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Mack C, Gibson JS, Meler E, Woldeyohannes S, Yuen N, Herndon A. Antimicrobial susceptibility patterns of aerobic bacteria isolated from canine urinary samples in South East Queensland, 2013 to 2018. Aust Vet J 2024. [PMID: 38654674 DOI: 10.1111/avj.13333] [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: 11/09/2023] [Revised: 03/10/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
Urinary tract infections are a common diagnosis in dogs presenting to veterinary practice. Veterinarians often treat suspected infections empirically, either in the absence of culture and susceptibility testing results or whilst waiting for them. This study aimed to identify the bacteria most frequently isolated from canine urinary samples and their antimicrobial susceptibility patterns in South East Queensland (SEQ) to help guide responsible empirical antimicrobial prescription by the veterinary community in this geographical location. Cumulative antibiograms were generated from the results of 1284 culture-positive urinary samples in SEQ, obtained from a commercial veterinary laboratory over a 5-year period. Escherichia coli was the most commonly isolated bacterial species (43%), followed by Staphylococcus spp. (23%), Proteus spp. (21%) and Enterococcus spp. (10%). Of the six most common isolates, 97% had susceptibility to at least one low-importance antimicrobial. Susceptibility to the low-importance and first-line antimicrobial recommendation, amoxicillin, was 81% for E. coli and 24% for Staphylococcus spp. Susceptibility of both E. coli and Staphylococcus spp. to medium-importance and commonly recommended empirical antimicrobials, trimethoprim sulphonamides and amoxicillin-clavulanic acid was ≥85% and >92% for high-importance antimicrobials enrofloxacin and ceftiofur. Of the E. coli and Staphylococcus spp. isolates, 8.8% and 4%, respectively, were considered multidrug resistant. There was no increase in resistance to antimicrobials detected over the study period. Susceptibilities suggest low- and medium-importance antimicrobials remain acceptable first-line empirical treatments. However, this should be continually assessed and updated using local surveillance data.
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Affiliation(s)
- C Mack
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
| | - J S Gibson
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
| | - E Meler
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
| | - S Woldeyohannes
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
| | - N Yuen
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
| | - A Herndon
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
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Subramaniyan Y, Khan A, Mujeeburahiman M, Rekha PD. High Incidence of Antibiotic Resistance in the Uropathogenic Bacteria Associated with Different Urological Diseases and Metabolic Complications: A Single Center Cross-Sectional Study. Microb Drug Resist 2024. [PMID: 38593462 DOI: 10.1089/mdr.2024.0015] [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: 04/11/2024] Open
Abstract
Urological diseases affect all age groups and are associated with different urinary complications. Presence of pathogenic bacteria complicates the urological diseases such as chronic kidney disease (CKD), kidney stone disease (KSD), emphysematous pyelonephritis (EPN), and urological cancers (UCs) coinciding with urinary metabolic complications. The One Health concept for preventing the spread of antibiotic resistant opportunistic pathogens necessitates detailed investigation on the virulence and the antibiotic sensitivity patterns of the pathogens from the urinary tract infections (UTIs). This cross-sectional study was aimed to profile the pathogenic bacteria associated with different urological diseases that included urine samples from the patients from a tertiary care hospital. The study included 258 patients representing CKD (15.1%), KSD (28.7%), EPN (15.5%), UC (12.0%), and UTI patients without any urological diseases (28.7%) with overall 70.5% patients showing positive urine culture. Furthermore, other than UTI in patients without any urological diseases (100%), higher culture positive cases were seen in KSD (64.9%), followed by CKD (61.5%), EPN (52.5%), and UC (48.4%). Escherichia coli was the most predominant bacteria in UTI (35.1%) and EPN (66.7%). In KSD, Pseudomonas aeruginosa (41.7%), Staphylococcus aureus (18.8%), and Proteus mirabilis (14.6%) were more common. S. aureus (86.7%) was the most isolated bacteria from the UC cases. Overall rate of multidrug resistance (MDR) was 77.8%. All (100%) E. coli, K. pneumoniae, P. mirabilis, and S. aureus strains were MDR. Among the strains, strong biofilm formation was observed in 73.6%, and 66.7% strains were urease positive. Biofilm was positively correlated with MDR and urease activity. The abundance and distribution of bacteria differed among the urological diseases suggesting their association with the urine metabolite profile. Colonization of MDR pathogens in patients with urological diseases is a serious concern requiring steps to control the emergence of drug resistance and their further spread into the ecosystem.
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Affiliation(s)
- Yuvarajan Subramaniyan
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Altaf Khan
- Department of Urology, Yenepoya Medical College and Hospital, Yenepoya (Deemed to be University), Mangalore, India
| | - M Mujeeburahiman
- Department of Urology, Yenepoya Medical College and Hospital, Yenepoya (Deemed to be University), Mangalore, India
| | - Punchappady Devasya Rekha
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
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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.
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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
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Borcan AM, Radu G, Simoiu M, Costea EL, Rafila A. A Five-Year Analysis of Antibiotic Resistance Trends among Bacteria Identified in Positive Urine Samples in a Tertiary Care Hospital from Bucharest, Romania. Antibiotics (Basel) 2024; 13:160. [PMID: 38391546 PMCID: PMC10885884 DOI: 10.3390/antibiotics13020160] [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: 12/12/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
The rise of multidrug-resistant bacteria (MDR) has resulted in limited treatment options and poorer outcomes for patients. The objective of this study was to analyze the overall antibiotic resistance trends and distribution for pathogens identified in urine samples at the National Institute of Infectious Diseases "Prof. Dr. Matei Balș" from Bucharest, Romania, over a 5-year period. Antibiotic susceptibility testing was performed using automatic systems and the disk diffusion method. ESBL- and carbapenemases-producing strains were identified using immunochromatography tests, and ROSCO Diagnostica kits were used for definitive confirmation. All results were interpreted according to EUCAST clinical breakpoints. Gram-negative rods (GNR) had overall resistance rates higher than 50% for penicillin and 40% for 3rd- and 4th-generation cephalosporins. Escherichia coli resistance to fosfomycin (3%) and nitrofurantoin (2%) remains low, and 33.30% of E. coli, 48% of Klebsiella spp., and 37% of Pseudomonas aeruginosa isolates were multidrug-resistant (MDR). All Acinetobacter baumannii isolates were MDR by the last year of the study. For Gram-positive cocci (GPC), 37% of all Enterococcus faecium strains and 2% of Enterococcus faecalis were vancomycin-resistant (VRE). E. coli's incidence in UTIs' etiology is on a downward trend. The incidence of Klebsiella spp. and GPCs is rising. Antibiotic stewardship strategies should be implemented after carefully considering regional variations in etiology and resistance trends.
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Affiliation(s)
- Alina Maria Borcan
- The National Institute of Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
- Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Georgiana Radu
- Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Mădălina Simoiu
- The National Institute of Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
- Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Elena Liliana Costea
- Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Alexandru Rafila
- The National Institute of Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
- Faculty of Medicine, The University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
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Kazmi SY, Fathima K, Khan N, Kulsum SN, Faraz A. Sensitivity Profile of Fosfomycin, Nitrofurantoin, and Co-trimoxazole Against Uropathogens Isolated From UTI Cases in a Secondary Care Center, KSA. Cureus 2024; 16:e53999. [PMID: 38476810 PMCID: PMC10928802 DOI: 10.7759/cureus.53999] [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] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
Background Fosfomycin, nitrofurantoin, and co-trimoxazole are cheap and effective first-line oral antimicrobials in cases of uncomplicated cystitis in males and non-pregnant females. Fosfomycin and nitrofurantoin are called urinary antiseptics because these two drugs are primarily excreted in the kidney and concentrated in the urine without systemic effect. The present study was designed to evaluate the in vitro activities of fosfomycin, nitrofurantoin, and co-trimoxazole against uropathogens isolated at King Khalid Hospital Al-Majmaah, KSA. Methods The study was conducted at the King Khalid Hospital Al Majmaah, KSA, from September 1, 2021, until February 28, 2022. The patients' urine samples were inoculated on the Cystein Lactose Electrolytes Deficient (CLED) medium, and uropathogens were isolated. The organisms' identification and sensitivity testing against cotrimoxazole, fosfomycin, and nitrofurantoin was conducted using a Microscan automated analyzer, the MicroScan WalkAway Beckman Coulter, Sacramento, CA, USA. Results The study comprised non-repeat 137 patients who were either admitted to the hospital or treated as outpatients, yielding a total of 147 isolates. Nitrofurantoin showed a lower resistance rate, around 20% (n = 29), followed by fosfomycin at 23% (n = 34). The resistance rate of cotrimoxazole was 43% (n = 63). Overall, nitrofurantoin and fosfomycin showed relatively lower resistance against all isolates. Conclusions Being cheap and effective, we propose that fosfomycin and nitrofurantoin be used as first-line treatments in patients presenting with uncomplicated UTIs.
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Affiliation(s)
| | - Kauser Fathima
- Pathology and Laboratory Medicine, Tumair General Hospital, Tumair, SAU
| | - Nazia Khan
- Basic Sciences, Majmaah University, AlMajmaah, SAU
| | | | - Ali Faraz
- Basic Sciences, Majmaah University, AlMajmaah, SAU
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Young AM, Tanaka MM, Yuwono C, Wehrhahn MC, Zhang L. Clinical Setting Comparative Analysis of Uropathogens and Antibiotic Resistance: A Retrospective Study Spanning the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2024; 11:ofad676. [PMID: 38333882 PMCID: PMC10853000 DOI: 10.1093/ofid/ofad676] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
Background Antimicrobial resistance (AMR) in uropathogens has been increasing in Australia. Many nations observed heightened AMR during the coronavirus disease 2019 (COVID-19) pandemic, but it is not known how this may vary across clinical settings and in nations with lower infection rates. Methods We investigated the uropathogen composition and corresponding antibiotic resistance of 775 559 Australian isolates from the community, hospitals, and aged care facilities before (2016-2019) and during (2020-2022) the COVID-19 pandemic. A mathematical model was developed to predict the likelihood of resistance to currently recommended antibiotics for treating urinary tract infections (UTIs). Results Among uropathogens originating from the community, hospitals, and aged care facilities, Escherichia coli accounted for 71.4%, 57.6%, and 65.2%, respectively. During the COVID-19 pandemic period, there was an increase in UTIs caused by E coli across all settings. Uropathogens from aged care and hospitals frequently showed higher resistance to antibiotics compared to those isolated from the community. Interestingly, AMR among uropathogens showed a declining trend during the COVID-19 pandemic. Based on the resistance patterns of the past 3 years, our modeling predicted that 30%, 42.6%, and 38.8% of UTIs in the community, hospitals, and aged care facilities, respectively, would exhibit resistance to trimethoprim treatment as empirical therapy. In contrast, resistance to nitrofurantoin was predicted to be 14.6%, 26%, and 24.1% from these 3 respective settings. Conclusions Empirical therapy of UTIs in Australia with trimethoprim requires evaluation due to high rates of resistance observed across clinical settings.
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Affiliation(s)
- Alexandra M Young
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark M Tanaka
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Yuwono
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wehrhahn
- Douglass Hanly Moir Pathology, a Sonic Healthcare Australia Pathology Practice, Macquarie Park, New South Wales, Australia
| | - Li Zhang
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Mareș C, Petca RC, Popescu RI, Petca A, Mulțescu R, Bulai CA, Ene CV, Geavlete PA, Geavlete BF, Jinga V. Update on Urinary Tract Infection Antibiotic Resistance-A Retrospective Study in Females in Conjunction with Clinical Data. Life (Basel) 2024; 14:106. [PMID: 38255721 PMCID: PMC10820678 DOI: 10.3390/life14010106] [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: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Urinary tract infections (UTIs) represent a frequent pathology among the female population that has become more and more difficult to treat in the past decade, considering the increase in antibiotic resistance-a serious global public health problem. A cross-sectional retrospective study was conducted for six months to report an update regarding the rates of resistance and susceptibility of uropathogens necessary for optimal treatment. A total of 5487 patients were screened, of which 524 (9.54%) were female patients who met the criteria for inclusion in the study. Escherichia coli was the most common pathogen, representing 290 cases (55.34%), followed by Enterococcus spp. 82 (15.64%). Escherichia coli presented the highest resistance to amoxicillin-clavulanic acid (R = 33.1%), followed by trimethoprim-sulfamethoxazole (R = 32.41%) and levofloxacin (R = 32.06%). The highest sensitivity rates were observed for fosfomycin (S = 96.55%), followed by imipenem (S = 93.1%). Enterococcus spp. showed the highest resistance to levofloxacin (R = 50.0%), followed by penicillin (R = 39.02%). The highest sensitivity was observed for fosfomycin (S = 90.24%), linezolid (S = 89.02%), and nitrofurantoin (S = 86.58%). The second most frequent Gram-negative uropathogen was represented by Klebsiella spp., which had the highest resistance to amoxicillin-clavulanic acid (R = 35.89%), followed by levofloxacin (R = 25.64) and trimethoprim-suflamethoxazole (R = 24.35%). The most frequently associated pathology was an episode of UTI in the previous year, followed by diabetes and chronic kidney disease. Antibiotic resistance is a serious problem for all clinicians who treat UTIs. An up-to-date knowledge of antibiotic resistance rates is a major necessity to stop its evolution. Overall, the highest resistance rates were observed for aminopenicillins, fluoroquinolones, and trimethoprim-sulfamethoxazole. The best susceptibility rates were observed for fosfomycin, nitrofurantoin, and carbapenems. Our report aims to guide clinicians whenever they are forced to prescribe antibiotics empirically.
