Urinary Tract Infection: An Overview of the Infection and the Associated Risk Factors

Archaea in the Human Microbiome and Potential Effects on Human Infectious Disease

Archaea represent a separate domain of life, next to bacteria and eukarya. As components of the human microbiome, archaea have been associated with various diseases, including periodontitis, endodontic infections, small intestinal bacterial overgrowth, and urogenital tract infections. Archaea are generally considered nonpathogenic; the reasons are speculative because of limited knowledge and gene annotation challenges. Nevertheless, archaeal syntrophic principles that shape global microbial networks aid both archaea and potentially pathogenic bacteria. Evaluating archaea interactions remains challenging, requiring clinical studies on inflammatory potential and the effects of archaeal metabolism. Establishing a culture collection is crucial for investigating archaea functions within the human microbiome, which could improve health outcomes in infectious diseases. We summarize potential reasons for archaeal nonpathogenicity, assess the association with infectious diseases in humans, and discuss the necessary experimental steps to enable mechanistic studies involving archaea.

Occurrence of Imipenem-Resistant Uropathogenic Escherichia coli in Pregnant Women: An Insight into Their Virulence Profile and Clonal Structure

Uropathogenic Escherichia coli (UPEC) is the predominant pathogen in Urinary Tract Infection (UTI) in pregnant and non-pregnant women. Limited studies were initiated to explore UPEC from pregnant women with respect to imipenem resistance, pathogenicity, and their clonal lineage. In this study, imipenem resistance, phylogenetic background, virulence-associated genes, and clonal characteristics in UPECs isolated from pregnant and non-pregnant cohorts were investigated. E. coli was identified biochemically from urine culture-positive samples from pregnant and non-pregnant women. Carbapenem (meropenem, ertapenem, imipenem) susceptibility was determined by Kirby-Bauer disk diffusion test. The pathogenic determinants were identified by PCR. MEGA 11 was used to interpret clonal lineages from MLST. GraphPad Prism 8.0 and SPSS 26.0 were used for statistical interpretation. Results indicated highest resistance against imipenem compared to meropenem and ertapenem in UPECs isolated from pregnant (UPECp; 63.89%) and non-pregnant (UPECnp; 87.88%) women. Although phylogroup E was predominant in both imipenem-resistant isolates, acquisition of virulence factors was higher among UPECnp than UPECp. Akin to this observation, the presence of PAI III536 and PAI IV536 was statistically significant (p < 0.05) in the former. MLST analysis revealed similar clonal lineages between UPECnp and UPECp, which showed an overall occurrence of ST405 followed by ST101, ST410, ST131, and ST1195 in UPECnp and ST167 in UPECp, respectively, with frequent occurrence of CC131, CC405. Therefore, imipenem-resistant UPECp although discrete with respect to their virulence determinants when compared to UPECnp shared similar STs and CCs, which implied common evolutionary history. Thus, empiric treatment must be restricted in UTIs to especially protect maternal and fetal health.

Evaluation of Extended-Spectrum Beta-Lactamase Resistance in Uropathogenic Escherichia coli Isolates from Urinary Tract Infection Patients in Al-Baha, Saudi Arabia

Urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms are prevalent in both outpatient and inpatient settings, representing the most often encountered forms of infection. This research aimed to estimate the prevalence of ESBL-UTIs along with other uropathogens in the adult population and to assess the antibiotic activity against Escherichia coli extended-spectrum beta-lactamase (E. coli ESBL) isolates from patient samples in Al-Baha. A retrospective cross-sectional study included patients who presented to King Fahad Hospital in Al-Baha with clinical suspicion of UTI between 1 January 2019 and 30 September 2022. A total of 4406 urine samples with significant microbial growth were included in the scope of this investigation. A collective count of 1644 incidents of Escherichia coli (E. coli) was observed, wherein E. coli constituted 85% of the cases, while the remaining 15% comprised E. coli ESBL producers. The prevalence of E. coli ESBL was observed to be 64.7% in females and 35.3% in males, with a majority (67%) of the affected individuals being over the age of 50. The incidence of E. coli infections in the outpatient setting was found to be greater than that observed in the inpatient setting. E. coli ESBL were sensitive to colistin, tigecycline, amikacin, meropenem, imipenem, and nitrofurantoin by 100% and 93.3-100%, 95-99.6%, 95-99.06%, and 81-91%, respectively. On the other hand, the most resistant agents for E. coli ESBL were the group of cephalosporins, aztreonam, and ampicillin with 100% resistance, ciprofloxacin with 56-74% resistance, and cotrimoxazole with a 45-53% resistance level. ESBL-resistant E. coli strains are moderately prevalent in community- and hospital-acquired UTIs, especially in females and elderly patients (>50 years).

