New Trends in Medical Therapy of Resistant Urinary Tract Infections

Purpose: The incidence of antibiotic resistant urinary tract infections (UTIs) in children is increasing. In particular, there is growing concern about the emergence of multidrug resistant (MDR) UTIs caused by Enterobacteriaceae. The purpose of this study is to describe the incidence, clinical characteristics and risk factors for MDR UTIs presenting to the pediatric emergency department. Methods: This was a retrospective review conducted at BC Children’s Hospital. Children 0-18 years old who …

Urine culture susceptibility reports may be misleading: Cultured patients may be different than the majority treated empirically

Antibacterial activity of green silver nanoparticles synthesized from Anogeissus acuminata against multidrug resistant urinary tract infecting bacteria in vitro and host-toxicity testing

Introduction: Klebsiella pneumoniae are among the most common cause of urinary tract infections such as cystitis and pyelonephritis. These multi-drug resistant K. pneumoniae are producers of extended spectrum beta-lactamases (ESBL) that are capable of hydrolyzing beta-lactams and non-beta-lactams. This laboratory-based study sought to establish the increase of ESBL-producing K. pneumoniae in multi-drug resistant urinary tract infections and determine the effective antibiotic treatment options.
 Methods: One hundred and seventy five K. pneumoniae isolates obtained from urine cultures were randomly collected and the combined disc synergy method was used to determine the ESBL-producing K. pneumoniae. The Vitek 2 system (bioMérieux, France) was used to perform antimicrobial susceptibility testing of 17 commonly used antibiotics. The data from the work was collated and statistically analysed using the chi-square test and Mann-Whitney U test. P values < 0.05 were considered significant.
 Results: Of the 175 K. pneumoniae responsible for urinary tract infections, 73.7% were producing ESBL suggesting that most urinary tract infections caused by K. pneumoniae will be multi-drug resistant. The antimicrobial resistance differences between ESBL-producing and non-ESBL-producing Klebsiella pneumoniae indicated a significance difference with p < 0.05. This study indicated that imipenem and amikacin are the antibiotic of choice for the treatment of multi-drug resistant urinary tract infections caused by ESBL-producing K. pneumoniae. Cephalosporins and nitrofurantoin are suitable for the treatment of urinary tract infections due to non-ESBL-producing K. pneumoniae.
 Conclusion: This study indicated that imipenem (carbapenem) and amikacin are the antibiotic of choice for the treatment of multi-drug resistant urinary tract infections caused by ESBL-producing K. pneumoniae. The third and fourth generation cephalosporins and nitrofurantoin are suitable for the treatment of urinary tract infections due to non-ESBL-producing K. pneumoniae. Rational use of antibiotics and evidence based antibiotic prescription will help to control the spread of resistance by ESBL-producing K. pneumoniae. There is the need to intensify research in the use of natural products to treat multi-drug resistant urinary tract infections emanating from ESBL-producing K. pneumoniae

BackgroundThe prevalence of multidrug resistant gram-negative urinary tract infections (UTIs) is increasing, often requiring intravenous antimicrobial therapy. Oral fosfomycin is a recommended alternative agent for the treatment of cystitis caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli). The primary objective of this study is to evaluate the efficacy of fosfomycin in the treatment of UTIs at the Veterans Affairs Long Beach Healthcare System. The secondary objective is to assess the incidence of adverse drug reactions associated with fosfomycin. MethodsThis is a retrospective, single-center, cohort study. Patients who received fosfomycin between June 1st, 2015 – June 30th, 2020 were included. Data collection was completed by chart review through the Computerized Patient Record System (CPRS). Descriptive analysis was used to evaluate data. Treatment outcomes were analyzed using a composite of clinical and microbiological cure. Clinical cure was defined as resolution of UTI symptoms. Microbiological cure was defined as urine sterilization within 1 month after completing treatment course with fosfomycin.ResultsA total of 62 unique patients were evaluated in this study. The mean age was 71.9 years. 56 patients (90.3%) were male, 31 patients (50.0%) had an indwelling catheter present at the time of treatment, and 48 patients (77.4%) had the presence of genitourinary tract pathology that may increase the risk of developing UTIs. Majority of patients (50%) had a urine culture result positive for E. coli prior to treatment, of which 43.5% were ESBL-producing. 60 patients (96.8%) received more than 1 dose of Fosfomycin. Out of 29 patients who were eligible to be evaluated for clinical outcomes, 20 patients (68.9%) met a positive composite outcome of either microbiological cure, clinical cure, or both. 4 patients (6.5%) experienced an adverse drug reaction of diarrhea that was self-limited. ConclusionFosfomycin is an effective and well-tolerated antimicrobial agent that may be considered for treatment of complicated UTIs without evidence of pyelonephritis or bacteremia caused by multi-drug resistant organisms in the veteran population.DisclosuresAll Authors: No reported disclosures

