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Iddrisu AK, Owusu G, Doe SK, Yeboah AA, Agyapong J, Yankey N. Uropathogens and their antibiotic susceptibility patterns among diabetic patients at st. john of god hospital, duayaw nkwanta, Ghana: a cross-sectional study. Health Sci Rep 2024; 7:e70072. [PMID: 39296635 PMCID: PMC11409053 DOI: 10.1002/hsr2.70072] [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: 03/21/2024] [Revised: 08/31/2024] [Accepted: 09/04/2024] [Indexed: 09/21/2024] Open
Abstract
Background Uropathogens are microorganisms that cause urinary tract infections (UTIs). Owing to higher blood glucose levels and compromised immune functions, treatment of uropathogens in diabetic patients is a challenge. Aim This study aims to assess the prevalence of uropathogens and their antibiotic susceptibility among diabetic patients at St. John of God Hospital at Duayaw Nkwanta (SJGHDN) in the Ahafo region of Ghana. Methods The cross-sectional study recruited 175 diabetic patients at SJGHDN between August and September 2023. Questionnaires were used to collect patients' background information. Fasting Blood Sugar (FBS) was assessed by using a glucometer. Urine samples were examined for the presence of uropathogens. A sterile inoculating loop with a calibrated volume of 2 µl was used for plating. Each colony equals 500 CFU/mL. Significant uropathogen was determined by multiplying the counted colonies by 500 to obtain CFU/mL. Positive uropathogen was defined as CFU ≥ 105/mL. Significant uropathogen was defined as ≥200 colonies per sample. The disc diffusion method was used to determine antibiotic susceptibility. Results Out of the 175 patients, 19.4% expressed various uropathogens with Escherichia coli being the predominant. Suboptimal glucose level was the most significant risk factor (p = 0.038). Glucosuria (p = 0.036), hazy urine (p = 0.028), positive leukocyte esterase (p = 0.001), and pus cells in urine sediment (p = 0.020) were significant indicators of uropathogen occurrence. Klebsiella pneumonia and Proteus mirabilis were resistant to ≥4 antibiotics. Amikacin, nitrofurantoin, levofloxacin, ciprofloxacin, and ceftriaxone demonstrated efficacy against the isolates. Conclusion This study underscores the notable prevalence of uropathogens in diabetic patients and the alarming levels of antibiotic resistance observed. The results highlight the critical need for vigilant monitoring and customized treatment approaches, particularly for diabetic patients exhibiting risk factors such as elevated urine glucose levels, cloudy urine, and presence of leukocyte esterase and pus cells in urine sediment. The significant resistance to frequently used antibiotics like co-trimoxazole and tetracycline points to the necessity of routine susceptibility testing and the use of alternative antibiotics for effective treatment. These findings can assist healthcare providers in more effectively managing and preventing UTIs in diabetic populations.
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Affiliation(s)
- Abdul-Karim Iddrisu
- Department of Mathematics and Statistics University of Energy and Natural Resources Sunyani Ghana
| | - George Owusu
- Department of Medical Laboratory Science University of Energy and Natural Resources Sunyani Ghana
| | - Samuel Kofi Doe
- Department of Medical Laboratory Science University of Energy and Natural Resources Sunyani Ghana
| | - Augustine Apraku Yeboah
- Department of Medical Laboratory Science University of Energy and Natural Resources Sunyani Ghana
| | - Joseph Agyapong
- Department of Medical Laboratory Science University of Energy and Natural Resources Sunyani Ghana
| | - Nicholas Yankey
- Department of Medical Laboratory Science University of Energy and Natural Resources Sunyani Ghana
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Hamadalneel YB, Ahmed HO, Alamin MF, Almahy WM, Almustafa ZM, Yousif YM, Taha MA. Prevalence and Antimicrobial Sensitivity Patterns of Uropathogens in Wad Medani, Sudan: A Three Years, Cross-Sectional Study. Infect Drug Resist 2024; 17:2131-2140. [PMID: 38828377 PMCID: PMC11143980 DOI: 10.2147/idr.s464501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Urinary tract infections exert a significant negative impact on an individual's quality of life and cause significant economic and public health burdens. Therefore, this study was conducted to identify the common bacterial uropathogens associated with urinary tract infections in Wad Medani patients and their susceptibility to antibiotics. Patients and Methods This was a cross-sectional study. All urine samples were collected from patients at Wad Medani and investigated at the Pathology Center for Diagnosis and Research, Faculty of Medicine, University of Gezira, Sudan, from the 1st of January 2021 to the 15th of October 2023. Results A total of 2698 urine samples were analyzed during the three years study period, with a mean age of 45.29 ± 18.9 years. Among these patients, 1108 (41.8%) were positive for bacterial growth, and 888 (80.14%) were female. A total of 522 (47.1%) were gram positive bacteria (GPB), and 586 (52.9%) were gram negative bacteria (GNB). The most frequently isolated bacteria were S. aureus 42% (465/1108) and E. coli 38.5% (427/1108), while P. aeruginosa was less detected 3.4% (38/1108). Amikacin 91.5% was the most sensitive drug to isolated GPB, while cotrimoxazole 20.9% was the least sensitive drug. In particular, amikacin 94.1% (144/153) was the most sensitive drug to S. aureus, while cotrimoxazole 20.7% (80/386) was the least sensitive drug. Moreover, amikacin 91.5% was the most sensitive drug to the isolated GNB, while ampicillin 5.7% was the least sensitive drug. Notably, amikacin was the most sensitive drug to all the isolated GNB, and ampicillin was the least sensitive drug to all the isolated GNB. Conclusion This study reported a moderate uropathogen isolation rate of 41.8%. S. aureus and E. coli were the most frequently isolated bacteria, most of which were from female patients. Remarkably, amikacin was the most sensitive drug to isolated GNB and GPB.
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Affiliation(s)
- Yousif B Hamadalneel
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan
| | - Hifa O Ahmed
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan
| | - Marwa F Alamin
- Department of Molecular Biology, Institute of Endemic Disease, Khartoum University, Khartoum, Sudan
| | - Walaa M Almahy
- Clinical Pharmacy & Pharmacy Practice, Pharmacy Program, Wad Medani College for Science and Technology, Wad Medani, Gezira State, Sudan
| | - Zainab M Almustafa
- Clinical Pharmacy & Pharmacy Practice, Pharmacy Program, Wad Medani College for Science and Technology, Wad Medani, Gezira State, Sudan
| | - Yousif M Yousif
- Clinical Pharmacy & Pharmacy Practice, Pharmacy Program, Wad Medani College for Science and Technology, Wad Medani, Gezira State, Sudan
| | - Mohammed A Taha
- Pathology Center for Diagnosis and Research, Faculty of Medicine, University of Gezira, Wad Medani, Sudan
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Shahsavari S, Bakht M, Sadeghi H, Rahimi S, Movahed F, Chegini V, Gholamzadeh Khoei S. Effect of Diabetes Mellitus on the Spectrum of Uropathogens and the Antimicrobial Resistance in Patients with Urinary Tract Infection. ARCHIVES OF RAZI INSTITUTE 2024; 79:92-101. [PMID: 39192946 PMCID: PMC11345481 DOI: 10.32592/ari.2024.79.1.92] [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: 06/16/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2024]
Abstract
Patients with diabetes mellitus frequently experience urinary tract infections (UTIs). In the present study, we looked at how glycemic control affects diabetic patients' rates of UTI, the causing pathogens, the presence of multi-drug-resistant (MDR) and extensively drug-resistant organisms, and the infections' relation to diabetes. Diabetes patients' midstream urine samples were included, after collecting and identifying the organisms, disc diffusion antibiotic sensitivity tests were conducted. The HbA1c was measured for all patients. A total of 500 diabetic patients provided urine samples for this study, and 189 (37.2%) of them had UTIs. Compared to 59 patients with managed glycemia, 130 individuals in the uncontrolled glycemic group experienced the most UTI cases. In both diabetic groups, females had a significantly higher prevalence of UTI than males (88.4% and 11.6%, respectively). The most common bacterial isolate, E. coli, displayed 58.4% MDR. Regardless of age or gender, glycemic control in diabetes patients is essential for decreasing UTI rates.
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Affiliation(s)
- S Shahsavari
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - M Bakht
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - H Sadeghi
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - S Rahimi
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - F Movahed
- Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - V Chegini
- Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - S Gholamzadeh Khoei
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
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Confederat LG, Condurache MI, Alexa RE, Dragostin OM. Particularities of Urinary Tract Infections in Diabetic Patients: A Concise Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1747. [PMID: 37893465 PMCID: PMC10608443 DOI: 10.3390/medicina59101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Diabetes mellitus is a chronic disease that, untreated or poorly controlled, can lead to serious complications, reducing life expectancy and quality. Diabetic patients are more likely to develop infections, including many common infections, but also pathognomonic ones such as emphysematous pyelonephritis, malignant otitis externa, mucormycosis and Fournier's gangrene. Considering the fact that diabetic patients experience more frequently urinary tract infections (UTIs) with a worse prognosis than non-diabetic people, we conducted a review study based on data in the literature, following the particularities of UTIs in this group of patients, the risk factors, the mechanisms involved and the challenges in their management. The findings highlight that UTI in diabetic patients have some particularities, including a more frequent evolution to bacteremia, increased hospitalizations, and elevated rates of recurrence and mortality than non-diabetic patients. The possible risk factors identified seem to be female gender, pregnancy, older age, UTI in the previous six months, poor glycemic control and duration of diabetes. The mechanisms involved are related to glucosuria and bladder dysfunction, factors related to bacterial strains and host response. The bacterial strains involved in UTIs in diabetic patients and their antibiotic susceptibility profile are, with some exceptions, similar to those in non-diabetic people; however, the antimicrobial agents should be carefully chosen and the duration of the treatment should be as those required for a complicated UTI. The data related to the risk of developing UTIs in patients treated with SGLT-2 inhibitors, a new class of oral hypoglycaemic agents with cardiovascular and renal benefits, are controversial; overall, it was evidenced that UTIs occurred at the initiation of the treatment, recurrent infection was uncommon and the majority of UTIs responded to treatment with standard antibiotics. Moreover, interruption or discontinuation of SGLT-2 inhibitor as a result of UTI was rare and SGLT-2 inhibitors did not increase the risk of severe infections such as urosepsis and pyelonephritis.
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Affiliation(s)
- Luminita-Georgeta Confederat
- Department of Biomedical Sciences, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Mihaela-Iustina Condurache
- Department of Biomedical Sciences, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Raluca-Elena Alexa
- “Sfântul Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania;
| | - Oana-Maria Dragostin
- Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania;
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Hassan SA, Ahmed YMA, Hassan GD. Antimicrobial susceptibility of Escherichia coli isolated from diabetic patients in Mogadishu, Somalia. Front Microbiol 2023; 14:1204052. [PMID: 37692408 PMCID: PMC10484611 DOI: 10.3389/fmicb.2023.1204052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background Urinary tract infections (UTIs) are a major concern for diabetic patients due to the impact of diabetes on the urinary tract and immune system. Escherichia coli is the most common pathogen causing UTIs in diabetic patients and is known for its resistance. This study aimed to assess the antimicrobial susceptibility of Escherichia coli strains isolated from diabetic patients in Mogadishu, Somalia. Methods This descriptive cross-sectional study was conducted at Ummah Hospital in Mogadishu, Somalia, from November 2021 to April 2022. Clean catch mid-stream urine specimens were collected from each participant and uropathogens were identified using standard techniques. The samples were cultured on CLED agar and antibiotic susceptibility patterns were determined using the Kirby-Bauer disk diffusion method. Data analysis was performed using SPSS version 20. Results The overall prevalence of uropathogens among diabetic patients was 236/350 (67.5%) with Escherichia coli being the most common organism. According to multivariate logistic regression, the results showed that Female diabetic patients had a significantly higher likelihood of developing UTIs compared to males (AOR = 2.5, 95% CI: 1.357-4.522, p = 0.003). The duration of diabetes, history of previous UTIs, and previous antibiotic use were also significantly associated with UTIs. All isolates were found to be resistant to Cefotaxime (100%). In addition, high resistance rates were observed with ofloxacin (91%), ciprofloxacin (77.8%), amikacin (60.9%), ceftriaxone (58.3%), and cefepime (51.8%). The most sensitive antibiotics were colistin and imipenem (99.6 and 88.6%, respectively), followed by gentamycin (70%). Conclusion This study found a high prevalence of uropathogens and increased multi-drug resistance. Continuous surveillance is needed to monitor uropathogen prevalence and resistance rates, guiding treatment recommendations, rational prescription programs, and policy decisions.
