Urinary Tract Infections: The Current Scenario and Future Prospects

A comparative study on nosocomial and community-acquired bacterial urinary tract infections: prevalence, antimicrobial susceptibility pattern, and associated risk factors among symptomatic patients attending Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia

Background

Urinary tract infections (UTIs) remain one of the most common diseases worldwide that occur both in the community and in healthcare settings. Thus, this study aimed to compare the burden of nosocomial and community-acquired bacterial UTIs among patients attending Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia.

Method

A hospital-based cross-sectional study was conducted using a convenient sampling technique from January 2024 to April 2024. Descriptive statistics were employed, and bivariate and multivariable logistic regression analyses were used to identify associated factors at p < 0.05 with a 95% confidence interval (CI) considered statistically significant.

Results

The rate of hospital-acquired UTIs was 42% (95% CI: 35-50), while the rate of community-acquired UTIs was 28% (95% CI: 22-36). The predominant bacterial isolates were Escherichia coli (37%), Staphylococcus aureus (7.8%), and Klebsiella pneumoniae (7.8%). The overall multidrug resistance rate was 91 (77.8%). Lack of formal education [adjusted odds ratio (AOR), 0.02; 95% CI: 0.001-0.6], surgery during admission (AOR, 0.02; 95% CI: 0.002-0.3), delay in voiding urine (AOR, 0.01; 95% CI: 0.005-0.1), previous UTIs (AOR, 0.04; 95% CI: 0.004-0.4), and previous admission (AOR, 0.07; 95% CI: 0.01-0.5) were the main factors significantly associated with bacterial UTIs.

Conclusions

A significantly higher prevalence of hospital-acquired bacterial UTIs was observed compared to community-acquired bacterial UTIs. The commonest isolates were E.coli, S. aureus, and K. pneumoniae. The drug resistance rate was very high. Modifiable individual-level factors were the major significant factors of UTIs. Thus, health workers and other stakeholders should tackle UTIs by increasing community awareness, promoting personal hygiene, and improving healthcare service quality.

Characterization of urinary tract infections among females at a tertiary hospital in Malawi: a retrospective study

BACKGROUND

Urinary tract infections (UTIs) are among the most common infections in females, with many experiencing at least one episode in their lifetime. About 150 million cases of UTIs occur each year. Lately, the prognosis of UTIs has been poor, largely due to a rise in antimicrobial resistance among common uropathogens. The present study was conducted to describe UTIs in female clients at Zomba Central Hospital in Malawi.

METHODS

This was a retrospective cross-sectional study where 340 records of women suffering from UTIs were evaluated. Records were analysed for demographic characteristics, the causative agent of UTIs and their antimicrobial susceptibility profile. Data were cleaned and analysed in Excel 2016.

RESULTS

The overall prevalence of UTIs was 48.53%, with age group 15-45 having a higher frequency (53.33%) than other age groups. The most frequently isolated bacteria were Escherichia coli (27.2%), Staphylococcus species (26.5%), Enterobacter species (19.2%), Citrobacter freundii (11.9%), Proteus species (6.0%), Enterococcus species, and Serratia marcescens (4.6%). Comparatively, meropenem and amikacin were effective against most pathogens showing average sensitivity rates of 51% and 56% respectively. Nevertheless, high levels of resistance to ampicillin (87%), ceftriaxone (77%) ciprofloxacin (70%), gentamicin (77%), and cefoxitin (64%) were observed.

CONCLUSION

UTIs remain a significant health concern among females at Zomba Central Hospital, particularly in the reproductive age group. The high prevalence of multidrug-resistant uropathogens, especially against commonly used antibiotics like ampicillin and ceftriaxone, underscores the urgent need for regular antimicrobial resistance surveillance and evidence-based antibiotic stewardship to guide effective treatment strategies.

CLINICAL TRIAL NUMBER

Not applicable.

Cefepime versus carbapenem for treating complicated urinary tract infection caused by cefoxitin-nonsusceptible ESCPM organisms: a multicenter, real-world study

BACKGROUND

This investigation aimed to compare the efficacy of cefepime and carbapenem for complicated urinary tract infection (cUTI) caused by presumptive AmpC β-lactamase-producing Enterobacter spp., Serratia marcescens, Citrobacter freundii, Providencia spp., and Morganella morganii (ESCPM).

METHODS

Data of 458 individuals with cUTI caused by cefoxitin-nonsusceptible [minimum inhibitory concentration (MIC) > 8 µg/mL] and cefepime-susceptible (MIC ≤ 2 µg/mL) ESCPM was acquired from four Chinese hospitals between 2010 and 2022 and were reviewed retrospectively.

RESULTS

125 and 333 patients received cefepime and carbapenems, respectively, as antimicrobial therapy. The 28-day treatment failure rate was 15.7% (72/458). The following factors were identified as independent predictors for 28-day therapy: age, cefepime MIC = 2 µg/mL, immunocompromised status, infection source control, appropriate empirical therapy, and days from illness onset to active therapy. In patients who required cefepime MIC ≤ 1 µg/mL, a multivariate logistic model indicated that cefepime was linked with a similar risk of 28-day treatment failure [odd ratio (OR) 1.791, 95% confidence interval (CI) 0.600-5.350, p = 0.296] compared with carbapenems after controlling these predictors. Compared with individuals with cefoxitin-nonsusceptible ESCPM, those with isolates of cefepime (MIC = 2 µg/mL) had an enhanced risk of 28-day treatment failure (OR = 2.579, 95% CI = 1.012-6.572, p = 0.047). A propensity score for treatment analysis validated this relationship.

CONCLUSIONS

The cefepime and carbapenem had comparable efficacy for treating cUTI caused by cefoxitin-nonsusceptible ESCPM organisms with cefepime MIC ≤ 1 µg/mL, whereas carbapenems are potentially more effective for isolates with cefepime MIC = 2 µg/mL.

Rapid and accurate testing for urinary tract infection: new clothes for the emperor

SUMMARYUrinary tract infection (UTI) is among the most common infections in clinical practice. In some cases, if left untreated, it can lead to pyelonephritis and urosepsis. In other cases, UTI resolves without treatment. Clinical diagnosis is typically based on patient symptoms and/or urinalysis, including urine dipsticks. The standard urine culture method is sometimes employed to identify the suspected urinary pathogen (uropathogen) and/or guide antimicrobial choice, but results are rarely available before 24 h. The standard urine culture method also misses fastidious, anaerobic, and slow-growing uropathogens and rarely reports polymicrobial infections. The unexplained combination of negative urine cultures with persistent urinary tract symptoms is distressing to both patients and clinicians. Given the broad appreciation of the advantages provided by rapid testing (e.g., for COVID-19 or influenza A), a rapid, accurate diagnostic test is needed to deliver timely treatment to patients seeking care for UTI that optimizes antibiotic stewardship. Herein, we discuss progress being made toward an accessible, timely (i.e., within hours), accurate assay with results that are clinically useful for the treating clinician within the timeframe of the infection (i.e., the growth rate of the pathogen(s)). New and emerging uropathogens often overlooked by current diagnostic techniques are also reviewed.

Antimicrobial susceptibilities of clinical bacterial isolates from urinary tract infections to fosfomycin and comparator antibiotics determined by agar dilution method and automated micro broth dilution

Uncomplicated bacteremic urinary tract infections (bUTIs) are common, often caused by Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, with most encounters treated empirically. As rates of antimicrobial resistance increase, available antibiotic treatment options are dwindling. Novel antibiotics approved for treating bUTIs are limited, leading to a resurgence of interest in older antibiotics, including fosfomycin. Here, clinical urine samples from patients including military personnel, retirees, and their dependents diagnosed with bUTIs from a military hospital located in Bethesda, Maryland, were tested for susceptibility to fosfomycin and comparator antibiotics (levofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole [TMS]). A total of 1,353 nonduplicate bacterial isolates were tested, including 605 non-ESBL and 285 ESBL E. coli, and 84 non-ESBL and 52 ESBL K. pneumoniae. Fosfomycin susceptibility rates were similar for non-ESBL and ESBL E. coli (95.9% vs 96.1%) and K. pneumoniae (38.1% vs 36.5%). Fosfomycin demonstrated high activity against other Enterobacterales and gram-positive organisms including Enterobacter faecalis and Staphylococcus aureus. Interestingly, most fosfomycin non-susceptible isolates were susceptible to other first-line bUTI treatment options, and most isolates that were non-susceptible to other first-line bUTI treatment option were susceptible to fosfomycin. ESBL K. pneumoniae isolates were the least susceptible to current first-line treatment options. Fosfomycin Etest demonstrated high sensitivity compared to agar dilution, making it a viable AST testing method especially in resource-limited areas. Overall, we demonstrated fosfomycin has high activity against common etiologies that cause bUTIs. Further clinical efficacy studies investigating the use of fosfomycin in treating non-E. coli bUTI pathogens, as single or combination therapy, are warranted.

IMPORTANCE

Uncomplicated bUTIs are often caused by Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Fosfomycin is one of the recommended firstline antibiotics for the treatment of symptomatic, uncomplicated bUTIs. Fosfomycin susceptibility testing is complicated by the fact that although both CLSI and EUCAST recognize agar dilution (AD) as the reference method albeit being labor-intensive, breakpoints are different, and Etest is only approved by EUCAST. We investigated the susceptibility of bUTI clinical isolates to fosfomycin using AD and compared performance in a subset of isolates to Etest. Fosfomycin susceptibility profiles of bacterial isolates were compared to other firstline antibiotics. We found isolates were susceptible to fosfomycin at similar or higher rates compared to other firstline antibiotics. Importantly, fosfomycin was effective against isolates producing extended-spectrum beta-lactamases and those that were resistant to other firstline treatments. Furthermore, our data showed Etest was a viable option for susceptibility testing with 94% agreement to the AD.

