1
|
Pishdad R, Auwaerter PG, Kalyani RR. Diabetes, SGLT-2 Inhibitors, and Urinary Tract Infection: a Review. Curr Diab Rep 2024; 24:108-117. [PMID: 38427314 DOI: 10.1007/s11892-024-01537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to focus on epidemiology, pathogenesis, risk factors, management, and complications of UTI in people with diabetes as well as reviewing the association of SGLT-2 inhibitors with genitourinary infections. RECENT FINDINGS Individuals diagnosed with T2DM are more prone to experiencing UTIs and recurrent UTIs compared to individuals without T2DM. T2DM is associated with an increased risk of any genitourinary infections (GUI), urinary tract infections (UTIs), and genital infections (GIs) across all age categories. SGLT2 inhibitors are a relatively new class of anti-hyperglycemic agents, and studies suggest that they are associated with an increased risk of genitourinary infections. The management of diabetes and lifestyle modifications with a patient-centric approach are the most recognized methods for preventing critical long-term complications including genitourinary manifestations of diabetes. The available data regarding the association of SGLT-2 inhibitors with genitourinary infections is more comprehensive compared to that with UTIs. Further research is needed to better understand the mechanisms underlining the association between SGLT-2 inhibitors and genital infections and UTIs.
Collapse
Affiliation(s)
- Reza Pishdad
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Endocrinology, Diabetes, and Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Paul G Auwaerter
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Sahni RD, V A, Suji T, V AS, Jayanth ST. Complete genome sequence of Yokenella regensburgei isolated from a patient with urinary tract infection in India. Microbiol Resour Announc 2024:e0116223. [PMID: 38682779 DOI: 10.1128/mra.01162-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
Yokenella regensburgei, an environmental organism, is an emerging pathogen in patients chiefly with immune suppression. We report the draft genome of Y. regensburgei, strain UU2206353, isolated from the urinary tract of an immunocompetent individual. The assembled genome consisted of 4,669,536 bp distributed over 20 contigs with 4,283 protein-coding genes.
Collapse
Affiliation(s)
- Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aravind V
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thangamani Suji
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Annie Sheeba V
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | |
Collapse
|
3
|
Shea AE, Forsyth VS, Stocki JA, Mitchell TJ, Frick-Cheng AE, Smith SN, Hardy SL, Mobley HLT. Emerging roles for ABC transporters as virulence factors in uropathogenic Escherichia coli. Proc Natl Acad Sci U S A 2024; 121:e2310693121. [PMID: 38607934 PMCID: PMC11032443 DOI: 10.1073/pnas.2310693121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/07/2024] [Indexed: 04/14/2024] Open
Abstract
Urinary tract infections (UTI) account for a substantial financial burden globally. Over 75% of UTIs are caused by uropathogenic Escherichia coli (UPEC), which have demonstrated an extraordinarily rapid growth rate in vivo. This rapid growth rate appears paradoxical given that urine and the human urinary tract are relatively nutrient-restricted. Thus, we lack a fundamental understanding of how uropathogens propel growth in the host to fuel pathogenesis. Here, we used large in silico, in vivo, and in vitro screens to better understand the role of UPEC transport mechanisms and their contributions to uropathogenesis. In silico analysis of annotated transport systems indicated that the ATP-binding cassette (ABC) family of transporters was most conserved among uropathogenic bacterial species, suggesting their importance. Consistent with in silico predictions, we determined that the ABC family contributed significantly to fitness and virulence in the urinary tract: these were overrepresented as fitness factors in vivo (37.2%), liquid media (52.3%), and organ agar (66.2%). We characterized 12 transport systems that were most frequently defective in screening experiments by generating in-frame deletions. These mutant constructs were tested in urovirulence phenotypic assays and produced differences in motility and growth rate. However, deletion of multiple transport systems was required to achieve substantial fitness defects in the cochallenge murine model. This is likely due to genetic compensation among transport systems, highlighting the centrality of ABC transporters in these organisms. Therefore, these nutrient uptake systems play a concerted, critical role in pathogenesis and are broadly applicable candidate targets for therapeutic intervention.
Collapse
Affiliation(s)
- Allyson E. Shea
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI48109
| | - Valerie S. Forsyth
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI48109
| | - Jolie A. Stocki
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI48109
| | - Taylor J. Mitchell
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI48109
| | - Arwen E. Frick-Cheng
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI48109
| | - Sara N. Smith
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI48109
| | - Sicily L. Hardy
- Department of Microbiology and Immunology, College of Medicine, University of South Alabama, Mobile, AL36688
| | - Harry L. T. Mobley
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI48109
| |
Collapse
|
4
|
Naveed M, Tahir F, Aziz T, Waseem M, Makhdoom SI, Ali N, Alharbi M, Albekairi TH, Alasmari AF. Molecular identification of Proteus mirabilis, Vibrio species leading to CRISPR-Cas9 modification of tcpA and UreC genes causing cholera and UTI. Sci Rep 2024; 14:8563. [PMID: 38609487 PMCID: PMC11014924 DOI: 10.1038/s41598-024-59340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
Heavy metal accumulation increases rapidly in the environment due to anthropogenic activities and industrialization. The leather and surgical industry produces many contaminants containing heavy metals. Cadmium, a prominent contaminant, is linked to severe health risks, notably kidney and liver damage, especially among individuals exposed to contaminated wastewater. This study aims to leverage the natural cadmium resistance mechanisms in bacteria for bioaccumulation purposes. The industrial wastewater samples, characterized by an alarming cadmium concentration of 29.6 ppm, 52 ppm, and 76.4 ppm-far exceeding the recommended limit of 0.003 ppm-were subjected to screening for cadmium-resistant bacteria using cadmium-supplemented media with CdCl2. 16S rRNA characterization identified Vibrio cholerae and Proteus mirabilis as cadmium-resistant bacteria in the collected samples. Subsequently, the cadmium resistance-associated cadA gene was successfully amplified in Vibrio species and Proteus mirabilis, revealing a product size of 623 bp. Further analysis of the identified bacteria included the examination of virulent genes, specifically the tcpA gene (472 bp) associated with cholera and the UreC gene (317 bp) linked to urinary tract infections. To enhance the bioaccumulation of cadmium, the study proposes the potential suppression of virulent gene expression through in-silico gene-editing tools such as CRISPR-Cas9. A total of 27 gRNAs were generated for UreC, with five selected for expression. Similarly, 42 gRNA sequences were generated for tcpA, with eight chosen for expression analysis. The selected gRNAs were integrated into the lentiCRISPR v2 expression vector. This strategic approach aims to facilitate precise gene editing of disease-causing genes (tcpA and UreC) within the bacterial genome. In conclusion, this study underscores the potential utility of Vibrio species and Proteus mirabilis as effective candidates for the removal of cadmium from industrial wastewater, offering insights for future environmental remediation strategies.
Collapse
Affiliation(s)
- Muhammad Naveed
- Department of Biotechnology, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan.
| | - Fatima Tahir
- Department of Biotechnology, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan
| | - Tariq Aziz
- Laboratory of Animal Health, Food Hygiene and Quality, Department of Agriculture, University of Ioannina, 47100, Arta, Greece
| | - Muhammad Waseem
- Department of Biotechnology, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan
| | - Syeda Izma Makhdoom
- Department of Biotechnology, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan
| | - Nouman Ali
- Department of Biotechnology, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan
| | - Metab Alharbi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Thamer H Albekairi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Abdullah F Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Bryson AL, Bhalodi A, Liesman RM, Mathers AJ. Cefazolin as a predictor of urinary cephalosporin activity in indicated Enterobacterales. J Clin Microbiol 2024; 62:e0078821. [PMID: 38457194 PMCID: PMC11005412 DOI: 10.1128/jcm.00788-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Traditionally, cephalothin susceptibility results were used to predict the susceptibility of additional cephalosporins; however, in 2013-2014, the Clinical and Laboratory Standards Institute (CLSI) revisited this practice and determined that cefazolin is a more accurate proxy than cephalothin for uncomplicated urinary tract infections (uUTIs). Therefore, a cefazolin surrogacy breakpoint was established to predict the susceptibility of seven oral cephalosporins for Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis in the context of uUTIs. Clinical microbiology laboratories face several operational challenges when implementing the cefazolin surrogacy breakpoint, which may lead to confusion for the best path forward. Here, we review the historical context and data behind the surrogacy breakpoints, review PK/PD profiles for oral cephalosporins, discuss challenges in deploying the breakpoint, and highlight the limited clinical outcome data in this space.
Collapse
Affiliation(s)
- Alexandra L. Bryson
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Amira Bhalodi
- Scientific and Medical Affairs Consulting, Newton, Pennsylvania, USA
| | - Rachael M. Liesman
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy J. Mathers
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health, Charlottesville, Virginia, USA
- Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA
| |
Collapse
|
6
|
Tyagi P, Tyagi S, Stewart L, Glickman S. SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis. Antibiotics (Basel) 2024; 13:328. [PMID: 38667004 PMCID: PMC11047466 DOI: 10.3390/antibiotics13040328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
Nearly 150 million cases of urinary tract infections (UTIs) are reported each year, of which uncomplicated cystitis triggers > 25% of outpatient prescriptions of oral antimicrobial treatment (OAT). OAT aids immune cells infiltrating the urothelium in eliminating uropathogens capable of invading the urothelium and surviving hyperosmotic urine. This self-evident adaptability of uropathogens and the short interval between the introduction of Penicillin and the first report of antimicrobial resistance (AMR) implicate AMR as an evolutionary conserved heritable trait of mutant strains selected by the Darwinian principle to survive environmental threats through exponential proliferation. Therefore, AMR can only be countered by antimicrobial stewardship (AMS) following the principle of the five Ds-drug, dose, duration, drug route, and de-escalation. While convenient to administer, the onset of the minimum inhibitory concentration (MIC) for OAT in urine leaves a window of opportunity for uropathogens to survive the first contact with an antimicrobial and arm their descendant colonies with AMR for surviving subsequent higher urine antimicrobial levels. Meanwhile, the initial dose of intravesical antimicrobial treatment (IAT) may be well above the MIC. Therefore, the widespread clinical use of OAT for cystitis warrants an analysis of the strengths, weaknesses, opportunity, and threats (SWOTs) and a root cause analysis of the AMR associated with OAT and IAT.
Collapse
Affiliation(s)
- Pradeep Tyagi
- Department of Urology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shachi Tyagi
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | | | | |
Collapse
|
7
|
Chen EC, Shapiro RL, Pal A, Bartee D, DeLong K, Carter DM, Serrano-Diaz E, Rais R, Ensign LM, Freel Meyers CL. Investigating inhibitors of 1-deoxy-d-xylulose 5-phosphate synthase in a mouse model of UTI. Microbiol Spectr 2024; 12:e0389623. [PMID: 38376151 DOI: 10.1128/spectrum.03896-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
The rising rate of antimicrobial resistance continues to threaten global public health. Further hastening antimicrobial resistance is the lack of new antibiotics against new targets. The bacterial enzyme, 1-deoxy-d-xylulose 5-phosphate synthase (DXPS), is thought to play important roles in central metabolism, including processes required for pathogen adaptation to fluctuating host environments. Thus, impairing DXPS function represents a possible new antibacterial strategy. We previously investigated a DXPS-dependent metabolic adaptation as a potential target in uropathogenic Escherichia coli (UPEC) associated with urinary tract infection (UTI), using the DXPS-selective inhibitor butyl acetylphosphonate (BAP). However, investigations of DXPS inhibitors in vivo have not been conducted. The goal of the present study is to advance DXPS inhibitors as in vivo probes and assess the potential of inhibiting DXPS as a strategy to prevent UTI in vivo. We show that BAP was well-tolerated at high doses in mice and displayed a favorable pharmacokinetic profile for studies in a mouse model of UTI. Further, an alkyl acetylphosphonate prodrug (homopropargyl acetylphosphonate, pro-hpAP) was significantly more potent against UPEC in urine culture and exhibited good exposure in the urinary tract after systemic dosing. Prophylactic treatment with either BAP or pro-hpAP led to a partial protective effect against UTI, with the prodrug displaying improved efficacy compared to BAP. Overall, our results highlight the potential for DXPS inhibitors as in vivo probes and establish preliminary evidence that inhibiting DXPS impairs UPEC colonization in a mouse model of UTI.IMPORTANCENew antibiotics against new targets are needed to prevent an antimicrobial resistance crisis. Unfortunately, antibiotic discovery has slowed, and many newly FDA-approved antibiotics do not inhibit new targets. Alkyl acetylphosphonates (alkyl APs), which inhibit the enzyme 1-deoxy-d-xylulose 5-phosphate synthase (DXPS), represent a new possible class of compounds as there are no FDA-approved DXPS inhibitors. To our knowledge, this is the first study demonstrating the in vivo safety, pharmacokinetics, and efficacy of alkyl APs in a urinary tract infection mouse model.
Collapse
Affiliation(s)
- Eric C Chen
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachel L Shapiro
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arindom Pal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Drug Discovery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Bartee
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin DeLong
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Davell M Carter
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erika Serrano-Diaz
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rana Rais
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Drug Discovery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura M Ensign
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Caren L Freel Meyers
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Brannon JR, Reasoner SA, Bermudez TA, Comer SL, Wiebe MA, Dunigan TL, Beebout CJ, Ross T, Bamidele A, Hadjifrangiskou M. Mapping niche-specific two-component system requirements in uropathogenic Escherichia coli. Microbiol Spectr 2024; 12:e0223623. [PMID: 38385738 DOI: 10.1128/spectrum.02236-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Sensory systems allow pathogens to differentiate between different niches and respond to stimuli within them. A major mechanism through which bacteria sense and respond to stimuli in their surroundings is two-component systems (TCSs). TCSs allow for the detection of multiple stimuli to lead to a highly controlled and rapid change in gene expression. Here, we provide a comprehensive list of TCSs important for the pathogenesis of uropathogenic Escherichia coli (UPEC). UPEC accounts for >75% of urinary tract infections (UTIs) worldwide. UTIs are most prevalent among people assigned female at birth, with the vagina becoming colonized by UPEC in addition to the gut and the bladder. In the bladder, adherence to the urothelium triggers E. coli invasion of bladder cells and an intracellular pathogenic cascade. Intracellular E. coli are safely hidden from host neutrophils, competition from the microbiota, and antibiotics that kill extracellular E. coli. To survive in these intimately connected, yet physiologically diverse niches E. coli must rapidly coordinate metabolic and virulence systems in response to the distinct stimuli encountered in each environment. We hypothesized that specific TCSs allow UPEC to sense these diverse environments encountered during infection with built-in redundant safeguards. Here, we created a library of isogenic TCS deletion mutants that we leveraged to map distinct TCS contributions to infection. We identify-for the first time-a comprehensive panel of UPEC TCSs that are critical for infection of the genitourinary tract and report that the TCSs mediating colonization of the bladder, kidneys, or vagina are distinct.IMPORTANCEWhile two-component system (TCS) signaling has been investigated at depth in model strains of Escherichia coli, there have been no studies to elucidate-at a systems level-which TCSs are important during infection by pathogenic Escherichia coli. Here, we report the generation of a markerless TCS deletion library in a uropathogenic E. coli (UPEC) isolate that can be leveraged for dissecting the role of TCS signaling in different aspects of pathogenesis. We use this library to demonstrate, for the first time in UPEC, that niche-specific colonization is guided by distinct TCS groups.