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Affiliation(s)
- Cristian Mareș
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania;
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Răzvan-Ionuț Popescu
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania;
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 17 Mărăști Blvd., 050474 Bucharest, Romania
| | - Răzvan Mulțescu
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania;
| | - Cătălin Andrei Bulai
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania;
| | - Cosmin Victor Ene
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania;
| | - Petrișor Aurelian Geavlete
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania;
| | - Bogdan Florin Geavlete
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania;
| | - Viorel Jinga
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.M.); (R.-I.P.); (C.A.B.); (C.V.E.); (P.A.G.); (B.F.G.); (V.J.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
- Medical Sciences Section, Academy of Romanian Scientists, 050085 Bucharest, Romania
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Sachdeva S, Rosett HA, Krischak MK, Weaver KE, Heine RP, Denoble AE, Dotters-Katz SK. Urinary Tract Infection and Progression to Pyelonephritis: Group B Streptococcus versus E. coli. AJP Rep 2024; 14:e80-e84. [PMID: 38370326 PMCID: PMC10874690 DOI: 10.1055/s-0044-1779031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/22/2023] [Indexed: 02/20/2024] Open
Abstract
Objective Group B Streptococcus (GBS) colonization of the lower urinary tract in pregnancy is associated with severe infections such as chorioamnionitis, endometritis, and pyelonephritis. The objective of this study was to compare rates of progression to pyelonephritis between GBS and Escherichia coli lower urinary tract infections (LUTIs), as well as compare infectious and obstetric morbidity secondary to these pathogens. Study Design Retrospective cohort of pregnant women with LUTIs (asymptomatic bacteria or acute cystitis [AC]) from a single health system between July 2013 and May 2019. Demographic, infectious, antepartum, and intrapartum data were abstracted from medical records of women with GBS or E. coli LUTI. The primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis-related anemia, sepsis, pyelonephritis length of stay (LOS), median gestational age (GA) at delivery, preterm delivery, and low birth weight (LBW). Logistic regression was used to calculate the adjusted odds of the primary outcome. Results Of 729 pregnant women with urinary colonization, 433 were culture positive for one of the aforementioned bacteria, with 189 (43.6%) having GBS and 244 (56.4%) having E. coli. Women with E. coli were more likely to be younger, use tobacco, have a history of AC, and have a history of preterm birth. Rates of progression to pyelonephritis were markedly higher with E. coli (15.6%) than with GBS (1.1%; p < 0.001). Median LOS for pyelonephritis and pyelonephritis-related morbidities did not differ. Median GA at delivery, preterm delivery, and LBW rates also did not differ. In adjusted analysis, controlling for history of AC, insurance status, tobacco use, prior preterm birth, primary infection type, and maternal age, women with GBS LUTI had markedly decreased odds of developing pyelonephritis in pregnancy compared with those with E. coli (adjusted odds ratio: 0.04, 95% confidence interval: 0.01-0.28). Conclusion Escherichia coli infections progress to pyelonephritis in pregnancy at markedly higher rates than GBS, although obstetric outcomes are similar.
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Affiliation(s)
- Sarika Sachdeva
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Kristin E. Weaver
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - R. Phillips Heine
- Department of Obstetrics and Gynecology, Atrium Health Wake Forest, Winston-Salem, North Carolina
| | - Anna E. Denoble
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut
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Mohammed Y, Muhammad AS, Zainu SM, Jimoh AK, Olowo-Okere A, Ogunyinka IA, Abubakar J, Dada KM, Egbe OE, Galalain SM. Outbreak of Multidrug-resistant Acinetobacter baumannii in a Tertiary Health Center from Northwestern Nigeria. Ann Afr Med 2024; 23:40-45. [PMID: 38358170 PMCID: PMC10922177 DOI: 10.4103/aam.aam_141_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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 02/16/2024] Open
Abstract
Background In spite of its global notoriety and WHO alarm, Acinetobacter baumannii is still an understudied critical-priority pathobiont in Nigeria. We characterized its antimicrobial susceptibility profile and resistance genes during an outbreak. Materials and Methods This cross-sectional study involved collection of patients' urine samples and swabs from unit staff's hands and ward environments for the identification of A. baumannii strains using standard morphologic and biochemical methods. The disk diffusion method was used to assess the antimicrobial susceptibility profile of the isolates with the production of extended-spectrum beta-lactamases (ESBLs) confirmed by the combined disk test screening method. Characterization of the resistance genes of the ESBL producers was carried out using polymerase chain reaction polymerase chain reaction technique. Results A. total of eight (six clinical and two nonclinical) A. baumannii isolates were identified. The overall isolate susceptibility and resistance rates to all the antimicrobial agents was 56.3% (27/48) and 35.4% (17/48), respectively. Similarly, all (8/8; 100.00%) isolates were susceptible to meropenem and 75.0% (6/8) to ampicillin-sulbactam while 62.5% (5/8) were resistant to trimethoprim-sulfamethoxazole and 50.0% (4/8) to each of ciprofloxacin and ceftazidime. In addition, 37.5% (3/8) of the isolates were multidrug resistant (MDR) with nonclinical isolates exhibiting more antimicrobial resistance than their clinical counterparts (9/12%-75.0% vs. 8/36%-22.2%). Phenotypic detection and molecular characterization revealed three ESBL-producing isolates that each harbored blaSHV and blaTEM genes with blaCTX-M gene being absent. Conclusion MDR strains of A. baumannii harboring blaSHV and blaTEM genes were recovered from clinical and environmental sources during the outbreak, which was contained with preventive measures recommended.
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Affiliation(s)
- Yahaya Mohammed
- Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Abubakar Sadiq Muhammad
- Department of Surgery, Urology Unit, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Sabitu Muhammad Zainu
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ahmed Kolawole Jimoh
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ahmed Olowo-Okere
- Department of Pharmaceutics and Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Ibrahim Abayomi Ogunyinka
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Jibril Abubakar
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Khadijah Muhammad Dada
- Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Oloche Emmanuel Egbe
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Salma Muhammad Galalain
- Department of Biology, Faculty of Chemical and Life Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
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Minnullina LF, Misheeva PS, Mukhtarova GI, Sharipova MR, Mardanova AM. Features of Hemolysin Biosynthesis by Morganella morganii. Bull Exp Biol Med 2023; 176:181-186. [PMID: 38191876 DOI: 10.1007/s10517-024-05991-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 01/10/2024]
Abstract
We studied the influence of medium composition and aeration on the hemolytic activity of uropathogenic Morganella morganii strain MM 190. The maximum level of hemolysis was observed in LB (59%), DMEM supplemented with fetal bovine serum (62%), and urine (53%) under aeration conditions during the exponential growth phase. The presence of 2% urea in the medium suppressed hemolysin synthesis. Moreover, addition of bacterial culture fluid containing hemolysin to a monolayer of T-24 bladder carcinoma and OKP-GS kidney carcinoma cells led to 25 and 42% cell death, respectively. We found that the maximum expression of the hemolysin gene hlyA was observed in 2-h culture in LB medium, which correlated with the hemolytic activity of the bacteria in this medium and indicated the predominance of the short hlyCA transcript in the cells.
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Affiliation(s)
- L F Minnullina
- Kazan (Volga region) Federal University, Kazan, Republic of Tatarstan, Russia.
| | - P S Misheeva
- Kazan (Volga region) Federal University, Kazan, Republic of Tatarstan, Russia
| | - G I Mukhtarova
- Kazan (Volga region) Federal University, Kazan, Republic of Tatarstan, Russia
| | - M R Sharipova
- Kazan (Volga region) Federal University, Kazan, Republic of Tatarstan, Russia
| | - A M Mardanova
- Kazan (Volga region) Federal University, Kazan, Republic of Tatarstan, Russia
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Perdana MA, Wahyuni DD, Yunita R. Characteristics and susceptibility pattern of catheter-associated urinary tract infections (CAUTI) 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.
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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
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Rahimi BA, Afghan JK, Sirat R, Kakar KA, Lali WM, Rahimy N, Farooqi K. Antibiotic Resistance among Patients with Urinary Tract Infections in Kandahar, Afghanistan. Indian J Community Med 2023; 48:867-872. [PMID: 38249696 PMCID: PMC10795880 DOI: 10.4103/ijcm.ijcm_705_22] [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: 08/14/2022] [Accepted: 09/16/2023] [Indexed: 01/23/2024] Open
Abstract
Background Antimicrobial resistance is a global public health threat. Highest burden of resistance is reported from low- and middle-income countries. Objectives To investigate and report the current scenario of increased antibiotic resistance of uropathogens among symptomatic urinary tract infection patients in Kandahar, Afghanistan. Methods From January 2018 to December 2021, this retrospective study was carried out at two main hospitals in Kandahar City, Afghanistan. Here, culture and sensitivity profiles of uropathogens were studied among symptomatic Bacteriuria in the presence of genitourinary symptoms (i.e., dysuria, suprapubic pain or tenderness, frequency, or urgency) (UTI) patients. Results Among urine samples of 1589 patients, 1047 (65.9%) were culture positive and included in this study. Most of these patients (626/1047 [59.8%]) were females, with majority (818 [78.1%]) having age between 19 and 39 years. Gram-negative bacteria were the most prevalent (840/1047 [80.2%]), with E. coli (653/1047 [62.4%]) as the most common isolated uropathogen. Overall gram-negative bacteria had higher resistance against commonly used antibiotics of cotrimoxazole (62.8%), ciprofloxacin (56.0%), levofloxacin (47.5%), cefixime (44.5%), fosfomycin (41.5%), and even ceftriaxone (48.3%). Conclusions Kandahar province has higher resistance rates against commonly used empirical antibiotics like norfloxacin, ciprofloxacin, levofloxacin, and cefixime. Nitrofurantoin should be used as the first-line antibiotic in treating UTI patients. Public health authorities should make strict regulations and policies to reduce irrational use, inappropriate prescription, and over-the-counter availability of antibiotics in Kandahar.
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Affiliation(s)
- Bilal A. Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- Head of Research Unit, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Jalat K. Afghan
- Lecturer of Urology, Faculty of Medicine, Malalay Institute of Higher Education, Kandahar, Afghanistan
| | - Rahmatullah Sirat
- Department of Microbiology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Khalil A. Kakar
- Department of Public Health, Faculty of Medicine, Malalay Institute of Higher Education, Kandahar, Afghanistan
| | - Wais M. Lali
- Advisor of Natural Science, Research Center, Kandahar University, Kandahar, Afghanistan
| | - Najeebullah Rahimy
- Department of Histopathology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Khushhal Farooqi
- Department of Dermatology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
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Khan MA, Rahman AU, Khan B, Al-Mijalli SH, Alswat AS, Amin A, Eid RA, Zaki MSA, Butt S, Ahmad J, Fayad E, Ullah A. Antibiotic Resistance Profiling and Phylogenicity of Uropathogenic Bacteria Isolated from Patients with Urinary Tract Infections. Antibiotics (Basel) 2023; 12:1508. [PMID: 37887209 PMCID: PMC10603882 DOI: 10.3390/antibiotics12101508] [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: 08/16/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Urinary tract infections (UTIs) are healthcare problems that commonly involve bacterial and, in some rare instances, fungal or viral infections. The irrational prescription and use of antibiotics in UTI treatment have led to an increase in antibiotic resistance. Urine samples (145) were collected from male and female patients from Lower Dir, Khyber Pakhtunkhwa (KP), Pakistan. Biochemical analyses were carried out to identify uropathogens. Molecular analysis for the identification of 16S ribosomal RNA in samples was performed via Sanger sequencing. Evolutionary linkage was determined using Molecular Evolutionary Genetics Analysis-7 (MEGA-7). The study observed significant growth in 52% of the samples (83/145). Gram-negative bacteria were identified in 85.5% of samples, while Gram-positive bacteria were reported in 14.5%. The UTI prevalence was 67.5% in females and 32.5% in males. The most prevalent uropathogenic bacteria were Klebsiella pneumoniae (39.7%, 33/83), followed by Escherichia coli (27.7%, 23/83), Pseudomonas aeruginosa (10.8%, 9/83), Staphylococcus aureus (9.6%, 8/83), Proteus mirabilis (7.2%, 6/83) and Staphylococcus saprophyticus (4.8%, 4/83). Phylogenetic analysis was performed using the neighbor-joining method, further confirming the relation of the isolates in our study with previously reported uropathogenic isolates. Antibiotic susceptibility tests identified K. pneumonia as being sensitive to imipenem (100%) and fosfomycin (78.7%) and resistant to cefuroxime (100%) and ciprofloxacin (94%). Similarly, E. coli showed high susceptibility to imipenem (100%), fosfomycin (78.2%) and nitrofurantoin (78.2%), and resistance to ciprofloxacin (100%) and cefuroxime (100%). Imipenem was identified as the most effective antibiotic, while cefuroxime and ciprofloxacin were the least. The phylogenetic tree analysis indicated that K. pneumoniae, E. coli, P. aeruginosa, S. aureus and P. mirabilis clustered with each other and the reference sequences, indicating high similarity (based on 16S rRNA sequencing). It can be concluded that genetically varied uropathogenic organisms are commonly present within the KP population. Our findings demonstrate the need to optimize antibiotic use in treating UTIs and the prevention of antibiotic resistance in the KP population.