Prevalence of recurrent urinary tract infections and its associated factors in female staff of reproductive age group in a medical college in central Kerala: a cross-sectional study

AIM

To study the prevalence of recurrent urinary tract infections (UTIs) and its associated factors in female staff of reproductive age group in a medical college in central Kerala.

INTRODUCTION

Recurrent UTIs can be defined as ≥ 3 episodes of UTIs within a period of 12 months. Females with recurrent UTIs have lower health-related quality of life compared to the general population; the incidence of UTI in women of reproductive age group is very common. This study focused on female employees of reproductive age group in a private medical college.

METHODS

A cross-sectional study was done among female staff of reproductive age group in a private medical college in central Kerala, with a sample size of 417. All female staff (18-49 years) were given a questionnaire and asked to fill it out. All those who filled out the questionnaire were included in the study according to both inclusion and exclusion criteria. Data entry and analysis were performed via Microsoft Excel 2019 and SPSS version 22.0.

RESULT

Our study of 417 participants revealed a prevalence of recurrent UTIs of 22.30% (95% CI = 18.3- 26.3%). Recurrent UTI was significantly associated with daily water intake, urination frequency, holding urine, foul-smelling vaginal discharge, constipation, pre-coital urination, and pre- and post-intercourse vaginal hygiene. Also, occupation was found to be significantly associated with recurrent UTI, with cleaning staff having higher odds.

CONCLUSION

Our study found the prevalence of recurrent UTI in 417 population as 22.30%. Prevention of recurrent UTI requires a daily intake of > 2 L of water and personal & sexual hygiene. Reducing recurrent UTIs enhances quality of life. Educating female staff is crucial.

Novel technologies for the diagnosis of urinary tract infections

Urinary tract infections (UTIs) impose a substantial burden on patient quality of life and urine testing accounts for the majority of workload in many clinical microbiology laboratories. Traditional UTI diagnosis relies on symptoms, urinalysis, and culture which are interpreted based on historical guidelines. This approach, while foundational, presents limitations, particularly in complex cases. Low-level bacteriuria and the presence of fastidious organisms are often overlooked or entirely missed in standard urine culture, stressing the need for novel diagnostic methods and technologies. This mini-review summarizes the existing state of UTI diagnostics in 2024 and covers current and upcoming technologies including rapid molecular-based pathogen identification, next-generation sequencing, and advanced antimicrobial susceptibility testing. However, these methods represent unique challenges, and as they are implemented, they will require the field to adapt to new concepts to avoid misdiagnosis and overtreatment.

Understanding the Burden and Management of Urinary Tract Infections in Women

Urinary tract infections (UTIs) represent a prevalent health concern among the female population, with anatomical and physiological determinants such as a shorter urethra and its proximity to the rectum augmenting vulnerability. The presence of Escherichia coli and various other pathogens plays a significant role in the etiology of these infections, which can be aggravated by sexual intercourse and disturbances to the vaginal microbiome. The physiological alterations associated with pregnancy further elevate the likelihood of UTIs, with untreated cases potentially leading to severe complications such as pyelonephritis, preterm labor, and stillbirth. Furthermore, postmenopausal women encounter an augmented risk of UTIs attributable to estrogen deficiency and vaginal atrophy, as well as conditions including pelvic organ prolapse (POP) and urinary incontinence (UI), which hinder optimal bladder functionality. The aforementioned factors, in conjunction with the rising prevalence of cesarean deliveries and catheterization, complicate the management of UTIs. While precise diagnosis is paramount, it remains a formidable challenge, notwithstanding advancements in molecular diagnostic techniques. Management strategies encompass antibiotic-sparing therapies; however, the increasing incidence of multidrug resistance represents an alarming trend. Diverse guidelines from various medical specialties endeavor to standardize treatment approaches, yet significant inconsistencies continue to exist. This study systematically appraises the extant guidelines, evaluating the quality of evidence while identifying areas of agreement and discord to supply practitioners with effective strategies for UTI management.

Urologic Imaging: Infections and Inflammation

Urinary infections are common. Typically, infections of the upper and lower urinary tract do not require imaging. However, in the presence of confirmed or suspected complicated urinary tract infections, imaging to assess for underlying causes and complications is required. Computed tomography imaging is useful in identifying predisposing structural abnormalities of the urinary tracts and complications of urologic infection. Ultrasonography can be used to identify hydronephrosis and may be used to guide percutaneous intervention. Recurrent chronic infections can lead to end organ damage or chronic granulomatous processes. Rarely, systemic inflammatory disorders can involve the upper and lower urinary tracts.

In vitro antimicrobial activity of nitroxoline against uropathogens isolated from China

Background and objectives

The antimicrobial nitroxoline is used in treating uncomplicated urinary tract infections (UTIs) in some European countries. In vitro antimicrobial data on uropathogens from China are lacking. To investigate the activity of nitroxoline in vitro against uropathogens isolated from Chinese patients.

Methods

MICs of nitroxoline were determined using broth microdilution of 229 bacterial isolates of 10 species including Acinetobacter baumannii derived from urinary sample. The EUCAST susceptibility breakpoint for Escherichia coli (16 mg/L) was applied for all isolates. The MBC for A. baumannii (n = 34) was determined, with the MBC defined as the nitroxoline concentration at which a 99.9% reduction in the initial inoculum was observed. Time-kill curves of the two isolates of A. baumannii were tested over a 24 h period.

Results

Except for Pseudomonas aeruginosa, most isolates were susceptible to nitroxoline. The MIC50/90 values of nitroxoline for E. coli, Klebsiella pneumoniae and Proteus mirabilis were 4/8, 8/32 and 8/16 mg/L, respectively. Among the Gram-negative isolates, nitroxoline demonstrated a better inhibitory effect against A. baumannii with an MIC50/90 value of 2/2 mg/L. The MBC of A. baumannii was equal to the MIC or one dilution higher. The time-kill curves of A. baumannii displayed concentration-dependent killing.

Conclusions

Nitroxoline showed excellent in vitro activity against uropathogens isolated from China and may be a good option for uncomplicated UTIs caused by A. baumannii, which are more challenging and have few clinical options. Further in vivo efficacy studies are needed.

Bioactive Compounds as Alternative Approaches for Preventing Urinary Tract Infections in the Era of Antibiotic Resistance

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide. They occur in the urinary system when a microorganism, commonly present on the perineal skin or rectum, reaches the bladder through the urethra, and adheres to the luminal surface of uroepithelial cells, forming biofilms. The treatment of UTIs includes antibiotics, but their indiscriminate use has favored the development of multidrug-resistant bacteria strains, which represent a serious challenge to today's microbiology. The pathogenesis of the infection and antibiotic resistance synergistically contribute to hindering the eradication of the disease while favoring the establishment of persistent infections. The repeated requirement for antibiotic treatment and the limited therapeutic options have further contributed to the increase in antibiotic resistance and the occurrence of potential relapses by therapeutic failure. To limit antimicrobial resistance and broaden the choice of non-antibiotic preventive approaches, this review reports studies focused on the bacteriostatic/bactericidal activity, inhibition of bacterial adhesion and quorum sensing, restoration of uroepithelial integrity and immune response of molecules, vitamins, and compounds obtained from plants. To date, different supplementations are recommended by the European Association of Urology for the management of UTIs as an alternative approach to antibiotic treatment, while a variety of bioactive compounds are under investigation, mostly at the level of in vitro and preclinical studies. Although the evidence is promising, they are far from being included in the clinical practice of UTIs.

New evidence for content validity of the German version of the Acute Cystitis Symptom Score: cognitive interview study among patients and experts

PURPOSE

The Acute Cystitis Symptom Score (ACSS) is a clinically validated instrument to assess symptoms and quality of life in women with uncomplicated urinary tract infections (uUTIs). A previous study examining the content validity of the German version of the ACSS has shown some methodological limitations when rated against the criteria for content validity of the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) initiative. Extending the existing evidence, the present study aimed to assess the content validity of the German version of the ACSS according to the criteria of the COSMIN methodology.

METHODS

In individual cognitive interviews following a structured, standardized interview guide, women with a history of uUTI and experts from different medical fields rated the instructions, items, response options and recall period of the ACSS in terms of relevance, comprehensiveness and comprehensibility. Additionally, the Content Validity Index (CVI) was calculated based on expert assessments to quantify content validity.

RESULTS

A total of 14 patients and 14 experts participated in two rounds of interviews. The overall relevance and comprehensiveness of the instrument were rated as appropriate. Modifications focused on improving comprehensibility. Ten items underwent minor modifications or were given examples to enhance comprehensibility. The scales of five items were linguistically revised. Confirming good content validity, CVI was 0.97.

CONCLUSIONS

Comprehensive qualitative assessments support content validity of the ACSS for evaluating symptoms and quality of life in women with uUTIs. Minor modifications addressed comprehensibility. Psychometric validation of the revised ACSS is recommended.

Rapid Determination of Colistin Susceptibility by Flow Cytometry Directly from Positive Urine Samples-Preliminary Results

Urinary tract infections caused by Gram-negative bacteria (GNB) are among the most common infections and a significant cause of sepsis. The increasing prevalence of multidrug-resistant (MDR) bacteria poses challenges to empirical treatment. Colistin may be used a last-resort antibiotic for treating MDR infections, but this requires the rapid determination of susceptibility to colistin. Traditional susceptibility testing methods can take up to 48 h, and there are specific challenges in determining colistin susceptibility. This study evaluates a novel, rapid method for determining colistin susceptibility directly from positive urine samples using the FASTcolistin MIC kit from FASTinov®. A total of 100 urine samples positive for Gram-negative bacilli when screened by the UF-1000i system were included in this study. After a simple sample prep, the same bacterial suspension was used for identification on MALDI-TOF and inoculated in the FASTcolistin MIC panel for our AST; after incubation at 37 °C for 1 h, it was analyzed via flow cytometry using a CytoFLEX cytometer (Beckman Coulter, Brea, CA, USA). The categorical susceptibility to colistin according to EUCAST or CLSI standards as well as the MIC values were given by bioFAST software (bioFAST 2.0). The essential agreement (EA) and bias were calculated. Different species of Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp. were correctly identified by MALDI-TOF directly from the FASTcolistin MIC sample prep. The essential agreement between the two methods was 99%, with a bias of -17%. Both identification and susceptibility were obtained in less than 2 h. This study presents a rapid and accurate method for determining colistin MIC directly from urine samples. The shortness of time required to produce a result, 2 h versus 48 h with the conventional methods, will significantly impact treatment decisions, especially in urinary tract infections difficult to treat.