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Affiliation(s)
- Shafie Abdulkadir Hassan
- Department of Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia
- Department of Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Yousif Mousa Alobaid Ahmed
- Department of Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Gallad Dahir Hassan
- Department of Public Health, Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia
- School of Public Health and Research, Somali National University, Mogadishu, Somalia
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Girma A, Aemiro A, Workineh D, Tamir D. Magnitude, Associated Risk Factors, and Trend Comparisons of Urinary Tract Infection among Pregnant Women and Diabetic Patients: A Systematic Review and Meta-Analysis. J Pregnancy 2023; 2023:8365867. [PMID: 37545868 PMCID: PMC10403334 DOI: 10.1155/2023/8365867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/12/2023] [Accepted: 05/19/2023] [Indexed: 08/08/2023] Open
Abstract
Urinary tract infection (UTI) remains the most common bacterial infection that affects millions of people around the world, especially pregnant women (PW) and people with diabetes mellitus (DM). This systematic review and meta-analysis was aimed at finding the pooled prevalence of UTI and its associated risk factors among PW and DM patients. Scientific articles written in English were recovered from PubMed, ScienceDirect, Web of Science, Google Scholar, Cochrane Library, Google Engine, and University Library Databases. "Prevalence," "urinary tract infection," "associated factors," "pregnant women," "diabetic patients," and "Ethiopia" were search terms used for this study. For critical appraisal, PRISMA-2009 was applied. Heterogeneity and publication bias were evaluated using Cochran's Q, inverse variance (I2), and funnel plot asymmetry tests. A random effect model was used to calculate the pooled prevalence of UTI and its associated factors among both patients, along with the parallel odds ratio (OR) and 95% confidence interval (CI). For this meta-analysis, a total of 7271 participants were included in the 25 eligible studies. The pooled prevalence of UTI in Ethiopia among both patients was 14.50% (95% CI: 13.02, 15.97), of which 14.21% (95% CI: 12.18, 16.25) and 14.75% (95% CI: 12.58, 16.92) were cases of DM and PW, respectively. According to the subgroup analysis, the highest prevalence was observed in the Oromia region (19.84%) and in studies conducted from 2018 to 2022 (14.68%). Being female (AOR: 0.88, and 95% CI: 0.11, 1.65, P = 0.01) and having an income level ≤ 500ETB (AOR: 4.46, and 95% CI: -1.19, 10.12, P = 0.03) were risk factors significantly associated with UTI among patients with DM and PW, respectively. Furthermore, a history of catheterization (AOR = 5.58 and 95% CI: 1.35, 9.81, P < 0.01), urinary tract infection (AOR: 3.52, and 95% CI: 1.96, 5.08, P < 0.01), and symptomatic patients (AOR: 2.32, and 95% CI: 0.57, 4.06, P < 0.01) were significantly associated with UTI in both patients. Early diagnosis and appropriate medication are necessary for the treatment of UTI in patients with DM and PW.
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Affiliation(s)
- Abayeneh Girma
- Department of Biology, College of Natural and Computational Science, Mekdela Amba University, P.O. Box 32, Tulu Awlia, Ethiopia
| | - Aleka Aemiro
- Department of Biology, College of Natural and Computational Science, Mekdela Amba University, P.O. Box 32, Tulu Awlia, Ethiopia
| | - Dereba Workineh
- Department of Biology, College of Natural and Computational Science, Mizan-Tepi University, P.O. Box 121, Tepi, Ethiopia
| | - Dessalew Tamir
- Department of Veterinary Science, College of Agriculture and Environmental Sciences, Debre Tabor University, P.O. Box 272, Debre Tabor, Ethiopia
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Diriba K, Awulachew E, Bizuneh B. Identification of Bacterial Uropathogen and Antimicrobial Resistance Patterns Among Patients with Diabetic and Hypertension Attending Dilla University General Hospital, Dilla, Ethiopia. Infect Drug Resist 2023; 16:4621-4633. [PMID: 37484906 PMCID: PMC10361459 DOI: 10.2147/idr.s417033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Background Having a urinary tract infection (UTI) is a serious health issue which is caused by microbial colonization and proliferation in the urinary system. Patients with diabetes and blood pressure are more vulnerable to bacterial urinary tract infections because their host defense is compromised and their urine has a high glucose content. A proper and quick investigation of uropathogen and their antibiogram is key to patient treatment and infection control. Objective Aimed to assess the identification of bacterial uropathogen and antimicrobial resistance patterns among diabetic and hypertension patients attending DUGH, Ethiopia. Methods A Facility-based cross-sectional study was conducted from February to December 2022 among 158 diabetic and hypertensive patients using a clean catch mid-stream urine sample. Pretested structured questionnaires were used to collect data from study participants. Urine samples were taken and cultured on Blood agar, MacConkey agar and CLED Agar for the identification of uropathogen. An antimicrobial susceptibility test was done according to CLSI. Binary and multiple logistic regression were used to assess the association. A P-value less than 0.05 was considered statistically significant. Results The overall prevalence of bacterial uropathogenic among diabetes mellitus and hypertension patients was 15.2%. E. coli (29.2%), coagulase negative Staphylococci (CoNS) (20.8%), K. pneumoniae 3 (12.5%) and S. aureus 2 (12.5%) were the leading isolated uropathogens. In our study, illiterates (AOR =8.1, 95% CI: (5.1-12.4)), participants with high blood glucose levels (AOR=1.81, 95% CI: (1.01-2.21)) and comorbid patients (AOR = 4.2, 95% CI: (4.1-17.2)) were significantly associated with UTI. Both gram-negative and gram-positive isolated bacteria showed higher resistance to most of the commonly used antibiotics. Multidrug resistance was reported in 62.5% of the total isolates. Conclusion This study revealed a high prevalence of bacterial isolate and multidrug resistance. Therefore, continuous monitoring of microbiological and antimicrobial surveillance of UTI among DM patients is crucial for appropriate treatment and infection control.
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Affiliation(s)
- Kuma Diriba
- Department of Medical Laboratory Sciences, Health Science and Medical CollegeDilla University, Dilla, Ethiopia
| | - Ephrem Awulachew
- Department of Medical Laboratory Sciences, Health Science and Medical CollegeDilla University, Dilla, Ethiopia
| | - Bereket Bizuneh
- School of Medicine, Health Science and Medical College, Dilla University, Dilla, Ethiopia
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Osman EA, Yokoyama M, Altayb HN, Cantillon D, Wille J, Seifert H, Higgins PG, Al-Hassan L. Klebsiella pneumonia in Sudan: Multidrug Resistance, Polyclonal Dissemination, and Virulence. Antibiotics (Basel) 2023; 12:antibiotics12020233. [PMID: 36830144 PMCID: PMC9952582 DOI: 10.3390/antibiotics12020233] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
The emergence and global expansion of hyper-virulent and multidrug resistant (MDR) Klebsiella pneumoniae is an increasing healthcare threat worldwide. The epidemiology of MDR K. pneumoniae is under-characterized in many parts of the world, particularly Africa. In this study, K. pneumoniae isolates from hospitals in Khartoum, Sudan, have been whole-genome sequenced to investigate their molecular epidemiology, virulence, and resistome profiles. Eighty-six K. pneumoniae were recovered from patients in five hospitals in Khartoum between 2016 and 2020. Antimicrobial susceptibility was performed by disk-diffusion and broth microdilution. All isolates underwent whole genome sequencing using Illumina MiSeq; cgMLST was determined using Ridom SeqSphere+, and 7-loci MLST virulence genes and resistomes were identified. MDR was observed at 80%, with 35 isolates (41%) confirmed carbapenem-resistant. Thirty-seven sequence types were identified, and 14 transmission clusters (TC). Five of these TCs involved more than one hospital. Ybt9 was the most common virulence gene detected, in addition to some isolates harbouring iuc and rmp1. There is a diverse population of K. pneumoniae in Khartoum hospitals, harbouring multiple resistance genes, including genes coding for ESBLs, carbapenemases, and aminoglycoside-modifying enzymes, across multiple ST's. The majority of isolates were singletons and transmissions were rare.
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Affiliation(s)
- Einas A. Osman
- Bioscience Research Institute, Ibn Sina University, Khartoum 11111, Sudan
| | - Maho Yokoyama
- Department of Global Health and Infection, Brighton & Sussex Medical School, Brighton BN1 9PX, UK
| | - Hisham N. Altayb
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Daire Cantillon
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50935 Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50935 Cologne, Germany
| | - Paul G. Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50935 Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Leena Al-Hassan
- Department of Global Health and Infection, Brighton & Sussex Medical School, Brighton BN1 9PX, UK
- Correspondence: ; Tel.: +44-(0)-1278877817
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Owusu E, Adjei H, Afutu E. Similarities in Bacterial Uropathogens and Their Antimicrobial Susceptibility Profile in Diabetics and Their Non-Diabetic Caregivers at a National Diabetes Management and Research Centre, Accra-Ghana. Diseases 2022; 10:diseases10040124. [PMID: 36547210 PMCID: PMC9777486 DOI: 10.3390/diseases10040124] [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: 09/30/2022] [Revised: 11/15/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus has some damaging effects on the genitourinary system and has been found to have adverse effects on the host immune system, resulting in higher risk of infections including urinary tract infections (UTI). Incidences of UTI caused by bacteria have been increasingly reported globally and the abuse of antibiotics leading to evolving resistant strains of antibiotics is a public health challenge for the management of this condition. Information on the difference in types of bacterial agents causing UTI in diabetic patients and non-diabetic individuals, and their susceptibility profiles, will facilitate effective management among these groups of patients. Therefore, this study aimed at determining the difference in prevalence of UTI, the causative bacteria, and their antimicrobial susceptibility profiles in diabetic patients and non-diabetic individuals at a diabetes management center. METHODS This was a prospective cross-sectional study conducted amongst 100 diagnosed diabetic patients and 100 non-diabetic individuals. Urine sample was collected aseptically and analyzed microbiologically for the presence of urinary tract bacterial pathogens. Drug susceptibility testing was conducted on the isolates by the Kirby Bauer method to ascertain the antibiotic susceptibility patterns. RESULTS Among the diabetic and non-diabetic individuals, urinary tract bacterial pathogens were observed in 28.0% and 26.0% of samples, respectively. The organisms were in the following proportions for diabetic and non-diabetic individuals, respectively: E. coli (14/28, 50% and 8/26, 30.7%), S. aureus (2/28, 7.1% and 4/26, 15.4%), K. pneumoniae (4/28, 14.3% and 8/26, 30.7%), K. ozoenae (2/28, 7.14% and 0/26, 0%), K. oxytoca (0/28, 0% and 4/26, 15.4%) and C. urealyticum (6/28, 21.4% and 2/26, 7.69%). The difference between the proportions of bacteria isolated was, however, not statistically significant (p-value = 0.894). Bacteria isolated from both diabetic and non-diabetic individuals were highly susceptible to most of the antibiotics tested, especially nitrofurantoin, cefuroxime, ceftriaxone, and cefotaxime. CONCLUSION This study has shown that similarities exist in prevalence of UTI, the causative bacteria, and their antimicrobial susceptibility patterns amongst diabetic patients and non-diabetic individuals at a diabetes management center. These data will help in the management of UTI among these individuals.
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Affiliation(s)
- Enid Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
- Correspondence: (E.O.); (E.A.); Tel.: +233-0508-917-569 (E.O.)
| | - Henrietta Adjei
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
| | - Emmanuel Afutu
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
- Correspondence: (E.O.); (E.A.); Tel.: +233-0508-917-569 (E.O.)
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Pankok F, Fuchs F, Loderstädt U, Kaase M, Balczun C, Scheithauer S, Frickmann H, Hagen RM. Molecular Epidemiology of Escherichia coli with Resistance against Third-Generation Cephalosporines Isolated from Deployed German Soldiers-A Retrospective Assessment after Deployments to the African Sahel Region and Other Sites between 2007 and 2016. Microorganisms 2022; 10:microorganisms10122448. [PMID: 36557701 PMCID: PMC9788009 DOI: 10.3390/microorganisms10122448] [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: 11/12/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Colonization and infection with bacteria with acquired antibiotic resistance are among the risks for soldiers on international deployments. Enterobacterales with resistance against third-generation cephalosporines are amongst the most frequently imported microorganisms. To contribute to the scarcely available epidemiological knowledge on deployment-associated resistance migration, we assessed the molecular epidemiology of third-generation cephalosporine-resistant Escherichia coli isolated between 2007 and 2016 from German soldiers after deployments, with a particular focus on the African Sahel region. A total of 51 third-generation cephalosporine-resistant E. coli isolated from 51 military returnees from deployment collected during the assessment period between 2007 and 2016 were subjected to short-read next-generation sequencing analysis. Returnees from the Sahel region (Djibouti, Mali, South Sudan, Sudan, Sudan, and Uganda) comprised a proportion of 52.9% (27/51). Repeatedly isolated sequence types according to the Warwick University scheme from returnees from the Sahel region were ST38, ST131, and ST648, confirming previous epidemiological assessments from various sub-Saharan African regions. Locally prevalent resistance genes in isolates from returnees from the Sahel region associated with third-generation resistance were blaCTX-M-15, blaCTX-M-27, blaCTX-M-1, blaTEM-169, blaCTX-M-14, blaCTX-M-99-like, blaCTX-M-125, blaSHV-12, and blaDHA-1, while virulence genes were east1, sat, and tsh in declining order of frequency of occurrence each. In line with phenotypically observed high resistance rates for aminoglycosides and trimethoprim/sulfamethoxazole, multiple associated resistance genes were observed. A similar, slightly more diverse situation was recorded for the other deployment sites. In summary, this assessment provides first next-generation sequencing-based epidemiological data on third-generation cephalosporine-resistant E. coli imported by deployed German soldiers with a particular focus on deployments to the Sahel region, thus serving as a small sentinel. The detected sequence types are well in line with the results from previous epidemiological assessments in sub-Saharan Africa.