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Affiliation(s)
- Muhammad Ajmal Khan
- Centre for Biotechnology and Microbiology, University of Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan; (M.A.K.); (J.A.)
| | - Atta Ur Rahman
- Leprosy Laboratory, Department of Parasite Biology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil;
| | - Bakhtawar Khan
- Institute of Brain Disorders, Department of Physiology, Dalian Medical University, Dalian 116044, China
| | - Samiah Hamad Al-Mijalli
- Department of Biology, College of Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Amal S. Alswat
- Department of Biotechnology, College of Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia; (A.S.A.); (E.F.)
| | - Aftab Amin
- Center for Cancer Research, and State Key Lab of Molecular Neuroscience, Division of Life Science, Hong Kong University of Science and Technology, Hong Kong, China;
| | - Refaat A. Eid
- Department of Pathology, College of Medicine, King Khalid University, P.O. Box 62529, Abha 12573, Saudi Arabia;
| | - Mohamed Samir A. Zaki
- Anatomy Department, College of Medicine, King Khalid University, P.O. Box 62529, Abha 61413, Saudi Arabia;
| | - Sadia Butt
- Department of Microbiology, Shaheed Benazir Bhutto Women University Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan;
| | - Jamshaid Ahmad
- Centre for Biotechnology and Microbiology, University of Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan; (M.A.K.); (J.A.)
| | - Eman Fayad
- Department of Biotechnology, College of Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia; (A.S.A.); (E.F.)
| | - Amin Ullah
- Department of Health & Biological Sciences, Abasyn University Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan
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Umar UY, Giwa FJ, Ibrahim A, Gachi FS. Antimicrobial susceptibility pattern of extended-spectrum beta-lactamase-producing uropathogens in aminu Kano teaching hospital, Northwestern Nigeria. Ann Afr Med 2023; 22:508-514. [PMID: 38358153 PMCID: PMC10775926 DOI: 10.4103/aam.aam_155_22] [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: 11/14/2022] [Revised: 03/07/2023] [Accepted: 05/01/2023] [Indexed: 02/16/2024] Open
Abstract
Background UTI is the most common nosocomial infection among hospitalized patients. Emerging increasing resistance has been observed among uropathogens of the family enterobacterales. Extended spectrum beta lactamase genes encode for multidrug resistance and unrestricted use of antibiotics in hospitals provides an environment for spread of infections with limited treatment options. This necessitates therapies based on culture and antimicrobial sensitivity to improve patients' outcomes We aimed to determine susceptibility pattern of ESBL uropathogens among hospitalized patients in Aminu Kano Teaching Hospital, Kano. Methodology Three hundred and eighty-nine urine samples were obtained from in-patients with UTI between April 2020 and April 2021. Five samples were rejected and remaining analyzed. Susceptibility testing was done by modified Kirby Bauer technique. Clinical Laboratory Standards Institute guidelines 2019 (CLSI 2019) and the European Committee on Antimicrobial Susceptibility testing guidelines version 2 (EUCAST version 2) were used for screening and confirmation of ESBL production respectively. Results Of the 384-urine processed, 105 (27.3%) were gram negatives and 81 were Enterobacterales, Isolation rates were E. coli-55.6%, K. pneumoniae-29.6%, Citrobacter spp.-12.3%, P. mirabilis-1.2% and Morganella spp.-1.2%. Among Enterobacterales, 32 (39.5%) were ESBL producers. Prevalence of ESBL were 62.5% for Escherichia coli, 28.1% for Klebsiella pneumoniae and 9.4% for Citrobacter species. Susceptibility showed that ESBL-producing Isolates were highly susceptible to amikacin (96.9%). Resistance to other antibiotics varied from 3.1% to 100%. Conclusion We recommend strengthening laboratory capacity, antibiotics stewardship and Infection control to prevent spread of resistant pathogens including ESBLs.
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Affiliation(s)
- Usman Yahya Umar
- Department of Medical Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Fatima Jummai Giwa
- Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Abdulrasul Ibrahim
- Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Farida Suleiman Gachi
- Department of Medical Microbiology and Parasitology, Modibbo Adama University Teaching Hospital, Yola, Adamawa State, Nigeria
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Sharma P, Juhi, Halwai V, Rout S, Singh R. Antibacterial Activity of Selected Fruit Juices against Multidrug-Resistant Bacterial Pathogens Involved in Urinary Tract and Sexually Transmitted Infections among Tribal Women in Madhya Pradesh, India. J Pharmacopuncture 2023; 26:265-275. [PMID: 37799616 PMCID: PMC10547819 DOI: 10.3831/kpi.2023.26.3.265] [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: 05/04/2023] [Revised: 05/18/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Objectives The aim of this study was to evaluate the effect of fruit juices on Multi-Drug Resistant (MDR) bacterial pathogens involved in Urinary Tract Infections (UTIs) and Sexually Transmitted Infections (STIs) among tribal women in the district Anuppur, Madhya Pradesh, India. Methods Fresh juices of lemon (Citrus limon), amla/Indian gooseberry (Phyllanthus emblica), pineapple (Ananas comosus), mosambi/sweet lime (Citrus limetta), orange (Citrus sinensis), kiwi (Actinidia deliciosa), and pomegranate (Punica granatum) fruits were evaluated for in vitro antibacterial activity against bacterial pathogens involved in UITs and STIs among tribal women. Physico-chemical analysis of fresh fruits was also carried out by measuring the pH, moisture, protein, fat, crude fibre, carbohydrate, and ascorbic acid content. Results Lemon and amla juice showed better antibacterial activity against the pathogens as compared to other juices. MIC results fruit juices against UTIs and STIs pathogens vary depending on the specific pathogen and juice chemical constituents. The physico-chemical analysis showed that the moisture content was highest in mosambi (90%), followed by orange (87%). Ascorbic acid content was found highest in amla (540 mg/100 g), followed by kiwi (90.3 mg/100 g). Pomegranate showed highest concentration of carbohydrate (15.28 g/100 g), fat (1.28 g/100 g), and protein (1.65 g/100 g). Lemon juice had lowest pH of 2.20, followed by amla 2.67. Conclusion The lemon juice showed highest antibacterial activity against MDR bacterial pathogens involved in UTIs and STIs among tribal women in district Anuppur, Madhya Pradesh, India. The low pH of lemon may be responsible for its high antibacterial activity as compared to other juices.
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Affiliation(s)
- Poonam Sharma
- Department of Zoology, Indira Gandhi National Tribal University, Amarkantak, Madhya Pradesh, India
| | - Juhi
- Department of Zoology, Indira Gandhi National Tribal University, Amarkantak, Madhya Pradesh, India
| | - Vaishali Halwai
- Department of Zoology, Indira Gandhi National Tribal University, Amarkantak, Madhya Pradesh, India
| | - Sainivedita Rout
- Department of Zoology, Indira Gandhi National Tribal University, Amarkantak, Madhya Pradesh, India
| | - Rambir Singh
- Department of Horticulture, Aromatic and Medicinal Plants, Mizoram University, Aizawl, Mizoram, India
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Raj CTD, Muthukumar K, Dahms HU, James RA, Kandaswamy S. Structural characterization, antioxidant and anti-uropathogenic potential of biogenic silver nanoparticles using brown seaweed Turbinaria ornata. Front Microbiol 2023; 14:1072043. [PMID: 37727290 PMCID: PMC10505674 DOI: 10.3389/fmicb.2023.1072043] [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: 10/17/2022] [Accepted: 04/03/2023] [Indexed: 09/21/2023] Open
Abstract
Alternative treatment strategies for urinary tract infections (UTIs) are becoming more necessary due to increasing drug resistance patterns in uropathogens. Nanoparticle-based therapeutics is emerging as a way to treat UTIs. In the present study, using Turbinaria ornata extract, silver nanoparticles (AgNPs) were synthesized, characterized, and their anti-uropathogenic activity was evaluated. The stability and formation of synthesized To-AgNPs were confirmed by UV-visible spectroscopy, FTIR, XRD, SEM, and DLS. An FTIR spectrum confirmed the presence of seaweed functional groups in To-AgNPs, a XRD analysis confirmed their crystalline nature, and SEM imaging confirmed their spherical nature with an average size of 73.98 nm with diameters ranging from 64.67 to 81.28 nm. This was confirmed by TEM results. DLS determined that the cumulant hydrodynamic diameter of To-AgNPs was 128.3 nm with a PdI of 0.313 and the zeta potential value were found to be -63.3 mV which indicates the To-AgNPs are negatively charged and more stable. DPPH assays were used to assess the antioxidant activity of biosynthesized To-AgNPs, while an agar well diffusion method was used to test the antibacterial activity against uropathogens, including Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, and Klebsiella pneumoniae. The To-AgNPs showed the highest susceptibility to S. aureus (15.75 ± 0.35 mm) and E. coli (15 ± 0.7 mm) with MIC values of 0.0625 and 0.125 mg/ml, respectively in macro broth dilution method and observed considerable membrane damage under CLSM and SEM. To-AgNPs displayed stronger antioxidant and antimicrobial activity, suggesting they may be developed as a new class of antimicrobial agents for treating UTIs.
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Affiliation(s)
- C. T. Dhanya Raj
- Department of Marine Science, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Krishnan Muthukumar
- Department of Petrochemical Technology, Bharathidasan Institute of Technology, Anna University, Tiruchirappalli, Tamil Nadu, India
| | - Hans Uwe Dahms
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan, China
- Research Centre for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, China
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan, China
| | - Rathinam Arthur James
- Department of Marine Science, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Surabhi Kandaswamy
- Manchester Centre for Genomic Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, United Kingdom
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Ren H, Zhong Z, Zhou S, Wei Y, Liang Y, He H, Zheng Z, Li M, He Q, Long T, Lian X, Liao X, Liu Y, Sun J. CpxA/R-Controlled Nitroreductase Expression as Target for Combinatorial Therapy against Uropathogens by Promoting Reactive Oxygen Species Generation. Adv Sci (Weinh) 2023; 10:e2300938. [PMID: 37407509 PMCID: PMC10477892 DOI: 10.1002/advs.202300938] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/07/2023] [Indexed: 07/07/2023]
Abstract
The antibiotic resistances emerged in uropathogens lead to accumulative treatment failure and recurrent episodes of urinary tract infection (UTI), necessitating more innovative therapeutics to curb UTI before systematic infection. In the current study, the combination of amikacin and nitrofurantoin is found to synergistically eradicate Gram-negative uropathogens in vitro and in vivo. The mechanistic analysis demonstrates that the amikacin, as an aminoglycoside, induced bacterial envelope stress by introducing mistranslated proteins, thereby constitutively activating the cpxA/R two-component system (Cpx signaling). The activation of Cpx signaling stimulates the expression of bacterial major nitroreductases (nfsA/nfsB) through soxS/marA regulons. As a result, the CpxA/R-dependent nitroreductases overexpression generates considerable quantity of lethal reactive intermediates via nitroreduction and promotes the prodrug activation of nitrofurantoin. As such, these actions together disrupt the bacterial cellular redox balance with excessively-produced reactive oxygen species (ROS) as "Domino effect", accelerating the clearance of uropathogens. Although aminoglycosides are used as proof-of-principle to elucidate the mechanism, the synergy between nitrofurantoin is generally applicable to other Cpx stimuli. To summarize, this study highlights the potential of aminoglycoside-nitrofurantoin combination to replenish the arsenal against recurrent Gram-negative uropathogens and shed light on the Cpx signaling-controlled nitroreductase as a potential target to manipulate the antibiotic susceptibility.
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Affiliation(s)
- Hao Ren
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Zixing Zhong
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Shuang Zhou
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Yiyang Wei
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Yujiao Liang
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Huiling He
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Zijian Zheng
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Mengyuan Li
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Qian He
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Tengfei Long
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Xinlei Lian
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
| | - Xiaoping Liao
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
- Jiangsu Co‐Innovation Center for the Prevention and Control of Important Animal Infectious Disease and ZoonosesYangzhou UniversityYangzhou225009China
| | - Yahong Liu
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
- Jiangsu Co‐Innovation Center for the Prevention and Control of Important Animal Infectious Disease and ZoonosesYangzhou UniversityYangzhou225009China
| | - Jian Sun
- Guangdong Laboratory for Lingnan Modern AgricultureNational Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary MedicineSouth China Agricultural UniversityGuangzhou510642China
- Guangdong Provincial Key Laboratory of Veterinary PharmaceuticsDevelopment and Safety EvaluationSouth China Agricultural UniversityGuangzhou510642China
- Jiangsu Co‐Innovation Center for the Prevention and Control of Important Animal Infectious Disease and ZoonosesYangzhou UniversityYangzhou225009China
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Diriba K, Awulachew E, Bizuneh B. Identification of Bacterial Uropathogen and Antimicrobial Resistance Patterns Among Patients with Diabetic and Hypertension Attending Dilla University General Hospital, Dilla, Ethiopia. Infect Drug Resist 2023; 16:4621-4633. [PMID: 37484906 PMCID: PMC10361459 DOI: 10.2147/idr.s417033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Background Having a urinary tract infection (UTI) is a serious health issue which is caused by microbial colonization and proliferation in the urinary system. Patients with diabetes and blood pressure are more vulnerable to bacterial urinary tract infections because their host defense is compromised and their urine has a high glucose content. A proper and quick investigation of uropathogen and their antibiogram is key to patient treatment and infection control. Objective Aimed to assess the identification of bacterial uropathogen and antimicrobial resistance patterns among diabetic and hypertension patients attending DUGH, Ethiopia. Methods A Facility-based cross-sectional study was conducted from February to December 2022 among 158 diabetic and hypertensive patients using a clean catch mid-stream urine sample. Pretested structured questionnaires were used to collect data from study participants. Urine samples were taken and cultured on Blood agar, MacConkey agar and CLED Agar for the identification of uropathogen. An antimicrobial susceptibility test was done according to CLSI. Binary and multiple logistic regression were used to assess the association. A P-value less than 0.05 was considered statistically significant. Results The overall prevalence of bacterial uropathogenic among diabetes mellitus and hypertension patients was 15.2%. E. coli (29.2%), coagulase negative Staphylococci (CoNS) (20.8%), K. pneumoniae 3 (12.5%) and S. aureus 2 (12.5%) were the leading isolated uropathogens. In our study, illiterates (AOR =8.1, 95% CI: (5.1-12.4)), participants with high blood glucose levels (AOR=1.81, 95% CI: (1.01-2.21)) and comorbid patients (AOR = 4.2, 95% CI: (4.1-17.2)) were significantly associated with UTI. Both gram-negative and gram-positive isolated bacteria showed higher resistance to most of the commonly used antibiotics. Multidrug resistance was reported in 62.5% of the total isolates. Conclusion This study revealed a high prevalence of bacterial isolate and multidrug resistance. Therefore, continuous monitoring of microbiological and antimicrobial surveillance of UTI among DM patients is crucial for appropriate treatment and infection control.