A Four-Year Study of Antibiotic Resistance, Prevalence and Biofilm-Forming Ability of Uropathogens Isolated from Community- and Hospital-Acquired Urinary Tract Infections in Southern Italy

The aim of this study was to investigate the differences between nosocomial and community microorganisms isolated from patients with UTI by determining their bacterial profile, antibiotic resistance and ability to produce biofilms. A retrospective study, based on bacterial isolates from consecutive urine samples collected between January 2019 and December 2023, was conducted at a university hospital. The main pathogens isolated from both community and hospital samples were the same, but their frequency of isolation differed. Compared with community-associated cases, hospital-associated infections have more isolates of Acinetobacter baumanii complex. In contrast, Proteus mirabilis isolates were more prevalent in community than in hospital infections. In both hospital and community isolates, gram-positive bacteria showed a lower overall antimicrobial resistance (22%) compared to gram-negative bacteria (30%). The data demonstrated that individual strains exhibited disparate degrees of capacity for biofilm formation. Additionally, the data indicate an inverse correlation between biofilm production and antibiotic resistance. Isolates from community patients exhibited lower capacities for biofilm production in comparison to the capacities demonstrated by microorganisms isolated from nosocomial patients (29% and 35%, respectively). Area-specific surveillance studies can provide valuable information on UTI pathogens and antimicrobial resistance patterns, which can be useful in guiding empirical treatment.

Activity impairment, work productivity, health-related quality-of-life, and costs associated with uncomplicated urinary tract infection among females in Germany

Uncomplicated urinary tract infections (uUTIs) represent a sizable healthcare burden with a substantial negative impact on patients' health-related quality-of-life (HRQoL). However, the HRQoL impact of uUTI from the patient perspective is under-represented in research. A cross-sectional online survey assessed activity impairment and work productivity, HRQoL, costs, and treatment satisfaction of female patients with uUTIs in the US; the current study applies this earlier methodology to Germany to provide a European perspective. We examined: activity impairment and work productivity using Activity Impairment Assessment (AIA), and Work Productivity and Activity Impairment (WPAI) questionnaires, respectively; HRQoL using a modified Short Form-36, and participants completed the treatment satisfaction questionnaire for medication. Participants (≥ 12 years) self-reported a uUTI treated with oral antibiotics in the last 60 days, had no evidence of complicated UTI, and were recruited via a consumer panel. In the patient (N = 200) survey, bladder pain (70%), dysuria (69%), and frequent urination (66%) were the most common uUTI symptoms reported. Activities frequently affected by uUTI were sexual activity (56%) and exercise (48%), resulting in an overall AIA score of 8.2 indicating that activities among patients were impaired 'most of the time' during their recent uUTI. Absenteeism was 29% (of a 40-hour work week); presenteeism, 34%; and overall work impairment, 41%. Indirect costs due to impact of uUTI were €7.62/hour/participant, representing a loss for the employer. The lowest HRQoL scores were for mental (44%) and physical components (43%); emotional and physical functioning scores were 71% and 70%, respectively. Mean direct costs of €20.10 for medical treatments and €11.30 for other treatment costs were reported. Overall, most participants were satisfied with the uUTI treatment (76% satisfaction score). Results demonstrate the patient-reported burden of uUTI for patients and employers, with activities and ability to work impacted, resulting in a notable indirect burden in Europe.

Facile preparation of polyethyleneimine-conjugated silver sulfide nanoparticles as near-infrared-responsive to sterilization of multidrug resistant uropathogens, and cytotoxicity activity

We present the chemical synthesis of polyethyleneimine-conjugated silver sulfide nanoparticles (PEI/AS) utilizing an economical solvothermal synthesis method, aimed at developing effective alternative antibacterial agents. The antibacterial efficacy of the synthesized materials, both with and without the application of near-infrared (NIR) laser irradiation, was evaluated in vitro against two distinct clinically relevant multi-drug-resistant (MDR) uropathogenic strains: Escherichia coli and methicillin-resistant Staphylococcus aureus. The bactericidal effects induced by NIR light indicate that the PEI/AS nanoparticles possess an efficiency that is five times greater than that of Ag2S alone. A suggested antibacterial mechanism posits that the wrapping of PEI increases electrostatic interactions, thereby facilitating the attachment of Ag2S nanoparticles to the bacterial surface. This process leads to the disruption of the outer membrane through the generation of localized heat and an increased concentration of reactive oxygen species (ROS), including superoxide anions (·O2 -) and hydroxyl radicals (·OH). In addition, the mechanism involves the regulated release of Ag+ ions when exposed to NIR light irradiation. The combined action led to an over 95.79% elimination of bacteria at a concentration as low as 50 μg mL-1, which can be primarily ascribed to the regulated photothermal effect induced by 808 nm near-infrared light irradiation, demonstrating exceptional photothermal conversion efficiency. These results paves a way for manufacturing innovation in future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-024-04168-3.

Green Synthesis of Urethane-Linked Tamarind Seed Xyloglucan: Thermal Stability, Antibacterial Properties, and DFT Study

This study presents a feasible, one-pot synthesis approach for the preparation of a composite biopolymer material derived from tamarind seed xyloglucan (XG) by utilizing isocyanate chemistry. Through a facile reaction process, urethane bonds are formed in XG, resulting in the formation of a crosslinked network. FTIR spectra confirm the successful urethane link formation in XG via the OH-NCO reaction, and CHN analysis provides insights into the elemental composition. The synthesized XG-urethane composite (U-XG) exhibits enhanced thermal stability compared to native XG, with an enhanced degradation temperature (T5%) of 276°C (XG marked T5% at a lower temperature of 163°C). The optimized geometric structure, hydrogen bond types, and hydrogen bond strength of the synthesized U-XG are computationally studied by density functional theory (DFT) at the B3LYP/6-31G(d,p) level. This study also investigates the antibacterial efficacy of both XG and U-XG against a panel of pathogenic bacteria, including gram-positive bacteria such as S. aureus and S. epidermidis, as well as gram-negative E. coli. The U-XG demonstrates superior antibacterial activity against S. epidermidis compared to pristine XG. This research showcases the feasibility of a one-pot synthesis approach for preparing urethane-linked XG with enhanced thermal properties and superior antibacterial activity, offering promising prospects for biomedical and antimicrobial applications.

Antimicrobial and antibiofilm potential of α-MSH derived cationic and hydrophobic peptides against Escherichia coli: Mechanistic insight through peptide-lipopolysaccharide interactions

The prevalence of infections caused by various Gram-negative pathogens specifically Escherichia coli continuously poses a significant challenge in health care as well as community settings owing to their ability to form biofilm and escalating tolerance towards available antibiotics. While most treatment regimes are targeted at eliminating the E. coli cells, the pathogenicity factors called endotoxin (lipopolysaccharides), associated with the sepsis initiation and the leading cause of death in intensive care units globally, are often ignored. In this study, the potency of alpha-melanocyte stimulating hormone based-peptides, particularly Ana-9 and Ana-10 against E. coli was investigated through microbiological, biophysical, and microscopic assays. Both Ana-9 and Ana-10 demonstrated enhanced activity against planktonic E. coli cells, and retained their activity against biofilm, which was supported by confocal microscopy. From the mechanistic perspective, spectroscopic studies indicated that the binding of peptides with LPS led to structural alteration of peptides due to their insertion into the hydrophobic environment of LPS. The electrostatic interaction of the peptide with LPS leads to outer membrane disorganization, allowing the peptide to access the inner membrane, depolarize it and ultimately inhibit the bacterial cells within the biofilm. These observations were further confirmed by atomic force and scanning electron microscopy. Thus, this study deepens our understanding of the structural characteristics of peptides attached to LPS, which could lead to the gradual improvement in developing more potent, broad-spectrum endotoxin neutralizers.

Trends in Escherichia coli and Klebsiella pneumoniae Urinary Tract Infections and Antibiotic Resistance over a 5-Year Period in Southeastern Gabon

Background: Urinary tract infections (UTIs) are a substantial global health concern, exacerbated by the widespread use of antibiotics and leading to the development of multidrug-resistant strains. The aim of this study was to analyze the temporal patterns of Escherichia coli and Klebsiella pneumoniae UTIs and antibiotic resistance, taking into account various sociodemographic, clinical, and climatic factors within the study population. Methods: A total of 3026 urine samples from patients of all ages were analyzed over a period of five years by standard microbiological methods. Climatic data for the study area were also collected. Univariate and multivariate logistic regression analyses were performed to measure the impact of sociodemographic, clinical and climatic parameters on the occurrence of UTIs. Results: The study showed a 31.4% prevalence of UTIs among the population. Notably, there was a significant increase in pyelonephritis between 2019 and 2023 (p < 0.01). Furthermore, a significant association was found between cystitis and the long dry season, as well as the short rainy season. Furthermore, Escherichia coli and Klebsiella pneumoniae exhibited resistance to beta-lactams, quinolones, and co-trimoxazole. The resistance of Escherichia coli isolated from cystitis to nitrofurantoin showed a significant increase over the years (p < 0.04). Principal component analysis (PCA) suggested that humidity may play a role in the emergence of multidrug-resistant strains of Escherichia coli and Klebsiella pneumoniae. Conclusions: UTIs show variability according to various sociodemographic, clinical, and climatic factors, with a higher risk of complications seen in individuals aged ≤ 17 years. It is important to note that cases of pyelonephritis have been increasing over time, with a noticeable seasonal variation. This study suggests that humidity may play a role in promoting antibiotic multidrug resistance in Escherichia coli and Klebsiella pneumoniae.