Collapse
Affiliation(s)
- John R Brannon
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Seth A Reasoner
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tomas A Bermudez
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah L Comer
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle A Wiebe
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Taryn L Dunigan
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Connor J Beebout
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tamia Ross
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adebisi Bamidele
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maria Hadjifrangiskou
- Department of Pathology, Microbiology and Immunology, Division of Molecular Pathogenesis, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
9
|
Zhan ZS, Shi J, Zheng ZS, Zhu XX, Chen J, Zhou XY, Zhang SY. Epidemiological insights into seasonal, sex‑specific and age‑related distrib ution of bacterial pathogens in urinary tract infections. Exp Ther Med 2024; 27:140. [PMID: 38476915 PMCID: PMC10928815 DOI: 10.3892/etm.2024.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
Urinary tract infections (UTIs) are prevalent and recurrent bacterial infections that affect individuals worldwide, posing a significant burden on healthcare systems. The present study aimed to explore the epidemiology of UTIs, investigating the seasonal, gender-specific and age-related bacterial pathogen distribution to guide clinical diagnosis. Data were retrospectively collected from electronic medical records and laboratory reports of 926 UTIs diagnosed in Fuding Hospital (Fujian University of Traditional Chinese Medicine, Fuding, China). Bacterial isolates were identified using standard microbiological techniques. χ2 tests were performed to assess associations between pathogens and the seasons, sex and age groups. Significant associations were found between bacterial species and seasons. Enterococcus faecium exhibited a substantial prevalence in spring (χ2, 12.824; P=0.005), while Acinetobacter baumannii demonstrated increased prevalence in autumn (χ2, 16.404; P=0.001). Female patients showed a higher incidence of UTIs. Gram-positive bacteria were more prevalent in males, with Staphylococcus aureus showing significant male predominance (χ2, 14.607; P<0.001). E. faecium displayed an age-related increase in prevalence (χ2, 17.775; P<0.001), whereas Escherichia coli tended to be more prevalent in younger patients (χ2, 12.813; P=0.005). These findings highlight the complex nature of UTIs and offer insights for tailored diagnostic and preventive strategies, potentially enhancing healthcare outcomes.
Collapse
Affiliation(s)
- Zhi-Song Zhan
- Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Jing Shi
- Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Zu-Shun Zheng
- Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Xue-Xia Zhu
- Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Juan Chen
- Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Xin-Yi Zhou
- Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Shi-Yan Zhang
- Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| |
Collapse
|
10
|
Salam ME, Jeffres M, Molina KC, Miller MA, Huang M, Fish DN. Evaluation of Oral Amoxicillin/Clavulanate for Urinary Tract Infections Caused by Ceftriaxone Non-Susceptible Enterobacterales. Pharmacy (Basel) 2024; 12:60. [PMID: 38668086 PMCID: PMC11054542 DOI: 10.3390/pharmacy12020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/29/2024] Open
Abstract
Urinary tract infections (UTIs) are one of the most common infections and are frequently caused by Gram-negative organisms. The rise of resistant isolates has prompted evaluation of alternative therapies, including amoxicillin-clavulanate which has potent activity against Ambler class A enzymes. This study sought to evaluate clinical outcomes of patients with ceftriaxone non-susceptible UTIs receiving amoxicillin-clavulanate or standard of care (SOC). This was a single-center, retrospective, cohort study of adult patients with urinary tract infections caused by a ceftriaxone non-susceptible pathogen who received amoxicillin-clavulanate or SOC. The primary outcome was clinical failure at 90 days. Secondary outcomes included time to failure, isolation of a resistant organism, and hospital length of stay. Fifty-nine patients met study inclusion: 26 received amoxicillin/clavulanate and 33 received SOC. Amoxicillin-clavulanate recipients did not have higher failure rates compared to SOC recipients. For patients requiring hospital admission, hospital length of stay was numerically shorter with amoxicillin-clavulanate. The frequency of amoxicillin-clavulanate and carbapenem-resistant organisms did not differ significantly between groups. Amoxicillin-clavulanate may be a useful alternative therapy for the treatment of ceftriaxone non-susceptible Enterobacterales UTIs.
Collapse
Affiliation(s)
- Madison E. Salam
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, USA; (M.E.S.); (M.J.)
- Department of Pharmacy, UCHealth University of Colorado Hospital, Aurora, CO 80045, USA
| | - Meghan Jeffres
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, USA; (M.E.S.); (M.J.)
- Department of Pharmacy, UCHealth University of Colorado Hospital, Aurora, CO 80045, USA
| | - Kyle C. Molina
- Department of Pharmacy, Scripps Health, La Jolla, CA 92121, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Matthew A. Miller
- Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Misha Huang
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- Department of Medicine–Infectious Diseases, UCHealth University of Colorado Hospital, Aurora, CO 80045, USA
| | - Douglas N. Fish
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, USA; (M.E.S.); (M.J.)
| |
Collapse
|
11
|
Silva LC, Sanches MS, Guidone GHM, Montini VH, de Oliva BHD, do Nascimento AB, Galhardi LCF, Kobayashi RKT, Vespero EC, Rocha SPD. Clonal relationship, virulence genes, and antimicrobial resistance of Morganella morganii isolated from community-acquired infections and hospitalized patients: a neglected opportunistic pathogen. Int Microbiol 2024; 27:411-422. [PMID: 37479959 DOI: 10.1007/s10123-023-00400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
Morganella morganii is a bacterium belonging to the normal intestinal microbiota and the environment; however, in immunocompromised individuals, this bacterium can become an opportunistic pathogen, causing a series of diseases, both in hospitals and in the community, being urinary tract infections more prevalent. Therefore, the objective of this study was to evaluate the prevalence, virulence profile, and resistance to antimicrobials and the clonal relationship of isolates of urinary tract infections (UTI) caused by M. morganii, both in the hospital environment and in the community of the municipality of Londrina-PR, in southern Brazil, in order to better understand the mechanisms for the establishment of the disease caused by this bacterium. Our study showed that M. morganii presents a variety of virulence factors in the studied isolates. Hospital strains showed a higher prevalence for the virulence genes zapA, iutA, and fimH, while community strains showed a higher prevalence for the ireA and iutA genes. Hospital isolates showed greater resistance compared to community isolates, as well as a higher prevalence of multidrug-resistant (MDR) and extended-spectrum beta lactamase (ESBL)-producing isolates. Several M. morganii isolates from both sources showed high genetic similarity. The most prevalent plasmid incompatibility groups detected were FIB and I1, regardless of the isolation source. Thus, M. morganii isolates can accumulate virulence factors and antimicrobial resistance, making them a neglected opportunistic pathogen.
Collapse
Affiliation(s)
- Luana Carvalho Silva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Matheus Silva Sanches
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Gustavo Henrique Migliorini Guidone
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Victor Hugo Montini
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Bruno Henrique Dias de Oliva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Arthur Bossi do Nascimento
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil
| | - Lígia Carla Faccin Galhardi
- Laboratory of Virology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Renata Katsuko Takayama Kobayashi
- Laboratory of Basic and Applied Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Eliana Carolina Vespero
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, University Hospital of Londrina, State University of Londrina, Paraná, Brazil
| | - Sergio Paulo Dejato Rocha
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid PO-BOX 6001, 86051-980, Londrina, Paraná, Brazil.
| |
Collapse
|
12
|
Taha AB. Bacteriological profile, antimicrobial susceptibility, and factors associated with urinary tract infection in pregnant women. J Infect Dev Ctries 2024; 18:391-398. [PMID: 38635608 DOI: 10.3855/jidc.18239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 09/14/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Urinary tract infection (UTI) is a common bacterial complication in pregnancy. The study aimed to estimate the prevalence, risk factors, and bacterial etiology of UTI during pregnancy and determine the efficacy of antimicrobial drugs in treating UTIs. METHODOLOGY Urine specimens and clinical data were collected from pregnant women who attended primary health centers in Erbil, Iraq. All specimens were cultured on appropriate media and identified by standard microbiological methods. The pregnant women were grouped into symptomatic UTI group, asymptomatic bacteriuria group, and the control group. The agar dilution method was used to determine antimicrobial susceptibility. RESULTS Among the 5,042 pregnant women included in this study, significant bacteriuria was found in 625 (12.40%) of the cases, and 198 (31.68%) had symptomatic UTI, of which 43.59% were diagnosed during the third trimester. Out of the 643 bacteria isolated, 33.28% were symptomatic UTI, of which 43.59% developed during the third trimester. There was a significant difference in the bacterial etiology between symptomatic UTI and asymptomatic bacteriuria (p = 0.002), as well as between cystitis and pyelonephritis (p = 0.017). The most common bacterial species isolated was Escherichia coli, which was susceptible to fosfomycin (100%), meropenem (99.45%), and nitrofurantoin (97.8%). CONCLUSIONS Pregnant women are more likely to develop UTI in the third trimester. Escherichia coli is the predominant pathogen. The study suggests the use of fosfomycin, meropenem, and nitrofurantoin for the treatment of UTI. No Gram-positive isolates were resistant to daptomycin.
Collapse
Affiliation(s)
- Aza B Taha
- Medical Research Center, Hawler Medical University, Erbil, Kurdistan Region, Iraq
| |
Collapse
|
13
|
Lewis AJ, Richards AC, Mendez AA, Dhakal BK, Jones TA, Sundsbak JL, Eto DS, Rousek AA, Mulvey MA. Plant phenolics inhibit focal adhesion kinase and suppress host cell invasion by uropathogenic Escherichia coli. Infect Immun 2024:e0008024. [PMID: 38534100 DOI: 10.1128/iai.00080-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Traditional folk treatments for the prevention and management of urinary tract infections (UTIs) and other infectious diseases often include plants and plant extracts that are rich in phenolic compounds. These have been ascribed a variety of activities, including inhibition of bacterial interactions with host cells. Here, we tested a panel of four well-studied phenolic compounds-caffeic acid phenethyl ester (CAPE), resveratrol, catechin, and epigallocatechin gallate-for the effects on host cell adherence and invasion by uropathogenic Escherichia coli (UPEC). These bacteria, which are the leading cause of UTIs, can bind and subsequently invade bladder epithelial cells via an actin-dependent process. Intracellular UPEC reservoirs within the bladder are often protected from antibiotics and host defenses and likely contribute to the development of chronic and recurrent infections. In cell culture-based assays, only resveratrol had a notable negative effect on UPEC adherence to bladder cells. However, both CAPE and resveratrol significantly inhibited UPEC entry into the host cells, coordinate with attenuated phosphorylation of the host actin regulator Focal Adhesion Kinase (FAK or PTK2) and marked increases in the numbers of focal adhesion structures. We further show that the intravesical delivery of resveratrol inhibits UPEC infiltration of the bladder mucosa in a murine UTI model and that resveratrol and CAPE can disrupt the ability of other invasive pathogens to enter host cells. Together, these results highlight the therapeutic potential of molecules like CAPE and resveratrol, which could be used to augment antibiotic treatments by restricting pathogen access to protective intracellular niches.IMPORTANCEUrinary tract infections (UTIs) are exceptionally common and increasingly difficult to treat due to the ongoing rise and spread of antibiotic-resistant pathogens. Furthermore, the primary cause of UTIs, uropathogenic Escherichia coli (UPEC), can avoid antibiotic exposure and many host defenses by invading the epithelial cells that line the bladder surface. Here, we identified two plant-derived phenolic compounds that disrupt activation of the host machinery needed for UPEC entry into bladder cells. One of these compounds, resveratrol, effectively inhibited UPEC invasion of the bladder mucosa in a mouse UTI model, and both phenolic compounds significantly reduced host cell entry by other invasive pathogens. These findings suggest that select phenolic compounds could be used to supplement existing antibacterial therapeutics by denying uropathogens shelter within host cells and tissues and help explain some of the benefits attributed to traditional plant-based medicines.
Collapse
Affiliation(s)
- Adam J Lewis
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Amanda C Richards
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Alejandra A Mendez
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, USA
- Henry Eyring Center for Cell & Genome Science, University of Utah, Salt Lake City, Utah, USA
| | - Bijaya K Dhakal
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Tiffani A Jones
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Jamie L Sundsbak
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Danelle S Eto
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Alexis A Rousek
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, USA
- Henry Eyring Center for Cell & Genome Science, University of Utah, Salt Lake City, Utah, USA
| | - Matthew A Mulvey
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, USA
- Henry Eyring Center for Cell & Genome Science, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
14
|
Keith M, Park de la Torriente A, Chalka A, Vallejo-Trujillo A, McAteer SP, Paterson GK, Low AS, Gally DL. Predictive phage therapy for Escherichia coli urinary tract infections: Cocktail selection for therapy based on machine learning models. Proc Natl Acad Sci U S A 2024; 121:e2313574121. [PMID: 38478693 PMCID: PMC10962980 DOI: 10.1073/pnas.2313574121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/04/2024] [Indexed: 03/27/2024] Open
Abstract
This study supports the development of predictive bacteriophage (phage) therapy: the concept of phage cocktail selection to treat a bacterial infection based on machine learning (ML) models. For this purpose, ML models were trained on thousands of measured interactions between a panel of phage and sequenced bacterial isolates. The concept was applied to Escherichia coli associated with urinary tract infections. This is an important common infection in humans and companion animals from which multidrug-resistant (MDR) bloodstream infections can originate. The global threat of MDR infection has reinvigorated international efforts into alternatives to antibiotics including phage therapy. E. coli exhibit extensive genome-level variation due to horizontal gene transfer via phage and plasmids. Associated with this, phage selection for E. coli is difficult as individual isolates can exhibit considerable variation in phage susceptibility due to differences in factors important to phage infection including phage receptor profiles and resistance mechanisms. The activity of 31 phage was measured on 314 isolates with growth curves in artificial urine. Random Forest models were built for each phage from bacterial genome features, and the more generalist phage, acting on over 20% of the bacterial population, exhibited F1 scores of >0.6 and could be used to predict phage cocktails effective against previously untested strains. The study demonstrates the potential of predictive ML models which integrate bacterial genomics with phage activity datasets allowing their use on data derived from direct sequencing of clinical samples to inform rapid and effective phage therapy.