Nurse PrescribingVol. 16, No. 6 News AnalysisNew guidance to cover the problem of drug resistance in urinary tract infectionsAysha Mendes, Sarah Jane PalmerAysha MendesSearch for more papers by this author, Sarah Jane PalmerSearch for more papers by this authorAysha Mendes; Sarah Jane PalmerPublished Online:23 Jun 2018https://doi.org/10.12968/npre.2018.16.6.254AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References MacKenzie D. UTIs could soon be life-threatening without new antibiotics. 2017. https://www.newscientist.com/article/2122891-utis-could-soon-be-life-threatening-without-new-antibiotics/ (accessed 30 May 2018) Google ScholarNational Institute for Health and Care Excellence. Antibiotic resistance is now common in urinary tract infections. 2017. https://www.nice.org.uk/news/article/antibiotic-resistance-is-now-common-in-urinary-tract-infections (accessed 30 May 2018) Google ScholarNational Institute for Health and Care Excellence. New guidance will help combat drug resistant urinary tract infections, says NICE. 2018. https://www.nice.org.uk/news/article/new-guidance-will-help-combat-drug-resistant-urinary-tract-infections-says-nicereleases/2018/05/180514083923.htm (accessed 30 May 2018) Google Scholar FiguresReferencesRelatedDetails 2 June 2018Volume 16Issue 6ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 23 June 2018 Published in print 2 June 2018 Information© MA Healthcare LimitedPDF download

Urinary tract infection (UTI) is the most common infectious disease in post-kidney transplantation patients. The objective of the study was to investigate the prevalence, impact and risk factors of multiple drug resistant (MDR) UTI in kidney transplant recipients. This retrospective cohort study recruited 72 kidney transplant recipients between March 2017 and February 2018. Urine cultures performed during the 1st year of posttransplantation with reference to clinical data were evaluated. Predesigned questionnaire was used to collect data regarding demographic, transplant related, and microbiological information. Multivariate analysis was performed to ascertain risk factors of MDR UTI. Out of 72 patients, 28 (38.9%) had culture guided clinical UTI. Overall, 59 UTI episodes were noted throughout the duration of this study. Eschericia coli were found to be the most frequent uropathogen of UTI among kidney transplant recipients (n = 32, 54.2%). MDR bacteria were responsible for 27.1% (n = 16) of the post-transplantation UTI episodes among patients, with E. coli (n = 9, 56.3%) being the predominant bacterial pathogen. Most of the MDR strains of E. coli (n = 7, 77.8%) were extended spectrum beta-lactamase positive. Female gender (P <0.001), prolonged Foley's catheterization (P = 0.002), coexisting diabetes mellitus (DM) (P <0.001) and induction of anti-thymocyte globulin (ATG) therapy (P <0.001) were independently associated with high risk of MDR UTI. The allograft rejection was found to be significantly higher in patients of posttransplantation UTI with MDR uropathogen (P = 0.009). In conclusion, E. coli were the most prominent uropathogen of UTI with and without MDR pathogen in the present study. Female gender, prolonged Foley's catheterization, coexisting DM, and induction of ATG therapy were the risk factors independently associated with MDR UTI in kidney transplant recipients. MDR organisms were significantly associated with allograft rejection.

Objectives: To determine the frequency of Escherichia coli (E. Coli) with multi-drug resistance and sensitivity to oral Fosfomycin in urinary tract infections in a public sector hospital of Peshawar Pakistan. Material and Methods: A descriptive cross-sectional study with a convenient consecutive sampling technique at the Department of Medicine Khyber Teaching Hospital Peshawar. A total of 179 patients were recruited in the current study. Detailed history and examination were carried out followed by routine baseline investigations. Under rigorous aseptic settings, two clean midstream urine samples from patients exhibiting symptoms of a urinary tract infection were collected. These samples were then promptly transferred to the hospital laboratory for routine evaluation and E.Coli inoculation on culture media. Once E.Coli was detected, it was tested for antibiotic sensitivity and resistance against the antibiotics mentioned. The multi-drug resistant (MDR) strains were isolated and their sensitivity was checked against oral fosfomycin. All the variables of data were recorded in SPSS version 20. Descriptive and inferential statistics will be utilized to elaborate study findings. Results: The mean age in this study was 37 years with a standard deviation was ±11.27.Seventy-three (41%) patients were males and 106 (59%) patients were females. One hundred and eleven (62%) patients had multidrug-resistant E.Coli among which oral Fosfomycin was sensitive in 108(97%) patients and was resistant in 3(3%) patients presenting with urinary tract infection. Conclusion: The multidrug-resistant E. coli strains are common in our setup. However, oral fosfomycin has documented sensitivity against these MDR strains of E. coli in the majority of UTI cases. Keywords: Multidrug-resistant Escherichia coli, Drug Sensitivity, Fosfomycin, urinary tract infection