Specific Instantaneous Detection of Klebsiella pneumoniae for UTI Diagnosis with a Plasmonic Gold Nanoparticle Conjugated Aptasensor

Urinary tract infection (UTI), which can be caused by various pathogens, if not detected at an early stage can be fatal. It is essential to identify the specific pathogen responsible for UTI for appropriate treatment. This study describes a generic approach to the fabrication of a prototype for the noninvasive detection of a specific pathogen using a tailor-made plasmonic aptamer-gold nanoparticle (AuNP) assay. The assay is advantageous because the adsorbed specific aptamers passivate the nanoparticle surfaces and reduce and/or eliminate false-positive responses to nontarget analytes. Based on the localized surface plasmon resonance (LSPR) phenomena of AuNP, a point-of-care aptasensor was designed that shows specific changes in the absorbance in the visible spectra in the presence of a target pathogen for robust and fast screening of UTI samples. In this study, we demonstrate the specific detection of Klebsiella pneumoniae bacteria with LoD as low as 3.4 × 103 CFU/mL.

Emergence of microbial infections in some hospitals of Cairo, Egypt: studying their corresponding antimicrobial resistance profiles

BACKGROUND

Antimicrobial resistance is one of the ten major public health threats facing humanity, especially in developing countries. Identification of the pathogens responsible for different microbial infections and antimicrobial resistance patterns are important to help clinicians to choose the correct empirical drugs and provide optimal patient care.

METHODS

During the period from November 2020 to January 2021, one hundred microbial isolates were collected randomly from different specimens from some hospitals in Cairo, Egypt. Sputum and chest specimens were from COVID-19 patients. Antimicrobial susceptibility testing was performed according to CLSI guidelines.

RESULTS

Most microbial infections were more common in males and in elderly people over 45 years of age. They were caused by Gram-negative, Gram-positive bacteria, and yeast isolates that represented 69%, 15%, and 16%, respectively. Uropathogenic Escherichia coli (35%) were the most prevalent microbial isolates and showed high resistance rates towards penicillin, ampicillin, and cefixime, followed by Klebsiella spp. (13%) and Candida spp. (16%). Of all microbial isolates, Acinetobacter spp., Serratia spp., Hafnia alvei, and Klebsiella ozaenae were extremely multidrug-resistant (MDR) and have resisted all antibiotic classes used, except for glycylcycline, in varying degrees. Acinetobacter spp., Serratia spp., and Candida spp. were secondary microbial infections in COVID-19 patients, while H. alvei was a bloodstream infection isolate and K. ozaenae was recorded in most infections. Moreover, about half of Staphylococcus aureus strains were MRSA isolates and reported low rates of resistance to glycylcycline and linezolid. In comparison, Candida spp. showed high resistance rates between 77 and 100% to azole drugs and terbinafine, while no resistance rate towards nystatin was reported. Indeed, glycylcycline, linezolid, and nystatin were considered the drugs of choice for the treatment of MDR infections.

CONCLUSION

The prevalence of antimicrobial resistance in some Egyptian hospitals was high among Gram-negative, Gram-positive bacteria, and candida spp. The high resistance pattern -especially in secondary microbial infections in COVID-19 patients- to most antibiotics used is a matter of great concern, portends an inevitable catastrophe, and requires continuous monitoring to avoid the evolution of new generations.

Urinary Tract Infection and Associated Factors among Pregnant Women Receiving Antenatal Care at a Primary Health Care Facility in the Northern Region of Ghana

Urinary tract infection (UTI) is frequently encountered during pregnancy and is associated with adverse maternal, fetal, and neonatal effects. However, very little information is available on the prevalence of UTI among pregnant women in the northern part of Ghana, a region with a high birth rate. This study employed a cross-sectional analysis of the prevalence, antimicrobial profile, and risk factors associated with UTI in 560 pregnant women attending primary care for antenatal check-ups. Sociodemographic obstetrical history and personal hygiene information were obtained using a well-structured questionnaire. Afterward, clean catch mid-stream urine samples were collected from all participants and subjected to routine microscopy examination and culture. Of 560 pregnant women, 223 cases (39.8%) were positive for UTI. There was a statistically significant association between sociodemographic, obstetric, and personal hygiene variables and UTI (p < 0.0001). Escherichia coli (27.8%) was the commonest bacterial isolate followed by CoNS (13.5%) and Proteus species (12.6%). These isolates exhibited greater resistance to ampicillin (70.1-97.3%) and cotrimoxazole (48.1-89.7%) but were fairly susceptible to gentamycin and ciprofloxacin. Gram-negative resistance to meropenem was up to 25.0%, and Gram positives resistance to cefoxitin and vancomycin was up to 33.3% and 71.4% respectively. The current findings extend our knowledge of the high frequency of UTIs and associated risk factors in pregnant women with E. Coli being the predominant and usual isolate. Variation existed in the resistance pattern of isolates to various drugs, underscoring the need to perform urine culture and susceptibility before treatment.