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Affiliation(s)
- Kuma Diriba
- Department of Medical Laboratory Sciences, Health Science and Medical CollegeDilla University, Dilla, Ethiopia
| | - Ephrem Awulachew
- Department of Medical Laboratory Sciences, Health Science and Medical CollegeDilla University, Dilla, Ethiopia
| | - Bereket Bizuneh
- School of Medicine, Health Science and Medical College, Dilla University, Dilla, Ethiopia
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Darraj MA. The Appropriateness of Empirical Antimicrobial Treatment of Uncomplicated Urinary Tract Infection in Adult Female Patients in Jazan Region, Saudi Arabia. Clin Pract 2023; 13:743-752. [PMID: 37489416 PMCID: PMC10366825 DOI: 10.3390/clinpract13040067] [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: 04/18/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Uncomplicated urinary tract infection (uUTI) is one of the most prevalent bacterial infections in clinical practice. Empirical treatment is used commonly; thus, knowledge of the local antimicrobial susceptibility pattern is crucial to avoid the growing antibiotic resistance. PURPOSE The aim of this study is to evaluate the effectiveness of the empirical treatment of uUTI and determine the susceptibility pattern for common uUTI causative microorganisms at outpatient clinics in hospitals in the Jazan region. METHOD This is a prospective observational study of 120 patients with uncomplicated urinary tract infections attending internal medicine outpatient clinics in Al-Hayat Jazan hospital, Saudi Arabia, from September 2021 to January 2023. RESULTS In total, 120 patients were included in the study. The mean age of the participants was 48.53 ± 9.29. Risk factors for UTI were found in 57.5%, and type 2 diabetes mellitus (DM) was the major risk factor (27.5%). The most common causative microorganism was Escherichia coli (E. coli) (87.5%), followed by Klebsiella pneumoniae (5%), Staphylococcus aureus, Enterobacter spp., and Enterococcus spp. (2.5%). Nitrofurantoin was the most effective antimicrobial agent (sensitivity rate of 91.7%) against all microorganisms, followed by Ciprofloxacin (75%). CONCLUSIONS This study concluded that nitrofurantoin and Ciprofloxacin are suitable empirical treatments for uncomplicated urinary tract infection in the Jazan region, and increased resistance against trimethoprim/sulphamethoxazole (TMPSMX) and cefaclor was observed; thus, empirical therapy with these agents should be reconsidered in local guidelines. Wide surveillance research is necessary to monitor effective empirical therapies and to evaluate the regional antimicrobial susceptibility pattern.
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Affiliation(s)
- Majid A Darraj
- The Department of Internal Medicine, The Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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Mareș C, Petca RC, Popescu RI, Petca A, Geavlete BF, Jinga V. Uropathogens' Antibiotic Resistance Evolution in a Female Population: A Sequential Multi-Year Comparative Analysis. Antibiotics (Basel) 2023; 12:948. [PMID: 37370266 DOI: 10.3390/antibiotics12060948] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/27/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Urinary Tract Infections (UTIs) represent a common finding among females and an important basis for antibiotic treatment. Considering the significant increase in antibiotic resistance during the last decades, this study retrospectively follows the incidence of uropathogens and the evolution of resistance rates in the short and medium term. The current study was conducted at the "Prof. Dr. Th. Burghele" Clinical Hospital, including 1124 positive urine cultures, in three periods of four months between 2018 and 2022. Escherichia coli was the most frequent uropathogen (54.53%), followed by Klebsiella spp. (16.54%), and Enterococcus spp. (14.59%). The incidence of UTIs among the female population is directly proportional to age, with few exceptions. The highest overall resistance in Gram-negative uropathogens was observed for levofloxacin 30.69%, followed by ceftazidime 13.77% and amikacin 9.86%. The highest resistance in Gram-positive uropathogens was observed for levofloxacin 2018-R = 34.34%, 2020-R = 50.0%, and 2022-R = 44.92%, and penicillin 2018-R = 36.36%, 2020-R = 41.17%, and 2022-R = 37.68%. In Gram-negative uropathogens, a linear evolution was observed for ceftazidime 2018-R = 11.08%, 2020-R = 13.58%, and 2022-R = 17.33%, and levofloxacin 2018-R = 28.45%, 2020-R = 33.33%, and 2022-R = 35.0%. The current knowledge dictates the need to continuously assess antimicrobial resistance patterns, information that is necessary for treatment recommendations. The present study aims to determine the current situation and the evolution trends according to the current locoregional situation.
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Affiliation(s)
- Cristian Mareș
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Saint John" Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania
| | - Răzvan-Cosmin Petca
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Răzvan-Ionuț Popescu
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Bogdan Florin Geavlete
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Saint John" Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania
| | - Viorel Jinga
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
- Medical Sciences Section, Academy of Romanian Scientists, 050085 Bucharest, Romania
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Rusu A, Tiliscan C, Adamescu AI, Ganea OA, Arama V, Arama SS, Rascu SA, Jinga V. Carbapenemase-producing uropathogens in real life: epidemiology and treatment at a County Emergency Hospital from Eastern Romania. J Med Life 2023; 16:707-711. [PMID: 37520479 PMCID: PMC10375344 DOI: 10.25122/jml-2023-0139] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/29/2023] [Indexed: 08/01/2023] Open
Abstract
Urinary tract infections are a public health problem exacerbated by the rising concern of antibiotic resistance. Carbapenem-resistant Enterobacterales (CRE), mostly isolated from urine samples, represent an immediate public health threat, often associated with healthcare settings. This study investigated 27 cases of carbapenemase-producing organisms (CPO) detected in urinalysis over one year. There was a significant association between the presence of chronic indwelling urinary catheters and the temporary use of urinary catheters, with both groups accounting for 66.7% of all cases. We identified two modes of transmission for extended drug-resistant microorganisms: inter-hospital spread, covering wide geographical distances (involving four healthcare units across two other counties), and intra-hospital transmission (12 departments within our institution). Medium-size hospitals should thoroughly investigate their specific carbapenemase-producing strains. Their laboratories must be well-supplied to handle this situation and perform the necessary testing accurately. Treatment options should be available based on presumed susceptibility and antimicrobial susceptibility testing, with a range of antibiotics available, including novel agents such as Ceftazidime-avibactam, as well as established options like Aminoglycosides and Colistin. Adherence to rigorous catheter handling protocols, as emphasized by national and international guidelines, is essential and should be implemented consistently across all hospital departments.
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Affiliation(s)
- Aurel Rusu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Vaslui Emergency County Hospital, Vaslui, Romania
| | - Catalin Tiliscan
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Victoria Arama
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Viorel Jinga
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C. Urinary Tract Infections: The Current Scenario and Future Prospects. Pathogens 2023; 12:pathogens12040623. [PMID: 37111509 PMCID: PMC10145414 DOI: 10.3390/pathogens12040623] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [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: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, occurring in both community and healthcare settings. Although the clinical symptoms of UTIs are heterogeneous and range from uncomplicated (uUTIs) to complicated (cUTIs), most UTIs are usually treated empirically. Bacteria are the main causative agents of these infections, although more rarely, other microorganisms, such as fungi and some viruses, have been reported to be responsible for UTIs. Uropathogenic Escherichia coli (UPEC) is the most common causative agent for both uUTIs and cUTIs, followed by other pathogenic microorganisms, such as Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus spp. In addition, the incidence of UTIs caused by multidrug resistance (MDR) is increasing, resulting in a significant increase in the spread of antibiotic resistance and the economic burden of these infections. Here, we discuss the various factors associated with UTIs, including the mechanisms of pathogenicity related to the bacteria that cause UTIs and the emergence of increasing resistance in UTI pathogens.
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Affiliation(s)
- Giuseppe Mancuso
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| | - Angelina Midiri
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| | | | - Maria Marra
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| | - Sebastiana Zummo
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
| | - Carmelo Biondo
- Department of Human Pathology, University of Messina, 98125 Messina, Italy
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Maione A, Galdiero E, Cirillo L, Gambino E, Gallo MA, Sasso FP, Petrillo A, Guida M, Galdiero M. Prevalence, Resistance Patterns and Biofilm Production Ability of Bacterial Uropathogens from Cases of Community-Acquired Urinary Tract Infections in South Italy. Pathogens 2023; 12:pathogens12040537. [PMID: 37111423 PMCID: PMC10145297 DOI: 10.3390/pathogens12040537] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Community-acquired urinary tract infections represent the most common infectious diseases in the community setting. Knowing the antibiotic resistance patterns of uropathogens is crucial for establishing empirical treatment. The aim of the current study is to determine the incidence of the causative agents of UTIs and their resistance profiles. Patients of all ages and both sexes were enrolled in the study, and admitted to San Ciro Diagnostic Center in Naples between January 2019 and Jun 2020. Bacterial identification and antibiotic susceptibility testing were carried out using Vitek 2 system. Among the 2741 urine samples, 1702 (62.1%) and 1309 (37.9%) were negative and positive for bacterial growth, respectively. Of 1309 patients with infection, 760 (73.1%) were females and 279 (26.9%) were males. The greatest number of positive cases were found in the in the elderly (>61 years). Regarding uropathogens, 1000 (96.2%) were Gram-negative while 39 (3.8%) were Gram-positive strains. The three most isolated pathogenic strains were Escherichia coli (72.2%), Klebsiella pneumoniae (12.4%), and Proteus mirabilis (9.0%). Strong biofilm formation ability was observed in about 30% of the tested isolates. The low resistance rates recorded against nitrofurantoin, fosfomycin, piperacillin-tazobactam, and gentamicin could suggest them as the most appropriate therapies for CA-UTIs.
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Affiliation(s)
- Angela Maione
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | - Emilia Galdiero
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | - Luigi Cirillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Edvige Gambino
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | | | - Francesca Paola Sasso
- Department of Dermatology and Venereology, University of Rome "La Sapienza", 00161 Rome, Italy
| | | | - Marco Guida
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 81100 Naples, Italy
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24
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Iheanacho JN, Antai SP. Studies on plasmids of multidrug resistant uropathogens isolated from patients with urinary tract infection in a tertiary hospital in Calabar, Nigeria. Afr Health Sci 2023; 23:774-780. [PMID: 37545904 PMCID: PMC10398438 DOI: 10.4314/ahs.v23i1.81] [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] [Indexed: 08/08/2023] Open
Abstract
Background Urinary tract Infections caused by multidrug resistant uropathogens have become a significant global public health problem with Nigeria being no exception. Objective This study is aimed at profiling and curing the plasmids of selected multidrug resistant uropathogens isolated from patients with urinary tract infection in a tertiary hospital in Calabar, Nigeria. Methodology Isolates were obtained from urine samples of patients using standard microbiological techniques. Multidrug resistant bacterial isolates were then selected for plasmid DNA analysis and curing. Results The study revealed that E. coli, K. pneumoniae, P. aeruginosa and Proteus mirabilis were resistant to the antibiotics tested. The extracted plasmid DNA showed the presence of TEM, SHV and CTX-M genes in the isolates with sizes of 400-600bp, 300bp and 500-800bp, respectively. All isolates possessed the SHV genes while few had TEM and CTX-M genes. Cells were subjected to curing and plasmid curing was achieved at 200-300µl of ethidium bromide. Conclusion The reduction in percentage resistance due to plasmid curing observed in this study suggests that the resistance of the isolates to antibiotics were plasmid-mediated. Antibiogram and monitoring of plasmid mediated resistance are necessary for proper management of urinary tract infections.
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Affiliation(s)
| | - Sylvester Peter Antai
- Department of Microbiology, Faculty of Biological Sciences, University of Calabar, Nigeria
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25
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Iqbal Z, Sheikh AS, Basheer A, Hafsa HT, Ahmed M, Sabri AN, Shahid S. Antibiotic Drug Resistance Pattern of Uropathogens in Pediatric Patients in Pakistani Population. Antibiotics (Basel) 2023; 12. [PMID: 36830305 DOI: 10.3390/antibiotics12020395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
The common prevalent diseases in the age of 0 to 6 are related to urinary tract infections. If not properly diagnosed, they will lead to urological and nephrological complications. Uropathogens are developing resistance against most drugs and are harder to treat. A study was done on the inpatients and outpatients of the two hospitals located in Lahore. A total of 39,750 samples that were both male and female were collected. Escherichia and Klebsiella were found in 234 samples based on biochemical characterization, growth on CLED agar, and white blood cell/pus cell (WBC) microscopy. In comparison to males, female samples had a higher number of uropathogens (1:1.29). From the samples of Shaikh Zayed Hospital (SZH), the ratio of Klebsiella to Escherichia (1:1.93) was reported, while this ratio was 1.84:1 from the Children Hospital (CH). The incidence of UTI was higher in the month of September. Randomly selected Escherichia and Klebsiella were verified via a 16S rRNA sequence. Antibiotic resistance profiling of isolated bacterial strains was done against 23 antibiotics. The most efficient antibiotics against Klebsiella and Escherichia were colistin sulphate (100% sensitivity against bacteria from CH; 99.3% against strains from SZH) and polymyxin B (100% sensitivity against strains from SZH; 98.8% against strains from CH). Sensitivity of the total tested strains against meropenem (74%, SZH; 70% CH), Fosfomycin (68%, SZH; 73% CH strains), amikacin (74% SZH; 55% CH), and nitrofurantoin (71% SZH;67% CH) was found, Amoxicillin, ampicillin, and cefuroxime showed 100 to ≥90% resistance and are the least effective.
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Ortega-Lozano AJ, Hernández-Cruz EY, Gómez-Sierra T, Pedraza-Chaverri J. Antimicrobial Activity of Spices Popularly Used in Mexico against Urinary Tract Infections. Antibiotics (Basel) 2023; 12. [PMID: 36830236 DOI: 10.3390/antibiotics12020325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Urinary tract infections (UTIs) are the most common infectious diseases worldwide. These infections are common in all people; however, they are more prevalent in women than in men. The main microorganism that causes 80-90% of UTIs is Escherichia coli. However, other bacteria such as Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus mirabilis, and Klebsiella pneumoniae cause UTIs, and antibiotics are required to treat them. However, UTI treatment can be complicated by antibiotic resistance and biofilm formation. Therefore, medicinal plants, such as spices generally added to foods, can be a therapeutic alternative due to the variety of phytochemicals such as polyphenols, saponins, alkaloids, and terpenes present in their extracts that exert antimicrobial activity. Essential oils extracted from spices have been used to demonstrate their antimicrobial efficacy against strains of pathogens isolated from UTI patients and their synergistic effect with antibiotics. This article summarizes relevant findings on the antimicrobial activity of cinnamon, clove, cumin, oregano, pepper, and rosemary, spices popularly used in Mexico against the uropathogens responsible for UTIs.