Biogenic synthesized CuO nanoparticles and 5-fluorouracil loaded anticancer gel for HeLa cervical cancer cells

Cervical cancer remains a significant health challenge in developing countries are high due to low HPV vaccination rates, delayed diagnosis, and restricted healthcare access. Metal nanomaterials, such as copper oxide (CuO) nanoparticles (NPs), have shown significant promise in cancer therapy due to their ability to induce apoptosis. 5-Fluorouracil (5-Fu) enhances the cytotoxic effect against cervical cancer, working synergistically with CuO NPs to maximize the therapeutic impact while potentially reducing the 5-Fu's systemic side effects. This study explores the synergistic therapeutic potential of green-synthesized CuO NPs combined with 5-Fu in a gel formulation for targeted anticancer activity against HeLa cervical cancer cells. CuO NPs were synthesized using Trichosanthes dioica dried seeds extract and incorporated into a pectin-xanthan gum-based gel. The green-synthesized CuO NPs exhibited a zeta potential of -23.7 mV, a particle size of approximately 26 nm, and spherical morphology. Characterization studies, including FTIR, viscosity, spreadability, pH, and stability assessments, confirmed the gel's suitability for vaginal delivery. In-vitro drug release showed xanthan gum extended the release up to 8 h. The MTT assay revealed PXFCu6 gel's IC50 at 11.82 ± 0.22 μg/mL, significantly more cytotoxic to HeLa cells, being 3.62 times potent than CuO NPs (IC50: 42.8 ± 0.24 μg/mL) and 1.63 times potent than 5-Fu alone (IC50: 19.3 ± 0.49 μg/mL). The antibacterial assay showed no inhibition for the plain gel, but T. dioica-mediated CuO NPs exhibited inhibition of 22.35 ± 4.9 mm. PXFCu6 gel had the more potent inhibition at 52.05 ± 1.37 mm against Escherichia coli growth. The PXFCu6 gel showed better stability at 4 °C, maintaining viscosity, pH, and drug release, unlike 25 °C where a mild degradation occurred. This research highlights the potential of the CuO NPs-5-Fu gel as a novel, effective therapeutic strategy for cervical cancer treatment.

Urinary Cytology: The DxU-850 Iris automaton versus Microscopic Examination

INTRODUCTION

The use of urine cytobacteriological examination is a common and essential practice in medicine which helps guide therapeutic management in case of urinary tract infection. The cytological examination of urine samples can be done using the manual (microscopic) or automated technique. The automated approach, which involves the use of artificial intelligence, is faster, more reliable, and more efficient for laboratories.

AIM

This work aims to evaluate the performance of the DxU-850 Iris automate by comparing it to the microscopic method.

METHODS

Using a four-month prospective study from May to August 2023, we analyzed urine samples received during this period by the Microbiology laboratory of Mohammed VI University Hospital in Oujda. Strict quality standards were respected when obtaining the results. Several elements were analyzed, and various parameters calculated to evaluate the performance of this automaton.

RESULTS

The present study investigated 1000 CBEU samples, mainly from outpatient clinics (46.34%) and emergency departments (21.72%). Most patients were males (50.58%) and asymptomatic (72.9%). The samples' culture showed varied results: concordance between the results of automaton and microscopic count was satisfactory except for crystals and yeasts in turbid samples.

CONCLUSION

Automation has advantages like speed, traceability, error reduction, and time optimization. The results reveal a satisfactory concordance between the two methods despite discordances occurring mainly with crystals and yeasts, especially in turbid urine samples. The DxU-850 Iris automaton is an effective way to screen for urinary tract infections. We recommend that automated and manual techniques be considered complementary.

Imidazolium, pyridinium and pyrazinium based ionic liquids with octyl side chains as potential antibacterial agents against multidrug resistant uropathogenic E. coli

Urinary tract infections (UTIs) are the second most prevalent infectious disease with E. coli being the most common etiological agent behind these infections, affecting more than 150 million people globally each year. In recent decades, the emergence of multi-drug resistant (MDR) pathogens has rapidly escalated. To combat antimicrobial resistance (AMR), it is important to synthesize new biologically effective alternatives like ionic liquids (ILs) to control the bacterial infection and their spread. Ionic liquids are poorly coordinated organic salts characterized by melting points typically below 100 °C. The ability of ILs to form anionic and cationic interactions contributes to their versatile chemical, physical and biological attributes. In the present study, a total of 9 previously chemically synthesized and characterized ILs were used. For exploration of their antibacterial potential against the urinary tract infections (UTIs) caused by MDR Uropathogenic E. coli (UPEC) strains, in vitro and in vivo evaluation of ILs were performed. ILs showed pronounced zone of inhibition (ZOI), minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of 29.5 mm, 3.81 μM and 5.08 μM by agar disk diffusion and broth micro-dilution methods, respectively. Scanning electron microscopy results depicted substantial morphological changes in UPEC biofilm formation ascertaining antibiofilm potential of tested ILs. Moreover, ILs showed exceptional antioxidant potential depicted by DPPH assay along with low cytotoxic effect toward mammalian cell lines (NB4), red blood cells and whole blood. Furthermore, the gene expression analysis results justified the antibacterial potential of ILs showing down-regulation of fimH, uvrY and up-regulation of csrA gene in UPEC after ILs treatment. In vivo dermal sensitivity assessment also established their non-cytotoxic behavior. In silico analysis validated these results, with the majority of the compounds exhibiting moderate to good absorption.Due to remarkable antibacterial and antioxidant potential and negligible cytoxicity, it could be inferred that ILs could serve as novel antimicrobial alternative agents in the treatment of UTIs.

Prevalence and antibiotic resistance profile of UTI-causing uropathogenic bacteria in diabetics and non-diabetics at the Maternity and Children Hospital in Jeddah, Saudi Arabia

Introduction

One of the most prevalent and recurrent infectious diseases that can range from moderate to fatal is urinary tract infection (UTI). Broad-spectrum antibiotics are the only management strategy for UTIs in ambulators and hospital stays. Due to the ongoing emergence of antibiotic resistance among uropathogens, there is a need for proper selection of antibiotics for empirical therapy against UTIs. This study aimed to compare the etiological profiles and antibiotic susceptibility patterns between diabetic and non-diabetic UTI female patients from the Maternity and Children Hospital in Jeddah, Saudi Arabia.

Methods

Urine samples from different age categories of female UTI patients were collected from January 2021 to June 2023. The positive urine cultures with a single pathogen were selected and all bacterial isolates were identified by MALDI-TOF/MS system. Antibiotic susceptibility testing was done using VITEK-2. Our study included 2,245 female patients, of which 1825 (81%) were non-diabetic and 420 (19%) were diabetic.

Results

The results showed a significant relationship (p = 0.00063) between the average age and the number of diabetic UTI patients. Gram-negative bacilli were more dominant (84.7%, n = 1903) than gram-positive cocci (15.3%, n = 342). Escherichia coli (40.8%) was the most prevalent pathogen identified with a significant (p < 0.0001) increase in non-diabetic (45.26%) than diabetic UTI patients (21.43%). Proteus mirabilis (10.2%) and Pseudomonas aeruginosa (8.7%) followed E. coli in pathogen distribution. Among gram-positive species, Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus saprophyticus were found in all age groups of diabetic and non-diabetic UTI patients. The findings showed that the most resistant bacteria from patients with non-diabetic UTIs were found to be resistant to amoxicillin (37.7%) and ampicillin (40%), while the most resistant bacteria from patients with diabetes were found to be resistant to tetracycline (43.3%) and cephalothin (43.5%). In patients with UTIs, ciprofloxacin was found to be the most effective antibiotic against all bacterial species.

Discussion

According to the results, we concluded that the UTI etiological profiles varied among different ages. Ciprofloxacin is a safe medication with optimal sensitivity that can be used to treat both gram-positive and gram-negative bacteria.

Gut Microbiome Implication and Modulation in the Management of Recurrent Urinary Tract Infection

Urinary tract infections (UTIs) are one of the most common bacterial infections, affecting more than 150 million people each year in the world. UTIs have grown exponentially in the last few years. They represent a major load for both individuals and society. The highest incidence (about 55-60%) concerns women. Many pathogens are involved in UTIs, most of which are derived from the gut. Recent studies, together with recent diagnostic techniques (such as quantitative culture of urine or next-generation sequencing), have improved the knowledge of microbial communities in the urinary tract. It turned out that gut dysbiosis is strictly involved in the pathogenesis of UTIs. In particular, the human gut is the natural habitat for Escherichia coli (E. coli), the main bacterium responsible for UTIs. The overgrowth of E. coli pathogenic strains represents a risk factor for them. Furthermore, the human gut microbiota acts as a "global reservoir" for genes conferring resistance to clinically relevant antibiotics, thus influencing the treatment of UTIs. In addition, differently from the past, the idea of a sterile urinary environment has been replaced by the characterization of a urinary microbiome. The aim of our review is to explore recent studies on the association between gut microbiota and urinary microbiome and to summarize the current knowledge about the effects of interactions between gut and urinary microbial communities in the pathogenesis of UTIs, considering UTIs more as a "gut disease" and not only a urinary disease and providing new insight into the therapeutic options such as the use of probiotics.