Collapse
Affiliation(s)
- Marianne Keith
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| | - Alba Park de la Torriente
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| | - Antonia Chalka
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| | - Adriana Vallejo-Trujillo
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| | - Sean P. McAteer
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| | - Gavin K. Paterson
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
- Royal (Dick) School of Veterinary Studies, Easter Bush Pathology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| | - Alison S. Low
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| | - David L. Gally
- The Roslin Institute, Division of Bacteriology, University of Edinburgh, EdinburghEH25 9RG, United Kingdom
| |
Collapse
|
15
|
Hussain I, Shukar S, Subhan Arshad M, Rasool MF, Chang J, Fang Y. Relation of poverty with treatment-seeking behavior and antibiotic misuse among UTI patients in Pakistan. Front Public Health 2024; 12:1357107. [PMID: 38560437 PMCID: PMC10978578 DOI: 10.3389/fpubh.2024.1357107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The current study aimed to assess the relation between multi-dimension poverty, treatment-seeking behavior, and antibiotic misuse among urinary tract infection (UTI) patients. Method A cross-sectional approach was utilized to recruit patients who had a history of UTI in the previous month from two provinces of Pakistan. The treatment-seeking behavior and antibiotic misuse data were collected on a self-developed questionnaire, whereas the poverty data were collected on a modified multi-dimension poverty index (MPI). Descriptive statistics were applied to summarize the data. The logistic regression analysis was carried out to assess the association of multi-dimension poverty with patient treatment-seeking behavior and antibiotic misuse. Results A total of 461 participants who had UTI symptoms in the previous month were recruited. Most of the participants in the severely deprived stage treated the UTI (p < 0.001); however, there was a high proportion of the participants who consulted with friends and family for UTI treatment (p < 0.001). The patients with deprivation status (deprived and severely deprived) were less associated with formal consultation. The poorer subgroups were less likely to practice antibiotic course completion. Conclusion The current study highlighted that poverty plays an important role in antibiotic misuse. Poorer subgroups were associated with informal consultations and the incompletion of the antibiotic course. Further studies are needed to explore the potential role of poverty in treatment-seeking behavior and antibiotic misuse.
Collapse
Affiliation(s)
- Iltaf Hussain
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Muhammad Subhan Arshad
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| |
Collapse
|
16
|
Bhatt A, Pujari S, Mantri S, Kirdat K, Thakkar L, Poojary R, Kuyare S, Patil K, Yadav A. A rare urinary tract infection of multidrug-resistant Chryseobacterium urinae sp. nov. isolated from a diabetic, non-catheterized patient. Arch Microbiol 2024; 206:150. [PMID: 38466448 DOI: 10.1007/s00203-024-03881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 03/13/2024]
Abstract
Chryseobacterium demonstrates a diverse environmental presence and a significant pathogenic potential across various ecosystems. This clinical case showcases a rare instance of bacterial infection in a 75-year-old male with untreated diabetes and recurrent urinary tract infections (UTIs). The patient presented symptoms of abdominal pain, burning urination, fever, and an elevated eosinophil count. A subsequent urine culture identified a Chryseobacterium-related bacterium as the causative agent, exhibiting sensitivity to piperacillin/tazobactam, trimethoprim/sulfamethoxazole, and nitrofurantoin, which led to successful treatment using oral nitrofurantoin. Analysis of the 16S rRNA gene sequence of APV-1T revealed a close relationship of 98.2% similarity to Chryseobacterium gambrini strain 5-1St1aT (AM232810). Furthermore, comparative genome analysis, incorporating Average Nucleotide Identity (ANI), Digital DNA-DNA Hybridization (dDDH) values, and comprehensive phylogenetic assessments utilizing 16S rRNA gene sequences, core genes, and amino acid sequences of core proteins, highlighted the unique phylogenetic positioning of APV-1T within the Chryseobacterium genus. Distinct carbon utilization and assimilation patterns, along with major fatty acid content, set APV-1T apart from C. gambrini strain 5-1St1aT. These findings, encompassing phenotypic, genotypic, and chemotaxonomic characteristics, strongly support the proposal of a novel species named Chryseobacterium urinae sp. nov., with APV-1T designated as the type strain (= MCC 50690 = JCM 36476). Despite its successful treatment, the strain displayed resistance to multiple antibiotics. Genomic analysis further unveiled core-conserved genes, strain-specific clusters, and genes associated with antibiotic resistance and virulence. This report underscores the vital importance of elucidating susceptibility patterns of rare pathogens like Chryseobacterium, particularly in immunocompromised individuals. It advocates for further analyses to understand the functional significance of identified genes and their implications in treatment and pathogenesis.
Collapse
Affiliation(s)
- Agrima Bhatt
- Department of Biosciences and Technology, Vishwanath Karad MIT World Peace University, Kothrud, Pune, 411038, India
| | - Sujata Pujari
- Sujata Clinic, Mulund Colony, Mulund West, Mumbai, 400082, India
| | - Shailesh Mantri
- National Centre for Microbial Resource, National Centre for Cell Science, NCCS Complex, Ganeshkhind, 411007, Pune, India
| | - Kiran Kirdat
- National Centre for Microbial Resource, National Centre for Cell Science, NCCS Complex, Ganeshkhind, 411007, Pune, India
| | - Lucky Thakkar
- National Centre for Microbial Resource, National Centre for Cell Science, NCCS Complex, Ganeshkhind, 411007, Pune, India
| | - Reshma Poojary
- Apoorva Diagnostic and Healthcare, Kandivali (East), Mumbai, 400101, India
| | - Sunil Kuyare
- Apoorva Diagnostic and Healthcare, Kandivali (East), Mumbai, 400101, India
| | - Kritika Patil
- Vedantaa Institute of Medical Sciences, Saswand, Palghar, 401606, India
| | - Amit Yadav
- National Centre for Microbial Resource, National Centre for Cell Science, NCCS Complex, Ganeshkhind, 411007, Pune, India.
| |
Collapse
|
17
|
Sawant NV, Chang SS, Pandit KA, Khekare P, Warner WR, Zimmern PE, De Nisco NJ. VesiX cetylpyridinium chloride is rapidly bactericidal and reduces uropathogenic Escherichia coli bladder epithelial cell invasion in vitro. Microbiol Spectr 2024; 12:e0271223. [PMID: 38240572 PMCID: PMC10913388 DOI: 10.1128/spectrum.02712-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 03/06/2024] Open
Abstract
Management of urinary tract infection (UTI) in postmenopausal women can be challenging. The recent rise in resistance to most of the available oral antibiotic options together with high recurrence rate in postmenopausal women has further complicated treatment of UTI. As such, intravesical instillations of antibiotics like gentamicin are being investigated as an alternative to oral antibiotic therapies. This study evaluates the efficacy of the candidate intravesical therapeutic VesiX, a solution containing the cationic detergent Cetylpyridinium chloride, against a broad range of uropathogenic bacterial species clinically isolated from postmenopausal women with recurrent UTI (rUTI). We also evaluate the cytotoxicity of VesiX against cultured bladder epithelial cells and find that low concentrations of 0.0063% and 0.0125% provide significant bactericidal effect toward diverse bacterial species including uropathogenic Escherichia coli (UPEC), Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, and Proteus mirabilis while minimizing cytotoxic effects against cultured 5637 bladder epithelial cells. Lastly, to begin to evaluate the potential utility of using VesiX in combination therapy with existing intravesical therapies for rUTI, we investigate the combined effects of VesiX and the intravesical antibiotic gentamicin. We find that VesiX and gentamicin are not antagonistic and are able to reduce levels of intracellular UPEC in cultured bladder epithelial cells. IMPORTANCE When urinary tract infections (UTIs), which affect over 50% of women, become resistant to available antibiotic therapies dangerous complications like kidney infection and lethal sepsis can occur. New therapeutic paradigms are needed to expand our arsenal against these difficult to manage infections. Our study investigates VesiX, a Cetylpyridinium chloride (CPC)-based therapeutic, as a candidate broad-spectrum antimicrobial agent for use in bladder instillation therapy for antibiotic-resistant UTI. CPC is a cationic surfactant that is FDA-approved for use in mouthwashes and is used as a food additive but has not been extensively evaluated as a UTI therapeutic. Our study is the first to investigate its rapid bactericidal kinetics against diverse uropathogenic bacterial species isolated from postmenopausal women with recurrent UTI and host cytotoxicity. We also report that together with the FDA-approved bladder-instillation agent gentamicin, VesiX was able to significantly reduce intracellular populations of uropathogenic bacteria in cultured bladder epithelial cells.
Collapse
Affiliation(s)
- Namrata V. Sawant
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - Samuel S. Chang
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - Krutika A. Pandit
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - Prachi Khekare
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | | | - Philippe E. Zimmern
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole J. De Nisco
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
18
|
Pantha S, Parajuli H, Arjyal C, Karki ST, Shrestha D. Phenotypic characterization of ESBL-producing urinary isolates of E. coli and Klebsiella spp. in a tertiary care children's hospital in Nepal. Trop Med Health 2024; 52:20. [PMID: 38424623 PMCID: PMC10905773 DOI: 10.1186/s41182-024-00587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The production of extended-spectrum beta-lactamases (ESBLs) among uropathogens, particularly E. coli and Klebsiella spp., poses a severe public health concern. This study explored the epidemiology of ESBL-producing E. coli and Klebsiella spp. isolated from urine samples obtained at a tertiary care children's hospital in Nepal. METHODS A cross-sectional study was conducted from August 2016 to February 2017. A total of 745 clean catch urine samples were obtained from pediatric patients under the age of 13 and subjected to semiquantitative culture. E. coli and Klebsiella spp. were identified using standard laboratory protocols. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and ESBL producers were phenotypically identified using the combined disk method. RESULTS Among the bacterial isolates, E. coli predominated, accounting for 139 (81.8%) positive cases. Notably, E. coli showed high susceptibility to nitrofurantoin, with 117 (84.2%) isolates being susceptible. Meanwhile, K. pneumoniae showed high susceptibility to gentamicin, with 21 (91.3%) isolates being susceptible. Of the 163 isolates of E. coli and Klebsiella spp., 62 (38.0%) were identified as multidrug-resistant (MDR), with 42 (25.8%) confirmed as phenotypic ESBL producers. Remarkably, all 41 (100%) ESBL-producing E. coli isolates were susceptible to imipenem. CONCLUSIONS The prevalence of ESBL producers among E. coli and K. pneumoniae isolates from pediatric patients underscores the importance of antimicrobial stewardship. Nitrofurantoin and gentamicin emerge as effective empirical treatment choices against these pathogens in children. However, the high rates of multidrug resistance and ESBL production highlight the necessity for routine surveillance, and early detection strategies to manage such infections effectively.
Collapse
Affiliation(s)
- Santosh Pantha
- Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
| | - Hiramani Parajuli
- Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
- Center for Climate and One Health Research (CCOHR), Kathmandu, Nepal
| | - Charu Arjyal
- Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
- Department of Microbiology, Padma Kanya Multiple Campus, Kathmandu, Nepal
| | - Shovana Thapa Karki
- Department of Pathology, International Friendship Children Hospital, Kathmandu, Nepal
| | - Dhiraj Shrestha
- Center for Climate and One Health Research (CCOHR), Kathmandu, Nepal.
- Department of Microbiology, Shi-Gan International College of Science and Technology (SICOST), Kathmandu, Nepal.
| |
Collapse
|
19
|
İlhanlı N, Park SY, Kim J, Ryu JA, Yardımcı A, Yoon D. Prediction of Antibiotic Resistance in Patients With a Urinary Tract Infection: Algorithm Development and Validation. JMIR Med Inform 2024; 12:e51326. [PMID: 38421718 PMCID: PMC10940975 DOI: 10.2196/51326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/17/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The early prediction of antibiotic resistance in patients with a urinary tract infection (UTI) is important to guide appropriate antibiotic therapy selection. OBJECTIVE In this study, we aimed to predict antibiotic resistance in patients with a UTI. Additionally, we aimed to interpret the machine learning models we developed. METHODS The electronic medical records of patients who were admitted to Yongin Severance Hospital, South Korea were used. A total of 71 features extracted from patients' admission, diagnosis, prescription, and microbiology records were used for classification. UTI pathogens were classified as either sensitive or resistant to cephalosporin, piperacillin-tazobactam (TZP), carbapenem, trimethoprim-sulfamethoxazole (TMP-SMX), and fluoroquinolone. To analyze how each variable contributed to the machine learning model's predictions of antibiotic resistance, we used the Shapley Additive Explanations method. Finally, a prototype machine learning-based clinical decision support system was proposed to provide clinicians the resistance probabilities for each antibiotic. RESULTS The data set included 3535, 737, 708, 1582, and 1365 samples for cephalosporin, TZP, TMP-SMX, fluoroquinolone, and carbapenem resistance prediction models, respectively. The area under the receiver operating characteristic curve values of the random forest models were 0.777 (95% CI 0.775-0.779), 0.864 (95% CI 0.862-0.867), 0.877 (95% CI 0.874-0.880), 0.881 (95% CI 0.879-0.882), and 0.884 (95% CI 0.884-0.885) in the training set and 0.638 (95% CI 0.635-0.642), 0.630 (95% CI 0.626-0.634), 0.665 (95% CI 0.659-0.671), 0.670 (95% CI 0.666-0.673), and 0.721 (95% CI 0.718-0.724) in the test set for predicting resistance to cephalosporin, TZP, carbapenem, TMP-SMX, and fluoroquinolone, respectively. The number of previous visits, first culture after admission, chronic lower respiratory diseases, administration of drugs before infection, and exposure time to these drugs were found to be important variables for predicting antibiotic resistance. CONCLUSIONS The study results demonstrated the potential of machine learning to predict antibiotic resistance in patients with a UTI. Machine learning can assist clinicians in making decisions regarding the selection of appropriate antibiotic therapy in patients with a UTI.