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Affiliation(s)
- Frederik Pankok
- Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen, 37075 Göttingen, Germany
- Correspondence: (F.P.); (U.L.)
| | - Frieder Fuchs
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, 50931 Cologne, Germany
| | - Ulrike Loderstädt
- Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen, 37075 Göttingen, Germany
- Correspondence: (F.P.); (U.L.)
| | - Martin Kaase
- Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Carsten Balczun
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany
| | - Simone Scheithauer
- Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hospital Hygiene, University Medicine Rostock, 18057 Rostock, Germany
| | - Ralf Matthias Hagen
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany
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Oumer O, Metaferia Y, Gebretsadik D. Bacterial uropathogens, their associated factors, and antimicrobial susceptibility pattern among adult diabetic patients in two health centers at Kombolcha town, Northeastern Ethiopia. SAGE Open Med 2022; 10:20503121221139149. [PMID: 36457843 PMCID: PMC9706039 DOI: 10.1177/20503121221139149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/28/2022] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Urinary tract infection has catastrophic health outcome among diabetes mellitus patients. This study was conducted to investigate prevalence of bacterial uropathogens, their antibiogram, and associated factors among diabetes mellitus patients in Kombolcha town. METHOD Cross-sectional study was done from February to April 2020. A total of 282 study participants were involved and simple random technique was applied for enrollment of subjects. Well-constructed and pre-tested questionnaire was utilized to collect the data. Five to ten milliliters of mid-stream urine specimen was collected for microbiological data. Each sample was inoculated into cystine lactose electrolyte deficient medium, incubated overnight in aerobic atmosphere at 37°C for 24 h and finally biochemical tests were carried out. According to Kirby-Bauer disk diffusion method, the antimicrobial susceptibilities pattern of the bacteria was performed on Mueller-Hinton Agar. The data were analyzed with Statistical Package for Social Sciences version 23. Descriptive statistics, bi-variable, and multivariable logistic regression analyses were performed. For statistical significance association, p value ⩽ 0.05 with a 95% confidence interval was considered. RESULTS The general prevalence of urinary tract infection among study participants was 20.2% (57/282). Being female and having merchant occupation had a statistically significant association. Gram-negative bacteria accounted for 70.2% (40/57) and the leading isolate was Escherichia coli, followed by Klebsiella pneumoniae and Coagulase negative Staphylococcus. About 57.5% gram-negative and 35.3% gram-positive bacteria showed multidrug resistance. CONCLUSION The general prevalence of significant bacteriuria was found to be consistent with similar studies conducted in different areas. The higher multidrug resistance rate was observed for the isolated bacteria. Health-care professionals should give due attention and follow rational antibiotic prescription practices to treat these infections.
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Affiliation(s)
- Ousman Oumer
- Department of Medical Laboratory
Science, Gambela Teacher’s Education and Health Science College, Gambela,
Ethiopia
| | - Yeshi Metaferia
- Department of Medical Laboratory
Science, College of Medicine and Health Sciences, Wollo University, Dessie,
Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory
Science, College of Medicine and Health Sciences, Wollo University, Dessie,
Ethiopia
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12
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Bebars GM, Mostafa AN, Moness HM, Aziz RAA. Assessment of early kidney injury caused by asymptomatic bacteriuria in children with type 1 diabetes. BMC Pediatr 2022; 22:643. [PMCID: PMC9639256 DOI: 10.1186/s12887-022-03689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Introduction
Infection is one of the most frequent causes of morbidity and mortality in diabetic patients. Some microorganisms become more virulent in a high glucose concentration. Diabetics are more likely to have asymptomatic and symptomatic bacteriuria. NGAL is secreted in high concentrations into the blood and urine within two hours of AKI.
Objectives
The aim of the study is early detection of UTI in type1diabetic children through screening of their urine samples, and measurement of NGAL urinary levels in cases with asymptomatic bacteriuria for early detection of AKI to prevent serious complications.
Patients and methods
One thousand twenty-two known diabetic children on regular follow up in endocrine outpatient clinic at Minia Children University hospital were screened for UTI. From them only 52 diabetic children were diagnosed as asymptomatic bacteriuria (group I), 52 diabetic children with normal urine analysis (group II) and 52 apparently healthy children, age and sex matched, served as controls (group III). CBC, Renal function test, HbA1c, hs- CRP, Albumin/creatinine ratio, urine examination, urine culture, GFR and urinary NGAL were done to all children.
Results
Thirty-seven females (71.2%) had asymptomatic bacteriuria, Hs CRP and urinary NGAL were significantly higher, while GFR was significantly lower in diabetic children with bacteriuria than the other two groups. For diabetic children with bacteriuria, (AUC) for NGAL was 1 with optimal cutoff value of > 44.1 (Sensitivity 100% and Specificity 100%) while AUC for hsCRP was 0.887 with optimal cutoff value of > 1 (Sensitivity 82.69% and Specificity 90.38%).
Conclusion
Routine urine analysis should be done for all diabetic children even if they are asymptomatic. NGAL and hsCRP are non-invasive methods that could detect early renal injury in these patients thus, early, and proper management of UTI should be started to prevent renal injury.
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13
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Al Qurabiy HE, Abbas IM, Hammadi ATA, Mohsen FK, Salman RI, Dilfy SH. Urinary tract infection in patients with diabetes mellitus and the role of parental genetics in the emergence of the disease. J Med Life 2022; 15:955-962. [PMID: 36188660 PMCID: PMC9514823 DOI: 10.25122/jml-2021-0331] [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: 10/28/2021] [Accepted: 02/01/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess the role of paternal genetics in the development of diabetic mellitus (DM) and determine the impact of DM on the urinary system by investigating the percentage of patients with urinary tract infection (UTI). The study included 100 people with DM; their ages ranged from 5 to 83 years. The DM and blood sugar levels were diagnosed clinically and at a laboratory in Al-Zahra Teaching Hospital and the outpatient clinics. The age, gender, and causes of DM and the family history of diabetes were reported. Isolation and identification of bacterial species were made depending on culture media and biochemical tests. The average age of patients was 47.7±5.5, and most of them were female (67%). The incidence of DM increased with age, and the main cause of DM was likely to be a genetic predisposition (family history), where 32% of patients appeared to have a positive family history and the presence of DM in both parents or only the mother had a significant role in increasing the genetic predisposition of developing DM. Among the non-genetic causes of DM, the most common was exposure to sudden psychological or nervous shock (41%). Obesity also had an important role in the development of diabetes, and also pregnancy and smoking. Moreover, 66% of patients with type 2 DM and all with type 1 DM suffered from UTIs. The main causative agents were E. coli (60%) and Proteus spp. (13%). The majority of patients suffering from UTIs (73%) were females. In conclusion, type 2 DM is the most common, especially in females, and increases with age. The main cause of DM was family genetic predisposition and sudden shocks. The current study also showed that most diabetic patients suffered from UTIs, especially females, and the main causes of UTI inflammation are E. coli isolates.
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Affiliation(s)
| | - Ihab Majeed Abbas
- Department of Medical Laboratory Techniques, Kut University College, Al-Kut, Iraq
| | | | - Farah Kadhim Mohsen
- Department of Medical Laboratory Techniques, Kut University College, Al-Kut, Iraq
| | - Rasha Ibrahim Salman
- Department of Medical Laboratory Techniques, Kut University College, Al-Kut, Iraq
| | - Saja Hussain Dilfy
- Department of Biology, College of Education for Pure Science, Wasit University, Al-Kut, Iraq,Corresponding Author: Saja Hussain Dilfy, Department of Biology, College of Education for Pure Science, Wasit University, Al-Kut, Iraq. E-mail:
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14
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Al-Mijalli SHS, Shami AY, Al-Salem RA, Alnafisi NM. Development of Diagnostic Capabilities for Complications of Bacterial Infection in Diabetic Patients. Rev Diabet Stud 2022; 18:135-139. [PMID: 35831935 PMCID: PMC10044050 DOI: 10.1900/rds.2022.18.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE: Our objective was to assess the pattern of urine infections, the most common pathogen, and their susceptibility pattern to antibiotics among Saudi diabetic patients. METHODS: We performed a year-long cross-sectional study from January 2018 to January 2019 at
KAAU Hospital in Riyadh, KSA. We cultured the urine specimens obtained from diabetic patients based on optimal aerobic and anaerobic microbiological methods. By adopting standard microbiological methods, we identified the bacterial isolates. We also followed the guidelines of the Clinical
and Laboratory Standards Institute (CLSI) to do antibiotic susceptibility testing. RESULTS: A total of 100 isolates were evaluated, and a total of 22 organisms were isolated. The majority were multidrug-resistant organisms. Streptococcus haemolyticus was the most frequent organism
and rated (15%). It was followed by Staphylococcus hominis (11%), Pseudomonas aeruginosa (9%), Enterococcus faecalis (9%), Enterococcus fiseum (7%), Escherichia coli (7%), Staphylococcus aureus (7%), Staphylococcus lantus (5%) and Klebsiella
pneumoniae (5%). We also found multi-microbial infections. Most of the organisms were susceptible to tigecycline, gentamycin, and nitrofurantoin, rating (88%), (84%) and (78%), respectively. CONCLUSIONS: Our study revealed that a wide range of pathogens affects the diabetes patients.
Staphylococcus haemolyticus is the most prevalent pathogen. We observed considerable antimicrobial resistance. Tigecycline had a wide sensitivity spectrum and was effective against most of the bacteria. Thus, it can be used as an empirical antibiotic.
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Affiliation(s)
- Samiah Hamad S Al-Mijalli
- Department of Biology, College of Sciences, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Saudi Arabia
| | - Ashwag Y Shami
- Department of Biology, College of Sciences, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Saudi Arabia
| | - Rasha A Al-Salem
- Department of Biology, College of Sciences, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Saudi Arabia
| | - Nawaf M Alnafisi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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15
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Nath T, Das SK, Hazra S. Pattern of uropathogens and antibiotic sensitivity in diabetes patients attending to out - Patient department and diabetes clinic of a teaching hospital: A cross-sectional study. J Family Med Prim Care 2021; 10:3638-3643. [PMID: 34934659 PMCID: PMC8653490 DOI: 10.4103/jfmpc.jfmpc_71_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/25/2021] [Accepted: 07/04/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Diabetes mellitus is the most common endocrinological disease associated with different life-threatening infections. Urinary Tract Infection is one of them which may lead to Intensive care Unit admission and even death. In this study, we would like to find out the spectrum of uropathogen and its antibiotic sensitivity, so that we can choose empirical antibiotics early to save lives. Aim and Objectives: To find out spectrum of uropathogens in Diabetic patients attending to Diabetes Clinic of a tertiary hospital and to find out the Antibiotic sensitivity pattern in isolated bacteria. Material and Methods: In this cross-sectional observational hospital-based study, consecutive patients of any age and gender having Diabetes mellitus and symptoms of Urinary Tract Infection, who attended Out-patient Department and Diabetes Clinic of General Medicine Department from August 2020 to October 2020, were included. After taking consent and brief history, mid-stream clean catch urine sample was collected in sterile container and sent to a Microbiology laboratory for culture of micro-organism and sensitivity to antibiotics. Results: Among 202 diabetic patients recruited in our study, 138 (68.31%) were female and 64 (31.69%) were male. The mean age of all participants was 50.23 ± 11.45 years. Culture confirmed UTI was 24.3% and patients showing classic UTI symptoms were 32.7%. Compared to male, most of the culture-positive and symptomatic patients were female (26.0% and 37% respectively). Culture-positive patients who showed classic UTI symptoms were 42.42%; however, we found 15.44% asymptomatic patients who showed culture positivity. The mean HbA1c level was 7.5 ± 1.6%. Subgroup analysis revealed that patients with HbA1c >7.5% were at a significantly higher risk of developing culture-positive UTI (P < 0.00001, Odds ratio 21.71). Prevalence of gram-negative and gram-positive bacteria were 65.3% (32 out of 49) and 28.57% (14 out of 49), respectively. The major organism isolated were Escherichia coli (39%), Klebsiella spp. (19%), Enterococcus spp. (12%), Staphylococcus aureus (12%), and Candida spp. (6%). The sensitivity pattern of the gram-negative bacilli showed the presence of Extended-spectrum betalactamases (ESBLs) in 36.84% (11 out of 32 isolates). The bacteria grown were most sensitive to Piperacillin-tazobactam (100%), Cefoperazone-sulbactam (100%) and Meropenem (100%) whereas Fluoroquinolone and Co-Amoxyclav showed least sensitivity (43.8% and 37.5% respectively). The Staphylococcus spp. showed 100% sensitivity to Vancomycin, Teicoplanin, Linezolid whereas Penicillin-G and Ampicillin showed 12.5% sensitivity. The Enterococcus spp. revealed 100% sensitivity to Vancomycin, Teicoplanin, Linezolid, and Fosfomycin. Drug resistance is emerging in clinical isolates. Prevalence of ESBL in Enterobacteriacea was found to be 34%. Conclusion: All patients with diabetes must be searched for urinary tract bacterial colonization by simple routine urinary culture even though they are asymptomatic. Resistance to common antibiotics, particularly to oral formulations (especially Fluoroquinolones and Ampicillin) is increasing day by day due to indiscriminate use of antibiotics. This study highlighted that the policy makers should formulate antibiotic policy for rational use of antibiotics, which could help clinicians to prescribe proper antibiotics. However, regular monitoring of susceptibility pattern of urinary pathogens is essential.
