CTX-M-producing Escherichia coli strains: resistance to temocillin, fosfomycin, nitrofurantoin and biofilm formation

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections

IMPORTANCE

Urinary tract infections (UTIs) occur in 8.6% to 48.1% of patients after intradetrusor onabotulinumtoxinA injections.

OBJECTIVE

The objective of this study was to evaluate both choice and duration of antibiotic prophylaxis on the incidence of UTI within 30 days after in-office onabotulinumtoxinA injections.

STUDY DESIGN

We included a single-site, retrospective cohort of 305 patients with overactive bladder or bladder pain syndrome receiving postprocedure prophylactic antibiotics for in-office, 100-unit intradetrusor onabotulinumtoxinA injections from 2019 to 2023. Categories of antibiotic prophylaxis compared included (1) nitrofurantoin 100 mg twice daily for 3 days, (2) nitrofurantoin 100 mg twice daily for 5 days, (3) trimethoprim-sulfamethoxazole 160 mg/800 mg twice daily for 3 days, and (4) "other regimens." Primary outcome was incidence of UTI within 30 days. Variables were compared via χ2 test. Crude/adjusted odds were estimated using binary logistic regression.

RESULTS

Incidence of UTI was 10.4% for 3-day nitrofurantoin, 20.5% for 5-day nitrofurantoin, 7.4% for 3-day trimethoprim-sulfamethoxazole, and 25.7% among "other regimens" (P = 0.023). Differences among primary regimens were substantial but not statistically significant: 3-day trimethoprim-sulfamethoxazole had 31% lower odds of UTI versus 3-day nitrofurantoin (odds ratio [OR], 0.689; P = 0.518). Compared with 3-day nitrofurantoin regimen, the 5-day nitrofurantoin regimen had twice the odds of UTI (OR, 2.22; P = 0.088). Those receiving "other regimens" had nearly 3 times the odds of UTI (OR, 2.98; P = 0.018). Results were similar adjusting for age and race. Overall urinary retention rate was 1.97%.

CONCLUSIONS

Prophylactic antibiotic choice and duration of treatment potentially affect UTI incidence after in-office, intradetrusor onabotulinumtoxinA injections. Nitrofurantoin and trimethoprim-sulfamethoxazole for 3 days have the lowest UTI incidence.

A Five-Year Analysis of Antibiotic Resistance Trends among Bacteria Identified in Positive Urine Samples in a Tertiary Care Hospital from Bucharest, Romania

The rise of multidrug-resistant bacteria (MDR) has resulted in limited treatment options and poorer outcomes for patients. The objective of this study was to analyze the overall antibiotic resistance trends and distribution for pathogens identified in urine samples at the National Institute of Infectious Diseases "Prof. Dr. Matei Balș" from Bucharest, Romania, over a 5-year period. Antibiotic susceptibility testing was performed using automatic systems and the disk diffusion method. ESBL- and carbapenemases-producing strains were identified using immunochromatography tests, and ROSCO Diagnostica kits were used for definitive confirmation. All results were interpreted according to EUCAST clinical breakpoints. Gram-negative rods (GNR) had overall resistance rates higher than 50% for penicillin and 40% for 3rd- and 4th-generation cephalosporins. Escherichia coli resistance to fosfomycin (3%) and nitrofurantoin (2%) remains low, and 33.30% of E. coli, 48% of Klebsiella spp., and 37% of Pseudomonas aeruginosa isolates were multidrug-resistant (MDR). All Acinetobacter baumannii isolates were MDR by the last year of the study. For Gram-positive cocci (GPC), 37% of all Enterococcus faecium strains and 2% of Enterococcus faecalis were vancomycin-resistant (VRE). E. coli's incidence in UTIs' etiology is on a downward trend. The incidence of Klebsiella spp. and GPCs is rising. Antibiotic stewardship strategies should be implemented after carefully considering regional variations in etiology and resistance trends.