New Antimicrobial Materials Based on Plasticized Polyvinyl Chloride for Urinary Catheters: Preparation and Testing

Given the constant increased number of nosocomial infections in hospitals, especially associated with prolonged usage of inserted medical devices, our work aims to ameliorate clinical experience and promote faster healing of patients undergoing urinary catheterization by improving the properties of medical devices materials. Within this research, nine different composites were prepared based on polyvinyl chloride, using three different plasticizers (di-(2-ethylhexyl) phthalate, Proviplast 2646, and Proviplast 2755), and two different antimicrobial additives containing silver nanoparticles. The prepared materials were analyzed, and their physicochemical properties were determined: water absorption, relative density, plasticizer migration, hydrophobicity/hydrophilicity by contact angle measurement, Shore A hardness, tensile strength, and elongation at break. Structure and morphology were also investigated by means of FTIR, SEM, and EDX analyses, and thermal (TG-DSC) and biological properties were evaluated. The most important aspects of obtained results are showing that plasticizer migration was significantly reduced (to almost zero) and that the usage of antimicrobial additives improved the materials' biocompatibility. Thus, based on the concluded favorable properties, the obtained materials can be further used for catheter development. Pressure-flow studies for different sizes and configurations are the next steps toward advanced in vivo and clinical trials.

Challenges of infectious diseases in older adults: From immunosenescence and inflammaging through antibiotic resistance to management strategies

Infectious diseases in older adults present a significant challenge to the healthcare system, marked by increased morbidity, mortality, and rising costs of care. Age-related changes (ARCs) in the immune system, including immunosenescence and inflammaging, contribute to heightened susceptibility to severe infections and reduced vaccine responsiveness. Additionally, alterations in the normal microbial flora due to aging and factors such as antibiotic therapy predispose older individuals to infections and age-related diseases. Changes in body composition also affect the pharmacokinetics and pharmacodynamics of drugs, complicating the management of antibiotics and leading to potential overdoses, adverse drug reactions, or underdoses that foster antibiotic resistance. The inappropriate use of antibiotics has exacerbated the emergence of multidrug-resistant pathogens, posing a critical global concern. This narrative review provides an overview of immunosenescence and inflammaging and focuses on three major infectious diseases affecting older adults: bacterial pneumonia, urinary tract infections, and Clostridium difficile infections. Through this exploration, we aim to highlight the need for targeted approaches in managing infectious diseases in the aging population.

Beneficial Effects Induced by a Proprietary Blend of a New Bromelain-Based Polyenzymatic Complex Plus N-Acetylcysteine in Urinary Tract Infections: Results from In Vitro and Ex Vivo Studies

Background/Objectives: Urinary tract infections (UTIs) are infections that involve the urethra, bladder, and, in much more severe cases, even kidneys. These infections represent one of the most common diseases worldwide. Various pathogens are responsible for this condition, the most common being Escherichia coli (E. coli). Bromelain is a proteolytic complex obtained from the stem and stalk of Ananas comosus (L.) Merr. showing several beneficial activities. In addition to bromelain, N-acetylcysteine (NAC) has also been used. Methods: The purpose of this experiment was to evaluate the antibacterial, anti-motility, and anti-biofilm effects of a new polyenzymatic complex (DIF17BRO®) in combination with NAC (the Formulation) on various strains of E. coli isolated from patients with UTIs. Subsequently, the anti-inflammatory and antioxidant effects of the Formulation were studied in an ex vivo model of cystitis, using bladder samples from mice exposed to E. coli lipopolysaccharide (LPS). Results: Our results showed that the Formulation significantly affects the capability of bacteria to form biofilm and reduces the bacteria amount in the mature biofilm. Moreover, it combines the interesting properties of NAC and a polyenzyme plant complex based on bromelain in a right dose to affect the E. coli adhesion capability. Finally, the Formulation exhibited protective effects, as confirmed by the inhibitory activities on multiple inflammatory and oxidative stress-related pathways on bladder specimens exposed to LPS. Conclusions: This blend of active compounds could represent a promising and versatile approach to use to overcome the limitations associated with conventional therapies.

Schistosomiasis-Microbiota Interactions: A Systematic Review and Meta-Analysis

INTRODUCTION

Schistosomiasis, a tropical disease affecting humans and animals, affected 251.4 million people in 2021. Schistosoma mansoni, S. haematobium, S. intercalatum, and S. japonicum are primary human schistosomes, causing tissue damage, granulomas, ulceration, hemorrhage, and opportunistic pathogen entry. The gut and urinary tract microbiota significantly impact a host's susceptibility to schistosomiasis, disrupting microbial balance; however, this relationship is not well understood. This systematic review and meta-analysis explores the intricate relationship between schistosomiasis and the host's microbiota, providing crucial insights into disease pathogenesis and management.

METHODS

This systematic review used PRISMA guidelines to identify peer-reviewed articles on schistosomiasis and its interactions with the host microbiome, using multiple databases and Google Scholar, providing a robust dataset for analysis. The study utilized Meta-Mar v3.5.1; descriptive tests, random-effects models, and subgroups were analyzed for the interaction between Schistosomiasis and the microbiome. Forest plots, Cochran's Q test, and Higgins' inconsistency statistic (I2) were used to assess heterogeneity.

RESULTS

The human Schistosoma species were observed to be associated with various bacterial species isolated from blood, stool, urine, sputum, skin, and vaginal or cervical samples. A meta-analysis of the interaction between schistosomiasis and the host microbiome, based on 31 studies, showed 29,784 observations and 5871 events. The pooled estimates indicated a significant association between schistosomiasis and changes in the microbiome of infected individuals. There was considerable heterogeneity with variance effect sizes (p < 0.0001). Subgroup analysis of Schistosoma species demonstrated that S. haematobium was the most significant contributor to the overall heterogeneity, accounting for 62.1% (p < 0.01). S. mansoni contributed 13.0% (p = 0.02), and the coinfection of S. haematobium and S. mansoni accounted for 16.8% of the heterogeneity (p < 0.01), contributing to the variability seen in the pooled analysis. Similarly, praziquantel treatment (RR = 1.68, 95% CI: 1.07-2.64) showed high heterogeneity (Chi2 = 71.42, df = 11, p < 0.01) and also indicated that Schistosoma infections in males (RR = 1.46, 95% CI: 0.00 to 551.30) and females (RR = 2.09, 95% CI: 0.24 to 18.31) have a higher risk of altering the host microbiome.

CONCLUSIONS

Schistosomiasis significantly disrupts the host microbiota across various bodily sites, leading to increased susceptibility to different bacterial taxa such as E. coli, Klebsiella, Proteus, Pseudomonas, Salmonella, Staphylococcus, Streptococcus, and Mycobacterium species (M. tuberculosis and M. leprae). This disruption enables these bacteria to produce toxic metabolites, which in turn cause inflammation and facilitate the progression of disease. The impact of schistosomiasis on the vaginal microbiome underscores the necessity for gender-specific approaches to treatment and prevention. Effective management of female genital schistosomiasis (FGS) requires addressing both the parasitic infection and the resulting microbiome imbalances. Additionally, praziquantel-treated individuals have different microbiome compositions compared to individuals with no praziquantel treatment. This suggests that combining praziquantel treatment with probiotics could potentially decrease the disease severity caused by an altered microbiome.

Characterization and genomic analysis phage PmP19, a novel Proteus mirabilis phage with a broad host range

A lytic Proteus mirabilis phage, PmP19, was isolated from sewage on a farm. PmP19 has an icosahedral head (60 ± 3 nm in diameter) and a short tail (15 ± 2 nm long). Its genome, a linear, double-stranded DNA molecule 44,305 bp in length with an average GC content of 51.93%, has 52 putative open reading frames (ORFs). BLASTn comparisons and phylogenetic analysis revealed a close relationship between Pmp19 and Klebsiella phage vB_KpnP_ZK1. Bioinformatic analysis revealed that PmP19 belongs to the phage subfamily Molineuxvirinae.

Antimicrobial Potential of Probiotic Strains From Bulgarian Cheese and Shallot Yogurt Against Staphylococcus saprophyticus

The escalating incidence of hospital infections due to antibiotic resistance necessitates the identification of alternative therapeutic agents such as probiotics. This study was designed to isolate and evaluate the efficacy of probiotics against Staphylococcus saprophyticus, a prevalent etiological agent of urinary tract infections (UTIs). A total of 100 S. saprophyticus strains were isolated from clinical samples and subjected to antibiotic susceptibility testing via the disc diffusion method. Concurrently, probiotic bacteria were isolated from Bulgarian cheese and shallot yogurt, and their antibacterial activity against S. saprophyticus strains was assessed. The inhibitory potential of probiotic supernatants was evaluated using microtiter plate assays, with the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) determined at a 1/2 dilution. Cytotoxicity was evaluated using the MTT assay, and high-performance liquid chromatography (HPLC) was employed to analyze the concentrations of organic acids produced by the probiotics. The results revealed that all S. saprophyticus strains were resistant to tetracycline and doxycycline but susceptible to other antibiotics. Lactobacillus rhamnosus strains M and B demonstrated notable antibacterial and antibiofilm activity against S. saprophyticus isolates. These probiotics exhibited susceptibility to most antibiotics and lacked virulence factors, suggesting their safety for therapeutic use. The organic acids produced by the probiotics were identified as lactic acid, acetic acid, and formic acid. In conclusion, L. rhamnosus strains M and B exhibit potent antimicrobial properties against S. saprophyticus, indicating their potential as therapeutic agents for UTIs. Further research is warranted to validate these findings and explore the possibility of these probiotics in clinical applications.