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Affiliation(s)
- Tanusree Nath
- Senior Resident, Department of Physiology at College of Medicine and Sagore Dutta Hospital, WBMES, North 24 Parganas, India
| | - Somak Kumar Das
- Associate Professor, Department of Medicine at College of Medicine and Jawaharlal Nehru Memorial Hospital, WBUHS, Kalyani, West Bengal, India
| | - Santanu Hazra
- Senior Resident, Department of Microbiology, North Bengal Medical College, West Bengal, India
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16
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Walelgn B, Abdu M, Kumar P. The occurrence of urinary tract infection and determinant factors among diabetic patients at Dessie Referral Hospital, South Wollo, Northeast Ethiopia. SAGE Open Med 2021; 9:20503121211060614. [PMID: 34868594 PMCID: PMC8640288 DOI: 10.1177/20503121211060614] [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: 08/09/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Diabetic patients have a higher tendency of developing all infections, especially infections of the genitourinary tract. Urinary tract infections cause considerable disorders in diabetic patients, and if complicated, can cause renal failure. In Ethiopia, the magnitude of diabetes mellitus-associated urinary tract infections increased from 7.1% in 2005 to 33.9% in 2019. The successful management of patients suffering from urinary tract infections in diabetic patients depends upon the identification of risk factors. This study aimed to determine the magnitude and factors affecting the urinary tract infections among diabetic patients which enable professionals to prevent infections and manage them effectively. Methods: Hospital-based cross-sectional study was conducted with 365 diabetic patients selected by systematic sampling technique from March to April 2020. Data were collected by trained BSc nurses via face-to-face interview and patient chart review. Urine microscopy was done to diagnose urinary tract infections. Data were coded and entered using Epi data version 3.1 and exported to Statistical Package of Social Sciences version 26 for analysis. Variables with p-value < 0.25 in bivariable logistic regression were included multivariable logistic regression and variables with a p-value < 0.05 were considered statistically significant. Results: The magnitude of urinary tract infections was 22.3% (95% confidence interval: 18–27). The odds of being infected by urinary tract infections were significantly higher in diabetic females (adjusted odds ratio: 2.46; 95% confidence interval: 1.40–4.32), duration of diabetes mellitus diagnosis of ⩾5 years (adjusted odds ratio: 1.98; 95% confidence interval: 1.05–3.72), with comorbidity (adjusted odds ratio: 4.87; 95% confidence interval: 2.76–8.59) and khat chewer (adjusted odds ratio: 1.84; 95% confidence interval: 1.04–3.24) compared with their counter. Conclusion and recommendation: Urinary tract infections were high among diabetic patients. Predictors like sex, duration of diagnosis, comorbidity, and khat chewer were found to be associated with urinary tract infections. Improvement of the regular screening of patients with diabetes mellitus for urinary tract infections will provide more effective measures in prevention and management.
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Affiliation(s)
- Betelhem Walelgn
- Department of Comprehensive Nursing, School of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Mehd Abdu
- Department of Nursing, College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Prem Kumar
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Martínez-Santos VI, Ruíz-Rosas M, Ramirez-Peralta A, Zaragoza García O, Resendiz-Reyes LA, Romero-Pineda OJ, Castro-Alarcón N. Enteroaggregative Escherichia coli is associated with antibiotic resistance and urinary tract infection symptomatology. PeerJ 2021; 9:e11726. [PMID: 34513321 PMCID: PMC8395569 DOI: 10.7717/peerj.11726] [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: 03/23/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background Uropathogenic Escherichia coli (UPEC) is the causative agent of uncomplicated urinary tract infections (UTIs) in ambulatory patients. However, enteroaggregative E. coli (EAEC), an emergent bacterial pathogen that causes persistent diarrhoea, has recently been associated with UTIs. The aim of this study was to determine the frequency of EAEC virulence genes, antibiotic resistance, as well as biofilm production of UPEC isolates obtained from ambulatory patients with non-complicated UTIs that attended to the ISSSTE clinic in Chilpancingo, Guerrero, Mexico, and correlate these with the patients' urinary tract infection symptomatology. Methods One hundred clinical isolates were obtained. The identification of clinical isolates, antimicrobial susceptibility testing, and extended spectrum beta-lactamases (ESBLs) production were performed using the Vitek automated system. Assignment of E. coli phylogenetic groups was performed using the quadruplex phylo-group assignment PCR assay. UPEC virulence genes (hlyA, fimH, papC, iutA, and cnf1) and EAEC virulence genes (aap, aggR, and aatA) were detected by multiple PCR. Results We found that 22% of the isolates carried the aggR gene and were classified as UPEC/EAEC. The main phylogenetic group was B2 (44.1% were UPEC and 77.27% UPEC/EAEC isolates, respectively). Over half of the UPEC/EAEC isolates (63.64%) were obtained from symptomatic patients, however the aatA gene was the only one found to be associated with the risk of developing pyelonephritis (OR = 5.15, p = 0.038). A total of 77.71% of the UPEC/EAEC isolates were ESBL producers and 90.91% multidrug-resistant (MDR). In conclusion, UPEC/EAEC isolates are more frequent in symptomatic patients and the aatA gene was associated with a higher risk of developing pyelonephritis, along with UPEC genes hlyA and cfn1. UPEC/EAEC isolates obtained from UTI showed ESBL production and MDR.
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Affiliation(s)
| | - María Ruíz-Rosas
- Laboratorio Clínico, Área Microbiología, Clínica Hospital ISSSTE Chilpancingo, Chilpancingo, Guerrero, México
| | - Arturo Ramirez-Peralta
- Laboratorio de Patometabolismo Microbiano, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
| | - Oscar Zaragoza García
- Laboratorio de Investigación en Microbiología, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
| | - Luis Armando Resendiz-Reyes
- Laboratorio de Investigación en Microbiología, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
| | - Obed Josimar Romero-Pineda
- Laboratorio de Investigación en Microbiología, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
| | - Natividad Castro-Alarcón
- Laboratorio de Investigación en Microbiología, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
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18
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Tauseef A, Zafar M, Syyed E, Thirumalareddy J, Sood A, Mirza M. Asymptomatic Bacteriuria (ASB) in diabetic patients: Treat or not to treat: A prospective, observational study conducted at a tertiary care hospital. J Family Med Prim Care 2021; 10:1963-1969. [PMID: 34195132 PMCID: PMC8208176 DOI: 10.4103/jfmpc.jfmpc_1894_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/24/2020] [Accepted: 12/16/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The term asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine specimen of individuals who denied symptoms of urinary tract infection. Diabetes mellitus (DM) is a disease involving multiple organ systems, hallmarked for its chronicity and thus-forth endless complications including asymptomatic bacteriuria. Objectives: This study aimed to determine the characteristics of asymptomatic bacteriuria and antibiotic susceptibility pattern amongst patients with diabetes. Settings and Design: A prospective observational study was conducted at a tertiary care hospital in Karachi, Pakistan. Methods and Material: The study included all those patients with a diagnosis of diabetes with no signs and symptoms of urinary tract infection but showing the growth of an organism in urine culture. Pregnant females and subjects who used antibiotics in last two weeks were excluded. A total of 222 urine cultures were observed prospectively who met the inclusion criteria through non-probability consecutive sampling. Results: Out of 222 urine cultures observed, mean age of subjects were 62.89 ± 13.77 out of which 76% were females, and 61% had a family history of diabetes. The most frequent organisms isolated were Escherichia. Coli (E. Coli), Enterococcus, Klebsiella, Pseudomonas, and Enterobacter species. A total of 20 subjects got dual bacterial growth in their cultures among which 17 subjects had a growth of Enterococcus with any other pathogen causing UTI. Gender, family history of diabetes, levels of HBA1c, and older age groups all were found significantly associated with ASB. Conclusions: Our study is the first to analyze and study the associated risk factors amongst ASB in DM patients, and to identify the pathogens involved along with assessing their antibiotic resistance profiles. Also, due to the increase resistance to antibiotics we would recommend to use antibiotics in ASB patients only if they have any two or more comorbidities.
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Affiliation(s)
- Abubakar Tauseef
- Resident Physician, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
| | - Maryam Zafar
- Resident Physician in Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Erum Syyed
- Medical Student at Dow University of Health Sciences, Karachi, Pakistan
| | - Joseph Thirumalareddy
- Hospitalist, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
| | - Akshat Sood
- Hospitalist, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
| | - Mohsin Mirza
- Associate Program Director, Department of Internal Medicine, Creighton University Hospital Program, Omaha, NE, USA
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19
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Kamei J, Yamamoto S. Complicated urinary tract infections with diabetes mellitus. J Infect Chemother 2021; 27:1131-1136. [PMID: 34024733 DOI: 10.1016/j.jiac.2021.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
Patients with diabetes mellitus (DM) sometimes exhibited impaired immune function and aggravated infectious diseases. Urinary tract infection (UTI) is one of the major complications of DM. A systematic literature search was performed in PubMed and Cochrane Library using the following keywords: diabetes mellitus, urinary tract infection, asymptomatic bacteriuria, emphysematous pyelonephritis, emphysematous cystitis, renal papillary necrosis, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. The treatment of UTI in DM patients is not different from that in non-DM patients, and asymptomatic bacteriuria should not be screened or treated. Emphysematous pyelonephritis is a life-threatening renal infection with gas in the renal parenchyma or perirenal space, and 95% of affected patients had DM. Abdominal computed tomography is useful for diagnosis and determining treatment strategies. Medical management and percutaneous drainage are standard initial treatment, and subsequent nephrectomy for non-responders is considered. Nephrectomy, as an initial treatment, should be limited to a selected group of patients with severe conditions. In contrast, antibiotics, glycemic control, and bladder drainage are adequate treatment for most cases of emphysematous cystitis. SGLT2 inhibitors significantly increased the incidence of genital tract infection, but not that of UTI, pyelonephritis, or urosepsis. Here, we present cumulative evidence about etiology and management for complicated UTI with DM, but there was little information about racial differences and further evidence focusing on Asian population will be needed.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan.
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
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Yenehun Worku G, Belete Alamneh Y, Erku Abegaz W. Prevalence of Bacterial Urinary Tract Infection and Antimicrobial Susceptibility Patterns Among Diabetes Mellitus Patients Attending Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Infect Drug Resist 2021; 14:1441-1454. [PMID: 33883912 PMCID: PMC8055279 DOI: 10.2147/idr.s298176] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/25/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is caused by colonization and growth of microorganisms within the urinary system. Diabetic patients are more prone to bacterial UTI due to impaired host defense and high glucose concentration in urine. Surveillance of uropathogens and their antibiogram is a key to patient management. METHODS A hospital-based cross-sectional study was conducted from May to July, 2018. Urine samples were collected for culture and identification based on the standard protocol. An antimicrobial susceptibility test (AST) was done for all isolates using the Kirby-Bauer disk diffusion method. Data were entered into Epi-data version 3.2.1 and exported to the Statistical Package for the Social Science (SPSS) version 20. RESULTS Out of 225 participants, significant bacteriuria was reported in 9.8% of the cultures. Five species of bacteria were isolated and E. coli (63.6%) was the leading uropathogen, followed by K. pneumoniae (13.6%). Duration of diabetes, previous history of UTIs and symptomatic UTI were found to be strongly associated with significant bacteriuria. Gram-negative bacterial isolates showed high sensitivity to nitrofurantoin and meropenem (100%). In contrast, a high level of resistance to ampicillin, doxycycline and cefuroxime (100%) and to amoxicillin-clavulanate (94.4%) was observed. Gram-positive bacteria showed high level of resistance to penicillin (100%). Multiple-drug resistance (MDR) was high for Gram-negative bacteria (100%). CONCLUSION Previous history of UTIs and duration of diabetes were found to be important factors that increase the prevalence of UTI among diabetes patients. This study also showed a high prevalence of drug resistance to doxycycline, amoxicillin-clavulanate, cefuroxime and penicillin for both Gram-negative and Gram-positive bacteria. Since therapeutic selection for empirical treatment and management should be based on knowledge of the local bacterial profile and antimicrobial response, we suggest physicians take this high resistance profile in to consideration when prescribing antimicrobials against the pathogens in question.
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Affiliation(s)
- Gebremdhin Yenehun Worku
- Department of Microbiology, Addis Ababa Public Health Research and Emergency Management Directorate, Addis Ababa, Ethiopia
| | - Yerega Belete Alamneh
- Department of Microbiology, Immunology and Parasitology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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21
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Al-Hassan L, Elbadawi H, Osman E, Ali S, Elhag K, Cantillon D, Wille J, Seifert H, Higgins PG. Molecular Epidemiology of Carbapenem-Resistant Acinetobacter baumannii From Khartoum State, Sudan. Front Microbiol 2021; 12:628736. [PMID: 33717019 PMCID: PMC7952628 DOI: 10.3389/fmicb.2021.628736] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
Carbapenem resistant Acinetobacter baumannii (CRAb) is an important global pathogen contributing to increased morbidity and mortality in hospitalized patients, due to limited alternative treatment options. Nine international clonal (IC) lineages have been identified in many countries worldwide, however, data still lacks from some parts of the world, particularly in Africa. We hereby present the molecular epidemiology of MDR A. baumannii from four hospitals in Khartoum, Sudan, collected from 2017 to 2018. Forty-two isolates were whole-genome sequenced, and subsequent molecular epidemiology was determined by core genome MLST (cgMLST), and their resistomes identified. All isolates had an array of diverse antibiotic resistance mechanisms conferring resistance to multiple classes of antibiotics. We found a predominance (88%) of IC2 (with the intrinsic OXA-66 and acquired OXA-23), and some with NDM-1. IC2 isolates were sub-divided into 4 STs separated by 5 to 431 allelic differences, and with evidence of seven transmission clusters. Isolates belonging to IC1, IC5, and IC9 were also identified. These data illustrate that MDR IC2 A. baumannii are widely distributed in Khartoum hospitals and are in possession of multiple antibiotic resistance determinants.