Past studies exploring risk factors for fluoroquinolone (FQ) resistance in urinary tract infections (UTIs) focused only on UTIs caused by Gram-negative pathogens. The epidemiology of FQ resistance in enterococcal UTIs has not been studied. We conducted a case-control study at two medical centres within the University of Pennsylvania Health System in order to identify risk factors for FQ resistance in enterococcal UTIs. Subjects with positive urine cultures for enterococci and meeting CDC criteria for healthcare-acquired UTI were eligible. Cases were subjects with FQ-resistant enterococcal UTI. Controls were subjects with FQ-susceptible enterococcal UTI and were frequency matched to cases by month of isolation. A total of 136 cases and 139 controls were included from 1 January 2003 to 31 March 2005. Independent risk factors [adjusted OR (95% CI)] for FQ resistance included cardiovascular diseases [2·24 (1·05-4·79), P=0·037], hospitalization within the past 2 weeks [2·08 (1·05-4·11), P=0·035], hospitalization on a medicine service [2·15 (1·08-4·30), P<0·030], recent exposure to β-lactamase inhibitors (BLIs) [14·98 (2·92-76·99), P<0·001], extended spectrum cephalosporins [9·82 (3·37-28·60), P<0·001], FQs [5·36 (2·20-13·05), P<0·001] and clindamycin [13·90 (1·21-10·49), P=0·035]. Use of BLIs, extended spectrum cephalosporins, FQs and clindamycin was associated with FQ resistance in enterococcal uropathogens. Efforts to curb FQ resistance should focus on optimizing use of these agents.

Hospital-based surveillance of antimicrobial resistance may be irrelevant as a guide to antimicrobial use for urinary tract infections (UTIs) in primary care. To highlight the value of online computerized decision support systems (CDSS) in providing information on the surveillance of antimicrobial resistance in community-acquired UTIs. We collected the susceptibility profile for key antibiotics by type of UTI involving Escherichia coli from 2017 to 2020, using queries for UTI (Q-UTI) submitted to a French CDSS. We compared these results with those from the MedQual French surveillance system for community-acquired UTI and the European Antimicrobial Resistance Surveillance Network (EARS-NET) for invasive infections. We collected 43 591 Q-UTI, of which 10 192 (23%) involved E. coli: 40% cystitis, 32% male-UTI, and 27% pyelonephritis. Resistance was 41.3% (95% CI, 40.3%-42.2%) for amoxicillin, 16.6% (95% CI, 15.9%-17.3%) for fluoroquinolones, 6.6% (95% CI, 6.1%-7.0%) for third-generation cephalosporins (3GC), and 5.7% (95% CI, 5.2%-6.1%) for aminoglycosides. Resistance to amoxicillin was lower than that reported in MedQual (42.7%, P value = 0.004), and in EARS-NET (55.2%, P value < 0.001). For fluoroquinolones, resistance was higher than in MedQual (12.0%, P value < 0.001) and EARS-NET (15.8%, P value = 0.041). In complicated pyelonephritis and male UTI, fluoroquinolone resistance peaked at ∼20%. For 3GC, all UTI had higher resistance than in MedQual (3.5%, P value < 0.001), but lower than in EARS-NET (9.5%, P value < 0.001). Aminoglycoside resistance was not reported by MedQual, and was lower than in EARS-NET (7.1%, P value < 0.001). CDSS can inform prescribers in real-time about the ecology and surveillance of E. coli resistance in community-acquired UTI. In complicated upper UTIs, they can underline the risk of empirical use of fluoroquinolones and suggest preferential use of 3GC.

A multidrug-resistant clonal group (CgA) of Escherichia coli was shown to cause half of all trimethoprim-sulphamethoxazole (TMP-SMZ)-resistant urinary tract infections (UTIs) in a college community between October 1999 and January 2000. This second study was conducted to determine the fate of CgA. Urine E. coli isolates from women with UTI, collected between October 2000 and January 2001, were tested for antibiotic susceptibility, O serogroup, ERIC2 PCR and DNA macrorestriction patterns using pulsed-field gel electrophoresis. The proportion of UTIs caused by CgA declined by 38% (P<0.001) but the prevalence of resistance to TMP-SMZ did not change. Six additional clonal groups were identified and these were responsible for 32% of TMP-SMZ-resistant UTIs. The temporal decline in the proportion of UTIs caused by CgA provides evidence that CgA caused a community outbreak of UTI. The fluctuation and occurrence of other E. coli clonal groups in this community suggest that a proportion of community-acquired UTIs may be caused by E. coli disseminated from one or more point sources.