Insights from the molecular docking analysis of compounds from Vitex negundoi with targets from Klebsiella pneumoniai causing urinary tract infection

Antimicrobial resistance among bacterial strains has emerged out to be a serious threat and contributes to the loss of effectiveness of the common antibiotics. New Delhi metallo-β-lactamase-1 (blaNDM-1) is an enzyme present in several pathogenic bacteria with a high incidence in Klebsiella pneumoniaie and plays a crucial role in the development of antibacterial resistance. Mur enzymes are also important alternative drug targets in addition to blaNDM-1 which are crucial for the survival of the bacteria. Vitex negundoi is an aromatic medicinaltree with proven antibacterial properties. Fifteen compounds from V. negundo were evaluated for their inhibitory effects on the target proteins blaNDM-1, Mur C, Mur E and Mur F of K. pneumoniae through molecular docking using the Glide (xp) module of Schrodinger. ADME toxicity was also predicted for all the fifteen compounds in the QikProp module. The docking results revealed that the compounds agnuside, negundoside and isoorientin showed promising inhibitory effects on all four targets blaNDM-1, Mur C, Mur E and Mur F of K. pneumoniae with docking scores greater than -7 kcal/mol and reasonable hydrogen bond interactions. The findings of this study provide a lead for developing novel drugs against potent multidrug-resistant K. pneumoniae.

Point-of-Care Biosensing of Urinary Tract Infections Employing Optoplasmonic Surfaces Embedded with Metal Nanotwins

We report the synthesis of gold nanotwins (Au NTs) on a solid and transparent glass substrate which in turn has been employed for the selective optoplasmonic detection of Escherichia coli (EC) bacteria in human urine for the point-of-care diagnosis of urinary tract infections (UTIs). As compared to the single nanoparticle systems (Au NPs), the Au NTs show an enriched localized surface plasmon resonance (LSPR) due to the enhancement of the electric field under electromagnetic irradiation, e.g., photon, which helps in improving the limits of detection. For this purpose, initially a simple glass surface has been coated with Au NPs, with the help of the linker 3-aminopropyl-triethoxysilane - APTES. The surface has been linked further with another Au NP with the help of the 1,10-alkane-dithiol linker with two thiol ends, which eventually leads to the development of the optoplasmonic surface with Au NTs and an enhanced LSPR response. Subsequently, the EC specific aptamer has been chemically immobilized on the surface of Au NTs with the blocking of free sites via bovine serum albumin (BSA). Remarkably, Raman spectroscopy unfolds a 7-fold increase in the peak intensities with the Au NTs on the glass surface as compared to the surface coated with isolated Au NPs. The enhancement in the LSPR response of glass substrates coated with Au NTs and the EC specific aptamer has been further utilized for the selective and sensitive detection of UTIs. The results have been verified with the help of UV-visible spectroscopy to establish the utility of the proposed sensing methodology. An extensive interference study with other bacterial species unveils the selectivity and specificity of the proposed optoplasmonic sensors toward EC with a detection range of 5 × 10³ to 10⁷ CFU/mL. Intuitively, the method is more versatile in a sense that the sensor can be made specific to any other pathogens by simply changing the design of the aptamer. Finally, a low-cost, portable, and point-of-care optoplasmonic transduction setup is designed with a laser light illumination source, a sample holder, and a sensitive photodetector for the detection of UTIs in human urine.

High burden of ESBL- producing Klebsiella spp., Proteus mirabilis, Enterobacter cloacae and Pseudomonas aeruginosa in diagnosed cases of urinary tract infection in a Nigerian Teaching Hospital

Infections of the urinary tract have been on the rise globally and these are also worsened by the increasing rate of antibiotic resistance in uropathogens. This study aimed to determine the susceptibility profile of extended spectrum β-lactamase (ESBL)- producing uropathogens to selected antibiotics and their carriage of ESBL genes. Bacterial uropathogens were obtained from the urine bench of a Microbiology laboratory in a Teaching Hospital in South-West Nigeria. Susceptibility to antibiotics was tested using the disc diffusion method, while detection of ESBL production was done using the double disc synergy test (DDST). Detection of ESBL genes was performed by PCR. A total of 21 ESBL- producing uropathogens were obtained namely: Klebsiella pneumoniae (11), Klebsiella oxytoca (6), Proteus mirabilis (2), Enterobacter cloacae (1) and Pseudomonas aeruginosa (1). The resistance to antibiotics in the uropathogens was: imipenem (0%), gentamicin (38.1%), sulfamethoxazole-trimethoprim (52.4%), amoxicillin-clavulanate (61.9%), aztreonam (66.7%), ceftazidime (66.7%), tetracycline (90.5%), cefpodoxime (100%) and cefotaxime (100%). Altogether, 90.5% (19/21) of the isolates were multidrug resistant (MDR). Of the 21 uropathogens, 61.9% (13/21) carried bla CTX-M, 52.4% (11/21) carried bla TEM while bla SHV was detected in 47.6% (10/21) of the isolates. There was co-carriage of ESBL genes in 12 uropathogens. This study showed a high prevalence of multidrug resistance and a high carriage of ESBL genes in the ESBL- producing isolates obtained over the study period. There is a need for a review of antibiotic options in the treatment of UTI to clamp down on the ever-increasing tide of antibiotic resistance in uropathogens.