Collapse
Affiliation(s)
- Nevruz İlhanlı
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Republic of Korea
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
| | - Se Yoon Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Republic of Korea
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
| | - Jaewoong Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Republic of Korea
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jee An Ryu
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Ahmet Yardımcı
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
| | - Dukyong Yoon
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Republic of Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
- Institute for Innovation in Digital Healthcare, Severance Hospital, Seoul, Republic of Korea
| |
Collapse
|
20
|
Wilkie ED, Ezeani CV, Olasehinde DO, Oyedemi OT, Alao JO, Oluduro AO, Oyetunde OB. Molecular analysis of multidrug-resistant E. coli in pediatric UTIs: findings from a Nigerian Hospital. J Infect Dev Ctries 2024; 18:251-257. [PMID: 38484349 DOI: 10.3855/jidc.18520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/07/2023] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION This study aimed to isolate and characterize antibiotic-resistant Escherichia coli from urine samples of children at the Mother and Child Hospital in Ondo State, Nigeria, assessing antibiogram profiling and resistance genes. METHODOLOGY Three hundred urine samples (158 females, 142 males), aged 3-5 years, were collected, transported on ice, and analyzed bacteriologically. E. coli and Gram-negative bacteria were isolated using Eosin Methylene Blue agar and identified through colony morphology and biochemical tests. Antibiotic susceptibility was determined via Kirby Bauer's disc diffusion, and resistance genes were detected using Polymerase Chain Reaction (PCR). RESULTS Of the 300 samples, 40 (13.3%) yielded E. coli with varying antibiotic resistance profiles. The highest resistance was against Amoxicillin-clavulanate (87.5%) followed by Ceftriaxone (80%). Susceptibility was observed to Nitrofurantoin, Erythromycin, and Chloramphenicol. Multiple resistance patterns against 3-4 antibiotic classes were recorded, with 12 distinct patterns observed. Eight isolates harbored blaCTX-M gene, while five carried the aac3-IV gene. CONCLUSIONS The study concluded a high occurrence of E. coli infection and multiple antibiotic resistance in the region. The presence of resistance genes suggests significant economic and health implications, emphasizing prudent antibiotic use under physician guidance to mitigate multiple antibiotic resistance.
Collapse
|
21
|
Fekri Kohan S, Nouhi Kararoudi A, Bazgosha M, Adelifar S, Hafezolghorani Esfahani A, Ghaderi Barmi F, Kouchakinejad R, Barzegari E, Shahriarinour M, Ranji N. Determining the potential targets of silybin by molecular docking and its antibacterial functions on efflux pumps and porins in uropathogenic E. coli. Int Microbiol 2024:10.1007/s10123-024-00488-9. [PMID: 38363383 DOI: 10.1007/s10123-024-00488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND One of the causes of antibiotic resistance is the reduced accumulation of antibiotics in bacterial cells through pumping out the drugs. Silybin, a key component of the Silybum marianum plant, exhibits various beneficial properties, including anti-bacterial, anti-inflammatory, antioxidant, and hepatoprotective effects. METHODS AND RESULTS Clinical isolates of E. coli were procured from 17 Shahrivar Children's Hospital in Rasht, Guilan, located in northern Iran. Their susceptibility to six antibiotics was assessed using disc diffusion and broth dilution (MIC) methods. The antibacterial effects of silybin-loaded polymersome nanoparticles (SPNs) were investigated with broth dilution (MIC) and biofilm assays. Molecular docking was utilized to evaluate silybin's (the antibacterial component) binding affinity to efflux pumps, porins, and their regulatory elements. Additionally, qRT-PCR analysis explored the expression patterns of acrA, acrB, tolC, ompC, and ompF genes in both SPNs (sub-MIC) and ciprofloxacin (sub-MIC)-treated and untreated E. coli isolates. The combined use of SPNs and ciprofloxacin exhibited a notable reduction in bacterial growth and biofilm formation, in ciprofloxacin-resistant isolates. The study identified eight overlapping binding sites of the AcrABZ-TolC efflux pump in association with silybin, demonstrating a binding affinity ranging from -7.688 to -10.33 Kcal/mol. Furthermore, the qRT-PCR analysis showed that silybin upregulated AcrAB-TolC efflux pump genes and downregulated ompC and ompF porin genes in combination with ciprofloxacin in transcriptional level in uropathogenic E. coli. CONCLUSIONS Silybin, a safe herbal compound, exhibits potential in inhibiting antibiotic resistance within bacterial isolates, potentially through the regulation of gene expression and plausible binding to target proteins.
Collapse
Affiliation(s)
- Shirin Fekri Kohan
- Department of Biology, Faculty of Sciences, Rasht Branch, Islamic Azad University, P.O. Box: 41335-3516, Rasht, Iran
| | - Alireza Nouhi Kararoudi
- Department of Biology, Faculty of Sciences, Lahijan Branch, Islamic Azad University, Rasht, Iran
| | - Maryam Bazgosha
- Department of Biology, Faculty of Sciences, Rasht Branch, Islamic Azad University, P.O. Box: 41335-3516, Rasht, Iran
| | - Somayeh Adelifar
- Department of Biology, Faculty of Sciences, Rasht Branch, Islamic Azad University, P.O. Box: 41335-3516, Rasht, Iran
| | - Arman Hafezolghorani Esfahani
- Department of Biology, Faculty of Sciences, Rasht Branch, Islamic Azad University, P.O. Box: 41335-3516, Rasht, Iran
| | - Fatemeh Ghaderi Barmi
- Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Reyhaneh Kouchakinejad
- Department of Chemistry, Faculty of Sciences, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Ebrahim Barzegari
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Shahriarinour
- Department of Biology, Faculty of Sciences, Rasht Branch, Islamic Azad University, P.O. Box: 41335-3516, Rasht, Iran.
| | - Najmeh Ranji
- Department of Biology, Faculty of Sciences, Rasht Branch, Islamic Azad University, P.O. Box: 41335-3516, Rasht, Iran.
| |
Collapse
|
22
|
Wang W, Yao W, Tang W, Li Y, Sun H, Ding W. Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1360058. [PMID: 38405191 PMCID: PMC10884186 DOI: 10.3389/fmed.2024.1360058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Urinary tract infection (UTI) is a prevalent and consequential complication in hip fracture patients, leading to significant disability and heightened healthcare expenditures. Consequently, there is a critical need for a comprehensive systematic review to identify risk factors and establish early and effective preventive measures. Methods A comprehensive search was performed across the PubMed, Cochrane, Embase, Web of Science, and Scopus databases (up to August 31, 2023). Article screening, data extraction, and quality assessment were independently completed by two reviewers. Results Forty-four studies were eligible for inclusion, yielding an overall incidence rate of 11% (95% CI: 8%-14%). Our pooled analysis revealed 18 significant risk factors, including being female (OR = 2.23, 95% CI: 1.89-2.63), advanced age (MD = 1.35, 95% CI: 0.04-2.66), obesity (OR = 1.21, 95% CI: 1.11-1.31), catheterization (OR = 3.8, 95% CI: 2.29-6.32), blood transfusion (OR = 1.39, 95% CI: 1.21-1.58), American Society of Anesthesiologists ≥III (OR = 1.28, 95% CI: 1.18-1.40), general anesthesia (OR = 1.26, 95% CI: 1.11-1.43), intertrochanteric fracture (OR = 1.25, 95% CI: 1.01-1.54), hemiarthroplasty (OR = 1.43, 95% CI: 1.19-1.69), prolonged length of hospital stay (MD = 1.44, 95% CI: 0.66-2.23), delirium (OR = 2.66, 95% CI: 2.05-3.47), dementia (OR = 1.82, 95% CI: 1.62-2.06), Parkinson's disease (OR = 1.53, 95% CI: 1.46-1.61), diabetes (OR = 1.27, 95% CI: 1.13-1.43), hypertension (OR = 1.14, 95% CI: 1.03-1.26), congestive heart failure (OR = 1.35, 95% CI: 1.10-1.66), history of sepsis (OR = 7.13, 95% CI: 5.51-9.22), and chronic steroid use (OR = 1.29, 95% CI: 1.06-1.57). Conclusion Our study identifies numerous risk factors strongly associated with UTI, offering compelling evidence and actionable strategies for improving clinical prediction, enabling early intervention, and facilitating targeted UTI management. Systematic review registration identifier [CRD42023459600], https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600.
Collapse
Affiliation(s)
| | | | | | | | - Hongbo Sun
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| |
Collapse
|
23
|
Jebbia M, Gupta S, Klamer BG, Pavlek L, Ching CB, Mohamed TH, Becknell B. Concentration of novel urinary tract infection biomarkers in neonates. Sci Rep 2024; 14:2996. [PMID: 38316971 PMCID: PMC10844638 DOI: 10.1038/s41598-024-53486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
Urinary tract infections (UTIs) are a common comorbidity in hospitalized neonates. The current UTI diagnostics have several limitations including invasive collection of urinary samples to ensure sterility, risk of contamination and lack of consensus definitions of UTI based on urine culture. Antimicrobial peptides (AMPs) have been recently utilized as novel biomarkers that can efficiently and accurately diagnose pediatric UTI. However, the concentration of AMPs in neonatal urine is not well-defined. Urine from neonates admitted to a single level IV neonatal intensive care unit was obtained to determine baseline concentration of two AMPs, Ribonuclease 7 (RNase 7) and Beta Defensin-1 (BD-1) and to define the relationship between AMP concentration and gestational age (GA). AMP levels were normalized to urine creatinine. RNase 7 and BD-1 were expressed in neonatal urine (n = 66) regardless of GA and as early as 22 weeks gestation. Urinary concentrations of both AMPs decreased as GA and birthweight increased. The overall median urinary RNase 7/UCr and BD-1/UCr values were 271 ng/mg, and 116 ng/mg, respectively. Median urinary concentrations of RNase 7/UCr for infants born at < 27, 27-32, 33-35 and ≥ 36 weeks were 569, 308, 254, and 124 ng/mg respectively. Similarly, the concentrations of BD-1/UCr at these GA were 166, 115, 108, and 14 ng/mg, respectively. Baseline neonatal urinary concentration of two AMPs (RNase 7 and BD-1) and the variation by GA were identified. This is an essential first step toward the potential utilization of AMPs in improving neonatal UTI diagnostics.
Collapse
Affiliation(s)
- Maria Jebbia
- The Kidney and Urinary Tract Center at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA
- Division of Perinatal Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sudipti Gupta
- The Kidney and Urinary Tract Center at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA
- Center for Clinical and Translational Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Brett G Klamer
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Leeann Pavlek
- Division of Perinatal Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina B Ching
- The Kidney and Urinary Tract Center at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA
- Center for Clinical and Translational Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Pediatric Urology, Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tahagod H Mohamed
- The Kidney and Urinary Tract Center at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA.
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Brian Becknell
- The Kidney and Urinary Tract Center at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA
- Center for Clinical and Translational Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
24
|
Grygorcewicz B, Gliźniewicz M, Jabłońska J, Augustyniak A, Olszewska P, Wojciuk B, Miłek D, Serwin N, Czajkowski A, Cecerska-Heryć E, Rakoczy R, Cymbaluk-Płoska A. Bacteriophage-based approach for treatment of urinary tract infections: a quick outlook. APMIS 2024; 132:81-93. [PMID: 38031200 DOI: 10.1111/apm.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections affecting millions worldwide. The increasing emergence of antibiotic-resistant bacteria has become a serious concern in managing UTIs. Therefore, there is a growing interest in using bacteriophages as an alternative or adjunct therapy for UTIs. Bacteriophages are viruses that infect and kill bacteria, making them a promising tool for treating UTIs caused by antibiotic-resistant bacteria. This article provides a quick outlook on using bacteriophages to treat UTIs. We summarize the current understanding of the biology of bacteriophages, the challenges associated with developing phage-based therapies, and the promising results of several case reports and clinical trials. We also highlight the potential of phage therapy as a valuable tool in the fight against antibiotic-resistant UTIs. This quick outlook on a bacteriophage-based approach for treating UTIs offers a timely and informative summary of the current research in this field.
Collapse
Affiliation(s)
- Bartłomiej Grygorcewicz
- Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
- Department of Chemical and Process Engineering, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology, Szczecin, Szczecin, Poland
| | - Marta Gliźniewicz
- Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Joanna Jabłońska
- Department of Chemical and Process Engineering, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology, Szczecin, Szczecin, Poland
| | - Adrian Augustyniak
- Department of Chemical and Process Engineering, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology, Szczecin, Szczecin, Poland
- Chair of Building Materials and Construction Chemistry, Technische Universität Berlin, Germany, Berlin, Germany
- Institute of Biology, University of Szczecin, Szczecin, Poland
| | - Patrycja Olszewska
- Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Bartosz Wojciuk
- Department of Immunology Diagnostics, Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Dominika Miłek
- Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Natalia Serwin
- Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Artur Czajkowski
- Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Elżbieta Cecerska-Heryć
- Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
- Department of Chemical and Process Engineering, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology, Szczecin, Szczecin, Poland
| | - Rafał Rakoczy
- Department of Chemical and Process Engineering, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology, Szczecin, Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| |
Collapse
|
25
|
Aksu B, Afonso AC, Akil I, Alpay H, Atmis B, Aydog O, Bayazıt AK, Bayram MT, Bilge I, Bulut IK, Buyukkaragoz B, Comak E, Demir BK, Dincel N, Donmez O, Durmus MA, Dursun H, Dusunsel R, Duzova A, Ertan P, Gedikbasi A, Goknar N, Guven S, Hacihamdioglu D, Jankauskiene A, Kalyoncu M, Kavukcu S, Kenan BU, Kucuk N, Kural B, Litwin M, Montini G, Morello W, Obrycki L, Omer B, Oner HA, Ozdemir EM, Ozkayin N, Paripovic D, Pehlivanoglu C, Saygili S, Schaefer F, Schaefer S, Sonmez F, Tabel Y, Tas N, Tasdemir M, Teixeira A, Tekcan D, Topaloglu R, Tulpar S, Turkkan ON, Uysal B, Uysalol M, Vitkevic R, Yavuz S, Yel S, Yildirim T, Yildirim ZY, Yildiz N, Yuksel S, Yurtseven E, Yilmaz A. Urine soluble TLR4 levels may contribute to predict urinary tract infection in children: the UTILISE Study. Pediatr Nephrol 2024; 39:483-491. [PMID: 37462743 DOI: 10.1007/s00467-023-06063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND One of the most common bacterial infections in childhood is urinary tract infection (UTI). Toll-like receptors (TLRs) contribute to immune response against UTI recognizing specific pathogenic agents. Our aim was to determine whether soluble TLR4 (sTLR4), soluble TLR5 (sTLR5) and interleukin 8 (IL-8) can be used as biomarkers to diagnose UTI. We also aimed to reveal the relationship between urine Heat Shock Protein 70 (uHSP70) and those biomarkers investigated in this study. METHODS A total of 802 children from 37 centers participated in the study. The participants (n = 282) who did not meet the inclusion criteria were excluded from the study. The remaining 520 children, including 191 patients with UTI, 178 patients with non-UTI infections, 50 children with contaminated urine samples, 26 participants with asymptomatic bacteriuria and 75 healthy controls were included in the study. Urine and serum levels of sTLR4, sTLR5 and IL-8 were measured at presentation in all patients and after antibiotic treatment in patients with UTI. RESULTS Urine sTLR4 was higher in the UTI group than in the other groups. UTI may be predicted using 1.28 ng/mL as cut-off for urine sTLR4 with 68% sensitivity and 65% specificity (AUC = 0.682). In the UTI group, urine sTLR4 levels were significantly higher in pyelonephritis than in cystitis (p < 0.0001). Post-treatment urine sTLR4 levels in the UTI group were significantly lower than pre-treatment values (p < 0.0001). CONCLUSIONS Urine sTLR4 may be used as a useful biomarker in predicting UTI and subsequent pyelonephritis in children with UTI. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Bagdagul Aksu
- Department of Pediatrics Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey.