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Affiliation(s)
- Leena Al-Hassan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Hana Elbadawi
- Department of Microbiology, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Einas Osman
- Faculty of Medical Laboratories, Microbiology Department, Ibn Sina University, Khartoum, Sudan
- Bioscience Research Institute, Ibn Sina University, Khartoum, Sudan
| | - Sara Ali
- College of Health Sciences, Medical Laboratory Sciences Program, Gulf Medical University, Ajman, United Arab Emirates
| | - Kamal Elhag
- Department of Microbiology, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Daire Cantillon
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Paul G. Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
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22
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Asghar MS, Akram M, Singh M, Yasmin F, Yaseen R, Ahmed N, Siddiqui M, Hassan M, Rasheed U, Ali A. Characteristics of Asymptomatic Bacteriuria in Diabetes Mellitus Patients: A Retrospective Observational Study. Cureus 2021; 13:e13562. [PMID: 33791179 PMCID: PMC8004580 DOI: 10.7759/cureus.13562] [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: 11/25/2022] Open
Abstract
Background and objective The term asymptomatic bacteriuria (ASB) refers to the isolation of bacteria in a urine specimen of individuals without any symptoms of urinary tract infection (UTI). Diabetes mellitus (DM) is a disease involving multiple organ systems, characterized by its chronicity and hence endless complications including ASB. This study aimed to determine the characteristics of ASB and antibiotic susceptibility patterns among patients with diabetes. Materials and methods This was a retrospective observational study conducted in a tertiary care hospital. The study included patients with a diagnosis of diabetes with no signs and symptoms of UTI but who still showed the growth of an organism in urine culture. A total of 222 urine cultures were analyzed retrospectively, ensuring that they met the inclusion criteria through non-probability consecutive sampling. Results The mean age of the study participants was 62.89 ± 13.77 years; 76% of them were females, and 61% had a family history of diabetes. The most frequent organisms isolated were Escherichia coli (E. coli), Enterococcus, Klebsiella pneumonia, Pseudomonas aeruginosa, and Enterobacter species. A total of 20 subjects had dual bacterial growth in their cultures, with Enterococcus species (n=17) being the most common organism. Gender, family history of diabetes, levels of hemoglobin A1c (HbA1c), and advanced age were all found significantly associated with ASB. Conclusion Our study is the first of its kind to analyze and examine the risk factors associated with ASB in DM patients, and to identify the pathogens involved, along with assessing their antibiotic resistance profiles.
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Affiliation(s)
| | - Mohammed Akram
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Manjeet Singh
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Farah Yasmin
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Rabail Yaseen
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Nisar Ahmed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Mariam Siddiqui
- Internal Medicine, Dow International Medical College, Karachi, PAK
| | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Abraish Ali
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Multiclonal spread of Klebsiella pneumoniae across hospitals in Khartoum, Sudan. J Glob Antimicrob Resist 2020; 24:241-245. [PMID: 33373737 DOI: 10.1016/j.jgar.2020.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/04/2020] [Accepted: 12/06/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Multidrug-resistant (MDR) Klebsiella pneumoniae is increasing worldwide with poorly characterised epidemiology in many parts of the world, particularly in Africa. This study aimed to investigate the molecular epidemiology of K. pneumoniae, to identify the diversity of sequence types (ST), and to detect carbapenem resistance genes in major regional hospitals in Khartoum, Sudan. METHODS Klebsiella pneumoniae isolates (n = 117) were cultured from four hospitals in Khartoum, from April 2015 to October 2016. The isolates were characterised by sequencing of 16S-23S rDNA internal transcribed spacer (ITS) region. Molecular epidemiology was determined by multilocus sequence typing (MLST), and analysed by maximum likelihood phylogeny (PhyML). Antimicrobial susceptibility was determined by disk diffusion. Isolates phenotypically resistant to carbapenem were screened for carbapenemase genes: blaNDM, blaOXA48, blaIMP, blaVIM and blaGES by PCR. RESULTS ITS sequencing confirmed the 117 isolates as K. pneumoniae. MLST revealed 52 different STs grouped in four distinct clusters by PhyML. All isolates were MDR, and carbapenemase-producing K. pneumoniae (CP-KP) isolates accounted for 44/117 (37.6%) mostly harbouring blaNDM (28/44) and blaOXA-48 (7/44), with several isolates harbouring multiple genes. CONCLUSION MDR and CP-KP K. pneumoniae is widespread in Khartoum hospitals, with a diverse population of 52 STs clustering in four major lineages. There is an urgent need for systematic epidemiological studies of drug-resistant infections across all healthcare institutions in Sudan to inform local infection prevention and control strategies.
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Ahmad S, Hussain A, Khan MSA, Shakireen N, Ali I. Diabetes mellitus and urinary tract infection: Causative uropathogens, their antibiotic susceptibility pattern and the effects of glycemic status. Pak J Med Sci 2020; 36:1550-1557. [PMID: 33235573 PMCID: PMC7674886 DOI: 10.12669/pjms.36.7.2881] [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] [Indexed: 01/09/2023] Open
Abstract
Objective: To determine causative uropathogens and their antibiotic susceptibility pattern among Type-2 diabetics (T2D) with good and suboptimal glycemic control. Methods: A hospital based cross-sectional study was carried out in Peshawar from April–October, 2019. Four hundred consecutive T2D patients with symptomatic UTI or showing numerous pus cells on routine urinary examination attending outpatient clinic were included. As per the guidelines of the Clinical and Laboratory Standards Institute (CLSI), the urine samples collected were checked for identification of uropathogen by culture. Disc diffusion method was used to determined antimicrobial susceptibility. Results: Of the total (n=400) T2D patients, 205 (51.25%) showed microbial growth. Mean age of patients with UTI was 63.26 ±12.30 years. About two-third (63.9%) of the patients were females. Mean HbA1c was 8.80±2.20%. The frequency of patients with UTI was noticeably greater in the suboptimal glycemic control group 178(86.3%) compared to good control glycemic patients 27(13.7%). Significant mean difference in glycemic levels were observed (HbA1c = 5.86±0.48 and HbA1c = 9.25±2.02, respectively, P < 0.001). E. coli was the predominant pathogen isolated 120(71%), followed by Klebsiella pneumonia Spp (K. pn) 35(17.1%), Pseudomonas auregonosa (P. aeruginosa) 14(6.83%), Enterococcus 12 (5.85%) and Candida Spp were 2(0.98%). Both gram positive and negative-bacteria were highly susceptible to imipenem, meropenem, fosfomycin and nitrofurantoin. Conclusion: The frequency of UTI in diabetics was higher in female in comparison to male, and was significantly greater in the suboptimal glycemic control group. E. coli was the most typical isolate followed by K. pn. Imipenem, meropenem, fosfomycin and nitrofurantoin had high susceptibility profile against the isolated pathogens.
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Affiliation(s)
- Shahzad Ahmad
- Dr. Shahzad Ahmad, MBBS, FCPS (Medicine), PGT (Endo). Department of Medicine & Allied, Northwest General Hospital & Research Centre, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Arshad Hussain
- Dr. Arshad Hussain, FRCP (Edinburgh). Department of Medicine & Allied, Northwest General Hospital & Research Centre, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Sajjad Ali Khan
- Dr. Mohammad Sajjad Ali Khan, MBBS, FCPS (Medicine), PGT (Endo). Department of Medicine & Allied, Northwest General Hospital & Research Centre, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Najmush Shakireen
- Dr. Najmush Shakireen, MBBS. Department of Medicine & Allied, Northwest General Hospital & Research Centre, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Iftikhar Ali
- Dr. Iftikhar Ali, PharmD, MPhil, MPH. Pharmacy Unit, Paraplegic Centre, Hayatabad, Peshawar, Pakistan
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25
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Mehrabi M, Salehi B, Rassi H, Dehghan A. Evaluating the antibiotic resistance and frequency of adhesion markers among Escherichia coli isolated from type 2 diabetes patients with urinary tract infection and its association with common polymorphism of mannose-binding lectin gene. New Microbes New Infect 2020; 38:100827. [PMID: 33364032 PMCID: PMC7750139 DOI: 10.1016/j.nmni.2020.100827] [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: 03/29/2020] [Revised: 10/25/2020] [Accepted: 11/20/2020] [Indexed: 01/11/2023] Open
Abstract
The present paper aims to determine the frequency and antibiotic resistance patterns of pathogenic bacteria, the virulence factor profile of Escherichia coli and mannose-binding lectin (MBL) gene polymorphism in individuals with diabetes mellitus (DM) and urinary tract infection (UTI). The population under study was 130 individuals with type 2 diabetes mellitus (T2DM) and UTI. The patients' clinical characteristics and urine and blood samples (5 mL) were collected. Antibiotic resistance was determined using a disc diffusion method, and the results were interpreted according to CLSI. The presence of virulence genes was detected by multiplex PCR. To detect the MBL gene polymorphism, PCR and restriction fragment length polymorphism methods were applied. The predominant Gram-negative and Gram-positive bacteria included E. coli and Streptococcus spp.viridans group, respectively. Women were more susceptible to the incidence of UTI than men. The E. coli isolates showed a high level of resistance to amoxicillin-clavulanic acid (87.35%), and nitrofurantoin and ceftizoxime were the most effective antimicrobial agents for E. coli. Cefotaxime and ceftizoxime were the most effective antimicrobial agents for Enterobacter spp., norfloxacin and ciprofloxacin were the most effective antimicrobial agents for Staphylococcus epidermidis and Staphylococcus saprophyticus. papGII (52.87%) and papEF (1.14%) had the highest and lowest frequency among examined genes in E. coli isolates, respectively. The GG genotype had the highest frequency among patients with T2DM and UTI. Results showed that the detection of E. coli in individuals with an AA genotype, codon 54 of the MBL gene, can play an important role in the molecular diagnosis and timely treatment of bacterial infections in individuals with diabetes.
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Affiliation(s)
- M. Mehrabi
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - B. Salehi
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - H. Rassi
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - A. Dehghan
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Goncalves Mendes Neto A, Lo KB, Wattoo A, Salacup G, Pelayo J, DeJoy R, Bhargav R, Gul F, Peterson E, Albano J, Patarroyo-Aponte G, Rangaswami J, Azmaiparashvili Z. Bacterial infections and patterns of antibiotic use in patients with COVID-19. J Med Virol 2020; 93:1489-1495. [PMID: 32808695 PMCID: PMC7461450 DOI: 10.1002/jmv.26441] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
Bacterial coinfection is associated with poor outcomes in patients with viral pneumonia, but data on its role in the mortality of patients with coronavirus disease 2019 (COVID-19) is limited. This is a single-center retrospective analysis of 242 patients with confirmed COVID-19 admitted to both intensive care and non-intensive care settings. Bacterial coinfection was determined by the presence of characteristic clinical features and positive culture results. Multivariable logistic regression was used to analyze the association of concomitant bacterial infection with inpatient death after adjusting for demographic factors and comorbidities. Antibiotic use pattern was also determined. Bacterial coinfection was detected in 46 (19%) patients. Genitourinary source was the most frequent, representing 57% of all coinfections. The overall mortality rate was 21%. Concomitant bacterial infections were independently associated with increased inpatient mortality (OR, 5.838; 95% CI, 2.647-12.876). Patients with bacterial coinfection were relatively older (71.35 ± 11.20 vs 64.78 ± 15.23; P = .006). A total of 67% of patients received antibiotic therapy, yet 72% did not have an obvious source of bacterial infection. There was a significantly higher rate of inpatient mortality in patients who received antibiotics compared to those who did not (30% vs 5%; P < .0001). Bacterial coinfection in COVID-19 is associated with increased mortality.
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Affiliation(s)
| | - Kevin Bryan Lo
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Ammaar Wattoo
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Grace Salacup
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Jerald Pelayo
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Robert DeJoy
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Ruchika Bhargav
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Fahad Gul
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Eric Peterson
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Jeri Albano
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Gabriel Patarroyo-Aponte
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania.,Division of Pulmonary and Critical Care and Sleep Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Janani Rangaswami
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zurab Azmaiparashvili
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
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27
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Osman EA, El-Amin N, Adrees EAE, Al-Hassan L, Mukhtar M. Comparing conventional, biochemical and genotypic methods for accurate identification of Klebsiella pneumoniae in Sudan. Access Microbiol 2020; 2:acmi000096. [PMID: 32974573 PMCID: PMC7470312 DOI: 10.1099/acmi.0.000096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/28/2019] [Indexed: 11/21/2022] Open
Abstract
Klebsiella pneumoniae is recognized as one of the most important healthcare-associated pathogens worldwide due to its tendency to develop antibiotic resistance and cause fatal outcomes. Bacterial identification methods such as culture and biochemical tests are routinely used with limited accuracy in many low- and middle-income countries, including Sudan. The aim of this study was to test the accuracy of identification of K. pneumoniae in Khartoum, Sudan. Two hundred and fifty K. pneumoniae isolates were collected and identified using conventional phenotypic methods, biochemically using API 20E and genotypically by amplification of 16S−23S rDNA and sequencing of rpoB, gapA and pgi. Only 139 (55.6 %) of the isolates were confirmed as K. pneumoniae genotypically by PCR and 44.4 % were identified as non-K. pneumoniae. The results demonstrate that the identification panels used by the hospitals were inaccurately identifying K. pneumonia and led to overestimation of the prevalence of this organism. The current identification methods used in Khartoum hospitals are highly inaccurate, and therefore we recommend the use of a comprehensive biochemical panel or molecular methods, when possible, for accurate identification of K. pneumoniae.