Knowledge and Risk Perceptions of Chronic Kidney Disease Risk Factors among Women of Childbearing Age in Lagos State, Nigeria: From a Health Demography Approach

Background. Kidney disease (KD), also known as chronic kidney disease (CKD), is a long-term underrecognized public health concern and one of the eight leading causes of death in women. Despite that, little is known about women’s knowledge, perceived risk, and perceptions of CKD risk factors. In this study, we assessed knowledge, perceived risk, and perceptions of CKD risk factors among women of childbearing age in Lagos State, Nigeria. Methods. Administering a pretested and structured questionnaire among 825 women aged 15–49 years, we conducted a cross-sectional descriptive study to evaluate knowledge, self-reported CKD risk factors, and risk perception among women of childbearing age in urban and semiurban communities in Lagos State, Nigeria. We used descriptive (mean, frequencies, and percentages) and bivariate statistics (chi-square) to assess sociodemographic factors influencing knowledge and perceptions of CKD risk factors. Binary and multinomial logistic regressions were further employed to assess risk perceptions of CKD factors associated with knowledge. Results. Five hundred and forty (65.5%) out of 825 women reported being knowledgeable of CKD risk factors with majority of the younger adult women (15–29 years) having good knowledge than other age cohorts, with a mean age of 33.5 ± 11.5 years. The women’s knowledge of CKD was found to be significantly associated with independent and dependent risk factors ( $p$  < 0.05). The major self-reported independent CKD risk factors were misuse of analgesics (NSAIDs) (OR = 1.20; $p$  < 0.05), herbal drinks (OR = 2.30; $p$  < 0.05), and herbal supplements (OR = 1.37; $p$  < 0.05), while self-reported dependent CKD risk factors were hypertension (OR = 2.14; $p$  < 0.05), family history of KD ailments (OR = 1.30; $p$  < 0.05), and high cholesterol (OR = 1.44; $p$  < 0.05). Similarly, majority of the women had low perceived CKD risk (54.8%), while women with CKD risk factors (independent and dependent) view themselves at decreased perceived risk for the disease compared to those who are not associated with CKD risk factors ( $p$  < 0.05). Also, findings revealed that women had poor perception of risk factors associated with CKD. The multivariate analysis of perceived risk showed that demographic factors (younger aged adults, high education, and high income), independent risk factors of CKD (misuse of NASAIDs and excessive use of herbal drink and herbal supplement), and dependent risk factors (hypertension and family history of KD ailments) were significantly associated with knowledge of CKD ( $p$  < 0.05). Conclusion. Our study reveals high knowledge of CKD risk factors but low perceived risk and poor perception of the link between CKD risk factors and its ailments. Given this, there is a call for urgent measures to create sensitization and provide public CKD behavioural health interventions as well as easy communication strategies for women to secure better access to awareness intervention programmes and healthcare services.

Isolation, Identification, Characterization, and Plasmid Profile of Urinary Tract Infectious Escherichia coli from Clinical Samples

Objective

In recent times, urinary tract infection (UTI) is one of the most widely recognized bacterial diseases all over the planet. UTI influences individuals of any age and gender. The target of this study is to concentrate on the recurrence of uropathogens, the antimicrobial susceptibility pattern of the isolates, and the plasmid profile of people from the government clinics of Karaikudi.

Methods

From July 2017 to December 2017, 100 urine tests were gathered and handled for the isolation of pathogenic microbes. In total, 89 isolates were found from the samples collected.

Results

Escherichia coli was discovered as the most common bacterial isolate screened from the UTI-infected people, accounting for 28.09 percent of all isolates. E. coli was seen to be the highest prevalent bacterium for UTI in all age groups and demonstrated resistance to routinely used medications, especially cefpodoxime and novobiocin, which have been 100 percent resistant. The E. coli isolates screened were positive for beta-lactamase and film generation, and they have strong antimicrobial resistance. As a result, the E. coli strains with the highest prevalence of virulence determinants have become more resistant to many medications because they support the microorganism in overcoming the host's defense and colonizing or entering the urinary system. The amplified 16S rRNA product was analyzed, and phylogenetic relationships were determined. The presence of TEM (56 percent), CTX-M (64 percent), SHV (40 percent), and OXA (60 percent) was discovered. Among E. coli isolates, CTX-M was the most common extended spectrum-beta lactamase (ESBL). Multiplex PCR was also used to identify the existence of CTX-M subgroups in E. coli isolates.

Conclusion

Finally, we urge that antibiotic selection should be predicated on the awareness of the specific prevalence and that novel antimicrobial medicines for urinary infections be developed to combat the overuse of antibiotics.

Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania

Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient's well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p < 0.001). Older age (OR: 1.3, (95%CI: 1.1-1.5), p < 0.001), level of education (OR: 1.8, (95%CI: 1.1-3.1), p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1-5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2-3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2-0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2-0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC.

Prevalence of bacterial uropathogens and their antimicrobial susceptibility patterns among pregnant women in Eastern Ethiopia: hospital-based cross-sectional study

BACKGROUND

Urinary tract infection (UTI) is the commonest bacterial infections during pregnancy, leading to significant maternal and prenatal morbidity and mortality.

METHOD

This hospital-based cross-sectional study during November 2017 to January 2018 was aimed to determine hospital-based antibacterial susceptibility patterns of bacterial uropathogens among 200 pregnant women in Eastern Ethiopia. ~ 10-20 ml clean-catch midstream urine samples were collected by the study participants. The well-mixed urine samples standardized to 1 µl have inoculated onto Cystine Lactose Electrolyte-Deficient and MacConkey agar. The inoculum was cultured at 37 °C under aerobic conditions for 18-48 h and examined macroscopically to evaluate the colony appearance and size of colonies. The isolate on the plates with pure growth and colonies ≥ 105 CFU/ml were further subjected to biochemical identification and susceptibility testing according to the standard procedures explained in the Clinical and Laboratory Standards Institute guideline. SPSS version 25 was used for data analysis. Descriptive statistics such as frequency, percentage, and cross-tabulation were used to present the findings in the form of graphs and tables.