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey.
| | - Alberto Caldas Afonso
- Division of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ipek Akil
- Division of Pediatric Nephrology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Harika Alpay
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bahriye Atmis
- Pediatric Nephrology, Erzurum Training and Research Hospital, Erzurum, Turkey
- Division of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ozlem Aydog
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Aysun Karabay Bayazıt
- Division of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Meral Torun Bayram
- Division of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ilmay Bilge
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Koc University, Istanbul, Turkey
| | - Ipek Kaplan Bulut
- Division of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Bahar Buyukkaragoz
- Division of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Elif Comak
- Division of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Belde Kasap Demir
- Division of Pediatric Nephrology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Division of Pediatric Nephrology, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Nida Dincel
- Division of Pediatric Nephrology, Dr. Behcet Uz Children Diseases Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Osman Donmez
- Division of Pediatric Nephrology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Mehmet Akif Durmus
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasan Dursun
- Division of Pediatric Nephrology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ruhan Dusunsel
- Division of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Ertan
- Division of Pediatric Nephrology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Asuman Gedikbasi
- Department of Rare Diseases, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Nilufer Goknar
- Division of Pediatric Nephrology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sercin Guven
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Duygu Hacihamdioglu
- Division of Pediatric Nephrology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Mukaddes Kalyoncu
- Division of Pediatric Nephrology, Faculty of Medicine, Karadeniz Technic University, Trabzon, Turkey
| | - Salih Kavukcu
- Division of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Bahriye Uzun Kenan
- Division of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nuran Kucuk
- Division of Pediatric Nephrology, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Bahar Kural
- Department of Pediatrics, Health Science University Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mieczysław Litwin
- Division of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Lukasz Obrycki
- Division of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Beyhan Omer
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Adil Oner
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ebru Misirli Ozdemir
- Department of Pediatrics, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Nese Ozkayin
- Division of Pediatric Nephrology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Dusan Paripovic
- Division of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
| | - Cemile Pehlivanoglu
- Division of Pediatric Nephrology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Seha Saygili
- Division of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Susanne Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Ferah Sonmez
- Division of Pediatric Nephrology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Yilmaz Tabel
- Division of Pediatric Nephrology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Nesrin Tas
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Tasdemir
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Koc University, Istanbul, Turkey
- Department of Pediatric Nephrology, Istinye University, Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Ana Teixeira
- Division of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Demet Tekcan
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sebahat Tulpar
- Division of Pediatric Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozde Nisa Turkkan
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Berfin Uysal
- Division of Pediatric Nephrology, Dortcelik Children's Hospital, Bursa, Turkey
- Division of Pediatric Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Metin Uysalol
- Division of Pediatric Emergency, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Renata Vitkevic
- Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Sevgi Yavuz
- Division of Pediatric Nephrology, Department of Pediatrics, Kanuni Sultan Suleyman Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sibel Yel
- Division of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Tarik Yildirim
- Department of Pediatrics, Kanuni Sultan Suleyman Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Yuruk Yildirim
- Department of Pediatrics Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Nurdan Yildiz
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Selcuk Yuksel
- Division of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Eray Yurtseven
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alev Yilmaz
- Department of Pediatrics Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| |
Collapse
|
26
|
Negi SK, Vyas N, Desai S, Faujdar G, Priyadarshi S. Prevalence of LUTS in young female population attending tertiary care centre. Urologia 2024; 91:207-211. [PMID: 37933829 DOI: 10.1177/03915603231210350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To obtain the prevalence of lower urinary tract symptoms (LUTS) in young female population in tertiary care centre. METHOD We conducted a descriptive and analytic study with ques tionnaire based data collection. All subjects were interviewed using conventional method and International Consultation on Incontinence Questionnaire (ICIQ) Female LUTS form in the urology outpatient department, SMS medical college and hospital, Jaipur (India). RESULT Total 1278 patients enrolled in study. Using the well-structured questionnaire using ICIQ-FLUTS form, the prevalence of LUTS was 78.01% while conventional method having only 35.8%. This result revealed that LUTS is a common condition among young Indian female population with vaginal delivery as the common risk factor. CONCLUSION Screening for LUTS using a structured questionnaire identified a significantly higher prevalence of LUTS than the conventional method. The ICIQ-FLUTS form is a robust questionnaire that can be recommended for use in epidemiological research as well as routine clinical practice.
Collapse
Affiliation(s)
| | - Nachiket Vyas
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sandip Desai
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
| | - Gaurav Faujdar
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
| | | |
Collapse
|
27
|
Melnyk AI, Meckes N, Zyczynski HM, Grosse PJ, Guirguis M, Bradley MS. Antibiotic utilization and symptom improvement in a retrospective cohort of women with urinary tract infection symptoms. Int Urogynecol J 2024; 35:355-361. [PMID: 37962630 PMCID: PMC10922484 DOI: 10.1007/s00192-023-05676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary tract infections (UTIs) are one of the most common bacterial infections in women. We hypothesized that over half of those treated empirically would receive inappropriate antibiotics, those treated expectantly would have lower symptom improvement without antibiotics, and that overall progression to sequelae would be uncommon. METHODS In this retrospective cohort study of women with UTI symptoms, we quantified the proportion who received inappropriate antibiotics in those treated empirically, defined as those with a negative urine culture or antibiotics that were changed according to culture sensitivities, and identified factors associated with symptom improvement during expectant management. Secondarily, we sought to determine the proportion of UTI sequelae in both groups. During the study time frame, a modified UTI Symptom Assessment (UTISA) questionnaire was administered at baseline and again, with a global rating for change instrument, when urine culture results were relayed. RESULTS Analyses included 152 women, mean age 66.5 (SD 15.0) years, 30 (20%) received empiric antibiotics, and 122 (80%) expectant management. At baseline, the empiric group reported greater mean scores for dysuria (p < 0.01), urgency (p < 0.01), frequency (p < 0.01), and incomplete emptying (p < 0.01). Positive culture results were reported for 16 (53%) in the empiric group and 72 (59%) in the expectant group. Inappropriate antibiotics were prescribed to 18 (60%) of the empiric group. A negative urine culture was associated with improvement in symptoms in the expectant group. No subjects experienced UTI sequelae within 30 days of initial evaluation. CONCLUSION In our cohort of older women with UTI symptoms, deferring antibiotics until urine culture resulted appeared to be safe and decreased the use of inappropriate antibiotics.
Collapse
Affiliation(s)
- Alexandra I Melnyk
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Medical Education, Pittsburgh, PA, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA.
| | - Nicole Meckes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Medical Education, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Halina M Zyczynski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Philip J Grosse
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marina Guirguis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Medical Education, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Megan S Bradley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| |
Collapse
|
28
|
Gunathilaka GADKK, Dewasmika WAPM, Sandaruwan UM, Neelawala NGDAK, Madhumali GED, Dissanayake BN, Priyantha MAR, Prasada DVP, Dissanayake DRA. Biofilm-forming ability, antibiotic resistance and phylogeny of Escherichia coli isolated from extra intestinal infections of humans, dogs, and chickens. Comp Immunol Microbiol Infect Dis 2024; 105:102123. [PMID: 38217950 DOI: 10.1016/j.cimid.2023.102123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024]
Abstract
Escherichia coli (E. coli) causes various infections in humans and animals. The biofilm-forming ability of E. coli has increased antimicrobial resistance and capacity to cause recurrent and chronic infections. This study determined the biofilm-forming ability of E. coli isolated from extraintestinal infections of humans, chickens, and dogs in relation to the phylogroup, type of infection, and antibiotic resistance. Isolates from chickens showed significantly higher biofilm-forming ability compared to those causing urinary tract infections in humans (p = 0.0001). Further, isolates belonging to phylogroup B1 displayed a higher likelihood to form biofilms. Resistance to ciprofloxacin and trimethoprim-sulfamethoxazole was positively correlated with biofilm-forming ability. Harbouring plasmid-mediated quinolone resistance gene, qnrS was also positively correlated with biofilm formation. This study provides insight into factors such as phylogroup and the type of infections that could enhance biofilm formation, as well as genotypic and phenotypic antibiotic resistance that could correlate with the ability to form biofilms.
Collapse
Affiliation(s)
- G A D K K Gunathilaka
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - W A P M Dewasmika
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - U M Sandaruwan
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - N G D A K Neelawala
- Department of Basic Sciences, Faculty of Allied Health Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - G E D Madhumali
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - B N Dissanayake
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - D V P Prasada
- Faculty of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
| | - D R A Dissanayake
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka.
| |
Collapse
|
29
|
Bologna E, Licari LC, Manfredi C, Ditonno F, Cirillo L, Fusco GM, Abate M, Passaro F, Di Mauro E, Crocetto F, Pandolfo SD, Aveta A, Cilio S, Di Filippo I, Barone B, Franco A, Arcaniolo D, La Rocca R, Pinchera B, Napolitano L. Carbapenem-Resistant Enterobacteriaceae in Urinary Tract Infections: From Biological Insights to Emerging Therape utic Alternatives. Medicina (Kaunas) 2024; 60:214. [PMID: 38399502 PMCID: PMC10889937 DOI: 10.3390/medicina60020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Urinary tract infections (UTIs) are the second most frequent type of infection observed in clinical practice. Gram-negative Enterobacteriaceae are common pathogens in UTIs. Excessive antibiotic use in humans and animals, poor infection control, and increased global travel have accelerated the spread of multidrug-resistant strains (MDR). Carbapenem antibiotics are commonly considered the last line of defense against MDR Gram-negative bacteria; however, their efficacy is now threatened by the increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE). This comprehensive review aims to explore the biological mechanisms underlying carbapenem resistance and to present a focus on therapeutic alternatives currently available for complicated UTIs (cUTIs). A comprehensive bibliographic search was conducted on the PubMed/MEDLINE, Scopus, and Web of Science databases in December 2023. The best evidence on the topic was selected, described, and discussed. Analyzed with particular interest were the clinical trials pivotal to the introduction of new pharmacological treatments in the management of complicated cUTIs. Additional suitable articles were collected by manually cross-referencing the bibliography of previously selected papers. This overview provides a current and comprehensive examination of the treatment options available for CRE infections, offering a valuable resource for understanding this constantly evolving public health challenge.
Collapse
Affiliation(s)
- Eugenio Bologna
- Unit of Urology, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University, 00161 Rome, Italy; (E.B.); (L.C.L.)
| | - Leslie Claire Licari
- Unit of Urology, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University, 00161 Rome, Italy; (E.B.); (L.C.L.)
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Francesco Ditonno
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37100 Verona, Italy;
| | - Luigi Cirillo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Giovanni Maria Fusco
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Marco Abate
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Francesco Passaro
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Ernesto Di Mauro
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Felice Crocetto
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
- Department of Urology, University of L’Aquila, 67010 L’Aquila, Italy
| | - Achille Aveta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Isabella Di Filippo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, 80131 Naples, Italy; (I.D.F.); (B.P.)
| | - Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | - Antonio Franco
- Department of Urology, Sant’Andrea Hospital, “Sapienza” University, 00189 Rome, Italy;
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Roberto La Rocca
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, 80131 Naples, Italy; (I.D.F.); (B.P.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| |
Collapse
|
30
|
Paudel S, Kumar R, Rogers KA, Saini Y, Patial S, Kulkarni R. The NLRP3 Inflammasome Is Dispensable in Methicillin-Resistant Staphylococcus aureus Urinary Tract Infection. Pathogens 2024; 13:106. [PMID: 38392844 PMCID: PMC10893321 DOI: 10.3390/pathogens13020106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
The NLRP3 inflammasome is a cytoplasmic complex that senses molecular patterns from pathogens or damaged cells to trigger an innate immune defense response marked by the production of proinflammatory cytokines IL-1β and IL-18 and an inflammatory death called pyroptosis. The NLRP3 inflammasome is activated in the urinary tract by a variety of infectious and non-infectious insults. In this study, we investigated the role of the NLRP3 inflammasome by comparing the pathophysiology of methicillin-resistant Staphylococcus aureus (MRSA) ascending UTI in wild-type (WT) and Nlrp3-/- mice. The difference in the bacterial burden detected in the urinary tracts of MRSA-infected WT and Nlrp3-/- was not statistically significant at 6, 24, and 72 h post-infection (hpi). The levels of pro-inflammatory cytokines and chemokines as well as the numbers of granulocytes recruited to bladder and kidney tissues at 24 hpi were also similar between Nlrp3-/- and WT mice. The histopathological analysis of MRSA-infected bladder and kidney sections from Nlrp3-/- and WT mice showed similar inflammation. Overall, these results suggest that MRSA-induced urinary NLRP3 activity does not play a role in the pathophysiology of the ascending UTI.
Collapse
Affiliation(s)
- Santosh Paudel
- Department of Biology, University of Louisiana at Lafayette, Lafayette, LA 70504, USA;
| | - Rahul Kumar
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Kenneth A. Rogers
- New Iberia Research Center, University of Louisiana at Lafayette, Lafayette, LA 70560, USA
| | - Yogesh Saini
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Sonika Patial
- National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, Durham, NC 27709, USA
| | - Ritwij Kulkarni
- Department of Biology, University of Louisiana at Lafayette, Lafayette, LA 70504, USA;
| |
Collapse
|
31
|
Haley E, Luke N, Mathur M, Festa RA, Wang J, Jiang Y, Anderson LA, Baunoch D. The Prevalence and Association of Different Uropathogens Detected by M-PCR with Infection-Associated Urine Biomarkers in Urinary Tract Infections. Res Rep Urol 2024; 16:19-29. [PMID: 38221993 PMCID: PMC10787514 DOI: 10.2147/rru.s443361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024] Open
Abstract
Background Many emerging uropathogens are currently identified by multiplex polymerase chain reaction (M-PCR) in suspected UTI cases. Standard urine culture (SUC) has significantly lower detection rates, raising questions about whether these organisms are associated with UTIs and truly cause inflammation. Objective To determine if microbes detected by M-PCR were likely causative of UTI by measuring inflammatory biomarkers in the urine of symptomatic patients. Design Setting and Participants Midstream voided urine was collected from subjects ≥60 years presenting to urology clinics with symptoms of UTI (n = 1132) between 01/2023 and 05/2023. Microbe detection was by M-PCR and inflammation-associated biomarker (neutrophil gelatinase-associated lipocalin, interleukin 8, and interleukin 1β) was by enzyme-linked immunosorbent assay. Biomarker positivity was measured against individual and groups of organisms, E. coli and non-E. coli cases, emerging uropathogens, monomicrobial and polymicrobial cases. Outcome Measurements and Statistical Analysis Distributions were compared using 2-sample Wilcoxon Rank Sum test with 2-tailed p-values < 0.05 considered statistically significant. Results and Limitations M-PCR was positive in 823 (72.7%) specimens with 28 of 30 (93%) microorganisms/groups detected. Twenty-six of twenty-eight detected microorganisms/groups (93%) had ≥2 biomarkers positive in >66% of cases. Both non-E. coli cases and E. coli cases had significant biomarker positivity (p < 0.05). Limitations were that a few organisms had low prevalence making inferences about their individual significance difficult. Conclusion The majority of microorganisms identified by M-PCR were associated with active inflammation measured by biomarker positivity, indicating they are likely causative of UTIs in symptomatic patients. This includes emerging uropathogens frequently not detected by standard urine culture.