Objectives To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous...

Urinary tract infections (UTIs) are among the most prevalent bacterial infections worldwide, posing a significant health burden, particularly in the context of rising antimicrobial resistance. The increasing ineffectiveness of conventional antibiotics has necessitated the exploration of alternative therapeutic approaches, especially those derived from natural plant-based sources. This study aimed to evaluate the antimicrobial efficacy of Cymbopogon citratus (lemongrass) leaf extracts against multidrug-resistant uropathogens. Extracts were prepared using three solvents: methanol, ethanol, and n-hexane, and tested against three clinically relevant bacterial strains: Escherichia coli, Bacillus subtilis, and Enterobacter hormaechei subsp. xiangfangensis. Phytochemical screening revealed that extracts contained a wide variety of bioactive compounds, including alkaloids, flavonoids, saponins, tannins, terpenoids, phenols, coumarins, and volatile oils. Further analysis using Fourier-transform infrared spectroscopy identified characteristic functional groups, including O-H, C-H, C = O, C = C, and N-H, indicating the presence of alcohols, aldehydes, ketones, alkenes, and amines, which are often associated with antimicrobial activity. Antibacterial assays showed that the methanolic extract exhibited the strongest inhibitory activity. In disc diffusion tests, it produced the largest zones of inhibition: 14mm against Escherichia coli, 14mm against Bacillus subtilis, and 13mm against Enterobacter hormaechei subsp. xiangfangensis. Minimum inhibitory concentration values further confirmed its superior potency, with results of 3.12mg/mL for Escherichia coli, 6.25mg/mL for Bacillus subtilis, and 12.5mg/mL for Enterobacter hormaechei subsp. xiangfangensis. The extract also showed bactericidal activity, with minimum bactericidal concentrations of 12.5mg/mL for Escherichia coli and 25mg/mL for the other two strains. In summary, this study provides strong evidence that Cymbopogon citratus, particularly when extracted with methanol, possesses significant antibacterial and antioxidant properties against multidrug-resistant uropathogens. These findings support its potential use as a complementary or alternative therapeutic agent in managing resistant urinary tract infections, offering a promising natural strategy to address the growing challenge of antimicrobial resistance. IMPACT STATEMENT. Methanolic extracts of Cymbopogon citratus demonstrated strong antibacterial and bactericidal activity against multidrug-resistant uropathogens, including Escherichia coli and Enterobacter hormaechei subsp. xiangfangensis. Phytochemical and FTIR analyses confirmed the presence of bioactive functional groups associated with antimicrobial effects. These findings highlight lemongrass as a promising plant-based candidate for developing complementary therapies to address antimicrobial resistance in urinary tract infections and support further pharmacological standardization and clinical investigation.

BackgroundAntimicrobial resistance (AMR) is a health risk as it can lead to life‐threatening infections. There has been a rise in resistant urinary tract infections (UTIs) which is the most common infection in pregnancy. This can be challenging in pregnancy due to the additional need to safeguard foetal development. The study's aim was to explore views about AMR in women who experienced UTIs in pregnancy.DesignFifteen semi‐structured interviews were conducted in the UK and analysed using thematic analysis.ResultsResults highlighted two themes: conceptualization of AMR and pregnancy as a deviation from the norm, with an overarching theme of ‘self‐efficacy’. Results show that participants were concerned about AMR but uncertain about the effect on society compared to individual's taking antibiotics and about completing antibiotic courses. Participants reported an unsparing use of antibiotics was justified in pregnancy, and behaviours like drinking adequate water were ineffective at preventing UTIs. In summary, women had low self‐efficacy regards tackling AMR and managing their health.ConclusionMisconceptions about how AMR affects society vs the individual translated into viewing it as a future problem to be tackled by the health‐care sector. Consequently, AMR requires reconceptualization as a current problem requiring collective action. This research also indicates women endorse a biomedical model of UTIs in pregnancy which attributes resolving illness to interventions such as medicines, implying an automatic reliance on antibiotics. Subsequently, there is a need for self‐efficacy by focusing on a behavioural model which emphasizes behaviours for infection prevention, thus reducing the need for antibiotics.

Evaluation of spectinomycin and gentamicin in the treatment of hospitalized patients with resistant urinary tract infections.