RESULTS

The response rate for this study was 98.04%. Thirty-one bacteria were isolated among the 200 urine samples processed, which gave the overall UTI prevalence of 15.5%. The majority (90.3%) of the isolates were Gram-negative. Escherichia coli (45.2%) was the most frequent isolated uropathogen which followed by Proteus spp. (22.6%), Klebsiella pneumoniae (16.1%), Staphylococcus aureus (9.7%), and Pseudomonas aeruginosa (6.5%). Among the isolates, 96.4% of them were susceptible to amikacin and followed by nitrofurantoin (90.3%), and gentamicin (83.9%). However, high rates of resistance to ampicillin (58.1%), amoxicillin-clavulanate (51.6%), and cotrimoxazole (51.6%) were observed. Overall, 16(51.6%) of the bacterial isolates had developed multiple drug resistance to the selected antimicrobials.

CONCLUSION

In general, the overall prevalence of UTI was high, 15.5%. Most of isolated bacterial uropathogens were Gram-negative bacteria, and Escherichia coli was the most frequent isolate. The majority of the isolates were susceptible to amikacin, nitrofurantoin, and gentamicin. However, a high rate of resistance was observed to ampicillin, amoxicillin-clavulanate, and cotrimoxazole. More than half of the isolated bacteria had multiple drug-resistant features. Therefore, periodic and continuous urine culture for screening and diagnosis is mandatory to reduce the consequence of UTI and multidrug resistance bacteria in pregnancy.

Bacterial Profile and Antibiotic Susceptibility Pattern of Urinary Tract Infection among Pregnant Women Attending Antenatal Care at a Tertiary Care Hospital in Southern Ethiopia

Background

Urinary tract infection is one of the most common bacterial infections encountered in pregnant women with significant morbidity. This study aimed to determine the bacterial profile and its antimicrobial susceptibility pattern of urinary tract infection among pregnant women attending antenatal care (ANC) at a Hawassa University Comprehensive Specialized Hospital (HUCSH), Southern Ethiopia.

Method

A cross-sectional study was conducted in which consecutive pregnant women enrolled in the study from March to June 2019. The structured questionnaire used to collect sociodemographic and clinical data in a face-to-face interview. Midstream urine was collected from pregnant women using sterile containers. Culture and sensitivity were performed using a standard operating procedure of the microbiology laboratory. Data entry and analysis were conducted using the statistical package for social sciences (SPSS) version 20. Descriptive and logistic regression was used to conduct the output of the data. The odds ratio at 95% confidence interval was considered as a statistically significant association with a p value <0.05.

Result

The overall magnitude of urinary tract infection in this study was 7.8% (4.7–10.8%). Escherichia coli was found to be the most frequently isolated (47.8%), followed by Klebsiella pneumoniae (17.4%), Staphylococcus aureus (8.7%), Klebsiella ozaenae, Klebsiella rhinoscleromatis, Citrobacter spp., Salmonella group A, Staphylococcus saprophyticus, and Enterobacter cloacae each (4.3%). Gram-negative bacteria were sensitive to 78.3%, 91.3%, and 100% of ciprofloxacin, gentamicin, and nitrofurantoin, respectively. Gram-positive bacteria were sensitive to clindamycin (100%), gentamicin (100%), and nitrofurantoin (100%) and fully resistant to ceftriaxone (100%) and cefuroxime (100%). There is no statistically significant association (p < 0.05) between the risk factor of urinary tract infection and UTI.

Conclusion

The overall prevalence of urinary tract infection among pregnant women attending antenatal care was 7.8%. Escherichia coli were the dominant isolate followed by Klebsiella pneumoniae. Gram-negative isolates are highly sensitive to ciprofloxacin, gentamicin, nitrofurantoin, and ceftriaxone and Gram-positive isolates to gentamicin, clindamycin, and nitrofurantoin. Most of the bacteria are resistant to cotrimoxazole and cefuroxime. There is no statistically significantly associated variable. Screening for the presence of urinary tract infection during pregnancy will improve the quality of antenatal care further reducing complication. The above antibiotics can be prescribed based on the side effect to pregnant women in case empirical treatment is mandatory in the study area.