An Investigation Into Carbapenem Resistance in Enterobacteriaceae Among Outpatients With Urinary Tract Infection in Southwestern Uganda

Background and aim Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, primarily caused by Enterobacteriaceae. The rise of carbapenem-resistant Enterobacteriaceae (CRE), complicates treatment of UTIs, yet the distribution of CRE and carbapenemase genes in Uganda's hospitals is not sufficiently explored. This study aimed to examine the distribution of carbapenemase genes in Enterobacteriaceae isolated from urinary tract infections in outpatients in southwestern Uganda. Methods A cross-sectional hospital-based study was conducted in southwestern Uganda. The study involved 111 participants who tested positive for carbapenemase genes. These participants were selected from a total of 2,371 patients presenting with urinary tract infections (UTIs) at Bwizibwera Health Center IV and Rubaya Health Center III. Enterobacteriaceaewere identified using a series of biochemical tests, and the presence of carbapenemase resistance genes (blaVIM, blaOXA-48, blaNDM, blaKPC, and blaIMP) was confirmed through polymerase chain reaction (PCR) genotyping. Data were analyzed and presented as frequencies and proportions, displayed in tables and charts. Results We screened a total of 2,371 participants with symptoms of urinary tract infections (UTI) for Enterobacteriaceae, 455 (19.2%) tested positive for at least one of the Enterobacteriaceae species. Disk susceptibility testing (DST) for carbapenems (meropenem and ertapenem) revealed a phenotypic carbapenem resistance prevalence of 5.7% (26/455), while polymerase chain reaction (PCR) identified a genotypic prevalence of 24.4% (111/455). Klebsiella spp. was the most common carbapenemase gene carrier (60/111, 54.1%), with blaIMP being the most frequent gene detected (32.4%). PCR detected more carbapenemase-producing organisms compared to DST. Notably, 14.4% of the isolates harbored multiple carbapenem resistance genes, with one sample carrying four different genes. Conclusion Our study revealed a high genotypic prevalence of CRE, especially in Klebsiella spp. and Escherichia spp. isolates with a low phenotypic expression. This suggests that relying solely on DST could miss resistant strains, emphasizing the importance of molecular diagnostics like PCR for accurate detection. Carbapenemase inhibitors should be prescribed alongside carbapenem drugs where CREs are suspected, combined with continued surveillance to help manage CRE and reduce their spread in resource-limited settings.

Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management

Urinary tract infections (UTIs) are the second most common infectious disease, predominantly impacting women with 150 million individuals affected globally. It increases the socio-economic burden of society and is mainly caused by Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter spp., and Staphylococcus spp. The severity of the infection correlates with the host factors varying from acute to chronic infections. Even with a high incidence rate, the diagnosis is mainly based on the symptoms, dipstick analysis, and culture analysis, which are time-consuming, labour-intensive, and lacking sensitivity and specificity. During this period, medical professionals prescribe empirical antibiotics, which may increase the antimicrobial resistance rate. Timely and precise UTI diagnosis is essential for addressing antibiotic resistance and improving overall quality of life. In response to these challenges, new techniques are emerging. The review provides a comprehensive overview of the global burden of UTIs, associated risk factors, implicated organisms, traditional and innovative diagnostic methods, and approaches to UTI treatment and prevention.

Qualitative Profiling, Antioxidant and Antimicrobial Activities of Polar and Nonpolar Basil Extracts

Basil (Ocimum basilicum L.) is a widely used culinary herb. In this study, ethanol, dichloromethane, and sunflower oil were used separately as solvents with distinct polarities for the extraction of basil aerial parts to simulate the different polarity conditions in domestic food processing. The oil extract (OE) was re-extracted with acetonitrile, and the chemical composition, antioxidant potential, and antimicrobial activities of the ethanol (EE), dichloromethane (DCME), and acetonitrile (ACNE) extracts were determined. A total of 109 compounds were tentatively identified in EE, DCME, and ACNE by HPLC-DAD/ESI-ToF-MS. Fatty acids were present in all extracts. Phenolic acids and flavonoids dominated in EE. DCME was characterised by triterpenoid acids, while diterpenoids were mainly found in ACNE. The extracts were analysed for their antioxidant capacity using the 2,2-diphenyl-1-picrylhydrazyl radical (DPPH) assay. EE and DCME showed significant radical scavenging potential. Antimicrobial activity was explored in eight bacterial, two yeast, and one fungal species. All extracts exhibited high antifungal activity, comparable to or better than that of the commercial drug nistatin. Antibacterial activities were notable for EE and ACNE, while DCME showed no activity against bacteria in the applied concentration ranges. The different polarities of the solvents led to distinctive phytochemical compositions and bioactivities in the extracts.

Enterococcal-host interactions in the gastrointestinal tract and beyond

The gastrointestinal tract (GIT) is typically considered the natural niche of enterococci. However, these bacteria also inhabit extraintestinal tissues, where they can disrupt organ physiology and cause life-threatening infections. Here, we discuss how enterococci, primarily Enterococcus faecalis, interact with the intestine and other host anatomical locations such as the oral cavity, heart, liver, kidney, and vaginal tract. The metabolic flexibility of these bacteria allows them to quickly adapt to new environments, promoting their persistence in diverse tissues. In transitioning from commensals to pathogens, enterococci must overcome harsh conditions such as nutrient competition, exposure to antimicrobials, and immune pressure. Therefore, enterococci have evolved multiple mechanisms to adhere, colonize, persist, and endure these challenges in the host. This review provides a comprehensive overview of how enterococci interact with diverse host cells and tissues across multiple organ systems, highlighting the key molecular pathways that mediate enterococcal adaptation, persistence, and pathogenic behavior.

Innovative Biosensor Technologies in the Diagnosis of Urinary Tract Infections: A Comprehensive Literature Review

Urinary tract infections (UTIs) are prevalent bacterial infections globally, posing significant challenges due to their frequency, recurrence, and antibiotic resistance. This review delves into the advancements in UTI diagnostics over the past decade, particularly focusing on the development of biosensor technologies. The emergence of biosensors, including microfluidic, optical, electrochemical, immunosensors, and nanotechnology-based sensors, offers enhanced diagnostic accuracy, reduced healthcare costs. Despite these advancements, challenges such as technical limitations, the need for cross-population validation, and economic barriers for widespread implementation persist. The integration of artificial intelligence and smart devices in UTI diagnostics, highlighting the innovative approaches and their implications for patient care. The article envisions a future where multidisciplinary research and innovation overcome current obstacles, fully leveraging the potential of biosensor technologies to transform biosensor-based UTIs diagnosis. The ultimate goal is to achieve rapid, accurate, and non-invasive diagnostics, making healthcare more accessible and effective.

LC-SRM Combined With Machine Learning Enables Fast Identification and Quantification of Bacterial Pathogens in Urinary Tract Infections

Urinary tract infections (UTIs) are a worldwide health problem. Fast and accurate detection of bacterial infection is essential to provide appropriate antibiotherapy to patients and to avoid the emergence of drug-resistant pathogens. While the gold standard requires 24 h to 48 h of bacteria culture prior to MALDI-TOF species identification, we propose a culture-free workflow, enabling bacterial identification and quantification in less than 4 h using 1 ml of urine. After rapid and automatable sample preparation, a signature of 82 bacterial peptides, defined by machine learning, was monitored in LC-MS, to distinguish the 15 species causing 84% of the UTIs. The combination of the sensitivity of the SRM mode on a triple quadrupole TSQ Altis instrument and the robustness of capillary flow enabled us to analyze up to 75 samples per day, with 99.2% accuracy on bacterial inoculations of healthy urines. We have also shown our method can be used to quantify the spread of the infection, from 8 × 104 to 3 × 107 CFU/ml. Finally, the workflow was validated on 45 inoculated urines and on 84 UTI-positive urine from patients, with respectively 93.3% and 87.1% of agreement with the culture-MALDI procedure at a level above 1 × 105 CFU/ml corresponding to an infection requiring antibiotherapy.

Unveiling Potential Biomarkers for Urinary Tract Infection: An Integrated Bioinformatics Approach

Background

Urinary tract infections (UTIs) are a widespread health concern with high recurrence rates and substantial economic impact, and they can increase the prevalence of antibiotic resistance. This study employed an integrated bioinformatics approach to identify key genes associated with UTI development, offering potential targets for interventions.

Materials and Methods

For this study, the microarray dataset GSE124917 from the Gene Expression Omnibus (GEO) database was selected and reanalyzed. The differentially expressed genes (DEGs) between UTIs and healthy samples were identified using the LIMMA package in R software. In this section, Enrichr database was utilized to perform functional enrichment analysis of DEGs. Subsequently, the protein-protein interaction (PPI) network of the DEGs was constructed and visualized through Cytoscape, utilizing the STRING online database. The identification of hub genes was performed using Cytoscape's cytoHubba plug-in employing various methods. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic accuracy of hub genes.

Results

Among the outcomes of the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, the tumor necrosis factor (TNF) signaling pathway was identified as one of the notable pathways. The PPI network of the DEGs was successfully established and visualized in Cytoscape with the aid of the STRING online database. Using cytoHubba with different methods, we identified seven hub genes (STAT1, IL6, IFIT1, IFIT3, IFIH1, MX1, and IRF7). Based on the ROC analysis, all hub genes showed high diagnostic value.

Conclusion

These findings provide a valuable baseline for future research aimed at unraveling the intricate molecular mechanisms behind UTI.