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Affiliation(s)
- Einas A Osman
- Bioscience Research Institute, Ibn-Sina University, Aljerif West, Khartoum, Sudan
| | - Nagwa El-Amin
- Microbiology Department, College of Medicine, Al-Qassim University, Al-Mulida, Saudi Arabia
| | - Emad A E Adrees
- Microbiology Department, College of Medicine, Alribat University Hospital, Khartoum, Sudan
| | - Leena Al-Hassan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - Maowia Mukhtar
- Bioscience Research Institute, Ibn-Sina University, Aljerif West, Khartoum, Sudan
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28
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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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Evaluation of Sociodemographic Factors among Diabetic Patients with Urinary Tract Infections in Kisii Referral Hospital, Kenya. Int J Microbiol 2020; 2020:5053867. [PMID: 32724308 PMCID: PMC7364260 DOI: 10.1155/2020/5053867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022] Open
Abstract
People with noninsulin-dependent diabetes mellitus are prone to urinary tract infections. There is a wide gap of information in developing countries regarding the sociodemographic factors linked to UTI among diabetics and the gender disparity among the same. Sociodemographic factors differ with geographical location and many other factors, and this makes them an important aspect that can influence the social burden of UTI among diabetics. The objective of this study was to determine the association between sociodemographic factors and UTI among diabetics. The study was carried out in the Kisii Teaching and Referral Hospital in Kenya. One hundred and eighty diabetic patients were enrolled in cross-sectional study design. Clean-catch midstream urine was collected from all participants and cultured in cysteine lactose electrolyte deficient agar for bacterial isolation. Classification of a positive culture for urinary tract infection was based on more than 100,000 (≥105) colony-forming units of a single bacterial species. The data were analyzed using frequencies, chi-square (p < 0.05), and logic regression with the help of the Statistical Package for the Social Sciences (SPSS) version 20 to find the odds ratio. One hundred and seven participants were male (59.4%), and 73 (40.6%) were female. The majority of the participants were between the age of 55 and 59 years old (77.2%), and 125 participants (69.4%) had attained tertiary education as the highest level of education. The overall prevalence of urinary tract infections was 20.6% with 37 participants testing positive for urinary tract infection. Age was found to have a significant association with urinary tract infection (p=0.002) while gender (p=0.45) and level of education (p=0.11) showed no significant association with urinary tract infections among diabetic patients. These findings suggest that age was the biggest association factor that influenced urinary tract infections among diabetic patients.
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30
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Saheb Sharif-Askari F, Saheb Sharif-Askari N, Guella A, Alabdullah A, Bashar Al Sheleh H, Maher Hoory AlRawi A, Sami Haddad E, Hamid Q, Halwani R, Hamoudi R. Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients. Infect Drug Resist 2020; 13:1961-1970. [PMID: 32612372 PMCID: PMC7323571 DOI: 10.2147/idr.s251966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the most common uropathogens causing UTI (urinary tract infection) in type 2 diabetes mellitus (T2DM). Circulatory inflammatory markers such as C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are usually dysregulated during UTI. However, the differential regulation of these inflammatory signatures during E. coli and K. pneumoniae UTI in T2DM has not been determined. Methods A case–control study on 466 patients was performed to investigate the inflammatory signatures indicative of ESBL-E. coli and K. pneumoniae UTIs in T2DM. Serum CRP levels and blood NLR for these patients were determined and associated with E. coli and K. pneumoniae ESBL uropathogen using multivariate logistic regression analysis. Urinary interleukin 8 (IL-8) levels were also assessed and associated with these two UTI uropathogens in T2DM. The association of the two ESBL-uropathogens with the survival outcomes of T2DM patients was also analyzed using Cox-proportional hazard model. Results T2DM patients with ESBL-E. coli UTI had lower serum CRP levels (median, CRP mg/dL 33.7 vs 39.8, respectively; P=0.023) and higher blood NLR (median, NLR 3.2 vs 2.6, respectively; P=0.010) compared to those with K. pneumoniae UTIs (P<0.001). Moreover, in T2DM, the urinary IL-8 levels was higher in ESBL-E. coli compared to those with K. pneumoniae UTIs (P<0.0001). After adjusting for confounders, including age, gender, serum albumin, hemoglobulin, leukocytes, and platelet counts, T2DM patients with blood NLR ≥ 3.5 were at higher risk for ESBL-E. coli UTIs than ESBL-K. pneumoniae UTIs (odds ratio [OR], 3.61, 95% confidence interval, Cl, 1.49–8.73; P=0.004). Moreover, T2DM patients with ESBL-E. coli UTIs had higher all-cause mortality (hazard ratio [HR], 4.09; 95%, 1.14–14.59) than those with K. pneumoniae UTIs. Conclusion Serum CRP levels, blood NLR, and IL-8 urinary levels differentiate ESBL-E. coli from K. pneumoniae UTIs in T2DM.
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Affiliation(s)
- Fatemeh Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Narjes Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Adnane Guella
- Department of Nephrology, University Hospital Sharjah, Sharjah, United Arab Emirates
| | - Ali Alabdullah
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hour Bashar Al Sheleh
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Afnan Maher Hoory AlRawi
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Enad Sami Haddad
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Qutayba Hamid
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Prince Abdullah Ben Khaled Celiac Disease Research Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rifat Hamoudi
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Hossain A, Hossain SA, Fatema AN, Wahab A, Alam MM, Islam MN, Hossain MZ, Ahsan GU. Age and gender-specific antibiotic resistance patterns among Bangladeshi patients with urinary tract infection caused by Escherichia coli. Heliyon 2020; 6:e04161. [PMID: 32548331 PMCID: PMC7286969 DOI: 10.1016/j.heliyon.2020.e04161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/29/2019] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background In Bangladesh, treatment for urinary tract infection has become increasingly difficult due to antibiotic resistance. In addition, the prescription of age and gender-specific drugs is still far from being practiced in Bangladesh. We are examining trends of antibiotic resistance per age and gender in patients with urinary tract infection (UTI) caused by the most frequent agent, Escherichia coli. Methods We determined the resistance of 1663 E. coli isolates obtained from urine cultures. A sensitivity study using the Kirby-Bauer method was carried out to identify the antibiotic resistance trends. Results Imipenem with 1.9% resistance of all isolates found to be the lowest percentage of resistance. Meropenem (2.8%), amikacin (2.8%), colistin (2.9%), and nitrofurantoin (15.8%) showed low resistance percentages. The sensitivity analysis suggests that age and gender (area under curve = 0.67) should be taken into consideration to prescribe amikacin. The increasing odds ratios (OR) by age groups suggest that amikacin is a less effective agent for older patients with UTIs. Moreover, nitrofurantoin (OR = 1.45, 95% confidence interval (CI) = 1.07–1.95) and colistin (OR = 2.09, CI = 1.13–3.76) were less effective against isolates obtained from males compared to isolates obtained from females. Meropenem was effective against bacteria obtained from all age groups and genders. On the other hand, efficacy of imipenem was lower in isolates obtained from adults older than 40 years (OR: 0.44 for < = 18 years, OR = 0.47 for 19–40 years, OR = 0.86 for 41–60 years; reference: > = 61 years). Conclusion In Bangladesh, meropenem, imipenem, amikacin, colistin, and nitrofurantoin are suitable therapeutic alternatives against urinary tract pathogens. Among the oral agents, amikacin, colistin, and nitrofurantoin should be prescribed, taking consideration of age and gender. These results will assist physicians in prescribing effective primary care antibiotics for UTI patients and encouraging the implementation of health policies for a safe prescription of antibiotics.
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Affiliation(s)
- Ahmed Hossain
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh.,NSU Global Health Institute, Dhaka 1229, Bangladesh
| | | | - Aneeka Nawar Fatema
- Center for Climate Change and Environmental Research, BRAC University, Dhaka, Bangladesh
| | - Abrar Wahab
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh.,NSU Global Health Institute, Dhaka 1229, Bangladesh
| | - Mohammad Morshad Alam
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh.,NSU Global Health Institute, Dhaka 1229, Bangladesh
| | | | | | - Gias U Ahsan
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
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Alemu M, Belete MA, Gebreselassie S, Belay A, Gebretsadik D. Bacterial Profiles and Their Associated Factors of Urinary Tract Infection and Detection of Extended Spectrum Beta-Lactamase Producing Gram-Negative Uropathogens Among Patients with Diabetes Mellitus at Dessie Referral Hospital, Northeastern Ethiopia. Diabetes Metab Syndr Obes 2020; 13:2935-2948. [PMID: 32922054 PMCID: PMC7450280 DOI: 10.2147/dmso.s262760] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the bacterial profile with its associated risk factors and to identify extended spectrum beta-lactamase producing Gram-negative bacterial uropathogens among diabetic patients at Dessie Referral Hospital, Northeastern Ethiopia. MATERIALS AND METHODS A hospital-based cross-sectional study was conducted from May to September 2018. A total of 336 diabetic patients were included using a simple random sampling technique. A structured questionnaire was used to collect socio-demographic and risk factor-related data. A 10-mL mid-stream urine specimen was collected and transported to the microbiology laboratory for culture, antimicrobial susceptibility testing, and detection of ESBL-producing bacteria. The data were entered into SPSS version 22, and descriptive statistics, bivariate and multivariate logistic regression analyses were performed. A p-value ≤0.05 with a 95% confidence interval was considered for statistical significance. RESULTS Among 336 diabetic patients, the overall prevalence of UTI was 11.6%. The predominant bacterial isolate was Escherichia coli 12/39 (30.8%), followed by Klebsiella pneumoniae 11/39 (28.2%) and coagulase-negative staphylococci 7/39 (17.9%). Gram-negative isolates showed 100% resistance to ampicillin, whereas Gram-positive isolates showed a high level of resistance to penicillin and tetracycline. Moreover, MDR was observed among 18 (46.2%) of the isolates and 2 of the isolated Gram-negative bacteria were ESBL producers. Being illiterate (AOR=7.226, 95% CI: (1.478, 35.340), p<0.015), having current symptoms of UTI (AOR = 2.702, 95% CI: (1.102, 6.624), p=0.030), and blood glucose level ≥126 mg/dl (AOR = 2.940, 95% CI: (1.080, 8.005), p=0.035) were significantly associated with the occurrence of bacterial UTI. CONCLUSION The overall prevalence of significant bacteriuria (11.6%) in this study was comparable with some studies in Ethiopia and relatively lower than others. A moderately higher rate of resistance to the commonly used antimicrobial agents was noticed for both Gram-negative and Gram-positive isolates. Health information dissemination should be given about UTI, glycemic control, and habit of drug use for diabetes mellitus patients.
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Affiliation(s)
- Mekuanent Alemu
- Department of Medical Laboratory Science, Dessie Health Science College, Dessie1212, Amhara, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie1145, Ethiopia
- Correspondence: Melaku Ashagrie Belete Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie1145, EthiopiaTel +251- 913867849Fax +251 333115250 Email
| | - Solomon Gebreselassie
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa1176, Ethiopia
| | - Assefa Belay
- Department of Medical Laboratory Science, Dessie Health Science College, Dessie1212, Amhara, Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie1145, Ethiopia
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Methicillin-resistant Staphylococcus aureus pneumonia in diabetics: a single-center, retrospective analysis. Chin Med J (Engl) 2019; 132:1429-1434. [PMID: 31205100 PMCID: PMC6629320 DOI: 10.1097/cm9.0000000000000270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an important issue with significant morbidity and mortality in clinical practice, especially in diabetes mellitus (DM). Studies focusing on S. aureus pneumonia in DM is limited, we sought to make a relatively comprehensive exploration of clinical characteristics, antimicrobial resistance, and risk factors for mortality of S. aureus pneumonia in DM and non-diabetics mellitus (non-DM). Methods: A retrospective study was conducted in Ruijin Hospital from 2014 to 2017. The characteristics of DM and non-DM patients were assessed, including demographics, comorbidities, using of invasive mechanical ventilation, Hemoglobin A1c (HbA1C), confusion, urea, respiratory rate, blood pressure, age ≥65 years (CURB-65) score, length of hospital stay, clinical outcomes, antimicrobial susceptibility. Independent risk factors for mortality were identified by univariate and multivariate logistic regression analysis. Results: A total of 365 patients with S. aureus pneumonia were included in our study, including 144 with DM and 221 non-DM. DM patients were more susceptible to MRSA infection (65.3% vs. 56.1%, P > 0.05), suffered from much severer pneumonia with a higher CURB-65 score, invasive mechanical ventilation rate (46.5% vs. 28.1%, P < 0.01) and mortality rates (30.6% vs. 23.1%, P > 0.05); almost all DM patients had higher antimicrobial resistance than non-DM patients, the DM group had a higher co-infection rate (47.2% vs. 45.7%, P > 0.05), and Acinetobacter baumannii was the most common bacterium in DM, while Klebsiella pneumoniae ranked first in patients with non-DM. Independent risk factors for pneumonia-related mortality were MRSA and CURB-65. Higher HbA1c levels were linked to a higher MRSA infection and co-infection rate and more severe pneumonia, leading to an increase in mortality. Conclusions: DM patients with poor glucose control are more susceptible to MRSA infection. They suffer from higher antimicrobial resistance, a higher co-infection rate, and much severer pneumonia than non-DM. MRSA itself is an independent risk factor for mortality in all patients.
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Zubair KU, Shah AH, Fawwad A, Sabir R, Butt A. Frequency of urinary tract infection and antibiotic sensitivity of uropathogens in patients with diabetes. Pak J Med Sci 2019; 35:1664-1668. [PMID: 31777512 PMCID: PMC6861471 DOI: 10.12669/pjms.35.6.115] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the frequency of urinary tract infections and antibiotic sensitivity among patients with diabetes. Methods: This observational study was carried out in Microbiology Department of Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University from April 2015 to June 2016. All patients with diabetes having symptoms of UTI attending out patients department of BIDE were analyzed. All samples received in the laboratory were processed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Antimicrobial susceptibility pattern was determined by disc diffusion method. Results: A total number of 199 urine specimens, frequency of UTI were 24 (12.06%) in male and 175 (87.94%) in female. UTIs were highly found in (age group 51-60) 70 (35.18%). Escherichia coli was the most frequent pathogen (71%), followed by Klebsiellapneumoniae (7.48%), Proteus mirabilis (1.87%), Staphylococcus aureus (9.35%), Candida (5.61%) and Candidaalbicans were (2.80%). Majority of gram negative uropathogens were shown high sensitivity towards Imipenem and Piperacillin / Tazobactam followed by Nitrofurantion, Ceftriaxone, Levofloxacin, Ofloxacine, Ciprofloxacin, Norfloxacin, Cefixime, Nalidixic acid and Cephradine. Gram positive was most sensitive to Nitrofurantionand Vancomycin followed by Piperacillin / Tazobactam, Imipenem, Cephradine, Ceftriaxone, Norfloxacin and Cefixime. Conclusion: We observed the higher frequency of UTIs in female as compared to male participants due to poor hygiene. E.coli was the most frequent pathogen responsible for UTI in patients with diabetes, followed by Staphylococcus aureus.