Urinary Tract Infection in Chronic Kidney Disease Population: A Clinical Observational Study

Introduction Chronic kidney disease (CKD) is a state of chronic inflammation. Chronic inflammation weakens the body's immune response to infections. Hence, CKD patients are at an increased risk of infections. Urinary tract infection (UTI) is one of the most common types of community-acquired infection. There is a paucity of data with respect to UTI in CKD patients. Hence, our objective was to study the clinical and microbiological profile of UTI in CKD patients. Materials and methods We studied 129 CKD patients at a tertiary care hospital in south India from January 2020 to June 2020. Patients who fulfilled the inclusion criteria were included in the study. Urine samples were cultured aseptically. Only urine-culture positive samples were included in the study and antibiotic susceptibility was recorded. Results Males (76.2%) were most commonly infected. 94% were gram-negative bacteria, 3% were gram-positive bacteria and 3% were Candida species. E. coli (61.8%) was the most common isolated microorganism. Resistance to quinolones was recorded among gram-negative bacteria. Resistance to penicillin and quinolones was noted among gram-positive bacteria. Candida species were sensitive to amphotericin B and fluconazole. Conclusion The results of the study help in formulating the empiric antibiotic policy to treat UTI in CKD patients and hence prevent inadvertent use of antibiotics and the emergence of antibiotic resistance.

Prevalence, Antimicrobial Susceptibility Pattern, and Associated Factors of Urinary Tract Infections among Pregnant and Nonpregnant Women at Public Health Facilities, Harar, Eastern Ethiopia: A Comparative Cross-Sectional Study

BACKGROUND

Urinary tract infection is one of the most common health problems worldwide, afflicting many women in reproductive age, especially in developing countries. Increased risk of infection has been attributed to pregnancy and antimicrobial resistance.

OBJECTIVE

To compare the prevalence, antimicrobial susceptibility pattern of the bacteria and associated factors of urinary tract infections among pregnant and nonpregnant women attending public health facilities, Harar, Eastern Ethiopia.

METHODS

A health facility-based comparative cross-sectional study was conducted among 651 randomly selected women from public health facilities, Harar, Eastern Ethiopia, between February 2017 and December 2017. Pertinent data were collected through a face-to-face interview using a structured questionnaire. The midstream urine specimen was collected and cultured on cysteine-lactose-electrolyte-deficient agar and blood agar. Pure isolates were tested against the ten most prescribed antimicrobials using the Kirby-Bauer disk diffusion method. Data were entered and analysed using Statistical Program for Social Sciences version 21. A p value <0.05 was considered statistically significant.

RESULTS

The overall prevalence of significant bacteriuria was 23% (95% CI: 13.6, 26.8). The higher proportion of bacteria were isolated from pregnant women (14.1%) compared to nonpregnant women (8.9%). Escherichia coli (28.8%) and Streptococcus aureus (14.3%) were the most common isolates. E. coli was resistant to amoxicillin (83.3%), trimethoprim-sulfamethoxazole (78.6%), and ciprofloxacin (81%), whereas S. aureus was resistant to chloramphenicol (81%), erythromycin (81%), and amoxicillin (76.2%). Current symptoms, and history of catheterization increase the likelihood of urinary tract infections.

CONCLUSION

Pregnant women were more likely infected with bacterial pathogens than nonpregnant women. Current symptoms, and catheterization increase the odds of urinary tract infections. More than half of the isolates were resistant to the commonly prescribed antimicrobials. Regular assessment of urinary tract infections and antimicrobial resistance are recommended to provide effective therapy and thereby prevent urinary tract complications.

A Systematic Review on Drug Resistant Urinary Tract Infection Among Pregnant Women in Developing Countries in Africa and Asia; 2005-2016

Background

Urinary tract infection is one of the most common health problems during pregnancy. It is most commonly reported among pregnant women and is a known reason of morbidity during pregnancy worldwide, predominantly in developing countries. The etiological agents include Escherichia coli, Klebsiella species, Staphylococcus aureus, coagulase negative Staphylococci, Proteus mirabilis, Enterococcus species, Pseudomonas aeruginosa, Enterobacter species, non-hemolytic streptococci, Citrobacter species and others. Different risk factors expose pregnant women to urinary tract infection. Drug resistance by uropathogenic bacteria is a current problem of the world. This study was aimed at reviewing the prevalence of bacterial uropathogens and their antimicrobial resistance patterns among pregnant women in developing countries in Asia and Africa, during the past decade.

Methods

A systematic literature search was accomplished to identify published studies between January 2005 and November 2016. The literature search strategy in this paper included searching PubMed, PMC, Science Direct, Springer open, Google scholar and BioMed Central databases.

Results

The overall prevalence of UTI among pregnant women was 13.5%. Both Gram-positive and Gram-negative bacteria were isolated from all eligible studies. Gram-negative bacteria (83.7%) accounted for majority of infections while Gram positives accounted for 15.9%. Among the isolated bacteria, Escherichia coli was the most predominant uropathogen; it was shown to be present in all 26 eligible studies that were included in this review. Four studies from Africa and four from Asia were reviewed for antimicrobial resistance patterns of uropathogenic bacteria. In most of the regions, almost all the bacterial uropathogens had high resistance to ampicillin (67.2%) whereas all the strains showed relative sensitivity to ciprofloxacin (71.2%), nitrofurantoin (65%) and ceftriaxone (74.1%).

Conclusion

The prevalence of UTI in the selected regions of the two continents is different. A significant prevalence of UTI among pregnant women is mainly observed in Africa and Asia. Uropathogenic bacteria showed resistance to antimicrobial drugs that are regularly used in developing countries. This may show the need to incorporate culture and drug susceptibility tests into the routine antenatal care for pregnant women and drug resistance should be monitored.