Evaluation of Antimicrobial Resistance Profiles of Bacteria Isolated from Biofilm in Meat Processing Units

The aim of this study was to assess the hygiene of pork, beef, and poultry carcasses and to determine the phenotypic antibiotic susceptibility of the bacteria embedded in the biofilm formed on the carcasses kept in cooling chambers for at least three days. The level of hygiene was assessed by determining the total aerobic colony count (TACC) and the Enterobacteriaceae level in different sampling points of the carcasses, along with the detection of E. coli and Pseudomonas spp. embedded in the biofilm. Furthermore, the E. coli and Pseudomonas spp. isolates were tested for antimicrobial resistance profiles. A total of 130 samples collected from pork, beef, and poultry from processing units were analyzed to determine the total aerobic colony count as well as to measure the level of Enterobacteriaceae found on the carcasses. The antimicrobial susceptibility of 44 Escherichia coli and eight Pseudomonas spp. strains isolated from the carcasses were assessed using the Vitek 2 system using two different cards. Overall, the regulatory limits for the TACC were exceeded in 7.6% of the samples, and 65% of the samples exceeded the regulatory limits for Enterobacteriaceae levels. The antimicrobial susceptibility tests of the E. coli isolates analyzed with the AST-GN27 card revealed the highest resistance to be that towards ampicillin (76.1%), followed by cefazolin (71.4%), amoxicillin/clavulanic acid (61.9%), nitrofurantoin (52.3%), cefoxitin (47.6%), tetracycline (38.1%), piperacillin, norfloxacin (19%), trimethoprim-sulfamethoxazole (11.9%), cefotaxime (9.5%), ceftazidime, cefazolin, amikacin, gentamicin, and ciprofloxacin (4.7%). However, all of the isolates were sensitive to piperacillin-tazobactam and imipenem. Thirty-two (61.5%; 95% CI 47.9-73.5) out of fifty-two isolates exhibited multidrug resistance, resulting in the expression of 10 resistance profiles. The findings of this study highlight serious hygienic and sanitary deficiencies within the meat processing units and demonstrate that the resulting meat can harbor Multidrug-resistant Escherichia coli and Pseudomonas spp., both of which pose a serious public health risk. However, further research with a larger number of samples is required to reach thorough results.

New Pyrazolo-Benzimidazole Mannich Bases with Antimicrobial and Antibiofilm Activities

A new series of pyrazolo-benzimidazole hybrid Mannich bases were synthesized, characterized by ¹H-NMR, ¹³C-NMR, IR, UV-Vis, MS, and elemental analysis. In vitro cytotoxicity of the new compounds studied on fibroblast cells showed that the newly synthesized pyrazolo-benzimidazole hybrid derivatives were noncytotoxic until the concentration of 1 μM and two compounds presented a high degree of biocompatibility. The antibacterial and antibiofilm activity of the newly synthesized compounds was assayed on Gram-positive Staphylococcus aureus ATCC25923, Enterococcus faecalis ATCC29212, and Gram-negative Pseudomonas aeruginosa ATCC27853, Escherichia coli ATCC25922 strains. All synthesized compounds 5a–g are more active against all three tested bacterial strains Staphylococcus aureus ATCC25923, Enterococcus faecalis ATCC29212, and Escherichia coli ATCC25922 than reference drugs (Metronidazole, Nitrofurantoin), with the exception of compounds 5d and 5g, which are less active compared to Nitrofurantoin, and all synthesized compounds 5a–g are more active against Pseudomonas aeruginosa ATCC27853 compared to reference drugs (Metronidazole, Nitrofurantoin). Compound 5f showed the best activity against Staphylococcus aureus ATCC 25923, with a MIC of 150 μg/mL and has also inhibited the biofilm formed by all the bacterial strains, having an MBIC of 310 µg/mL compared to the reference drugs (Metronidazole, Nitrofurantoin).