Bacterial Resistances and Sensibilities in a Tertiary Care Hospital in Romania-A Retrospective Analysis

The increase in bacterial resistance is currently a global burden for the health care system. In order to evaluate the resistance rates of several bacteria from the most encountered cultures in clinical practice, we performed a retrospective analysis of all of the positive cultures from the year 2021 in a tertiary care hospital in Romania. Our analysis captured 3299 positive cultures. The median age of the patients was 62 years (IQR: 41-71 years old) with a slight predominance among females (53.1%). Overall, the most common cultures were urocultures, wound secretion cultures and blood cultures, and the most common identified bacteria were Escherichia coli, Staphylococcus aureus and Klebsiella spp. Positive cultures with the highest resistance rates were found in the bronchial aspirate cultures, catheter tip cultures, urocultures and blood cultures. Escherichia coli (n = 996) had the highest resistance to ampicillin (19.8%) and trimetoprim-sulfametoxazole (16.4%), while Staphylococcus aureus (n = 698) presented the highest resistance rates to clindamycin (27.4%) and oxaciline (19.7%). Klebsiella (n = 481) presented the highest resistance rates to piperaciline-tazobactam (25.2%) and ampicillin (20.4%), whereas Acinetobacter baumanii (n = 123) presented a resistance rate of more than 50% to carbapenems, gentamicin, ciprofloxacin and ceftazidime. The aim of our study was to identify bacterial resistance rates in order to provide updated clinical data to guide physicians in choosing the best empirical antibiotic treatment, especially in the west part of Romania.

Dissemination of Urinary Escherichia coli Phylogroup B2 in Provincial and Community Hospitals in Uthai Thani, Central Thailand

Escherichia coli is a Gram-negative bacterium that causes a variety of clinical infections in humans, including diarrhea, sepsis, and urinary tract infection. This bacterium is a common multidrug-resistant threat in community and hospital settings worldwide. This study examined the antimicrobial susceptibility and genetic relationship based on Clermont phylotyping and enterobacterial repetitive intergenic consensus (ERIC)-PCR of 84 E. coli urinary isolates from provincial and community hospitals in Thailand. All isolates were susceptible to nitrofurantoin, and almost all isolates were susceptible to carbapenem, fosfomycin, and amikacin. High resistance rates to fluoroquinolone, ampicillin, and trimethoprim/sulfamethoxazole were observed. Clermont phylogroup B2 was predominant (n = 58). Subtyping of the B2 phylogroup revealed diverse subgroups, of which subgroup V (n = 11), VII (n = 9), III (n = 6), and II (n = 6) were most prevalent. ERIC-PCR showed that the strains of the B2 subgroups III and V were spread between provincial and community hospitals and between hospital wards. This evidence suggests the need for comprehensive infection control monitoring, with strong active surveillance at all hospital levels.

Enhancing Pathogen Detection in Implant-Related Infections through Chemical Antibiofilm Strategies: A Comprehensive Review

Implant-related infections (IRIs) represent a significant challenge to modern surgery. The occurrence of these infections is due to the ability of pathogens to aggregate and form biofilms, which presents a challenge to both the diagnosis and subsequent treatment of the infection. Biofilms provide pathogens with protection from the host immune response and antibiotics, making detection difficult and complicating both single-stage and two-stage revision procedures. This narrative review examines advanced chemical antibiofilm techniques with the aim of improving the detection and identification of pathogens in IRIs. The articles included in this review were selected from databases such as PubMed, Scopus, MDPI and SpringerLink, which focus on recent studies evaluating the efficacy and enhanced accuracy of microbiological sampling and culture following the use of chemical antibiofilm. Although promising results have been achieved with the successful application of some antibiofilm chemical pre-treatment methods, mainly in orthopedics and in cardiovascular surgery, further research is required to optimize and expand their routine use in the clinical setting. This is necessary to ensure their safety, efficacy and integration into diagnostic protocols. Future studies should focus on standardizing these techniques and evaluating their effectiveness in large-scale clinical trials. This review emphasizes the importance of interdisciplinary collaboration in developing reliable diagnostic tools and highlights the need for innovative approaches to improve outcomes for patients undergoing both single-stage and two-stage revision surgery for implant-related infections.

A Comparison of Outcomes from Antibiotic Treatment with and without Probiotics in 897 Patients with Lower Urogenital Tract Infections, Including Cystitis, Urethritis, Prostatitis, and Vulvovaginitis

BACKGROUND Urogenital bacterial infections have a high incidence in humans. The most frequent cause of infections of the urogenital tract is gram-negative bacteria. Antibiotics are very effective in curing infectious diseases but they are accompanied by health complications. Probiotics are live microorganisms that are believed to confer a beneficial effect on human health when consumed in adequate amounts. This study aimed to compare outcomes from antibiotic treatment with and without the use of probiotics in 897 patients with lower urogenital tract infections, including cystitis, urethritis, prostatitis, and vulvovaginitis. MATERIAL AND METHODS A total of 897 patients aged 18 to 55 years were included in this research. Patients were divided into an intervention group including 460 patients (254 women, 206 men) and a comparison group including 437 patients (240 women, 197 men). The probiotics received by patients were capsules of ProBalans®. The diagnosis of cystitis, urethritis, prostatitis, vulvovaginitis, and sexually transmitted infection was done using several tests, and antibiotics were used for treatment. Qualitative data were analyzed using the chi-square or Fisher exact test. RESULTS We found a significant difference regarding patients' impressions of improvement after therapy between patients in the intervention group and the comparison group. CONCLUSIONS Use of probiotics together with antibiotics in the treatment of urogenital tract infection can help to reduce the adverse effects of antibiotics, increase the efficiency of antibiotic therapy, and reduce bacterial resistance to antibiotics. However, further research is needed to confirm these potential health benefits.

Does Phage Therapy Need a Pan-Phage?

The emergence of multidrug-resistant bacteria is undoubtedly one of the most serious global health threats. One response to this threat that has been gaining momentum over the past decade is 'phage therapy'. According to this, lytic bacteriophages are used for the treatment of bacterial infections, either alone or in combination with antimicrobial agents. However, to ensure the efficacy and broad applicability of phage therapy, several challenges must be overcome. These challenges encompass the development of methods and strategies for the host range manipulation and bypass of the resistance mechanisms developed by pathogenic bacteria, as has been the case since the advent of antibiotics. As our knowledge and understanding of the interactions between phages and their hosts evolves, the key issue is to define the host range for each application. In this article, we discuss the factors that affect host range and how this determines the classification of phages into different categories of action. For each host range group, recent representative examples are provided, together with suggestions on how the different groups can be used to combat certain types of bacterial infections. The available methodologies for host range expansion, either through sequential adaptation to a new pathogen or through genetic engineering techniques, are also reviewed.

The Impact of Polymerase Chain Reaction Urine Testing on Clinical Decision-Making in the Management of Complex Urinary Tract Infections

While urinary polymerase chain reaction (PCR) testing is effective in organism identification in patients with complex urinary tract infections (cUTI), limited data exists on the clinical usefulness of this test. We serially surveyed physicians treating symptomatic patients with cUTI both at presentation and after PCR, and urine culture (UC) results were available to ascertain how the test results modified the therapy. A total of 96 unique surveys completed by 21 providers were included in the data analysis. The mean age for female and male patients was 69.4 ± 15.5 and 71.6 ± 12.7 years, respectively. The test positivity and line-item concordance for UC and PCR were consistent with prior reports. The PCR results modified or confirmed treatment in 59/96 (61.5%) and 25/96 (26.0%) of the cases, respectively, with 12/29 (41.4%) and 47/67 (70.1%) having negative and positive PCR results, respectively, resulting in treatment change (difference 28.7%, p < 0.01). Of these, 55/59 (57.3%) were alterations in the antibiotic regimen. PCR use to modify treatment was similar across providers and not statistically different when stratified by patient age, gender, or prior empiric therapy. In 31/59 (52.5%) of the cases, the PCR results modified the treatment where UC would not; conversely, UC would have modified the treatment in 3/37 (8.1%) of the cases where PCR did not (difference 44.4%, p < 0.01). We find that PCR test results are used by clinicians in managing cUTI, and use of this test provides an opportunity to improve antibiotic stewardship in this difficult-to-treat subset of patients.

Molecular Characterization of High and Low Virulent Escherichia coli Clinical Strains Isolated from Patients with Urinary Tract Infections with or without Bacteremia in Southern Taiwan

Objective

The most common extraintestinal pathogen and infection site is uropathogenic Escherichia coli (UPEC), which causes urinary tract infections (UTIs). UPEC is also a common pathogen in bloodstream infections; in severe cases, it can lead to death. Although host and bacterial virulence factors have been demonstrated to be associated with UTI pathogenesis, the role of the related contributing factors in UTI and urinary source bacteremia is not yet fully understood. This study aimed to compare and analyze the factors contributing to urinary bacteremia in patients with UTI.

Methods

A total of 171 E. coli strains collected from patients with UTI and urinary source bacteremia at Chiayi Christian Hospital were used. Phylogenetic groups and virulence factors were determined using PCR. Drug resistance patterns were determined using the disk diffusion assay.

Results

Previous studies have demonstrated that fimbriae and papGII may be associated with first-step infections and severe UTIs, respectively. As expected, highly virulent E. coli strains (belonging to the phylogenetic B2 and D groups) were dominant in the bacteremic UTI (90%) and UTI (86.27%) groups. However, our results showed that the UTI group had a significantly higher prevalence of sfa/focDE (belonging to the S and FIC fimbriae) than the bacteremic UTI group (29.4% vs 12.5%; p=0.008). In the bacteremic group, we found that sfa/focDE was only detected in highly virulent strains. The bacteremic UTI group had a significantly higher prevalence of papGII (belonging to P fimbriae) than the UTI group (55.8% vs 37.3%; p=0.026). In addition, the P fimbriae gene cluster, including papC, papEF, and papGII, was predominant in highly virulent strains. Notably, our results show that multidrug-resistant (MDR) strains were significantly less virulent than non MDR strains.

Conclusion

Taken together, our results provide insights into the contributing factors in patients with UTI and urinary bacteremia.