In-Vitro Biofilm Formation and Antimicrobial Resistance of Escherichia coli in Diabetic and Nondiabetic Patients

Background

Diabetic patients are more susceptible to urinary tract infection compared to nondiabetic patients, Escherichia coli being the most common uropathogen causing UTI. Unreasonable and incorrect antibiotic prescription for UTI in these patients may induce the development of antibiotic-resistant urinary pathogens resulting in delayed recovery and longer hospitalization. In addition to these, biofilm forming capacity of the pathogen may worsen the problem. The main aim of this cross-sectional study (conducted from March to September 2015) is to detect the biofilm forming capacity of UTI causing micro-organisms and compare the antibiotic resistance pattern of Escherichia coli, the most common cause of UTI, which will help the physician in choosing the best antibiotic.

Method

Total of 1,099 clean-catch mid stream urine (CCMSU) was processed by standard microbiological technique; 182 were from the diabetic group and 917 nondiabetic. Following identification, all isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer disc diffusion method. In-vitro biofilm forming capacity of the isolates were detected by Microtitre plate method. The data were analyzed using SPSS software 16.

Result

Urinary tract infection was found to be significantly higher in diabetic patients (42.9%) compared to nondiabetic patients (17.4%) with Escherichia coli as the most common uropathogen in both diabetic and nondiabetic groups. Similarly, UTI was more common in elderly population (29.5%). Imipenem, nitrofurantoin and amikacin were found to be the most effective drug for uropathogenic E. coli in both diabetic and nondiabetic patients, whereas amoxicillin, ciprofloxacin, and cotrimoxazole were least effective. Of the total bacterial isolates, 43.3% showed positive results for in-vitro biofilm production by the Microtitre plate method. A significantly higher resistance rate was observed among biofilm producing E. coli for quinolones, cotrimoxazole, and third generation cephalosporin ceftriaxone. Most of the biofilm producers (79.5%) were found to be MDR (p-value 0.015).

Conclusion

Elderly populations with diabetes are at a higher risk of UTI. Higher biofilm production and resistance to in-use antimicrobial agents in this study render its inefficacy for empirical treatment and point out the importance of biofilm screening to ensure the effective management of infection.

Evaluation of antibacterial efficacy of sulfur nanoparticles alone and in combination with antibiotics against multidrug-resistant uropathogenic bacteria

Urinary tract infections (UTIs) have been frequently reported from different parts of the world. The current knowledge on distribution of causative agents of urinary infections and antibiotics susceptibility pattern is essentially required. In the present study, total 351 uropathogenic bacteria were isolated; among them most prevalent were Escherichia coli (75%), followed by Pseudomonas aeruginosa (8%), Proteus mirabilis (6%), Klebsiella pneumoniae (4%), Staphylococcus aureus (4%) and Enterococcus faecalis (3%). Most isolates of uropathogenic bacteria showed resistance to amoxicillin and trimethoprim, followed by chloramphenicol and kanamycin. Biosynthesis of sulfur nanoparticles (SNPs) was performed by co-precipitation method using sodium thiosulfate in presence of Catharanthus roseus leaf extract. The characterization data showed that SNPs were polydispersed, spherical in shape with size range of 20-86 nm and having negative zeta potential of -9.24 mV. The potential antibacterial activity was observed for SNPs alone and in combination with antibiotics particularly amoxicillin and trimethoprim against majority of the uropathogens. The synergistic effect yielded increase in fold area with high activity index against tested uropathogens. Based on overall results, it can be recommended to use SNPs for the management of UTI alone and also in combination with antibiotics.

Alterations in the Urinary Microbiota Are Associated With Cesarean Delivery

Similar to the gut, the bladder contains urinary microbiota, and its bacterial composition and structure are determined by the individual’s health status. Cesarean section is a traumatic event for women and it is correlated with postpartum complications. To better understand the urinary microbiota alterations caused by cesarean section, 16S rDNA sequencing was used to assess urine specimens collected by transurethral catheterization from 30 healthy women undergoing cesarean section pre-delivery (PreD) and post-delivery (PostD). A significant increase in bacterial diversity and more detectable bacteria at the phylum, family, and genus levels was observed in the PostD group compared to the PreD group, indicating that cesarean delivery (a process that includes surgery and delivery) altered the bacterial community. Specifically, the phylum Firmicutes and its affiliated family Lactobacillaceae and genus Lactobacillus dramatically decreased in the PostD group, suggesting that beneficial bacteria decreased after cesarean section, and clinicians should be aware that this might increase the risk of complications. Concurrently, the phylum Proteobacteria and its affiliated bacteria Pseudomonadaceae and Pseudomonas increased in the PostD group compared to the PreD group. This indicates that pathogen growth increases after cesarean section, making it important for clinicians to combat these changes to protect women from infectious diseases. Interestingly, several metabolic pathways, such as metabolism of energy, cofactors and vitamins were strengthened in the PostD group, whereas membrane transport was lessened in this group. This suggests that women’s metabolic disorders might be cured by balancing urinary microbiota. In conclusion, the altered urinary microbiota between the PreD and PostD periods appears to provide insight into how to prevent postpartum metabolic disorders.