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Affiliation(s)
- Kaleem Ullah Zubair
- Kaleem Ullah Zubair, M.Phil Scholar, Department of Biological Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - Abdul Haleem Shah
- Abdul Haleem Shah, Dean, Department of Biological Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - Asher Fawwad
- Asher Fawwad, Ph.D. Chairman and Professor of Biochemistry, Department of Biochemistry, Baqai Medical University, Research Director, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Rubina Sabir
- Rubina Sabir, M.Sc, Laboratory Manager, Department of Clinical and Research Laboratory, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Anum Butt
- Anum Butt, M.Phil, Research Officer, Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Kumar R, Kumar R, Perswani P, Taimur M, Shah A, Shaukat F. Clinical and Microbiological Profile of Urinary Tract Infections in Diabetic versus Non-Diabetic Individuals. Cureus 2019; 11:e5464. [PMID: 31641561 PMCID: PMC6802799 DOI: 10.7759/cureus.5464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction Diabetic patients have a higher tendency of developing all infections, especially infections of the genitourinary tract. In most cases, urinary tract infections (UTI) in diabetic patients are asymptomatic. The aim of this study to was to compare the incidence and clinical and microbiological features of UTI between diabetic and non-diabetic patients. Methods In this prospective, comparative study, the incidence and clinical and microbiological features of UTI were compared between diabetic and non-diabetic patients via consecutive non-probability sampling technique. For every diabetic patient, one non-diabetic control was included. All patients were screened for UTI through a midstream urinary sample. Their demographic characteristics, clinical profile, and urinary microscopy were compared. Data were entered and analyzed using SPSS version 22.0. Results In the diabetes group, 35/256 (13.67%) patients had culture-positive UTI as compared to 18/250 (7.2%) in the non-diabetic group. Diabetic group had twice the risk of UTI (p = 0.01; odds ratio [OR]: 2.04; confidence interval [CI]: 1.12, 3.71) and female gender in the diabetic group had a risk of almost five times (p = 0.01; OR: 4.93; CI: 1.12, 20.16) that of the non-diabetic group. In the diabetic group, 31.4% patients were asymptomatic as compared to 5.6% in the non-diabetic group (p = 0.03; OR: 7.79; CI: 0.92, 66.18). E. coli was the most commonly identified microorganism in both groups. Pseudomonas aeruginosa was identified in 14% of diabetic cases and none in the non-diabetic. Conclusions UTIs are more frequent among diabetics. Asymptomatic bacteriuria is a more common entity in diabetic patients and does not require any treatment.
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Affiliation(s)
- Ravi Kumar
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Rajesh Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Prinka Perswani
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Muhammad Taimur
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ali Shah
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Faizan Shaukat
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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Woldemariam HK, Geleta DA, Tulu KD, Aber NA, Legese MH, Fenta GM, Ali I. Common uropathogens and their antibiotic susceptibility pattern among diabetic patients. BMC Infect Dis 2019; 19:43. [PMID: 30630427 PMCID: PMC6327582 DOI: 10.1186/s12879-018-3669-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/28/2018] [Indexed: 01/12/2023] Open
Abstract
Background Urinary tract infection (UTIs) is a significant health problem in diabetic patients because of the multiple effects of this disease on the urinary tract and host immune system. Complicated UTIs occur most commonly in patients with abnormal genitourinary tract. Proper investigation and prompt treatment are needed to prevent morbidity and serious life threatening condition associated with UTI and diabetes co-morbidities. Objective To determine common uropathogens and antibiotic susceptibility patterns with associated risk factors among adult diabetic patients attending at St. Paul Specialized Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods A hospital based, cross-sectional study was conducted from April–July 2015. A total of 248 diabetic patients with asymptomatic and symptomatic UTI were investigated for common uropathogens. Clean catch mid-stream urine specimens were collected from each study subjects. Uropathogens were isolated and identified by using conventional standard techniques. Samples were cultured on Blood agar, MacConkey agar and Sabouraud Dextrose Agar. Antibiotic Susceptibility pattern was determined on Mueller-Hinton using Kirby –Bauer disc diffusion method. The collected data and the result of the laboratory were analyzed using SPSS version 20. Results The overall prevalence of uropathogens among diabetic patients was 56/248(22.6%) of which 21/177(11.9%) and 35/71(49.3%) had asymptomatic and symptomatic UTI respectively. E. coli 13/56(23.2%), Coagulase negative Staphylococci (CONs) 7/56(12.5%), Enterococcus Spp.6/56 (10.7%), Candida albicans 10/56(17.9%) and Non-albicans Candida Spp. 9/56(16.1%) were the commonest isolated uropathogens. In this study uropathogens were significantly associated with being type II diabetes patient and having previous UTI history. Both gram positive and gram negative bacteria showed resistance to most tested antibiotics. Drug resistance to two or more drugs was observed in 81.1% of bacterial isolates. Conclusion High prevalence of uropathogens and increased rate of Multi-drug resistance was shown in this study. Therefore, continued surveillance on uropathogens prevalence and resistance rates is needed to ensure appropriate recommendations for the empirical treatment, develop rational prescription programs and make policy decisions.
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Affiliation(s)
| | | | - Kassu Desta Tulu
- Department of Medical Laboratory Sciences, College of Health sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Melese Hailu Legese
- Department of Medical Laboratory Sciences, College of Health sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Genet Molla Fenta
- Department of Medical Laboratory Sciences, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ibrahim Ali
- Department of Medical Laboratory Sciences, College of Health sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Bharti A, Chawla SPS, Kumar S, Kaur S, Soin D, Jindal N, Garg R. Asymptomatic bacteriuria among the patients of type 2 diabetes mellitus. J Family Med Prim Care 2019; 8:539-543. [PMID: 30984669 PMCID: PMC6436301 DOI: 10.4103/jfmpc.jfmpc_403_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Asymptomatic bacteriuria (ASB) is common in neonates, preschool children, pregnant women, elderly, diabetics, catheterized patients, and patients with abnormal urinary tracts or renal diseases. Though there is currently no consensus on treatment of ASB in various population groups, it is advisable to treat the same in patients with diabetes mellitus (DM). Aims: To determine the prevalence of ASB in patients with type 2 DM and to study the spectrum of uro-pathogens causing ASB along with their antibiotic susceptibility profile. Settings and Design: This prospective, observational study was conducted in the department of Medicine of a tertiary care teaching hospital. Methods: The study was conducted on 100 patients with type 2 DM. Urine wet mount and gram stain examination was done for all to detect the presence of pus cells and bacteria in urine. Antibiotic sensitivity testing was performed in patients with significant bacteriuria to determine the sensitivity profile of isolated uro-pathogens. The data were analyzed to determine the association between diabetes and ASB. Results: ASB was common among diabetics, as evident by a prevalence of 21%. Presence of ASB showed positive correlation with poor glycemic control. Escherichia coli (E. coli) was the most common organism causing ASB followed by Candida, Pseudomonas, Klebsiella, and Citrobacter. E. coli isolated from study patients was most sensitive to imipenem and nitrofurantoin (NFT). Conclusions: ASB is common among diabetics, with poor glycemic control being a significant risk factor. E. coli is the most common organism causing ASB in diabetics, and it is most sensitive to imipenem and NFT.
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Affiliation(s)
- Aman Bharti
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumit Pal Singh Chawla
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sandeep Kumar
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sarabjot Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Divya Soin
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Neerja Jindal
- Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Uropathogens and their antimicrobial resistance patterns: Relationship with urinary tract infections. Int J Health Sci (Qassim) 2019; 13:48-55. [PMID: 30983946 PMCID: PMC6436442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study was performed to determine the prevalence of uropathogens causing urinary tract infections (UTIs) and to determine their pattern of antimicrobial resistance. METHODS This study was conducted on 273 urine samples collected from outpatient departments (OPDs) of Qassim University affiliated hospitals. Fully automated VITEK 2 compact system was used in the identification and antimicrobial susceptibility testing of causative microorganisms. RESULTS Of 273 urine samples, only 89 (32.6%) were found to show significant growth for UTI, and overall, drug resistance was found in 92% (n = 82/89) of samples, with most (80%) being resistant to at least two drugs. Antibiotic resistance was commonly observed in ampicillin (88.3%), piperacillin (72.7%), clindamycin (66.7%), amoxicillin/clavulanic acid (66.2%), and trimethoprim/sulfamethoxazole (50%). The commonly isolated microorganisms were Escherichia coli 24 (27%), Klebsiella pneumoniae 11 (12.4%), Proteus mirabilis 4 (4.5%), Pseudomonas aeruginosa 4 (4.5%), Enterobacter cloacae 5 (5.6%), Enterococcus faecalis 5 (5.6%), and Staphylococcus saprophyticus 3 (3.4%). CONCLUSIONS This research work has shown that patients with UTI in Qassim are at high risk of antibiotic resistance. The work also showed that multidrug-resistant bacteria can lead to momentous therapeutic problems in OPD patients.
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Gutema T, Weldegebreal F, Marami D, Teklemariam Z. Prevalence, Antimicrobial Susceptibility Pattern, and Associated Factors of Urinary Tract Infections among Adult Diabetic Patients at Metu Karl Heinz Referral Hospital, Southwest Ethiopia. Int J Microbiol 2018; 2018:7591259. [PMID: 30515216 PMCID: PMC6236978 DOI: 10.1155/2018/7591259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infection causes considerable morbidity in diabetic patients and if complicated, can cause severe renal damage and life-threatening infections. The escalating antimicrobial resistance rate among bacteria over the past years is another concern in the treatment of urinary tract infections. This study investigated the prevalence, antimicrobial susceptibility pattern of the isolates and associated factors of urinary tract infection among adult diabetic patients attending Metu Karl Heinz Referral Hospital, Southwest Ethiopia. An institutional-based cross-sectional study was conducted among 233 adult diabetic patients selected using simple random sampling technique. Data were collected using a structured questionnaire. Clean-catch midstream urine samples were investigated for the presence of pathogenic bacteria and their antimicrobial susceptibility pattern using recommended culture methods. Data were entered, cleaned, and analyzed using the Statistical Program for Social Sciences version 21.0. Statistical significance was set at a p-value < 0.05. The prevalence of urinary tract infection was 16.7% (95%, CI: 12.0, 21.5). The predominant isolates were Escherichia coli (25.6%) and Klebsiella spp. (20.5%). E. coli isolates showed higher sensitivity to ceftriaxone (80%), ciprofloxacin (70%), and gentamycin (70%), but resistant to tetracycline (60%). Staphylococcus aureus was sensitive to amoxicillin-clavulanic acid (85.7%), and gentamycin (57.1%), while resistant to tetracycline (85.7%), nitrofurantoin (85.7%), and ampicillin (71.4%). The odds of developing urinary tract infections were significantly higher in diabetic females (AOR: 3.56, 95% CI: 1.44, 8.76), those who were not able to read and write (AOR: 2.55, 95% CI: 1.19, 5.49) and those with a history of urinary tract infection (AOR: 2.31, 95% CI: 1.09, 4.90) compared with their counterparts. In this study, the prevalence of urinary tract infection among diabetic patients was relatively comparable with the previous studies conducted in Ethiopia. Management of urinary tract infection in diabetic patients should be supported with culture and antimicrobial susceptibility testing.
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Affiliation(s)
- Tesfaye Gutema
- Medical Microbiology Unit, Metu Karl Heinz Referral Hospital, Metu, Ethiopia
| | - Fitsum Weldegebreal
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dadi Marami
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Zelalem Teklemariam
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mageto VM, Gatwiri MS, Njoroge W. Uropathogens antibiotic resistance patterns among type 2 diabetic patients in Kisii Teaching and Referral Hospital, Kenya. Pan Afr Med J 2018; 30:286. [PMID: 30637070 PMCID: PMC6317395 DOI: 10.11604/pamj.2018.30.286.15380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/01/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Non-insulin dependent diabetes mellitus is a major risk factor for urinary tract infections. Irrational use of antibiotics has led to the emergency of uropathogens resistant to available antibiotics. The main objective was to determine the bacterial causative agents of urinary tract infections and their antibiotic resistance patterns. METHODS One hundred and eighty (180) type 2 diabetic patients were recruited to take part in the study. Urine samples were collected and cultured for urinary tract infections diagnosis and antibiotic sensitivity. RESULTS A total of 35 isolates were obtained from the study. All the isolates were sensitive to gentamicin. All 21 (100%) isolates of E. coli were sensitive to gentamicin and cephalexin. All 10 (100%) K. pneumoniaeisolates were sensitive to gentamicin and nitrofurantoin. Out of the 21 E. coli isolates, five of them showed resistance to ampicillin, three E. coli isolates showed resistance to nitrofurantoin and another three E. coliisolates showed resistance to co-trimoxazole. Out of 10 K. pneumoniae isolates, two of them were found to be resistant to ampicillin, one K. pneumoniae isolate was resistant to cephalexin and two K. pneumoniaeisolates were resistant to co-trimoxazole. Out of the four P. mirabilis isolates, there were three cases where one isolate was each resistant to ampicillin, nitrofurantoin and co-trimoxazole. CONCLUSION There is a need to have a regular screening of bacterial isolates causing urinary tract infection in diabetic patients and their antibiotic sensitivity in order to have effective therapy. Present findings show that there is increased resistance to the commonly prescribed antibiotics.