Collapse
Affiliation(s)
- Emery Haley
- Department of Clinical Research, Pathnostics, Irvine, CA, USA
| | - Natalie Luke
- Department of Clinical Research, Pathnostics, Irvine, CA, USA
| | - Mohit Mathur
- Department of Medical Affairs, Pathnostics, Irvine, CA, USA
| | - Richard A Festa
- Department of Research and Development, Pathnostics, Irvine, CA, USA
| | - Jimin Wang
- Department of Statistical Analysis, Stat4Ward, Pittsburgh, PA, USA
| | - Yan Jiang
- Department of Statistical Analysis, Stat4Ward, Pittsburgh, PA, USA
| | - Lori A Anderson
- L.Anderson Diagnostic Market Access Consulting, San Diego, CA, USA
| | - David Baunoch
- Department of Research and Development, Pathnostics, Irvine, CA, USA
| |
Collapse
|
32
|
Joshi CS, Salazar AM, Wang C, Ligon MM, Chappidi RR, Fashemi BE, Felder PA, Mora A, Grimm SL, Coarfa C, Mysorekar IU. D-Mannose reduces cellular senescence and NLRP3/GasderminD/IL-1β-driven pyroptotic uroepithelial cell shedding in the murine bladder. Dev Cell 2024; 59:33-47.e5. [PMID: 38101412 PMCID: PMC10872954 DOI: 10.1016/j.devcel.2023.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 07/24/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
Aging is a risk factor for disease via increased susceptibility to infection, decreased ability to maintain homeostasis, inefficiency in combating stress, and decreased regenerative capacity. Multiple diseases, including urinary tract infection (UTI), are more prevalent with age; however, the mechanisms underlying the impact of aging on the urinary tract mucosa and the correlation between aging and disease remain poorly understood. Here, we show that, relative to young (8-12 weeks) mice, the urothelium of aged (18-24 months) female mice accumulates large lysosomes with reduced acid phosphatase activity and decreased overall autophagic flux in the aged urothelium, indicative of compromised cellular homeostasis. Aged bladders also exhibit basal accumulation of reactive oxygen species (ROS) and a dampened redox response, implying heightened oxidative stress. Furthermore, we identify a canonical senescence-associated secretory phenotype (SASP) in the aged urothelium, along with continuous NLRP3-inflammasome- and Gasdermin-D-dependent pyroptotic cell death. Consequently, aged mice chronically exfoliate urothelial cells, further exacerbating age-related urothelial dysfunction. Upon infection with uropathogenic E. coli, aged mice harbor increased bacterial reservoirs and are more prone to spontaneous recurrent UTI. Finally, we discover that treatment with D-mannose, a natural bioactive monosaccharide, rescues autophagy flux, reverses the SASP, and mitigates ROS and NLRP3/Gasdermin/interleukin (IL)-1β-driven pyroptotic epithelial cell shedding in aged mice. Collectively, our results demonstrate that normal aging affects bladder physiology, with aging alone increasing baseline cellular stress and susceptibility to infection, and suggest that mannose supplementation could serve as a senotherapeutic to counter age-associated urothelial dysfunction.
Collapse
Affiliation(s)
- Chetanchandra S Joshi
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
| | - Arnold M Salazar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
| | - Caihong Wang
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Marianne M Ligon
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rayvanth R Chappidi
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Bisiayo E Fashemi
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Paul A Felder
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Amy Mora
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sandra L Grimm
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Cristian Coarfa
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Indira U Mysorekar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA; Huffington Center of Aging, Baylor College of Medicine, Houston, TX 77030, USA.
| |
Collapse
|
33
|
Patel J, Politis MD, Howley MM, Browne ML, Bolin EH, Ailes EC, Johnson CY, Magann E, Nembhard WN. Fever and antibiotic use in maternal urinary tract infections during pregnancy and risk of congenital heart defects: Findings from the National Birth Defects Prevention Study. Birth Defects Res 2024; 116:e2281. [PMID: 38093546 DOI: 10.1002/bdr2.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/21/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Previous studies report an association between prenatal maternal urinary tract infections (UTI) and specific congenital heart defects (CHDs); however, the role of fever and antibiotic use on this association is poorly understood. Using data from the National Birth Defects Prevention Study, we examined whether the relationship between maternal UTIs during the periconceptional period and occurrence of CHDs is modified by the presence of fever due to UTI and corresponding antibiotic use among 11,704 CHD case infants and 11,636 live-born control infants. METHODS Information on UTIs, fever associated with UTI and antibiotic use (sulfonamides, nitrofurantoin, cephalosporins, penicillin, macrolides, and quinolones) during pregnancy were obtained using a computer-assisted telephone interview. Using unconditional multivariable logistic regression, we calculated adjusted odds ratios (ORs) to determine the association between maternal UTIs and subtypes of CHDs. Analyses were stratified by the presence of fever and medication use associated with UTI. RESULTS The prevalence of UTIs during the periconceptional period was 7.6% in control mothers, and 8.7% in case mothers. In the absence of fever, UTI was associated with secundum atrial septal defects (ASD) (OR 1.3; 95% confidence interval [CI] 1.1-1.5) and in the absence of antibiotics, UTI was associated with conotruncal defects as a group and for four specific CHDs. When fever and UTI occurred concomitantly, no significantly elevated odds ratios were noticed for any subtypes of CHD. Among women with UTIs who used antibiotics, an elevated but statistically non-significant estimate was observed for secundum ASD (OR 1.4; 95% CI 1.0-2.0). CONCLUSION Findings in the present study suggest that fever due to UTI and corresponding maternal antibiotic use do not substantially modify the association between maternal UTIs and specific CHDs in offspring. Further studies with larger sample sizes are warranted to guide clinical management of UTIs during the periconceptional period.
Collapse
Affiliation(s)
- Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maria D Politis
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Marilyn L Browne
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Elijah H Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Everett Magann
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
34
|
Nityadarshini N, Mohapatra S, Das BK, Gautam H, Sood S, Dhawan B. A Quality Improvement (QI) initiative in diagnostic stewardship of urine culture in an era of Laboratory Information Systems (LIS). Trop Doct 2024; 54:7-8. [PMID: 37844878 DOI: 10.1177/00494755231207122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Standard urine culture is the gold standard for diagnosing urinary tract infections (UTIs) but fails to differentiate true UTI from asymptomatic bacteriuria, which is important to prevent the overuse of antibiotics. Correlation with the presence or absence of pyuria can be helpful in giving a hint of the true situation. With the help of Laboratory Information System (LIS), patients' urinalysis reports can be conveniently accessed and compared simultaneously with appropriate reports. In our study, a quality improvement initiative was planned for appropriate reporting of urine culture and antimicrobial susceptibility testing using information obtained through LIS.
Collapse
Affiliation(s)
- Neha Nityadarshini
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal Kumar Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
35
|
Hartinger JM, Dvořáčková E, Krátký V, Hrušková Z, Mysliveček M, Bobek D, Benáková H, Závora J, Kroneislová G, Halouzková BA, Brejníková M, Martínková V, Tesař V, Slanař O. Elimination and penetration of amikacin into urine in patients with decreased glomerular filtration rate. Clin Kidney J 2024; 17:sfae002. [PMID: 38260825 PMCID: PMC10802929 DOI: 10.1093/ckj/sfae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Background Amikacin monotherapy is recommended for urinary tract infection (UTI) treatment with multi-resistant pathogens. Even though amikacin efficacy in the treatment of UTIs is dependent on its urinary concentration, there are no robust data proving that sufficiently high urinary concentration is reached in patients with reduced glomerular filtration rate (GFR). Methods A prospective study to monitor amikacin penetration into urine of 70 patients [40 males, median (interquartile range) age 70 (65-79) years] with different levels of glomerular filtration decline, including patients treated by dialysis, was conducted. The bactericidal efficacy of amikacin in urine samples has been evaluated. Results Patients with estimated GFR (eGFR) <30 mL/min had significantly lower median amikacin urinary concentration than patients with eGFR >30 mL/min (89.75 vs 186.0 mg/L, P < .0001; 200.5 vs 830.0 mg/L, P < .0001; and 126.0 vs 408.0 mg/L, P < .0001 for minimal, maximal and minimal together with maximal concentrations, respectively). The amount of amikacin eliminated in the first 10-13 h after dose administration was dependent on eGFR (r2 = 0.6144, P < .0001). The urinary concentration of amikacin in patients treated by dialysis was indirectly proportional to pH of urine. The plasma concentrations of amikacin did not correlate with urinary levels in patients in either of the GFR categories. Microbiological evaluation showed that the critical urinary concentration for efficacy of amikacin during UTI monotherapy in patients treated by dialysis is 100 mg/L. We found that 4 out of 11 patients treated by dialysis did not reach this level during the treatment. Conclusion Systemic administration of amikacin monotherapy in patients treated by dialysis is questionable as the concentrations of amikacin in their urine are often below the threshold of effectivity. Amikacin plasma concentrations are not a major determinant of amikacin concentration in urine, therefore pulse dosing is neither necessary nor safe in patients treated by dialysis, and may cause undesirable toxicity.
Collapse
Affiliation(s)
- Jan Miroslav Hartinger
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Eliška Dvořáčková
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Vojtěch Krátký
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Zdenka Hrušková
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Marek Mysliveček
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Daniel Bobek
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Hana Benáková
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Závora
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Gabriela Kroneislová
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Barbora Agatha Halouzková
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martina Brejníková
- 3rd Department of Surgery, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vendula Martínková
- 3rd Department of Surgery, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vladimír Tesař
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ondřej Slanař
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| |
Collapse
|
36
|
Alenazi AM, Taher IA, Taha AE, Elawamy WE, Alshlash AS, El-Masry EA, Ghazy AA. Pregnancy-associated asymptomatic bacteriuria and antibiotic resistance in the Maternity and Children's Hospital, Arar, Saudi Arabia. J Infect Dev Ctries 2023; 17:1740-1747. [PMID: 38252724 DOI: 10.3855/jidc.18184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/09/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The Ministry of Health in Saudi Arabia provides comprehensive antenatal care for all pregnant women with all required investigations. However, it does not include urine culture for diagnosis of asymptomatic bacteriuria (ASB). This is the first study to evaluate the prevalence of ASB among pregnant females, identify the causative organisms and determine their antibiotic susceptibility patterns in the Maternity and Children's Hospital, Arar, Saudi Arabia. METHODOLOGY This cross-sectional study included 400 pregnant women attending an antenatal clinic. Two midstream urine samples were aseptically collected and screened using standard microbiological techniques including microscopic examination, dipstick testing, and urine culture. In order to interpret the urine culture results, ≥ 105 CFUs/mL was considered significant bacteriuria. Identification of the isolates and their antibiotic sensitivity testing was performed using the Vitek 2 system (BioMérieux, Marcy l'Etoile, France) with the available test kits. RESULTS The prevalence of ASB was 8.25% (35/400). Significant positive correlations (p ˂ 0.05) were detected between positive urine culture results and random blood sugar, leucocytes, nitrites, pus cells, urine red blood cells, epithelial cells, and mucus. Escherichia coli was the most common causative organism (45.7%), followed by Staphylococcus aureus (22.9%). Klebsiella pneumoniae represented 11.4% of the isolates. Most of the isolated Gram-positive organisms were sensitive to many of the tested antibiotics; most of the detected Gram-negative isolates were resistant. CONCLUSIONS ASB caused by antibiotic resistant organisms is alarming. Screening for ASB during pregnancy using urine culture and sensitivity testing is of vital importance to improve the maternal and neonatal outcome.
Collapse
Affiliation(s)
- Amjad M Alenazi
- Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ibrahim A Taher
- Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ahmed E Taha
- Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Waleed E Elawamy
- Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ahmed S Alshlash
- Department of Surgery, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Eman A El-Masry
- Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Amany A Ghazy
- Department of Microbiology and Immunology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt The work was conducted at the Arar Maternal and Children's Hospital, Northern Borders, Saudi Arabia, and the Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Saudi Arabia
| |
Collapse
|
37
|
Uttam I, Sudarsan S, Ray R, Chinnappan R, Yaqinuddin A, Al-Kattan K, Mani NK. A Hypothetical Approach to Concentrate Microorganisms from Human Urine Samples Using Paper-Based Adsorbents for Point-of-Care Molecular Assays. Life (Basel) 2023; 14:38. [PMID: 38255653 PMCID: PMC10820215 DOI: 10.3390/life14010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
This hypothesis demonstrates that the efficiency of loop-mediated isothermal amplification (LAMP) for nucleic acid detection can be positively influenced by the preconcentration of microbial cells onto hydrophobic paper surfaces. The mechanism of this model is based on the high affinity of microbes towards hydrophobic surfaces. Extensive studies have demonstrated that hydrophobic surfaces exhibit enhanced bacterial and fungal adhesion. By exploiting this inherent affinity of hydrophobic paper substrates, the preconcentration approach enables the adherence of a greater number of target cells, resulting in a higher concentration of target templates for amplification directly from urine samples. In contrast to conventional methods, which often involve complex procedures, this approach offers a simpler, cost-effective, and user-friendly alternative. Moreover, the integration of cell adhesion, LAMP amplification, and signal readout within paper origami-based devices can provide a portable, robust, and highly efficient platform for rapid nucleic acid detection. This innovative hypothesis holds significant potential for point-of-care (POC) diagnostics and field surveillance applications. Further research and development in this field will advance the implementation of this technology, contributing to improved healthcare systems and public health outcomes.