Urinary Tract Infections among Bladder Outlet Obstruction Patients in Accra, Ghana: Aetiology, Antibiotic Resistance, and Risk Factors

The aim of this study was to investigate urinary tract infections among patients with Bladder Outlet Obstruction (BOO) at the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana, including the prevalence, risk factors, aetiological agents and their antibiogram. Urine specimens were collected from 188 male patients presenting with BOO and cultured for bacteria. The bacterial isolates were identified using standard microbiological methods and tested against a spectrum of antimicrobial agents using the Kirby Bauer method. Demographic information and the clinical history of study participants were also recorded. The prevalence of urinary tract infection among the BOO patients was 76.6% and the main risk factor identified was catheterization (p < 0.0001). A wide range of bacterial organisms was isolated from urine specimens and they were predominantly, Enterobacteriaceae; Escherichia coli was the most frequent cause of bacteriuria (33.3%), followed by Klebsiella (17.3%). Bacterial isolates were most resistant to Augmentin (97.8%) followed by tetracycline (85.8%), nalidixic acid (82.8%) and ciprofloxacin (75%) while 93.6% were multi-drug resistant. The highest susceptibility was observed with amikacin, which had a resistance prevalence of 4.4% resistance. These findings have important implications in the treatment of urinary tract infections among the BOO patients in Ghana.

Prevalencia de infección del tracto urinario, uropatógenos y perfil de susceptibilidad en un hospital de Cartagena, Colombia. 2016

Introducción. Dada la alta prevalencia de la infección del tracto urinario (ITU) y la significativa resistencia de los patógenos implicados, el mundo se enfrenta a un problema creciente de salud pública.Objetivos. Describir la prevalencia de ITU y uropatógenos y analizar los perfiles de susceptibilidad en los reportes de urocultivos del laboratorio de microbiología de un hospital de referencia.Materiales y métodos. Se llevó a cabo un estudio transversal con una muestra de 396 urocultivos positivos en el que se calculó la prevalencia de ITU, uropatógenos y perfil de resistencia microbiana. Se realizaron pruebas de hipótesis y regresión logística no condicional para conocer si existía diferencia estadística entre el género.Resultados. La prevalencia de ITU fue del 28%, los tres patógenos aislados más frecuentes fueron Escherichia coli, Escherichia. coli con ß-lactamasas de espectro extendido y Pseudomonas. aeruginosa. La mayor frecuencia de resistencia a antibióticos para estos patógenos fue ampicilina (66.6%), ceftriaxona (100%) y gentamicina (39.5%), respectivamente.Conclusiones. Por la alta prevalencia, el amplio espectro de uropatógenos aislados y la diversidad de perfiles de resistencia antibiótica, se evidencia la necesidad de desarrollar investigaciones locales que permitan orientar las acciones en salud y vigilancia epidemiológica.

Design of a microfluidic paper-based device for analysis of biomarkers from urine samples on diapers

Among all infections, urinary tract infections (UTI) are one of the most common. Nowadays the procedures to analyze urine and consequently detect UTI are often painful and time-consuming. Recent studies about microfluidic paper-based devices have developed the interest of researchers due their outstanding characteristics. In this paper is presented a novel design for a microfluidic paper-based device for screening and analysis of multiple biomarkers from urine samples on diapers. The device consists on a set of eight layers. It was designed based on the previous attempts to improve and overcome some problems detected as the continuous entrance of fluids, the possibility of contamination and the invalidity of results due to communication between different reagent pads. One approach was create a "self-locking" mechanism that closes the sample inlet in approximately four minutes solving the first two problems. Furthermore, is important that comfort is guaranteed, hence a device with a total thickness of 5,3 mm is presented. This device can keep the results for eight hours and can be used as a low-cost and more effective alternative than conventional methods being a strategy with potential for the diagnostic and analysis of biological samples in the future improving healthcare.

Risk of Asymptomatic Bacteriuria among People with Sickle Cell Disease in Accra, Ghana

Asymptomatic bacteriuria (ASB) is benign except in certain medical conditions such as pregnancy and immunosuppression. In Ghana, there are hardly any studies on urinary infections among sickle cell disease (SCD) patients, and the few studies carried out in Africa focused on pediatric SCD populations. The current study aimed to investigate the risk of ASB among SCD patients at a tertiary hospital in Ghana. This was a cross-sectional study involving 110 SCD patients and 110 age and sex matched healthy controls. Urine specimens were collected from all the study subjects and analyzed by standard microbiological methods. Demographic information were also collected from the study subjects. The overall ASB prevalence was significantly higher among SCD patients (17.2%) than among the control group (8.2%), and the relative risk was 2.11 (p = 0.0431; CI = 1.00–4.45). Being female was as a predictor of ASB among the SCD patients (OR = 14.76; CI = 11.23–18.29; p = 0.0103). The most common organism isolated from the study participants was coagulase negative Staphylococcus species (4.1%), followed by Escherichia coli (2.7%); etiology of ASB in the SCD patients was more diverse compared to healthy people. All the E. coli isolates were susceptible to amikacin, sparfloxacin and norfloxacin but resistant to ampicillin.