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Behzadi P, García-Perdomo HA, Autrán Gómez AM, Pinheiro M, Sarshar M. Editorial: Uropathogens, urinary tract infections, the host-pathogen interactions and treatment. Front Microbiol 2023; 14:1183236. [PMID: 37032879 PMCID: PMC10076865 DOI: 10.3389/fmicb.2023.1183236] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Payam Behzadi
- Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
- *Correspondence: Payam Behzadi
| | - Herney Andrés García-Perdomo
- Division of Urology, Department of Surgery, School of Medicine, UROGIV Research Group, Universidad del Valle, Cali, Colombia
| | | | - Marina Pinheiro
- Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
- Life and Health Sciences Research Institute, Instituto de Investigação em Ciências da Vida e Saúde, Escola de Medicina, Universidade do Minho, Braga, Portugal
- Public Health Unit, ACES Cávado III, ARS Norte, Porto, Portugal
| | - Meysam Sarshar
- Research Laboratories, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Meysam Sarshar
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Firissa YB, Shelton D, Azazh A, Engida H, Kifle F, Debebe F. Prevalence and Antimicrobial Sensitivity Patterns of Uropathogens, in Tikur Anbessa Specialized Hospital Emergency Medicine Department Addis Ababa, Ethiopia. Infect Drug Resist 2023; 16:1649-1656. [PMID: 36992968 PMCID: PMC10041979 DOI: 10.2147/idr.s402472] [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: 01/25/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Background Empirical treatment of infections remains a major contributing factor to the emergence of pathogens that are resistant to antibiotics. The study aimed to assess the prevalence and anti-microbial sensitivity patterns of uropathogens in the Emergency Medicine Department of Tikur Anbessa Hospital, Ethiopia. Methods Urine sample data collected over two years from January 2015 to January 2016 at Tikur Anbessa Hospital's laboratory were retrospectively analyzed for bacterial pathogens, and their antimicrobial susceptibility. Antimicrobial sensitivity tests were done using the disc diffusion technique as per the standard of the Kirby-Bauer method. Results Of the total 220 samples that were collected, 50 (22.7%) were culture-positive. Male to female data ratio was 1:1.1. Escherichia coli was the dominant isolate (50%) followed by Enterococcus species (12%), Enterobacter species (12%), and Klebsiella species (8%). Overall resistance rates to Cotrimoxazole, Ampicillin, Augmentin, and Ceftriaxone were 90.4%, 88.8%, 82.5%, and 79.3%, respectively. The sensitivity rates for Chloramphenicol, Amikacin, Vancomycin, Meropenem, Cefoxitin, and Nitrofurantoin ranged from 72% to 100%. The antibiogram of isolates showed that 43 (86%) isolates were resistant to two or more antimicrobials, and 49 (98%) were resistant to at least one antibiotic. Conclusion and Recommendation Urinary tract infections are mostly caused by Gram-negative bacteria predominantly in females and Escherichia coli are the most common isolates. Resistance rates to Cotrimoxazole, Ampicillin, Augmentin, and Ceftriaxone were high. Chloramphenicol, Amikacin, Vancomycin, Meropenem, Cefoxitin, and Nitrofurantoin are considered appropriate antimicrobials for the empirical treatment of complicated urinary tract infections in the emergency department. Yet, using antibiotics indiscriminately for patients with complicated UTIs may increase the resistance rate and also lead to treatment failure, hence the prescriptions should be revised following the culture and sensitivity results.
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Affiliation(s)
- Yared Boru Firissa
- Emergency Medicine and Critical Care Department, ALERT Hospital, Addis Ababa, Ethiopia
- Correspondence: Yared Boru Firissa, Department of Emergency Medicine and Critical Care, ALERT Hospital, Addis Ababa, 165, Ethiopia, Email
| | - Dominick Shelton
- Emergency Medicine Department, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aklilu Azazh
- Emergency Medicine and Critical Care Department, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
| | - Hywet Engida
- Emergency Medicine and Critical Care Department, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
| | - Fitsum Kifle
- Network for Perioperative and Critical Care, Addis Ababa, Ethiopia
| | - Finot Debebe
- Emergency Medicine and Critical Care Department, Tikur Anbessa Hospital, Addis Ababa, Ethiopia
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Seid M, Markos M, Aklilu A, Manilal A, Zakir A, Kebede T, Kulayta K, Endashaw G. Community-Acquired Urinary Tract Infection Among Sexually Active Women: Risk Factors, Bacterial Profile and Their Antimicrobial Susceptibility Patterns, Arba Minch, Southern Ethiopia. Infect Drug Resist 2023; 16:2297-2310. [PMID: 37095780 PMCID: PMC10122500 DOI: 10.2147/idr.s407092] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Background Globally, urinary tract infections (UTIs) are a common health issue among women. Investigating risk factors associated with culture-proven UTIs and the antimicrobial resistance profile of uropathogens would provide insight into planning prevention and control measures. Objective To identify the risk factors associated with UTIs among sexually active women and determine antimicrobial susceptibility patterns of uropathogenic bacterial isolates. Methods A case-control study was conducted from February to June 2021, involving 296 women (62 case group and 234 control group in a ratio of 4:1). Cases were defined as culture-confirmed UTIs, and controls were non-UTIs. A semi-structured questionnaire was used to collect demographic, clinical, and behavioral data. The antimicrobial susceptibility test was done by the Kirby-Bauer disc diffusion method. The data were analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were used to identify risk factors, and the strength of association was measured by adjusted odds ratios and a 95% confidence interval used at P-values < 0.05. Results The results revealed that recent coitus and frequency of coitus more than three times per week (P=0.001) were independent predictors of UTIs. Swabbing from back to front, a history of UTI and a delay in voiding were also independent predictors (P < 0.05). On the other hand, a daily water intake of 1 to 2 litres reduced the risk of UTI (P= 0.001). The predominant uropathogenic isolate was Escherichia coli (35.48%). Over 60% of isolates were resistant to cotrimoxazole, penicillin, cephalosporin, and fluoroquinolones. The most effective antibiotics included piperacillin-tazobactam, aminoglycosides, carbapenem, and nitrofurantoin. 85% and 50% of isolates were MDR and ESBL producers, respectively. Conclusion The finding indicates the importance of public intervention targeting the identified risk factors and the resistance phenotype to reduce the burden of UTIs with antimicrobial resistance in the study area.
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Affiliation(s)
- Mohammed Seid
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Correspondence: Mohammed Seid, Email
| | - Mesafint Markos
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Addis Aklilu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abdurezak Zakir
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | - Kebede Kulayta
- Department of Medical Laboratory Science, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
| | - Gessila Endashaw
- Department of Nursing, Arba Minch University, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
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Alsubaie MA, Alsuheili AZ, Aljehani MN, Alothman AA, Alzahrani AS, Mohammedfadel HA, Alnajjar AA. Pediatric community acquired urinary tract infections due to extended-spectrum beta-lactamase versus non-extended-spectrum beta-lactamase producing bacteria. Pediatr Int 2023; 65:e15620. [PMID: 37735838 DOI: 10.1111/ped.15620] [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: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND This study aimed to evaluate the demographics, clinical characteristics, risk factors, and antibiotic resistance of pediatric community-acquired urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing uropathogens. METHODS This retrospective study was conducted at a tertiary care hospital in Saudi Arabia, among children aged between 0 and 14 years, with a culture-proven diagnosis of community-acquired UTI between February 2019 and September 2021. Patients were divided into two groups based on whether or not their UTI was caused by ESBL-producing bacteria. RESULTS A total of 383 patients with community-acquired UTI were evaluated. Escherichia coli was detected in 72.6% of cultures. Extended-spectrum beta-lactamase-producing organisms were responsible for 35.7% of UTI episodes. Of these 69% and 31% were caused by E. coli and Klebsiella pneumoniae, respectively. There were no significant differences between the two groups with regard to clinical presentation or urine analysis. The resistance rates in the ESBL-producing group were 39.4% for amoxicillin/clavulanic acid, 65.7% for ciprofloxacin, 72.3% for co-trimoxazole, 32.8% for nitrofurantoin, 21.2% for gentamicin, and 0.7% for amikacin and carbapenems. In the non-ESBL-producing group, it was 22.4% for amoxicillin/clavulanic acid, 22.4% for ciprofloxacin, 38.2% for co-trimoxazole, 23.6% for nitrofurantoin, 6.1% for gentamicin, and zero for amikacin and carbapenems. The presence of renal abnormalities (p = 0.014) and male gender (p = 0.026) were determined to be independent risk factors for ESBL UTIs. CONCLUSIONS Recognizing risk factors and antibiotic resistance for ESBL-producing bacteria may aid in tailoring an antibiotic regimen for pediatric patients at high risk of ESBL-UTIs.
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Affiliation(s)
| | | | | | | | | | | | - Abeer A Alnajjar
- Infectious Diseases Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Asamoah B, Labi AK, Gupte HA, Davtyan H, Peprah GM, Adu-Gyan F, Nair D, Muradyan K, Jessani NS, Sekyere-Nyantakyi P. High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017-2021. Int J Environ Res Public Health 2022; 19:16556. [PMID: 36554436 PMCID: PMC9779193 DOI: 10.3390/ijerph192416556] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Management of urinary tract infections is challenged by increasing antimicrobial resistance (AMR) worldwide. In this study, we describe the trends in antimicrobial resistance of uropathogens isolated from the largest private sector laboratory in Ghana over a five-year period. We reviewed positive urine cultures at the MDS Lancet Laboratories from 2017 to 2021. The proportions of uropathogens with antimicrobial resistance to oral and parenteral antimicrobials recommended by the Ghana standard treatment guidelines were determined. The proportion of multi-drug resistant isolates, ESBL and carbapenemase-producing phenotypes were determined. Of 94,134 urine specimens submitted for culture, 20,010 (22.1%) were culture positive. Enterobacterales was the most common group of organisms, E. coli (70.6%) being the most common isolate and Enterococcus spp. the most common gram-positive (1.3%) organisms. Among oral antimicrobials, the highest resistance was observed to ciprofloxacin (62.3%) and cefuroxime (60.2%) and the least resistance to fosfomycin (1.9%). The least resistance among parenteral antimicrobials was to meropenem (0.3%). The highest multi-drug resistance levels were observed among Klebsiella spp. (68.6%) and E. coli (64.0%). Extended-spectrum beta-lactamase (ESBL) positivity was highest in Klebsiella spp. (58.6%) and E. coli (50.0%). There may be a need to review the Ghana standard treatment guidelines to reflect increased resistance among uropathogens to recommended antimicrobials.
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Affiliation(s)
| | | | | | - Hayk Davtyan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | | | | | - Divya Nair
- International Union Against TB and Lung Disease (The Union), 75006 Paris, France
| | - Karlos Muradyan
- Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia
| | - Nasreen S. Jessani
- Centre for Evidence based Health Care, Department of Global Health, Stellenbosch University, Cape Town 800, South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Silago V, Moremi N, Mtebe M, Komba E, Masoud S, Mgaya FX, Mirambo MM, Nyawale HA, Mshana SE, Matee MI. Multidrug-Resistant Uropathogens Causing Community Acquired Urinary Tract Infections among Patients Attending Health Facilities in Mwanza and Dar es Salaam, Tanzania. Antibiotics (Basel) 2022; 11. [PMID: 36551375 DOI: 10.3390/antibiotics11121718] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 12/05/2022] Open
Abstract
In low-income countries, the empirical treatment of urinary tract infections (UTIs) without laboratory confirmation is very common, especially in primary health facilities. This scenario often leads to unnecessary and ineffective antibiotic prescriptions, prompting the emergence and spread of antimicrobial resistance. We conducted this study to examine the antibiogram of uropathogens causing community-acquired urinary tract infections among outpatients attending selected health facilities in Tanzania. METHOD This was a cross-sectional health centre-based survey conducted for a period of five months, from July to November 2021, in the Mwanza and Dar es Salaam regions in Tanzania. We enrolled consecutively a total of 1327 patients aged between 2 and 96 years with a median [IQR] age of 28 [22-39] from Dar es Salaam (n = 649) and Mwanza (n = 678). RESULTS Significant bacteriuria was observed in 364 (27.4% [95%CI: 25.0-29.9]) patients, from whom 412 urinary pathogens were isolated. Gram-negative bacteria contributed to 57.8% (238) of the 412 uropathogens isolated, of which 221 were Enterobacterales, and Escherichia coli was the most frequent. Staphylococcus aureus and Staphylococcus haemolyticus were the most frequently isolated among Gram-positive uropathogens (n = 156). Generally, resistance among Escherichia coli ranged from 0.7% (meropenem) to 86.0% (ampicillin) and from 0.0% (meropenem) to 75.6% (ampicillin) in other Enterobacterales. Moreover, about 45.4% (108) of Enterobacterales and 22.4% (35) of Gram-positive bacteria were multidrug resistant (MDR), p = 0.008. We observed 33 MDR patterns among Gram-negative bacteria, predominantly AMP-CIP-TCY (23/108; 21.3%), and 10 MDR patterns among Gram-positive bacteria, most commonly CIP-GEN-TCY (22/35; 62.9%). CONCLUSION the presence of a high number of wide-ranging uropathogens that are multidrug resistant to a variety of antibiotics points to the need to strengthen the laboratory diagnostic systems for the regular surveillance of the antimicrobial resistance of uropathogens to guide and update empirical treatment guidelines.
