabilis 10.0%; Acinetobacter spp. 20.0%) were isolated. Bacterial isolates were tested for their resistance to nine antibacterial drugs (ampicillin, gentamicin, norfloxacin, cefuroxime, ceftazidime, Bactrim, imipenem, augmentin, and ciprofloxacin). Gram-negative bacteria showed higher antimicrobial drug resistance.
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Affiliation(s)
- Deepak Sharma
- Anatomy, St. George's University School of Medicine, St Georges, GRD
| | - Sara E Preston
- Basic Science, St. George's University School of Medicine, St Georges, GRD
| | - Robert Hage
- Otolaryngology, St. George's University School of Medicine, St Georges, GRD
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