Collapse
Affiliation(s)
- Isha Uttam
- Microfluidics, Sensors and Diagnostics (µSenD) Laboratory, Centre for Microfluidics, Biomarkers, Photoceutics and Sensors (μBioPS), Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India; (I.U.); (S.S.)
| | - Sujesh Sudarsan
- Microfluidics, Sensors and Diagnostics (µSenD) Laboratory, Centre for Microfluidics, Biomarkers, Photoceutics and Sensors (μBioPS), Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India; (I.U.); (S.S.)
| | - Rohitraj Ray
- Department of BioSystems Science and Engineering (BSSE), Indian Institute of Science, CV Raman Rd, Bangalore 560012, Karnataka, India;
| | - Raja Chinnappan
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (A.Y.); (K.A.-K.)
- Tissue/Organ Bioengineering & BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research & Innovation Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ahmed Yaqinuddin
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (A.Y.); (K.A.-K.)
| | - Khaled Al-Kattan
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (A.Y.); (K.A.-K.)
| | - Naresh Kumar Mani
- Microfluidics, Sensors and Diagnostics (µSenD) Laboratory, Centre for Microfluidics, Biomarkers, Photoceutics and Sensors (μBioPS), Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India; (I.U.); (S.S.)
| |
Collapse
|
38
|
Safdar S, Shamim S, Khan M, Imran A, Khan MA, Ali Q, Han S. Probing Antibacterial and Anticancer Potential of Selenicereus undatus, Pistacia vera L. and Olea europaea L. against Uropathogens, MCF-7 and A2780 Cancer Cells. Molecules 2023; 28:8148. [PMID: 38138636 PMCID: PMC10746009 DOI: 10.3390/molecules28248148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Urinary tract infection is an infectious disease that requires immediate treatment. It can occur in any age group and involves both genders equally. The present study was to check the resistance of some antibiotics and to assess the antibacterial potential of three extracts of three plants against notorious bacteria involved in urinary tract infections. Along with assessing the antibacterial activity of plant extracts, we checked for the anticancer potential of these extracts against the cancer cell lines MCF-7 and A2780. Cancer is the leading cause of mortality in developed countries. Determinations of total flavonoid content, total phenolic content, total alkaloid content, total tannin content, total carotenoid content, and total steroid content were performed. The disk diffusion method was used to analyze the antibacterial activity of plant extracts. Ethanolic extract of Selenicereus undatus showed sensitivity (25-28 mm) against bacteria, whereas chloroform and hexane extracts showed resistance against all bacteria except Staphylococcus (25 mm). Ethanolic extract of Pistacia vera L. showed sensitivity (22-25 mm) against bacteria, whereas chloroform and hexane extracts showed resistance. Ethanolic extract of Olea europaea L. showed sensitivity (8-16 mm) against all bacteria except Staphylococcus, whereas chloroform and hexane extracts showed resistance. Positive controls showed variable zones of inhibition (2-60 mm), and negative control showed 0-1 mm. The antibiotic resistance was much more prominent in the case of hexane and chloroform extracts of all plants, whereas ethanolic extract showed a sensitivity of bacteria against extracts. Both cell lines, MCF-7 and A2780, displayed decreased live cells when treated with plant extracts.
Collapse
Affiliation(s)
- Sahar Safdar
- School of Biological Sciences and Technology, Liupanshui Normal University, Liupanshui 553004, China;
- Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Lahore 54000, Pakistan; (M.K.); (A.I.)
| | - Saba Shamim
- Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Lahore 54000, Pakistan; (M.K.); (A.I.)
| | - Maryam Khan
- Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Lahore 54000, Pakistan; (M.K.); (A.I.)
| | - Ali Imran
- Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Lahore 54000, Pakistan; (M.K.); (A.I.)
| | - Mudassar Ali Khan
- Department of Physiology, Rashid Latif Medical College, Lahore 54000, Pakistan;
| | - Qurban Ali
- Department of Plant Breeding and Genetics, Faculty of Agricultural Sciences, University of the Punjab, Lahore 54590, Pakistan;
| | - Shiming Han
- School of Biological Sciences and Technology, Liupanshui Normal University, Liupanshui 553004, China;
| |
Collapse
|
39
|
Lewis J, Dye A, Koehler T, Grill J, Baribeau S, Bryant C. An Approach to Improving Compliance of Treatment in Asymptomatic Bacteriuria. Spartan Med Res J 2023; 8:38898. [PMID: 38084333 PMCID: PMC10702150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 03/16/2024] Open
Abstract
INTRODUCTION Asymptomatic bacteriuria (ASB) is the presence of bacteria in the urine without attributable signs or symptoms of a urinary tract infection (UTI). This condition is often inappropriately treated per the 2019 Infectious Disease Society of America guidelines. This quality improvement project aimed to reduce improper treatment of ASB via a three-phase spaced repetition approach over a 12-month 2021-2022 period within a Michigan emergency department (ED), targeting 43 ED clinicians. METHODS During Phase I, a 20-minute teleconference educational intervention was delivered by an Infectious Disease physician and pharmacist. During Phase II, a "hard stop" was implemented within the electronic health record preventing reflex urinalysis culture without indication. During Phase III, a latent period of no intervention took place. The authors' goal was to achieve > 80% compliance to ASB treatment guidelines. RESULTS Overall compliance after the project initiative was 66.7%, an absolute increase of 16.7% from baseline compliance. Using data from 54 patients, this represented a statistically significant (p = 0.01) increase from baseline but fell short of the target of > 80%. DISCUSSION Although the authors fell short of their goal of a 30% increase, data from the project suggests a spaced repetition approach to education and workflow changes could be an effective method to increasing medical provider compliance with treatment of ASB. CONCLUSION Identifying the ideal strategy to change treatment patterns of ED clinicians for ASB to align with guidelines remains key. There is still a need for ongoing efforts in this realm for progress to be made. Keywords: asymptomatic bacteriuria, urinary tract infection, compliance, spaced repetition, antibiotics.
Collapse
Affiliation(s)
- Johnathan Lewis
- Graduate Medical Education, Emergency Medicine Residency Program Mercy Health Muskegon
| | - Angelic Dye
- Graduate Medical Education, Emergency Medicine Residency Program Mercy Health Muskegon
| | | | | | | | | |
Collapse
|
40
|
Fisher SJ, Graham C, Kennard J, Jonker L. Management of urinary tract infections in the community: a clinical audit and patient survey. BJGP Open 2023; 7:BJGPO.2022.0191. [PMID: 37391209 DOI: 10.3399/bjgpo.2022.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/21/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is a common ailment but can develop into sepsis. The outcomes related to UTI may potentially be affected by both patient and clinician management of UTI. AIM To explore the circumstances around a single UTI episode to determine whether there are patient and clinician-related variables that may contribute to differences in management. DESIGN & SETTING Survey and clinical audit in 12 general practices in England. METHOD Patients (n = 504) completed a bespoke survey and their corresponding index UTI consultation was audited. The TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) UTI audit toolkit was utilised. RESULTS A significantly higher proportion of females compared with males used self-management measures. Increase in fluid intake was 78% for females aged <65 years and 71% for females aged >65 years compared with 53% for males (P<0.001, Χ2 test). Analgesic use was 50% for females aged <65 years and 41% for females aged >65 years compared with 36% for males (P = 0.036, Χ2 test). Males also indicated they lacked UTI knowledge when compared with females (P = 0.002, Kruskal-Wallis test). Males also claimed to have waited significantly longer for a consultation appointment (P = 0.027, Χ2 test). Antibiotics were prescribed in 98% of all cases, with adherence to clinical diagnostic guidelines lowest in females aged <65 years. Only 40% (89/221 of cases in this guideline sub-cohort [females aged >65 years]) would have been a UTI, according to TARGET criteria, following a medical record audit. CONCLUSION UTI symptom management by clinicians is suboptimal; the presence or absence of symptoms is often insufficiently recorded in medical records. Additionally, suboptimal adherence to guidelines concerning urinalysis and microbiological investigation is common. Known increased clinical risks for males may be compounded by their more limited knowledge of (self)-managing UTI and their comparatively late presentation.
Collapse
Affiliation(s)
- Stacey Jayne Fisher
- Research & Development Department, North Cumbria Integrated Care NHS Foundation Trust, Penrith, UK
| | - Clive Graham
- Microbiology Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | | | - Leon Jonker
- Research & Development Department, North Cumbria Integrated Care NHS Foundation Trust, Penrith, UK
| |
Collapse
|
41
|
Zhang HL, Perez R, Krishnan J, Lautenbach E, Anderson DJ. Risk Factors for Recurrence of Community-Onset Urinary Tract Infections Caused by Extended-Spectrum Cephalosporin-Resistant Enterobacterales. Open Forum Infect Dis 2023; 10:ofad561. [PMID: 38130594 PMCID: PMC10733196 DOI: 10.1093/ofid/ofad561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Background Extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) are an increasingly important cause of community-onset urinary tract infections (UTIs), including recurrent infections. We evaluated risk factors for recurrence among patients with community-onset ESCrE UTI. Methods This retrospective cohort study included adults with community-onset ESCrE UTI in the Duke University Health System from April 2018 through December 2021. ESCrE UTI recurrence by the same species was assessed 14-180 days (ie, 6 months) after completion of antibiotic treatment. We evaluated the relationships between candidate risk factors and time to recurrence using Cox proportional hazards regression models. Results Among 1347 patients with community-onset ESCrE UTI, 202 (15.0%) experienced recurrent infection during the 6-month follow-up period. Independent risk factors for recurrence included neurogenic bladder (adjusted hazard ratio [aHR], 1.8 [95% confidence interval {CI}, 1.2-2.6]; P = .005), prior history of UTI (aHR, 2.4 [95% CI, 1.7-3.3]; P < .001), and fluoroquinolone nonsusceptibility of the index UTI (aHR, 1.5 [95% CI, 1.1-2.1]; P = .02). Klebsiella pneumoniae infection was associated with recurrence in univariate analysis (HR, 1.6 [95% CI, 1.1-2.1]; P = .007) but not multivariate analysis (aHR, 1.4 [95% CI, 1.0-1.9]; P = .06). Inappropriate initial or definitive antibiotic therapy was not predictive of ESCrE UTI recurrence. Conclusions Recurrence of community-onset ESCrE UTI was common and associated with several patient and pathogen-level risk factors. Future studies should evaluate microbial risk factors for recurrence and improve the management of ESCrE UTI.
Collapse
Affiliation(s)
- Helen L Zhang
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Reinaldo Perez
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Jay Krishnan
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Ebbing Lautenbach
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
42
|
Perdana MA, Wahyuni DD, Yunita R. Characteristics and susceptibility pattern of catheter-associated urinary tract infections (CA UTI) bacteria in Indonesia: A study in a national reference hospital of Sumatra region 2020-2021. Narra J 2023; 3:e436. [PMID: 38450331 PMCID: PMC10914051 DOI: 10.52225/narra.v3i3.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/19/2023] [Indexed: 03/08/2024]
Abstract
Catheter-associated urinary tract infection (CAUTI) is defined as a urinary tract infection associated with catheter placement for more than two consecutive days. Hence, antibiotic resistance in the context of CAUTIs represents a substantial challenge. The aim of this study was to present the characteristics of patients with CAUTI and the susceptibility pattern of CAUTI bacteria in the national reference hospital of the Sumatra region of Indonesia. A cross-sectional study was conducted at H. Adam Malik General Hospital, Medan, Indonesia, from 2020 to 2021, using a total sampling. All CAUTI patients included were on catheterization and diagnosed based on the Centers for Disease Control and Prevention (CDC) guidelines. The patient's urine culture and antibiotic susceptibility test were carried out on the patient's admitted urine sample for further assessment. Identification of bacteria, antibiotic susceptibility test, and the extended-spectrum beta-lactamase (ESBL) test for Escherichia coli and Klebsiella pneumoniae were conducted using the VITEK-2 Compact. A total of 74 CAUTI patients were included in the study, 59.5% were female, 54.1% were 46-65 years old, and a third had cardiovascular disease comorbidities (33.8%). A total of 83 CAUTI-associated bacteria were isolated. The majority were Gram-negative bacteria (74.7%), and the most bacteria isolated was E. coli (31.3%), followed by K. pneumoniae, Enterococcus faecalis, Acinetobacter baumannii, and Enterococcus faecium. The ESBL test was positive mostly in K. pneumoniae (100%) and E. coli (76.9%). CAUTI-associated E. coli was susceptible to tigecycline, meropenem, ertapenem, nitrofurantoin, and gentamicin. The isolated K. pneumoniae was susceptible to tigecycline, meropenem, ertapenem, and amikacin. While E. faecalis showed susceptibility to tigecycline, nitrofurantoin, vancomycin, imipenem, linezolid, ampicillin, piperacillin/tazobactam, amoxicillin/clavulanic acid, ampicillin/sulbactam, and piperacillin.
Collapse
Affiliation(s)
| | - Dian D Wahyuni
- Department of Microbiology, Universitas Sumatera Utara, Medan, Indonesia
- Department of Clinical Microbiology, H. Adam Malik General Hospital, Medan, Indonesia
| | - Rina Yunita
- Department of Microbiology, Universitas Sumatera Utara, Medan, Indonesia
- Department of Clinical Microbiology, H. Adam Malik General Hospital, Medan, Indonesia
| |
Collapse
|
43
|
Hawas S, Vagenas D, Haque A, Totsika M. Bladder-draining lymph nodes support germinal center B cell responses during urinary tract infection in mice. Infect Immun 2023; 91:e0031723. [PMID: 37882531 PMCID: PMC10652902 DOI: 10.1128/iai.00317-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
Bacterial urinary tract infections (UTIs) are both common and exhibit high recurrence rates in women. UTI healthcare costs are increasing due to the rise of multidrug-resistant (MDR) bacteria, necessitating alternative approaches for infection control. Here, we directly observed host adaptive immune responses in acute UTI. We employed a mouse model in which wild-type C57BL/6J mice were transurethrally inoculated with a clinically relevant MDR UTI strain of uropathogenic Escherichia coli (UPEC). Firstly, we noted that rag1-/- C57BL/6J mice harbored larger bacterial burdens than wild-type counterparts, consistent with a role for adaptive immunity in UTI control. Consistent with this, UTI triggered in the bladders of wild-type mice early increases of myeloid cells, including CD11chi conventional dendritic cells, suggesting possible involvement of these professional antigen-presenting cells. Importantly, germinal center B cell responses developed by 4 weeks post-infection in bladder-draining lymph nodes of wild-type mice and, although modest in magnitude and transient in nature, could not be boosted with a second UTI. Thus, our data reveal for the first time in a mouse model that UPEC UTI induces local B cell immune responses in bladder-draining lymph nodes, which could potentially serve to control infection.