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Duan W, Yang Y, Zhao J, Yan T, Tian X. Application of metagenomic next-generation sequencing in the diagnosis and treatment of recurrent urinary tract infection in kidney transplant recipients. Front Public Health 2022; 10:901549. [PMID: 36072369 PMCID: PMC9441654 DOI: 10.3389/fpubh.2022.901549] [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: 03/23/2022] [Accepted: 07/12/2022] [Indexed: 01/22/2023] Open
Abstract
Background Rapid and accurate pathogen diagnosis is an urgent unmet clinical need for recurrent urinary tract infection (RUTI) in kidney transplant recipients (KTRs). Metagenomic next-generation sequencing (mNGS) may offer another strategy for diagnosing uropathogens but remains to be studied. Methods Nineteen KTRs with RUTI were collected in this study. The uropathogens were detected and compared by mNGS and urine culture, respectively. Modifications of the anti-infection strategy were also assessed. Results Rich and diverse pathogens were revealed by mNGS. mNGS was significantly higher than culture in total positive rate (100.0% vs. 31.6%; p < 0.01) and in identification rates for bacteria (89.5% vs. 31.6%; p < 0.01), for viruses (57.9% vs. 0; p < 0.01), and for fungi (42.1% vs. 0; p < 0.01), respectively. mNGS identified a significantly higher proportion of mixed infections than culture (89.5% vs. 10.5%; p < 0.01). The anti-infection therapies were adjusted in two (33.3%) and 12 (76.9%) cases guided by culture and mNGS, respectively. Conclusion mNGS has more remarkable etiological diagnostic performance compared with urine culture for KTRs with RUTI to guide anti-infection strategies and, in turn, protect the graft.
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Affiliation(s)
- Wenjing Duan
- Department of the Clinical Research Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Yongguang Yang
- Department of the Clinical Research Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Jingge Zhao
- Department of the Clinical Research Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Tianzhong Yan
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China,Tianzhong Yan
| | - Xiangyong Tian
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China,*Correspondence: Xiangyong Tian
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Silva A, Costa E, Freitas A, Almeida A. Revisiting the Frequency and Antimicrobial Resistance Patterns of Bacteria Implicated in Community Urinary Tract Infections. Antibiotics (Basel) 2022; 11:antibiotics11060768. [PMID: 35740174 PMCID: PMC9220357 DOI: 10.3390/antibiotics11060768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/11/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open
Abstract
Urinary tract infections (UTIs) are one of the most common infectious diseases at the community level. The continue misuse of antimicrobials is leading to an increase in bacterial resistance, which is a worldwide problem. The objective of this work was to study the incidence and pattern of antimicrobial resistance of the main bacteria responsible for UTI in the community of central and northern Portugal, and establish an appropriate empirical treatment. The urine samples were collected in Avelab—Laboratório Médico de Análises Clínicas over a period of 5 years (2015−2019). The urine cultures were classified as positive when bacterial growth was equal to or higher than 105 CFU/mL, and only for these cases, an antimicrobial susceptibility test was performed. Of the 106,019 samples analyzed, 15,439 had a urinary infection. Urinary infections were more frequent in females (79.6%) than in males (20.4%), affecting more elderly patients (56.9%). Escherichia coli (70.1%) was the most frequent uropathogen, followed by Klebsiella pneumoniae (8.9%). The bacteria responsible for UTI varied according to the patient’s sex, with the greatest differences being observed for Enterococcus faecalis and Pseudomonas aeruginosa, these being more prevalent in men. In general, there was a growth in bacterial resistance as the age of the patients increased. The resistance of bacteria in male patients was, in most cases, statistically different (Chi-Square test, p < 0.05) from that observed for bacteria isolated from female patients, showing, in general, higher resistance in male patients. Although E. coli was the most responsible uropathogen for UTI, it was among the bacteria most susceptible to antibiotics. The isolates of K. pneumoniae, Proteus vulgaris and Enterobacter showed high resistance to the tested antimicrobials. The most common multidrug-resistant (MDR) bacteria implicated in UTI were K. pneumoniae (40.4%) and P. aeruginosa (34.7%), but E. coli, the most responsible bacteria for UTI, showed a MDR of 23.3%. When we compared our results with the results from 10 years ago for the same region, in general, an increase in bacterial resistance was observed. The results of this study confirmed that urinary tract infections are a very common illness, caused frequently by resistant uropathogens, for which the antibiotic resistance profile has varied over a short time, even within a specific region. This indicates that periodically monitoring the microbial resistance of each region is essential in order to select the best empirical antibiotic therapy against these infections, and prevent or decrease the resistance among uropathogenic strains.
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Affiliation(s)
- Andreia Silva
- Department of Biology & CESAM, University of Aveiro, 3810-193 Aveiro, Portugal;
- Clinical Analysis Laboratory Avelab, Rua Cerâmica do Vouga, 3800-011 Aveiro, Portugal; (E.C.); (A.F.)
| | - Elisabeth Costa
- Clinical Analysis Laboratory Avelab, Rua Cerâmica do Vouga, 3800-011 Aveiro, Portugal; (E.C.); (A.F.)
| | - Américo Freitas
- Clinical Analysis Laboratory Avelab, Rua Cerâmica do Vouga, 3800-011 Aveiro, Portugal; (E.C.); (A.F.)
| | - Adelaide Almeida
- Department of Biology & CESAM, University of Aveiro, 3810-193 Aveiro, Portugal;
- Correspondence: ; Tel.: +351-234370200
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Campbell JSO, van Henten S, Koroma Z, Kamara IF, Kamara GN, Shewade HD, Harries AD. Culture Requests and Multi-Drug Resistance among Suspected Urinary Tract Infections in Two Tertiary Hospitals in Freetown, Sierra Leone (2017-21): A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19084865. [PMID: 35457729 PMCID: PMC9024669 DOI: 10.3390/ijerph19084865] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
In sub-Saharan Africa, there is limited information about the use of microbiology laboratory services in patients with suspected urinary tract infections (UTIs). This cross-sectional study assessed the requests for urine culture in patients with suspected UTI in two tertiary (maternal and paediatric) hospitals—Freetown and Sierra Leone, during May 2017–May 2021—and determined antimicrobial resistance (AMR) patterns among bacterial isolates. One laboratory served the two hospitals, with its electronic database used to extract information. Overall, there were 980 patients, of whom 168 (17%) had cultures requested and performed. Of these, 75 (45%) were culture positive. During 2017–2019, there were 930 patients, of whom 156 (17%) had cultures performed. During 2020–2021, when services were disrupted by the COVID-19 pandemic, there were 50 patients, of whom 12 (24%) had cultures performed. The four commonest isolates were Escherichia coli (36), Klebsiella pneumoniae (10), Staphylococcus aureus (9), and Pseudomonas spp. (6). There were high levels of AMR, especially for trimethoprim-sulfamethoxazole (47%), nalidixic acid (44%), nitrofurantoin (32%) and cefotaxime (36%). Overall, 41 (55%) bacterial isolates showed multidrug resistance, especially E. coli (58%), Pseudomonas spp. (50%), and S. aureus (44%). These findings support the need for better utilization of clinical microbiology services to guide antibiotic stewardship and monitoring of trends in resistance patterns.
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Affiliation(s)
- Julian S. O. Campbell
- Ola During Children’s Hospital (ODCH) and Princess Christian Maternity Hospital (PCMH) Laboratory, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Correspondence: ; Tel.: +232-79-553-177
| | - Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium;
| | - Zikan Koroma
- Directorate of Laboratory, Diagnostics and Blood Services, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone;
| | - Ibrahim Franklyn Kamara
- Infection Prevention and Control Unit-Health Security and Emergency Cluster, World Health Organization Country Office, Freetown 00232, Sierra Leone;
| | - Gladys N. Kamara
- Joint Medical Unit, Ministry of Defense, Republic of Sierra Leone Armed Forces, Freetown 00232, Sierra Leone;
| | - Hemant Deepak Shewade
- Division of Health System Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India;
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 2 Rue Jean Lantier, 75001 Paris, France;
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Konstantinovitch KY, Arsene MMJ, Aliya MV, Viktorovna PI, Elena VG, Azova MM, Amira AA. Assessment of Antimicrobial Activity of Ethanolic and Aqueous Extracts of Aesculus hippocastanum L. (Horse Chestnut) Bark against Bacteria Isolated from Urine of Patients Diagnosed Positive to Urinary Tract Infections. Front Biosci (Schol Ed) 2022; 14:11. [PMID: 35730436 DOI: 10.31083/j.fbs1402011] [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: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022]
Abstract
The search for new antimicrobials is essential to address the worldwide issue of antibiotic resistance. The present work aimed at assessing the antimicrobial activity of Aesculus hippocastanum L. (horse chestnut) bark against bacteria involved in urinary tract infections (UTIs). Bioactive compounds were extracted from A. hippocastanum bark using water and ethanol as solvents. The extracts were tested against 10 clinical uropathogenic strains including five Gram-positive and five Gram-negative bacteria. Staphylococcus aureus ATCC 6538 and Escherichia coli ATCC 25922 were used as reference bacteria. The susceptibility to antibiotics was assessed using the Kirby Bauer disc diffusion method and the antibacterial activity of the extracts was evaluated using the well diffusion method. The Minimum inhibitory concentration (MIC) and the minimum bactericidal concentrations (MBC) were asseded by the microdilution method. A. hippocastanum bark possessed a dry matter content of 65.73%. The aqueous extract (AE) and ethanolic extract (EE) showed a volume yield of 77.77% and 74.07% (v/v), and a mass yields of 13.4% and 24.3% (w/w) respectively. All the bacteria were susceptible to amoxiclav, imipenem and ceftriaxone but the clinical strains were resistant to at least one antibiotic. Kocuria rizophilia 1542 and Corynebacterium spp 1638 were the most resistant bacteria both with multidrug resistance index of 0.45. Except AE on Proteus Mirabilis 1543 and Enterococcus faecalis 5960 (0 mm), both AE and EE were active against all the microorganisms tested with inhibition diameters (mm) which ranged from 5.5-10.0 for AE and 8.0-14.5 for EE. The MICs of EEs varied from 1-4 mg/mL while those of AEs varied from 4-16 mg/mL. The ethanolic extracts (EE) were overall more active than the aqueous ones. The A. hippocastanum bark extracts had overall weak antibacterial activity (MIC ≥0.625 mg/mL) and bacteriostatic potential (MBC/MIC ≥16) on both Gram-positive and Gram-negative bacteria.
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Affiliation(s)
| | - Mbarga M J Arsene
- Department of Microbiology and Virology, Institute of Medicine, RUDN University, 117198 Moscow, Russia
| | - Martynenkova V Aliya
- Department of Microbiology and Virology, Institute of Medicine, RUDN University, 117198 Moscow, Russia
| | - Podoprigora I Viktorovna
- Department of Microbiology and Virology, Institute of Medicine, RUDN University, 117198 Moscow, Russia
| | - Volina G Elena
- Department of Microbiology and Virology, Institute of Medicine, RUDN University, 117198 Moscow, Russia
| | - Madina M Azova
- Department of Biology and General Genetics, Institute of Medicine, RUDN University, 117198 Moscow, Russia
| | - Ait A Amira
- Department of Biology and General Genetics, Institute of Medicine, RUDN University, 117198 Moscow, Russia
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Ksiezarek M, Novais Â, Peixe L. The Darkest Place Is under the Candlestick-Healthy Urogenital Tract as a Source of Worldwide Disseminated Extraintestinal Pathogenic Escherichia coli Lineages. Microorganisms 2021; 10:27. [PMID: 35056476 PMCID: PMC8778945 DOI: 10.3390/microorganisms10010027] [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: 11/28/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Since the discovery of the urinary microbiome, including the identification of Escherichia coli in healthy hosts, its involvement in UTI development has been a subject of high interest. We explored the population diversity and antimicrobial resistance of E. coli (n = 22) in the urogenital microbiome of ten asymptomatic women (representing 50% of the sample tested). We evaluated their genomic relationship with extraintestinal pathogenic E. coli (ExPEC) strains from healthy and diseased hosts, including the ST131 lineage. E. coli prevalence was higher in vaginal samples than in urine samples, and occasionally different lineages were observed in the same individual. Furthermore, B2 was the most frequent phylogenetic group, with the most strains classified as ExPEC. Resistance to antibiotics of therapeutic relevance (e.g., amoxicillin-clavulanate conferred by blaTEM-30) was observed in ExPEC widespread lineages sequence types (ST) 127, ST131, and ST73 and ST95 clonal complexes. Phylogenomics of ST131 and other ExPEC lineages revealed close relatedness with strains from gastrointestinal tract and diseased host. These findings demonstrate that healthy urogenital microbiome is a source of potentially pathogenic and antibiotic resistant E. coli strains, including those causing UTI, e.g., ST131. Importantly, diverse E. coli lineages can be observed per individual and urogenital sample type which is relevant for future studies screening for this uropathogen.
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Affiliation(s)
- Magdalena Ksiezarek
- UCIBIO–Applied Molecular Biosciences Unit, REQUIMTE, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (M.K.); (Â.N.)
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Ângela Novais
- UCIBIO–Applied Molecular Biosciences Unit, REQUIMTE, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (M.K.); (Â.N.)
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Luísa Peixe
- UCIBIO–Applied Molecular Biosciences Unit, REQUIMTE, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (M.K.); (Â.N.)