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Affiliation(s)
| | | | - Wachuka Njoroge
- Department of Medical Laboratory Sciences, Kenyatta University, Nairobi, Kenya
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Babikir IH, Abugroun EA, Bilal NE, Alghasham AA, Abdalla EE, Adam I. The impact of cathelicidin, the human antimicrobial peptide LL-37 in urinary tract infections. BMC Infect Dis 2018; 18:17. [PMID: 29310594 PMCID: PMC5759217 DOI: 10.1186/s12879-017-2901-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 12/10/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The defense mechanisms of the urinary tract are attributed mainly to the innate immune system and the urinary tract urothelium which represent the first line of defense against invading pathogens and maintaining sterility of the urinary tract. There are only a few publications regarding cathelicidin (LL-37) and a urinary tract infection (UTI). This study was done to investigate the plasma and urine levels of human LL-37 in patients with UTI. METHODS A case-control study was conducted at Omdurman Hospital, Sudan during the period from August 2014 to May 2017. The cases were patients with confirmed UTI and the controls were healthy volunteers without UTI. Sociodemographic and clinical data were obtained from each participant using questionnaires. Urine cultures and antimicrobial susceptibility were tested. Plasma and urine levels of LL-37 were determined using an enzyme-linked immunosorbent assay (ELISA) kit. SPSS (version 16.0) was used for analyses. RESULTS Cases and controls (87 in each arm) were matched according to their basic characteristics. Compared with controls, the median (inter-quartile) LL-37 level in plasma [2.100 (1.700-2.700) vs. 1.800 (1.000-2.200) ng/ml, P = 0.002] and in urine [0.900 (0.300-1.600) vs. 0.000 (0.000-1.000) ng/mg creatinine, P < 0.001] was significantly higher in cases. There was no significant difference in the median plasma [2.1 (1.7-2.9) vs. 2.000 (1.700-2.400) ng/ml, P = 0.561] and urine [0.850 (0.275-2.025) vs. 0.900 (0.250-1.350) ng/mg creatinine, P = 0.124]. The uropathogenic Escherichia coli (UPEC) was the predominant isolate, n = 38 (43.7%). LL-37 levels between the E. coli isolates and the other isolated organisms. There was no significant correlation between plasma and urine LL-37 levels (r = 0.221), even when the data of the cases were analyzed separately. CONCLUSION LL-37 is notably increased among patients with UTI compared with normal control subjects. Severity of UTI increases the levels of LL-37. The increased level was not only in the patient's urine, but has also been observed in the patient's plasma. Detection of increased levels of LL-37 could help to differentiate subjects with suspected UTI. Accordingly, LL-37 could act as a good marker for diagnosing UTIs.
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Affiliation(s)
- Ibrahim H Babikir
- College of Medical Laboratory Sciences, Microbiology Department, University of Khartoum, Khartoum, Sudan. .,College of Medicine, Qassim University, Buraydah, Qassim, Kingdom of Saudi Arabia.
| | - Elsir A Abugroun
- Faculty of Medical Laboratory Sciences, University of Science and Technology, Omdurman, Sudan
| | - Naser Eldin Bilal
- Khartoum University Central Research Laboratory, University of Khartoum, PO Box 321, Khartoum, Sudan
| | | | | | - Ishag Adam
- College of Medicine, Qassim University, Buraydah, Qassim, Kingdom of Saudi Arabia
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Chaudhary M, Ayub SG, Mir MA. CSE-1034 versus Ceftriaxone: Efficacy and Safety Analysis from a Randomized, Open-labeled Phase III Study in Complicated Urinary Tract Infections. J Glob Infect Dis 2018; 10:188-195. [PMID: 30581259 PMCID: PMC6276312 DOI: 10.4103/jgid.jgid_98_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of this study was to determine the clinical outcome, microbiological outcome and safety profile of CSE-1034, a novel combination of Ceftriaxone, Sulbactam and EDTA in patients with complicated urinary tract infections (cUTI). Materials and Methods: This was a randomized, controlled, open-labeled Phase-3 trial with the primary objective of assessing the efficacy and safety of CSE-1034 versus Ceftriaxone for the empirical treatment of cUTI. Adult cUTI patients were randomized to receive either intravenous dose of CSE-1034 or Ceftriaxone. The primary end point was composite cure rate (clinical response and bacterial eradication) in mMITT population at test of cure (TOC) visit. Secondary measures included verification of primary endpoint across other visits in different population sets, safety of patients and treatment duration. Results: Overall, 204 patients were enrolled in the study and received one of the two treatments. At primary endpoint (TOC visit), the composite cure rate was much higher in CSE-1034 treatment arm compared to Ceftriaxone arm i.e. 97% (68/70) vs 83% (58/71) (treatment difference 12.6%; 95% CI: 5.9% to 26.4%). The adverse events (AEs) rates reported in two treatment arms were 21% in CSE-1034 and 36% in Ceftriaxone groups. Additionally, the treatment duration in CSE-1034 arm was significantly less (P < 0.05). Conclusions: CSE-1034 3 g every 24 h showed a high favorable clinical and bacteriological response, and 95% CI around the treatment difference prove the superiority of CSE-1034 vs. Ceftriaxone for the treatment of cUTI. Therefore, CSE-1034 provides an effective alternative in the treatment of patients with cUTI.
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Affiliation(s)
- Manu Chaudhary
- Department of Clinical Research, Venus Remedies, Panchkula, Haryana, India
| | | | - Mohd Amin Mir
- Department of Clinical Research, Venus Remedies, Panchkula, Haryana, India
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Tadesse BT, Ashley EA, Ongarello S, Havumaki J, Wijegoonewardena M, González IJ, Dittrich S. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis 2017; 17:616. [PMID: 28893183 PMCID: PMC5594539 DOI: 10.1186/s12879-017-2713-1] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/04/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is widely acknowledged as a global problem, yet in many parts of the world its magnitude is still not well understood. This review, using a public health focused approach, aimed to understand and describe the current status of AMR in Africa in relation to common causes of infections and drugs recommended in WHO treatment guidelines. METHODS PubMed, EMBASE and other relevant databases were searched for recent articles (2013-2016) in accordance with the PRISMA guidelines. Article retrieval and screening were done using a structured search string and strict inclusion/exclusion criteria. Median and interquartile ranges of percent resistance were calculated for each antibiotic-bacterium combination. RESULTS AMR data was not available for 42.6% of the countries in the African continent. A total of 144 articles were included in the final analysis. 13 Gram negative and 5 Gram positive bacteria were tested against 37 different antibiotics. Penicillin resistance in Streptococcus pneumoniae was reported in 14/144studies (median resistance (MR): 26.7%). Further 18/53 (34.0%) of Haemophilus influenza isolates were resistant to amoxicillin. MR of Escherichia coli to amoxicillin, trimethoprim and gentamicin was 88.1%, 80.7% and 29.8% respectively. Ciprofloxacin resistance in Salmonella Typhi was rare. No documented ceftriaxone resistance in Neisseria gonorrhoeae was reported, while the MR for quinolone was 37.5%. Carbapenem resistance was common in Acinetobacter spp. and Pseudomonas aeruginosa but uncommon in Enterobacteriaceae. CONCLUSION Our review highlights three important findings. First, recent AMR data is not available for more than 40% of the countries. Second, the level of resistance to commonly prescribed antibiotics was significant. Third, the quality of microbiological data is of serious concern. Our findings underline that to conserve our current arsenal of antibiotics it is imperative to address the gaps in AMR diagnostic standardization and reporting and use available information to optimize treatment guidelines.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- 0000 0001 1507 3147grid.452485.aFoundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202 Geneva, Switzerland ,0000 0000 8953 2273grid.192268.6College of Medicine and Health Sciences, Department of Pediatrics, Hawassa University, Hawassa, Ethiopia ,grid.463322.2Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211, 27 Geneva, Switzerland
| | | | - Stefano Ongarello
- 0000 0001 1507 3147grid.452485.aFoundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Joshua Havumaki
- 0000 0001 1507 3147grid.452485.aFoundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Miranga Wijegoonewardena
- 0000 0001 1507 3147grid.452485.aFoundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Iveth J. González
- 0000 0001 1507 3147grid.452485.aFoundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Sabine Dittrich
- 0000 0001 1507 3147grid.452485.aFoundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202 Geneva, Switzerland
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Antimicrobial susceptibility profile in urinary pathogens causing community-acquired infections in diabetic patients in Colombia. BIOMEDICA 2017; 37:353-360. [DOI: 10.7705/biomedica.v37i3.3348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/26/2016] [Indexed: 12/26/2022]
Abstract
Introducción. La infección de las vías urinarias es la más frecuente en pacientes diabéticos, y es un factor determinante de la morbilidad y la mortalidad en este grupo de pacientes. El aumento de la resistencia de los microorganismos adquiridos en la comunidad a los antibióticos comúnmente utilizados para combatirla es alarmante.Objetivo. Determinar el perfil de sensibilidad a los antibióticos de los microorganismos responsables de infecciones urinarias adquiridas en la comunidad en pacientes diabéticos atendidos en algunos hospitales de Colombia.Materiales y métodos. Se hizo un estudio descriptivo de un subgrupo de pacientes diabéticos en el marco de una investigación en adultos con infección de origen comunitario de las vías urinarias. Durante un año, se recolectaron aislamientos de Escherichia coli, Klebsiella spp. y Proteus mirabilis en nueve hospitales de Colombia y se determinó su perfil de sensibilidad mediante métodos microbiológicos y moleculares, para establecer la presencia de betalactamasas de espectro extendido del tipo AmpC y de carbapenemasas del tipo KPC.Resultados. Se recolectaron 68 aislamientos (58 de E. coli, nueve de Klebsiella spp. y uno de P. mirabilis). Cuatro (6,9 %) de los aislamientos de E. coli expresaron dichas betalactamasas, en dos (3,4 %) de ellos, pertenecientes al grupo filogenético B2 y al clon ST131, se detectaron las betalactamasas TEM-1 y CTM-X-15. En otros cuatro (6,9 %) aislamientos de E. coli se encontró el fenotipo AmpC, y en tres de ellos se produjeron las betalactamasas TEM-1 y CMY-2. Un aislamiento de K. pneumoniae expresó la carbapenemasa KPC-3.Conclusión. Se confirmó la presencia de cepas productoras de betalactamasas de espectro extendido y carbapenemasas en microorganismos responsables de infección urinaria adquirida en la comunidad en pacientes diabéticos.
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Mamuye Y. Antibiotic Resistance Patterns of Common Gram-negative Uropathogens in St. Paul's Hospital Millennium Medical College. Ethiop J Health Sci 2017; 26:93-100. [PMID: 27222621 PMCID: PMC4864337 DOI: 10.4314/ejhs.v26i2.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The resistance of bacteria causing urinary tract infection (UTI) to commonly prescribed antibiotics is increasing both in developing and developed countries. Resistance has emerged even to more potent antimicrobial agents. This study was undertaken to determine the current antibiotic resistance pattern among common bacterial uropathogens in St.paul's Hospital Millennium Medical College. Methods Using cross sectional study design, a total of 217 female and 207 male participants were consecutively recruited. Mid-urine samples were collected from all patients using wide mouthed urine cup. Inoculation was performed onto blood agar and MacConkey agar symoultaniously, and isolated organisms were identified by conventional methods. Antibiotic susceptibility was done by Kirby Bauer disk diffusion method. Thirteen different antibiotics representing different families of antibiotics were tested on all isolated organisms. Results Of the total 424 samples, 95(22.4%) showed significant growth. Gram negative organisms totaled 85(20.05%), and 10(2.4%) isolates were gram positive. The most frequently isolated gram negative bacterium was E. coli followed by Protues and Klebsiella spp. 53(12.5%), 8(8.4%), and 7(7.4%) respectively. Resistance to Tetracyclin, Ampicilin, Amoxycilin and Nalidixic Acid was more than 70% of all isolates of E.coli strains. There was relatively low resistance rate to Nitrofurantoin, Gentamycin and Trimethoprim-Sulfamethoxazole. However, there was emerging resistance to Ciprofloxacilin and Ceftriaxone especially for common bacteruria. Conclusion In this study setting, resistant rates to Tetracyclin, Ampicilin, Amoxycilin and Nalidixic Acid were high. Since most isolates were sensitive for Nitrofurantoin, Gentamycin and Trimethoprim-Sulfamethoxazole, they are considered as appropriate antimicrobials for empirical treatment for urinary tract infections with the absence of culture and sensitivity setting. Increasing antibiotic resistance trends indicate that it is imperative to rationalize the use of antimicrobials in the community and use these conservatively.
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Affiliation(s)
- Yeshwondm Mamuye
- Department of Microbiology St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Nabaigwa BI, Mwambi B, Okiria J, Oyet C. Common uropathogens among diabetic patients with urinary tract infection at Jinja Regional Referral Hospital, Uganda. Afr J Lab Med 2017; 7:621. [PMID: 29850436 PMCID: PMC5963006 DOI: 10.4102/ajlm.v7i1.621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/08/2017] [Indexed: 01/11/2023] Open
Abstract
Between June 2015 and October 2015, 159 mid-stream urine samples from diabetic patients were cultured. The prevalence of urinary tract infection was high at 22% and women were more affected compared with men (P = 0.017). Factors associated with urinary tract infection in these patients were age, sex and high blood glucose levels. Diabetic patients should be screened periodically for urinary tract infection.
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Affiliation(s)
| | - Bashir Mwambi
- International Health Sciences University, Kampala, Uganda
| | - John Okiria
- International Health Sciences University, Kampala, Uganda
| | - Caesar Oyet
- International Health Sciences University, Kampala, Uganda
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Development of carboxymethyl cellulose-based hydrogel and nanosilver composite as antimicrobial agents for UTI pathogens. Carbohydr Polym 2016; 138:229-36. [DOI: 10.1016/j.carbpol.2015.11.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 02/04/2023]
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