Collapse
Affiliation(s)
- Sophia Hawas
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ashraful Haque
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Microbiology and Immunology, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Makrina Totsika
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
44
|
Brubaker L, Horsley H, Khasriya R, Wolfe AJ. Microbiologist in the clinic: coitally related symptoms with negative urine cultures. Int Urogynecol J 2023; 34:2701-2704. [PMID: 37837460 DOI: 10.1007/s00192-023-05662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/24/2023] [Indexed: 10/16/2023]
Abstract
In this first episode of the Microbiologist in the Clinic series, clinicians and laboratory scientists share their perspectives about a 30 y/o woman, who is seeking specialty consultation for frequent episodes of urinary urgency, frequency, and dysuria, which respond to short courses of antibiotics. Although her home dipsticks suggest that she has a UTI, and her urinalysis typically has a moderate number of white blood cells, her urine cultures are always negative. The challenges of this clinical presentation are discussed with evidence for evaluation and treatment.
Collapse
Affiliation(s)
- Linda Brubaker
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.
| | - Harry Horsley
- Department of Renal Medicine, Division of Medicine, UCL, London, UK
| | - Rajvinder Khasriya
- Eastman Dental Institute, Department of Microbial Disease, UCL, London, UK
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Loyola University, Chicago, IL, USA
| |
Collapse
|
45
|
Manoharan A, Farrell J, Aldilla VR, Whiteley G, Kriel E, Glasbey T, Kumar N, Moore KH, Manos J, Das T. N-acetylcysteine prevents catheter occlusion and inflammation in catheter associated-urinary tract infections by suppressing urease activity. Front Cell Infect Microbiol 2023; 13:1216798. [PMID: 37965267 PMCID: PMC10641931 DOI: 10.3389/fcimb.2023.1216798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Proteus mirabilis is a key pathobiont in catheter-associated urinary tract infections (CA-UTIs), which is well known to form crystalline biofilms that occlude catheters. Urease activity alkylates urine through the release of ammonia, consequentially resulting in higher levels of Mg2+ and Ca2+ and formation of crystals. In this study, we showed that N-acetyl cysteine (NAC), a thiol antioxidant, is a potent urease inhibitor that prevents crystalline biofilm formation. Methods To quantify urease activity, Berthelot's method was done on bacterial extracts treated with NAC. We also used an in vitro catheterised glass bladder model to study the effect of NAC treatment on catheter occlusion and biofilm encrustation in P. mirabilis infections. Inductively-coupled plasma mass spectrometry (ICP-MS) was performed on catheter samples to decipher elemental profiles. Results NAC inhibits urease activity of clinical P. mirabilis isolates at concentrations as low as 1 mM, independent of bacterial killing. The study also showed that NAC is bacteriostatic on P. mirabilis, and inhibited biofilm formation and catheter occlusion in an in vitro. A significant 4-8log10 reduction in viable bacteria was observed in catheters infected in this model. Additionally, biofilms in NAC treated catheters displayed a depletion of calcium, magnesium, or phosphates (>10 fold reduction), thus confirming the absence of any urease activity in the presence of NAC. Interestingly, we also showed that not only is NAC anti-inflammatory in bladder epithelial cells (BECs), but that it mutes its inflammatory response to urease and P. mirabilis infection by reducing the production of IL-6, IL-8 and IL-1b. Discussion Using biochemical, microbiological and immunological techniques, this study displays the functionality of NAC in preventing catheter occlusion by inhibiting urease activity. The study also highlights NAC as a strong anti-inflammatory antibiofilm agent that can target both bacterial and host factors in the treatment of CA-UTIs.
Collapse
Affiliation(s)
- Arthika Manoharan
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute of Infectious Disease, The University of Sydney, Sydney, NSW, Australia
| | - Jessica Farrell
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Whiteley Corporation, Tomago, NSW, Australia
| | - Vina R. Aldilla
- School of Chemistry, The University of New South Wales, Sydney, NSW, Australia
| | - Greg Whiteley
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Whiteley Corporation, Tomago, NSW, Australia
- School of Medicine, Western Sydney University, NSW, Australia
| | - Erik Kriel
- Whiteley Corporation, Tomago, NSW, Australia
| | | | - Naresh Kumar
- School of Chemistry, The University of New South Wales, Sydney, NSW, Australia
| | - Kate H. Moore
- Department of Urogynaecology, St George Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Jim Manos
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute of Infectious Disease, The University of Sydney, Sydney, NSW, Australia
| | - Theerthankar Das
- Infection, Immunity and Inflammation Theme, School of Medical Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute of Infectious Disease, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
46
|
V AS, Suji T, Jayanth ST, Sahni RD. Yokenella regensburgei urinary tract infection in an immunocompetent patient: a case report. Access Microbiol 2023; 5:000571.v4. [PMID: 37970085 PMCID: PMC10634489 DOI: 10.1099/acmi.0.000571.v4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/11/2023] [Indexed: 11/17/2023] Open
Abstract
Yokenella regensburgei , belonging to the order Enterobacterales , is a rare and emerging human pathogen reported to cause both superficial and invasive infections. The 13 case reports in the literature worldwide highlight blood, bone and wound infections. To our knowledge this is the first case description of Y. regensburgei causing a urinary tract infection in a 69-year-old immunocompetent patient which was isolated in two separate specimens and identified using matrix-assisted laser desorption ionization time-of-flight MS. It was found to be susceptible to most antimicrobials but resistant to penicillin, amoxicillin-clavulanate, cefoxitin and colistin. Inducible chromosomal ampC resistance was demonstrated on disc approximation testing, and blaYOC-1 class C beta-lactamase, beta lactamase superfamily and MBL fold metallo-hydrolase genes were found on whole genome sequencing.
Collapse
Affiliation(s)
- Annie Sheeba V
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thangamani Suji
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
47
|
Mlugu EM, Mohamedi JA, Sangeda RZ, Mwambete KD. Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in morogoro, Tanzania: a cross-sectional study. BMC Infect Dis 2023; 23:660. [PMID: 37798713 PMCID: PMC10557311 DOI: 10.1186/s12879-023-08641-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Urinary tract infection (UTI) is the second most common infectious disease affecting more than 150 million people globally annually. Uropathogenic E. coli (UPEC), the predominant cause of UTI, can occur as a biofilm associated with antimicrobial resistance (AMR). There is a data gap on global AMR patterns from low-income settings, including Tanzania. Data on antimicrobial susceptibility patterns in relation to biofilm formation will help in the proper selection of antibiotics and the fight against AMR. METHODS This analytical cross-sectional study was conducted among consecutively selected outpatients (n = 344) from January to May 2022 at Morogoro Regional Referal Hospital. Mid-stream urine samples were collected aseptically from symptomatic patients. A significant UTI was defined when more than 105 colonies/ml of urine were recorded. Kirby Bauer's disc diffusion method was used for antibiotics susceptibility patterns and a Congo Red Agar method was used to determine biofilm formation. Two-sided χ2 test or Fisher's exact test, Cohen's kappa coefficient and logistic regression were used for data analysis. A p-value < 0.05 was considered statistically significant. RESULTS The prevalence of UTIs was 41% (141/344) and elders (>=60 years) had five times higher odds of having UTI as compared to adolescents (p < 0.001). E. coli was the most predominant bacteria (47%; 66/141), which displayed moderate susceptibility against ciprofloxacin (59.1%) and nitrofurantoin (57.6%). A total of 72 (51%) of all isolated bacteria were multi-drug resistant. All isolated bacteria demonstrated high resistance (> 85%) against ampicillin and co-trimoxazole. In this study, 51.5% (34/66) were biofilm-forming E. coli and demonstrated relatively higher antibiotic resistance as compared to non-biofilm forming bacteria (p < 0.05). CONCLUSION We report high antibiotic resistance against commonly used antibiotics. Slightly more than half of the isolated bacteria were biofilm forming E. coli. A need to strengthen stewardship programs is urgently advocated.
Collapse
Affiliation(s)
- Eulambius M Mlugu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Juma A Mohamedi
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kennedy D Mwambete
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
48
|
Gebretensaie Y, Atnafu A, Alemu Y, Girma S, Desta K. Evaluation of the Diagnostic Performance of the LINEAR Cromatest and Laboquick URS 10-T Dipsticks Among Urinary Tract Infection Suspects in Addis Ababa, Ethiopia: A Cross-Sectional Study. Res Rep Urol 2023; 15:437-445. [PMID: 37818231 PMCID: PMC10560765 DOI: 10.2147/rru.s434128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
Background Urinary tract infections (UTIs) bring a significant and serious health-related problem. Repeated infections may lead to the development of renal scarring and end-stage renal dysfunction. Therefore, balancing the choices of UTI diagnostic tools depending on the costs versus accuracy can minimize false results that may subject patients to wrong treatments. Objective The objective of the study was to evaluate the diagnostic performance of LINEAR cromatest and Laboquick URS 10-T dipsticks against conventional urine culture at Arsho Advanced Medical Laboratory (AAML), Addis Ababa, Ethiopia. Methods A similar cohort of UTI-suspected patients from our previous study, who were prospectively enrolled from Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia, were considered for this analysis. Data analysis was performed using SPSS version 26. The sensitivity, specificity, and predictive value of different dipsticks were calculated using culture as a gold standard. ROC curve analysis was also used to determine diagnostic performance. A test with a P-value of <0.05 was considered statistically significant. Results Out of 446 urine samples processed, bacterial growth was observed in 141 (31.6%). Of this figure, 105/141 (74.5%) and 36/141 (25.5%) were from female and male participants, respectively. The sensitivity and specificity of the LINEAR Cromatest dipstick were 83.7% and 67.9%, respectively (P-value <0.001). The Laboquick URS 10-T dipstick showed sensitivity and specificity of 87.9% and 68.5%, respectively (P-value <0.001). The ROC analysis showed an AUC of >0.7 for both dipsticks. Conclusion In a setting where there is no access to urine culture, the urine dipstick may be considered an alternative diagnostic tool in the diagnosis of UTIs.
Collapse
Affiliation(s)
- Yosef Gebretensaie
- American Advanced Medical Laboratory, American Medical Center, Addis Ababa, Ethiopia
| | - Abay Atnafu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Yonas Alemu
- Department of Microbiology, Immunology, and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Selfu Girma
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
49
|
Raja MMM, Reehana N, Ahamed AA, Begum AF. Characterization of bioactive compound isolated from Micromonospora marina KPMS1 and its activity against emerging antibiotics resistant strains of Klebsiella pneumoniae HA UTI7 and Proteus vulgaris HAUTI14. Int J Biol Macromol 2023; 250:125954. [PMID: 37532185 DOI: 10.1016/j.ijbiomac.2023.125954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Abstract
Multiple antibiotic resistances have increased gradually in many classes of antibiotics among the gram negative organisms like Klebsiella pneumoniae and Proteus vulgaris which are the major causes of infection among worldwide. Nearly a hundred urine samples were collected, among them 16 urine samples were having plasmid and its resistant to various antibiotics. This present investigation has determined the resistant plasmid pattern of multi drug resistant Klebsiella pneumoniae and Proteus vulgaris from urinary tract site isolated from hospital patients. The detection and characterization of antimicrobial metabolite derived from marine sediments that produce potent activity against multidrug resistant pathogen. The 16S rRNA sequencing results and phylogeny showed that the resistant bacteria belong to the genera of Klebsiella pneumoniae HAUTI7 and Proteus vulgaris HAUTI14. The antibacterial activity and the characterization of bioactive compound like FT-IR and NMR studies were performed to analyze the structural elucidation of active compounds derived from marine source Micromonospora marina KPMS1. The 16S rRNA sequences of Micromonospora marina KPMS1was deposited in the Gen bank with the accession number MH036351. The effective bioactive compound derived from marine sediments are virtually unlimited interest that control the emerging multiple antibiotic resistant strains.
Collapse
Affiliation(s)
- M Mohamed Mahroop Raja
- PG and Research Department of Microbiology, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620 020, Tamil Nadu, India.
| | - N Reehana
- PG and Research Department of Microbiology, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620 020, Tamil Nadu, India
| | - A Asrar Ahamed
- PG and Research Department of Chemistry, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620 020, Tamil Nadu, India
| | - A Fasila Begum
- PG and Research Department of Microbiology, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620 020, Tamil Nadu, India
| |
Collapse
|
50
|
Salari N, Khoshbakht Y, Hemmati M, Khodayari Y, Khaleghi AA, Jafari F, Shohaimi S, Mohammadi M. Global prevalence of urinary tract infection in pregnant mothers: a systematic review and meta-analysis. Public Health 2023; 224:58-65. [PMID: 37734277 DOI: 10.1016/j.puhe.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Urinary tract infection (UTI) is a prevalent infection during pregnancy that can lead to complications for both the mother and the foetus. The objective of this systematic review and meta-analysis is to determine the global prevalence of UTIs (both symptomatic and asymptomatic) during pregnancy, based on previous studies in this area. Furthermore, this study aims to identify any factors that contribute to heterogeneity in the prevalence of UTIs during pregnancy. STUDY DESIGN Systematic review and meta-analysis. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines on August 8, 2022. To conduct the systematic review and meta-analysis, a search was performed using the keywords "urinary tract system", "UTI", "pregnancy", and "gestation" was performed in several databases, including Web of Science (WoS), PubMed, Scopus, ScienceDirect, Embase, and Google Scholar, without a time limit until September 18, 2022. The analysis was performed using a random-effects model, and the heterogeneity of the studies was assessed using the I2 index. The Comprehensive Meta-Analysis software (Version 2) was used for data analysis. RESULTS The systematic review and meta-analysis of 27 studies, which included a total of 30,641 pregnant women, showed an overall prevalence of UTI (both symptomatic and asymptomatic) to be 23.9% (95% confidence interval: 16.2-33.8). Meta-regression analysis was conducted to examine the impact of two factors, namely study sample size and study year, on the heterogeneity of the meta-analysis. The results revealed that an increase in sample size, and the study year was associated with a decrease in the prevalence of UTI in pregnant women (P < 0.05). CONCLUSION The results of our study indicate a global prevalence of UTI in pregnant women to be 23.9%. Therefore, it is recommended that all pregnant women undergo regular UTI screening tests and receive prompt treatment if diagnosed with UTI. Early detection and treatment of UTI during pregnancy are crucial to prevent complications that may affect the health of both the mother and the foetus.
Collapse
Affiliation(s)
- N Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; Sleep Disorders Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Y Khoshbakht
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - M Hemmati
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Y Khodayari
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - A A Khaleghi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
| | - F Jafari
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - S Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia.
| | - M Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
| |
Collapse
|