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
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Cai T, Anceschi U, Tamanini I, Migno S, Rizzo M, Liguori G, Garcia-Larrosa A, Palmieri A, Verze P, Mirone V, Bjerklund Johansen TE. Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 11:14. [PMID: 35052890 DOI: 10.3390/antibiotics11010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background: In the era of antibiotic resistance, an antibiotic-sparing approach presents an interesting alternative treatment of uncomplicated cystitis in women. Our aim is to perform a systematic review and meta-analysis to compare the effectiveness and safety profile of a medical device containing xyloglucan, hibiscus and propolis (XHP) in women with uncomplicated cystitis. Methods: Relevant databases were searched using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary endpoint was clinical or microbiological success, defined as the complete (cure) and/or non-complete (improvement) resolution of symptoms at the end of treatment, or microbiological resolutions. Results: After screening 21 articles, three studies were included, recruiting a total of 178 patients. All three studies used placebo as comparator. A statistically significant difference was found in terms of clinical or microbiological resolution between the medical device and the comparator (3 RCTs, 178 patients, OR: 0.13; 95% CI: 0.05–0.33; p < 0.0001). No clinically significant adverse effects have been reported. Conclusion: A medical device containing xyloglucan, hibiscus and propolis is superior to comparator regimens in terms of clinical effectiveness in adult women with microbiologically confirmed or clinical suspicion of uncomplicated cystitis and is associated with a high patient compliance.
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Baral R, Shrestha LB, Ortuño-Gutiérrez N, Pyakure P, Rai B, Rimal SP, Singh S, Sharma SK, Khanal B, Selvaraj K, Kumar AMV. Low yield but high levels of multidrug resistance in urinary tract infections in a tertiary hospital, Nepal. Public Health Action 2021; 11:70-76. [PMID: 34778019 DOI: 10.5588/pha.21.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/22/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING There are concerns about the occurrence of multidrug resistance (MDR) in patients with urine tract infections (UTI) in Nepal. OBJECTIVE To determine culture positivity, trends in MDR among Escherichia coli and Klebsiella pneumoniae infections and seasonal changes in culture-positive UTI specimens isolated from 2014 to 2018 at the B P Koirala Institute of Health Sciences, Dharan, Eastern Nepal. DESIGN This was a cross-sectional study using secondary laboratory data. RESULTS Among 116,417 urine samples tested, 19,671 (16.9%) were culture-positive, with an increasing trend in the number of samples tested and culture positivity. E. coli was the most common bacteria (54.3%), followed by K. pneumoniae (8.8%). Among E. coli and K. pneumoniae isolates, MDR was found in respectively 42.5% and 36.0%. MDR was higher in males and people aged >55 years, but showed a decreasing trend over the years. The numbers of isolates increased over the years, with a peak always observed from July to August. CONCLUSION Low culture positivity is worrying and requires further work into improving diagnostic protocols. Decreasing trends in MDR are a welcome sign. Information on seasonal changes that peak in July-August can help laboratories better prepare for this time with adequate buffer stocks to ensure culture and antibiotic susceptibility testing.
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Affiliation(s)
- R Baral
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - L B Shrestha
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | - P Pyakure
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.,School of Public Health and Community Medicine, BPKIHS, Dharan, Nepal
| | - B Rai
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S P Rimal
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S Singh
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S K Sharma
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - B Khanal
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - K Selvaraj
- All India Institute of Medical Sciences, Nagpur, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India.,Yenepoya Medical College, Yenepoya (deemed University), Mangaluru, India
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40
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Hussain T, Moqadasi M, Malik S, Salman Zahid A, Nazary K, Khosa SM, Arshad MM, Joyce J, Khan R, Puvvada S, Walizada K, Khan AR. Uropathogens Antimicrobial Sensitivity and Resistance Pattern From Outpatients in Balochistan, Pakistan. Cureus 2021; 13:e17527. [PMID: 34646592 PMCID: PMC8485873 DOI: 10.7759/cureus.17527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To determine the pattern of microbes responsible for urinary tract infections and their susceptibility to different antibiotics. Method This is a cross-sectional study conducted at Quetta, Pakistan. The urine samples of 400 patients were collected and sent for culture and sensitivity analysis. The results were recorded on an excel datasheet. Descriptive statistics were used to describe the data. Results Out of 400 urine samples, 266 samples were culture positive for microorganisms. The most common organism on analysis was Escherichia coli 123/266 (46.24%) followed by Staphylococcus saprophyticus 59/266 (22.18%) and Klebsiella pneumonia 49/266 (18.42%). Gram-negative microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, and meropenem. Gram-positive microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, meropenem, and amoxicillin/clavulanate. High rates of resistance in E. coli were observed to most commonly prescribed broad-spectrum antibiotics; ceftriaxone (64.35%), cefotaxime (76.54%), ceftazidime (49.43%), cefepime (53.44%), levofloxacin (71.26%), and amoxicillin/clavulanate (70.31%). E. coli was the major multidrug-resistant organism. Conclusion High rates of antibiotic resistance and multi-drug resistance were revealed in this study due to the widespread and injudicious use of broad-spectrum antibiotics. Thus, it is highly recommended to regulate the pharmacies. Physicians should judiciously prescribe antibiotics and practice the culture and sensitivity of urine samples rather than blind prescription. Continued surveillance on uropathogens prevalence and resistance, new and next-generation antibiotics, and rapid diagnostic tests to differentiate viral from bacterial infections is the need of time.
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Affiliation(s)
- Taimoor Hussain
- Neurology/General Practitioner, Bolan Medical College, Quetta, PAK
| | - Mehdi Moqadasi
- Medical Laboratory Technology, Shafa Khana Sahib Zaman Hosptial, Quetta, PAK
| | - Sheza Malik
- Medicine, Army Medical College Rawalpindi, Rawalpindi, PAK
| | | | | | | | | | - John Joyce
- Intern, M.S. Ramaiah Medical College, Bangalore, IND
| | - Rajeswari Khan
- Medicine and Surgery, College of Medicine & Sagore Dutta Hospital, Kolkata, IND
| | - Sneha Puvvada
- Medicine and Surgery, M.S. Ramaiah Medical College, Bangalore, IND
| | | | - Abdul Rahim Khan
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK
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Holá V, Opazo-Capurro A, Scavone P. Editorial: The Biofilm Lifestyle of Uropathogens. Front Cell Infect Microbiol 2021; 11:763415. [PMID: 34604120 PMCID: PMC8486040 DOI: 10.3389/fcimb.2021.763415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Veronika Holá
- Microbiological Institute, Faculty of Medicine of Masaryk University and St. Anne´s University Hospital, Brno, Czechia
| | - Andrés Opazo-Capurro
- Laboratorio de Investigación en Agentes Antibacterianos (LIAA), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile.,Millennium Nucleus for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago de Chile, Chile
| | - Paola Scavone
- Laboratory of Microbial Biofilms, Department of Microbiology, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay
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Mothibi LM, Bosman NN, Nana T. Fosfomycin susceptibility of uropathogens at Charlotte Maxeke Johannesburg Academic Hospital. S Afr J Infect Dis 2021; 35:173. [PMID: 34485478 PMCID: PMC8377994 DOI: 10.4102/sajid.v35i1.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/10/2019] [Accepted: 08/13/2020] [Indexed: 01/09/2023] Open
Abstract
Background Multidrug-resistant uropathogens are becoming widespread both in community and hospital setting. Safe yet effective treatments are a priority. Fosfomycin is an antibacterial that displays good activity against most bacteria causing urinary tract infections (UTIs), including multidrug-resistant bacteria. The aim of this study was to evaluate fosfomycin susceptibility for uropathogens isolated from a microbiology laboratory at a tertiary academic hospital. In addition, this was compared to the susceptibility of other oral antimicrobials. Methods We conducted a retrospective analysis of laboratory reports for uropathogens isolated at Charlotte Maxeke Johannesburg Academic Hospital from September 2015 to August 2017. Antimicrobial susceptibility testing of the isolates was performed using the Kirby–Bauer disk diffusion method or the Vitek® 2 system according to the Clinical and Laboratory Standards Institute. Results Overall susceptibility of fosfomycin for the 4700 Enterobacteriaceae isolates was 95.7%; 95% confidence interval (CI) 95.1–96.2. The overall susceptibility for fosfomycin against the gram-positives was 98.6%. There were 37.9% multidrug-resistant Enterobacteriaceae (MDRE) isolated during the study period. Fosfomycin displayed activity against 94.4% of extended-spectrum β-lactamase (ESBL) producers and 90.7% for carbapenem-resistant Enterobacteriaceae (CRE). None of the methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus isolates tested was fosfomycin resistant. The overall in vitro susceptibility was significantly higher for fosfomycin (p = 0.0001) compared to amoxicillin/clavulanic acid, cephalexin, cefuroxime, ciprofloxacin, trimethoprim/sulfamethoxazole and nitrofurantoin. Conclusion This study confirmed the high susceptibility of fosfomycin against UTI pathogens isolated at our institution. In an era of increasing antimicrobial resistance, fosfomycin represents a potential option for the treatment of UTIs at Charlotte Maxeke Johannesburg Academic Hospital.
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Affiliation(s)
- Lesego M Mothibi
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Parktown, South Africa.,National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Norma N Bosman
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Parktown, South Africa.,National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Parktown, South Africa.,National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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43
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Yakovlev SV, Suvorova MP. [Rationale for the choice of an antibiotic for urinary tract infections with an emphasis on the environmental safety of therapy]. Urologiia 2021:97-105. [PMID: 34486282] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Difficulties in prescribing antibiotics for lower urinary tract infections (UTI) are associated with a fact that such patients can be treated not only by urologists, but also by general practitioners, internists, pediatricians, and gynecologists. Therefore, it is important to adapt the practical recommendations for the treatment of cystitis for different medical disciplines. When creating clinical guidelines, experts take into account the different factors in choosing antibiotic therapy. First of all, pharmacokinetics is of importance and drugs with renal excretion should be preferred. Secondly, the natural activity of the antibiotic against the pathogens, which cause cystitis, has to be considered. In uncomplicated infections, E. coli predominates, while in complicated and recurrent infections E. coli and other enterobacteria are commonly isolated, as well as Enterococci. In addition, local resistance pattern is reviewed. In the Russian Federation E. coli has minimal resistance to nitrofurans and fosfomycin. Lastly, antibiotics can negatively affect the gastrointestinal and urinary tract microbiota and contribute to the increase of antibiotic resistance and the selection of antibiotic-resistant strains, therefore the environmental safety of therapy should be considered. The effect of antibiotics on the resident flora of the gastrointestinal tract, urinary tract and vagina is called collateral effect, or concomitant (parallel) damage, and it may exceed the therapeutic effect of some antibiotics. Cephalosporins and fluoroquinolones can cause ecologically unfavorable effects with the risk of selection of resistant strains; therefore, these drugs are currently considered as second-line agents for UTI. When choosing an antibiotic, preference should be given to drugs with the narrow spectrum and minimal collateral damage, i.e., the principle of "minimum sufficiency" is of importance. Nitrofurans and fosfomycin trometamol are the optimal drugs in terms of efficiency and environmental safety in UTI. WHO experts consider nitrofurans as the most environmentally safe antibiotics with a minimally sufficient spectrum of activity. The environmental safety of antimicrobial therapy is an important component of preventing antibiotic resistance at the global and local levels.
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Affiliation(s)
- S V Yakovlev
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M P Suvorova
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Oumer Y, Regasa Dadi B, Seid M, Biresaw G, Manilal A. Catheter-Associated Urinary Tract Infection: Incidence, Associated Factors and Drug Resistance Patterns of Bacterial Isolates in Southern Ethiopia. Infect Drug Resist 2021; 14:2883-2894. [PMID: 34335034 PMCID: PMC8318706 DOI: 10.2147/idr.s311229] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/15/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection and a leading cause of morbidity. The aim of this study was to determine the prevalence, associated factors and antibiogram of the bacterial isolates among CAUTIs patients. Methods A facility-based, cross-sectional study was conducted from March to December 2019 at Arba Minch General Hospital, Southern Ethiopia. Clinical and socio-demographic data were obtained using a questionnaire. Clean catch midstream urine samples were collected and inoculated onto blood agar, MacConkey agar, and cysteine lactose electrolyte deficient agar (CLED). The inoculated culture media were incubated in an aerobic atmosphere at 37°C for 24 h. After overnight incubation, the bacterial growth on the respective media was inspected visually and graded for the presence of significant bacteriuria. A significant bacteriuria was considered, if pure culture at a concentration of ≥105 colony forming unit (CFU)/mL. All isolates were further identified using colony morphology and biochemical tests. Antimicrobial sensitivity was determined by modified Kirby–Bauer disc diffusion method. Data were analyzed using SPSS version 25. P-value less than 0.05 was used as statistical significance. Results The overall incidence of symptomatic CAUTIs was 39/231 (16.8%). Independent predictors of CAUTIs were prolonged (≥7 days) catheterization (AOR = 3.6, 95% CI = 1.0–12.2), diabetes mellitus (AOR = 5.3, 95% CI = 1.4–19.6) and insertion of catheter in surgical ward (AOR = 3.6, 95% CI = 1.08–12.28). The most common bacterial isolates were E. coli 17/42 (40.5%), Klebsiella species 9/42 (21.4%) and Enterococcus species 5/42 (11.9%). High (>80%) drug resistance was observed against cotrimoxazole, cefoxitin and tetracycline. Ciprofloxacin and nitrofurantoin were the most active drugs. The overall prevalence of MDR among isolates was 37/42 (88.1%). Most bacterial isolates 30/42 (71.4%) were biofilm producers. Conclusion High levels of drug resistance were observed to commonly used antibiotics. In our study, biofilm-producing bacterial isolates were the predominant cause of CAUTIs. Therefore, continuous surveillance of antimicrobial resistance patterns is necessary to help physicians in treatment and management of CAUTIs.