Uropathogenic E. coli and Hybrid Pathotypes in Mexican Women with Urinary Tract Infections: A Comprehensive Molecular and Phenotypic Overview

Uropathogenic Escherichia coli (UPEC) is the main cause of urinary tract infections (UTIs) and carries virulence and resistance factors often found in mobilizable genetic elements, such as plasmids or pathogenicity islands (PAIs). UPEC is part of the extraintestinal pathogenic E. coli (ExPEC), but hybrid strains possessing both diarrheagenic E. coli (DEC) and ExPEC traits, termed "hypervirulent", present a significant health threat. This study assessed the prevalence of UPEC PAIs, ExPEC sequence types (ST), DEC genes, carbapenemase and extended-spectrum β-lactamase (ESBL) phenotypes, resistance genotypes, and plasmids in 40 clinical isolates of UPEC. Results showed that 72.5% of isolates had PAIs, mainly PAI IV536 (53%). ESBL phenotypes were found in 65% of β-lactam-resistant isolates, with 100% of carbapenem-resistant isolates producing carbapenemase. The predominant ESBL gene was blaCTX-M-2 (60%), and the most common resistance gene in fluoroquinolone and aminoglycoside-resistant isolates was aac(6')Ib (93%). Plasmids were present in 57% of isolates, and 70% belonged to the ST131 clonal group. Molecular markers for DEC pathotypes were detected in 20 isolates, with 60% classified as hybrid pathotypes. These findings indicate significant pathogenic potential and the presence of hybrid pathotypes in E. coli UTI clinical isolates in the Mexican population.

Improving the diagnosis of urinary tract infections by the use of enriched media and a 48-hour incubation period

Introduction. The absence of a gold-standard methodology for the microbiological diagnosis of urinary tract infections (UTI) has led to insufficient standardization of criteria for the interpretation of results and processing methods, particularly incubation time and culture media.Hypothesis. 48-hour incubation time period and use of blood agar enhances the sensitivity of microorganisms isolated significantly.Aim. To determine the sensitivity of blood agar and Brilliance UTI chromogenic agar, incubating for different periods (24-48 hours), for the detection of positive urine cultures.Methodoloy. Comparisons were made between all possible combinations of media and incubation times. As the gold-standard reference, we used the routine methodology of our laboratory, which involves prior screening with available clinical data, flow cytometry, sediment analysis and/or Gram staining. Screened samples were then cultured on blood agar and chromogenic agar and incubated for 48 hours. Also, based on the results of Gram staining, additional media were added in selected cases.Results. The most significant difference was found between chromogenic agar incubated for 24 hours and blood agar incubated for 48 hours, with the latter method allowing the recovery of 10.14 % more microorganisms (P < 0.0001). Furthermore, the value of performing Gram staining to guide processing was demonstrated, as it avoided the loss of at least 5.14 % of isolates.Conclusions. At least in urological and nephrological patients it is essential to include enriched culture media (blood agar) or to extend the incubation times due to the improvement of the diagnostic sensitivity of urine cultures. Gram staining also can help detect the presence of fastidious microorganisms or mixed infections, indicating whether rich and/or selective media should be included to enhance the diagnostic sensitivity of cultures. If this methodology is not followed, it should be noted that besides fastidious species, fastidious strains of Escherichia coli, Proteus mirabilis, Pseudomonas aerugniosa and Stenotrophomonas maltophilia will also be missed.

Antimicrobial susceptibility patterns of urinary tract infections causing bacterial isolates and associated risk factors among HIV patients in Tigray, Northern Ethiopia

BACKGROUND

Urinary tract infections, a prevalent global infectious disease, are clinical issues not well studied in HIV-positive individuals. UTIs have become a global drug resistance issue, but the prevalence and antibiotic susceptibility patterns of UTI-causing bacteria among HIV patients in Tigray, Ethiopia, are poorly understood. This study aims to identify the prevalence of UTI-causing bacteria, their antibiotic susceptibility patterns, and associated risk factors in HIV patients attending ART clinics at Mekelle General Hospital and Ayder Comprehensive Specialized Hospital in Tigray, Northern Ethiopia.

METHOD

Clean-catch midstream urine samples (10-15 mL) were collected from HIV patients who are attending ART clinics at Mekelle General Hospital and Ayder Comprehensive Specialized Hospital. Samples were analyzed based on standard microbiological protocols using cysteine-lactose electrolyte deficient (CLED) agar. Pure colonies of bacterial isolates were obtained by sub-culturing into Mac-Conkey, Manitol Salt agar and blood agar plates. The bacterial isolates were then identified using macroscopic, microscopic, biochemical, and Gram staining methods. Gram-negative bacteria were identified using biochemical tests like triple sugar iron agar, Simon's citrate agar, lysine iron agar, urea, motility test, and indol test, whereas Gram-positive isolates were identified using catalase and coagulase tests. The Kirby-Bauer disk diffusion technique was used to analyze the antimicrobial susceptibility pattern of bacterial isolates. Data was analyzed using SPSS version 25.0.

RESULTS

Among the 224 patients, 28 (12.5%) of them had been infected by UTIs-causing bacteria. E. coli was the dominant bacterium (16 (57%)) followed by K. pneumoniae (4 (14%)), and S. aureus (3 (11%)). Of the total bacterial isolates, 22 (78.6%) of them developed multi-drug resistance. All Gram-positive (100%) and 75% of Gram-negative bacterial isolates were found to be resistant to two or more drugs. Patients with a history of UTIs, and with CD4 count < 200 cells/ mm3, were more likely to have significant bacteriuria. Compared to male patients, female patients were more affected by the UTIs-causing bacteria. More than 93% of the UTIs-causing bacterial isolates were susceptible to nitrofurantoin, ceftriaxone, ciprofloxacin, and gentamycin; whereas they are highly resistant to ampicillin (96%), cotrimoxazole (82%) and tetracycline (71%).

CONCLUSIONS

Most of the bacterial isolates were highly resistant to ampicillin, cotrimoxazole, and tetracycline. Female patients were more affected by the UTIs causing bacteria. The highest prevalence (12.5%) of UTIs in HIV patients needs special attention for better management and monitoring. Previous UTI history and immune suppression are predictors of UTIs, highlighting the need for intervention measures involving molecular studies to identify resistant bacteria genes and promote patient immune reconstitution.

Pharmacokinetics of Enrofloxacin in Plasma, Urine, and Feces of Donkey (Equus asinus) after a Single Intragastric Administration

Enrofloxacin is a broad-spectrum antimicrobial agent, but the study of its pharmacokinetics/pharmacodynamics (PKs/PDs) in donkeys is rarely reported. The present study aimed to investigate the pharmacokinetics of enrofloxacin administered intragastrically, and to study the pharmacokinetics of enrofloxacin and its metabolite ciprofloxacin in plasma, urine, and feces, and the PK/PD parameters were investigated to provide a rationale for enrofloxacin treatment in donkeys. A total of five healthy donkeys were selected for intragastric administration of 7.5 mg·kg-1 BW of enrofloxacin by gavage, and blood, urine, and fecal samples were collected. The results showed that the elimination half-life of plasma enrofloxacin was 11.40 ± 6.40 h, Tmax was 0.55 ± 0.12 h, Cmax was 2.46 ± 0.14 mg·L-1, AUC0-∞ was 10.30 ± 3.37 mg·L-1·h, and mean residence time (MRT) was 7.88 ± 1.26 h. The Tmax of plasma ciprofloxacin was 0.52 ± 0.08 h, Cmax was 0.14 ± 0.03 mg·L-1, and AUC0-∞ was 0.24 ± 0.16 mg·L-1·h. Urinary Cmax was 38.18 ± 8.56 mg·L-1 for enrofloxacin and 15.94 ± 4.15 mg·L-1 for ciprofloxacin. The total enrofloxacin and ciprofloxacin recovered amount in urine was 7.09 ± 2.55% of the dose for 144 h after dosing. The total enrofloxacin and ciprofloxacin recovered amount in feces was 25.73 ± 10.34% of the dose for 144 h after dosing. PK/PD parameters were also examined in this study, based on published MICs. In conclusion, 7.5 mg/kg BW of enrofloxacin administered intragastrically to donkeys was rapidly absorbed, widely distributed, and slowly eliminated in their bodies, and was predicted to be effective against bacteria with MICs < 0.25 mg·L-1.

Antibacterial Property of Silver Nanoparticles Green Synthesized from Stachys schtschegleevii Plant Extract on Urinary Tract Infection Bacteria

Urinary tract infections are one of the most common infections worldwide. Given the increasing antibiotic resistance, monitoring antibiotic sensitivity patterns is crucial. Furthermore, silver nanoparticles synthesized from Stachys schtschegleevii can exhibit potent antibacterial, antibiotic, and antifungal properties. The plant S. schtschegleevii was collected from its natural habitat, dried, and its extract was then exposed to silver nitrate. Under specific conditions, silver nanoparticles were synthesized from it. Subsequently, the production and validation of silver nanoparticles were confirmed through techniques such as FTIR analysis, UV-Vis analysis, TEM, SEM, EDX analysis, and zeta potential analysis. In the in vitro section of the research, the impact of the extracted silver nanoparticles on bacteria isolated from patients' urine and standard bacterial culture (control) was assessed using the disc diffusion and MIC test methods. The results of the analyses are FTIR (high protein content; proteins and phenols serve as stabilizing agents), UV-Vis (peak of 460 nm), TEM (spherical to occasionally elliptical shapes), SEM (sizes: 26 to 72 nm), EDX (peak at 3 keV), and zeta potential (- 15.76 ± 0.05 mV). The effect of silver nanoparticles by disc diffusion method (mm) is Enterococcus faecalis = 18.31 ± 0.35, Escherichia coli = 21.51 ± 0.61, and Staphylococcus aureus = 19.02 ± 1.28, and by MIC test (μg/ml), E. faecalis = 19, E. coli = 18, and Staphylococcus aureus = 16. Antibacterial activity of the silver nanoparticles synthesized from S. schtschegleevii means that these herbal nanoparticles treat urinary tract infections caused by some of the test isolates.