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Affiliation(s)
- Yisiak Oumer
- Department of Medical Microbiology, Arba Minch University, Arba Minch, Ethiopia
| | | | - Mohamed Seid
- Department of Medical Microbiology, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Hematology and Immunohematology, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Microbiology, Arba Minch University, Arba Minch, Ethiopia
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Parente G, Gargano T, Pavia S, Cordola C, Vastano M, Baccelli F, Gallotta G, Bruni L, Corvaglia A, Lima M. Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study. Children (Basel) 2021; 8:children8060436. [PMID: 34071019 PMCID: PMC8224700 DOI: 10.3390/children8060436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 12/13/2022]
Abstract
Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life–3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were Escherichia coli (97%), Proteus mirabilis (2%), and Klebsiella spp. (1%). The only Gram-positive bacteria isolated was an Enterococcus faecalis. As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life–11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1–5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were Pseudomonas aeruginosa (44%), Escherichia coli (27%), and Klebsiella spp. (12%), while Enterococcus spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found (p = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
- Correspondence:
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Stefania Pavia
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Chiara Cordola
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Marzia Vastano
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Francesco Baccelli
- Specialty School of Paediatrics, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (F.B.); (G.G.); (L.B.)
| | - Giulia Gallotta
- Specialty School of Paediatrics, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (F.B.); (G.G.); (L.B.)
| | - Laura Bruni
- Specialty School of Paediatrics, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (F.B.); (G.G.); (L.B.)
| | - Adelaide Corvaglia
- School of Medicine, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy;
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
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Zandbergen LE, Halverson T, Brons JK, Wolfe AJ, de Vos MGJ. The Good and the Bad: Ecological Interaction Measurements Between the Urinary Microbiota and Uropathogens. Front Microbiol 2021; 12:659450. [PMID: 34040594 PMCID: PMC8141646 DOI: 10.3389/fmicb.2021.659450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 01/16/2023] Open
Abstract
The human body harbors numerous populations of microorganisms in various ecological niches. Some of these microbial niches, such as the human gut and the respiratory system, are well studied. One system that has been understudied is the urinary tract, primarily because it has been considered sterile in the absence of infection. Thanks to modern sequencing and enhanced culture techniques, it is now known that a urinary microbiota exists. The implication is that these species live as communities in the urinary tract, forming microbial ecosystems. However, the interactions between species in such an ecosystem remains unknown. Various studies in different parts of the human body have highlighted the ability of the pre-existing microbiota to alter the course of infection by impacting the pathogenicity of bacteria either directly or indirectly. For the urinary tract, the effect of the resident microbiota on uropathogens and the phenotypic microbial interactions is largely unknown. No studies have yet measured the response of uropathogens to the resident urinary bacteria. In this study, we investigate the interactions between uropathogens, isolated from elderly individuals suffering from UTIs, and bacteria isolated from the urinary tract of asymptomatic individuals using growth measurements in conditioned media. We observed that bacteria isolated from individuals with UTI-like symptoms and bacteria isolated from asymptomatic individuals can affect each other's growth; for example, bacteria isolated from symptomatic individuals affect the growth of bacteria isolated from asymptomatic individuals more negatively than vice versa. Additionally, we show that Gram-positive bacteria alter the growth characteristics differently compared to Gram-negative bacteria. Our results are an early step in elucidating the role of microbial interactions in urinary microbial ecosystems that harbor both uropathogens and pre-existing microbiota.
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Affiliation(s)
- Laurens E. Zandbergen
- Microbial Eco-Evolutionary Medicine Group, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Thomas Halverson
- Department of Microbiology and Immunology, Stritch School of Medicine, Health Sciences Division, Loyola University Chicago, Maywood, IL, United States
| | - Jolanda K. Brons
- Microbial Eco-Evolutionary Medicine Group, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Alan J. Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Health Sciences Division, Loyola University Chicago, Maywood, IL, United States
| | - Marjon G. J. de Vos
- Microbial Eco-Evolutionary Medicine Group, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
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Petca RC, Negoiță S, Mareș C, Petca A, Popescu RI, Chibelean CB. Heterogeneity of Antibiotics Multidrug-Resistance Profile of Uropathogens in Romanian Population. Antibiotics (Basel) 2021; 10:antibiotics10050523. [PMID: 34063317 PMCID: PMC8147389 DOI: 10.3390/antibiotics10050523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
Urinary tract infections (UTIs) are a leading cause of morbidity for both males and females. The overconsumption of antibiotics in general medicine, veterinary, or agriculture has led to a spike in drug-resistant microorganisms; obtaining standardized results is imposed by standard definitions for various categories of drug-resistant bacteria—such as multiple-drug resistant (MDR), extensive drug-resistant (XDR), and pan drug-resistant (PDR). This retrospective study conducted in three university teaching hospitals in Romania has analyzed urine probes from 15,231 patients, of which 698 (4.58%) presented multidrug-resistant strains. Escherichia coli was the leading uropathogen 283 (40.54%), presenting the highest resistance to quinolones (R = 72.08%) and penicillin (R = 66.78%) with the most important patterns of resistance for penicillin, sulfonamides, and quinolones (12.01%) and aminoglycosides, aztreonam, cephalosporins, and quinolones (9.89%). Klebsiella spp. followed—260 (37.24%) with the highest resistance to amoxicillin-clavulanate (R = 94.61%) and cephalosporins (R = 94.23%); the leading patterns were observed for aminoglycosides, aminopenicillins + β-lactams inhibitor, sulfonamides, and cephalosporins (12.69%) and aminoglycosides, aztreonam, cephalosporins, quinolones (9.23%). The insufficient research of MDR strains on the Romanian population is promoting these findings as an important tool for any clinician treating MDR-UTIs.
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Affiliation(s)
- Răzvan-Cosmin Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Silvius Negoiță
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Anesthesiology and Critical Care, Elias University Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Cristian Mareș
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
- Correspondence: (C.M.); (A.P.); Tel.: +40-745-383-552 (C.M.); +40-745-787-448 (A.P.)
| | - Aida Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Obstetrics and Gynecology, Elias University Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
- Correspondence: (C.M.); (A.P.); Tel.: +40-745-383-552 (C.M.); +40-745-787-448 (A.P.)
| | - Răzvan-Ionuț Popescu
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (R.-C.P.); (S.N.); (R.-I.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Călin Bogdan Chibelean
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, 38 Gheorghe Marinescu Str., 540139 Targu-Mures, Romania;
- Department of Urology, Mureș County Hospital, 1st Gheorghe Marinescu Str., 540136 Targu-Mures, Romania
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Bazaid AS, Saeed A, Alrashidi A, Alrashidi A, Alshaghdali K, A Hammam S, Alreshidi T, Alshammary M, Alarfaj A, Thallab R, Aldarhami A. Antimicrobial Surveillance for Bacterial Uropathogens in Ha'il, Saudi Arabia: A Five-Year Multicenter Retrospective Study. Infect Drug Resist 2021; 14:1455-1465. [PMID: 33888997 PMCID: PMC8057796 DOI: 10.2147/idr.s299846] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/30/2020] [Accepted: 03/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Urinary tract infections (UTIs) are among the most common infections that require antibiotic intervention. Antibiotic surveillance programs are crucial to assess resistance patterns of microorganisms associated with UTIs and to tailor antibiotic therapy accordingly. Therefore, the aim of the current study is to investigate the prevalence of uropathogens and their antimicrobial susceptibility patterns in Ha’il region. Methods We conducted a retrospective study in two main hospitals in Ha’il over a 5-year period (January 2015 to December 2019). Laboratory reports and clinical data of patients with a positive urine culture (≥105 CFU/mL) were included in the study. Results A total of 428 patients were included in this study. The majority of positive cultures belonged to female patients (94.4%), adults (76.9%) and outpatients (74.3%). Generally, Escherichia coli was the most common pathogen (45%), followed by Klebsiella pneumoniae (17%) and Staphylococcus aureus (12%). Extended-spectrum β-lactamase (ESBL) strains of E. coli (15.7%) and K. pneumoniae (19.7%) showed resistance to most tested antibiotics, while almost all Gram-negative uropathogens including ESBL strains presented low resistance to cefoxitin, imipenem and meropenem. Most strains of Staphylococcus aureus and Enterococcus faecalis were resistant to trimethoprim/sulfamethoxazole including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecalis (VRE), whereas the activity of linezolid was monitored against almost all different strains of Gram-positive uropathogens. Conclusion This surveillance study which was conducted over a 5-year period in the Ha’il region revealed that the most common UTI-associated pathogen was E. coli. Based on the current sensitivity profiles obtained from this surveillance, carbapenems and linezolid can be considered as a first therapeutic choice treating UTIs in Ha’il caused by Gram-negative and positive uropathogens, respectively. Frequent targeted surveillance programs for antibiotic-resistant pathogens and their susceptibility profiles are crucial to enable tailored empirical treatment for patients.
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Affiliation(s)
- Abdulrahman S Bazaid
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Amir Saeed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.,Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, University of Medical Sciences & Technology, Khartoum, Sudan
| | - Abdulaziz Alrashidi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Abdulkarim Alrashidi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Khalid Alshaghdali
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | | | | | | | - Abdullah Alarfaj
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Rawan Thallab
- Department of Statistics, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdu Aldarhami
- Department of Medical Microbiology, Qunfudah Faculty of Medicine, Umm Al-Qura University, Al-Qunfudah, 28814, Saudi Arabia
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Khalid M. Comparison of Chromogenic (HiCrome Urinary Tract Infection Agar) Medium with Cysteine Lactose Electrolyte Deficient Agar in a Resource-Limited Setting. Int J Appl Basic Med Res 2021; 11:9-13. [PMID: 33842289 PMCID: PMC8025950 DOI: 10.4103/ijabmr.ijabmr_306_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/15/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Urinary tract infections (UTI) are one of the most frequent infections encountered in hospital settings as well as in community, making urine the most cultured specimens in laboratories across the world. Urine samples occupy most of the time and manpower in the form of resources in the microbiology laboratories. The microbiological performance of HiCrome UTI agar was compared with cysteine lactose electrolyte deficient (CLED) agar for isolation and presumptive identification of bacteria from urine culture with ease of reporting with less human resource and reduction in the cost. Materials and Methods: The study was conducted in a total of 208 collected midstream catch urine samples from patients attending the Department of Microbiology, Khartoum Teaching Hospital Central Laboratories. Urine samples received in the bacteriology laboratory were inoculated on CLED agar and for HiCrome UTI agar simultaneously and incubated overnight. Isolates were identified by the colony's color for HiCrome UTI agar and by standard microbiological techniques for CLED agar. Results: Out of 208 urine samples tested, significant growth was obtained in 94 (45.2%) plates of CLED agar and 84 (40.4%) of HiCrome UTI; moreover, 15 (7.2%) and 28 (13.5%) plates showed mixed with no growth observed in 99 (47.6%) and 96 (46.1%) on CLED agar and HiCrome UTI agar, respectively. The rate of presumptive identification was found significantly higher on HiCrome UTI agar (94%) than CLED agar (84%) (P < 0.05) as the primary urine culture medium. out of 43 (100%) polymicrobial growths 28 (65.1%) were demonstrated distinctly on HiCrome UTI agar and only 15 (34.9%)were obtained fromCLED agar. Conclusions: HiCrome UTI agar was found to be more useful as a primary urine culture medium in both higher rate of isolation and presumptive identification of uropathogens in comparison to conventional media. Its inherent characteristics in demonstrating polymicrobial growth and ease of rapid identification by distinct colony color are unique.
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Affiliation(s)
- Mohamed Khalid
- Department of Laboratory Medicine, Kamal Medical Polyclinics, Riyadh, Saudi Arabia
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Sun Z, Liu W, Zhang J, Wang S, Yang F, Fang Y, Jiang W, Ding L, Zhao H, Zhang Y. The Direct Semi-Quantitative Detection of 18 Pathogens and Simultaneous Screening for Nine Resistance Genes in Clinical Urine Samples by a High-Throughput Multiplex Genetic Detection System. Front Cell Infect Microbiol 2021; 11:660461. [PMID: 33912478 PMCID: PMC8072482 DOI: 10.3389/fcimb.2021.660461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/03/2021] [Accepted: 03/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background Urinary tract infections (UTIs) are one the most common infections. The rapid and accurate identification of uropathogens, and the determination of antimicrobial susceptibility, are essential aspects of the management of UTIs. However, existing detection methods are associated with certain limitations. In this study, a new urinary tract infection high-throughput multiplex genetic detection system (UTI-HMGS) was developed for the semi-quantitative detection of 18 pathogens and the simultaneously screening of nine resistance genes directly from the clinical urine sample within 4 hours. Methods We designed and optimized a multiplex polymerase chain reaction (PCR) involving fluorescent dye-labeled specific primers to detect 18 pathogens and nine resistance genes. The specificity of the UTI-HMGS was tested using standard strains or plasmids for each gene target. The sensitivity of the UTI-HMGS assay was tested by the detection of serial tenfold dilutions of plasmids or simulated positive urine samples. We also collected clinical urine samples and used these to perform urine culture and antimicrobial susceptibility testing (AST). Finally, all urine samples were detected by UTI-HMGS and the results were compared with both urine culture and Sanger sequencing. Results UTI-HMGS showed high levels of sensitivity and specificity for the detection of uropathogens when compared with culture and sequencing. In addition, ten species of bacteria and three species of fungi were detected semi-quantitatively to allow accurate discrimination of significant bacteriuria and candiduria. The sensitivity of the UTI-HMGS for the all the target genes could reach 50 copies per reaction. In total, 531 urine samples were collected and analyzed by UTI-HMGS, which exhibited high levels of sensitivity and specificity for the detection of uropathogens and resistance genes when compared with Sanger sequencing. The results from UTI-HMGS showed that the detection rates of 15 pathogens were significantly higher (P<0.05) than that of the culture method. In addition, there were 41(7.72%, 41/531) urine samples were positive for difficult-to-culture pathogens, which were missed detected by routine culture method. Conclusions UTI-HMGS proved to be an efficient method for the direct semi-quantitative detection of 18 uropathogens and the simultaneously screening of nine antibiotic resistance genes in urine samples. The UTI-HMGS could represent an alternative method for the clinical detection and monitoring of antibiotic resistance.
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Affiliation(s)
- Zhaoyang Sun
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Wenjian Liu
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Jinghao Zhang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Su Wang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Feng Yang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Yi Fang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Wenrong Jiang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Li Ding
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Hu Zhao
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Yanmei Zhang
- Department of Laboratory Medicine, Huadong Hospital, Affiliated With Fudan University, Shanghai, China.,Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Research Center on Aging and Medicine, Fudan University, Shanghai, China
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