Abstract
Urinary tract infection (UTI) causes significant renal damage and disease severity is compounded by antimicrobial resistance (AMR) and other comorbidities in the patient. Blood group antigens secreted in body fluids (secretor status) are known to play a role in bacterial adhesion and we studied its influence on AMR in UTI. A total of 2758 patients with UTI were studied with urine culture, qualitative and semiquantitative urine microscopy, serum creatinine and secretor status in saliva samples by adsorption-inhibition method. Of these, AMR from 300 patients with E. coli infection were assessed as per CLSI 2019 guidelines and extended-spectrum beta-lactamase (ESBL) genes (bla TEM, bla CTX-M, bla SHV) and NDM1 genes were studied using TaqMan probes in Real-time polymerase chain reaction. Patients with UTI were followed up for two weeks. Female patients had higher predilection (57%) for E. coli infection while patients with diabetes or non-secretors had none. In our study, ESBL producers were seen in 62% of the E. coli isolates and fosfomycin had 100% susceptibility. Non-secretors were significantly associated with acute kidney injury (AKI), AMR and ESBL genes. Multidrug-resistance (MDR) was noted in 127/160 (79.4%) ESBL and 17/18 (94%) NDM1 gene encoding strains. Quantitative urine microscopy scoring predicted AKI both at presentation and at end of follow up. ESBL producers were common in our study population and non-secretors had a significant association with AMR genes. Urine microscopy scoring system may be a useful tool to predict AKI in patients with UTI.
Highlights
Upper urinary tract infection (UTI)remains the third most frequent infectious disease next to respiratory and gastrointestinal infections.[1]
Our study focused on the patients with upper UTI, caused by E. coli, who had at least two weeks follow up and 300 patients fulfilled the criteria
UTI is a significant cause for acute kidney injury (AKI) thereby leading to morbidity and antimicrobial resistance (AMR) is a constant threat to severe and persistent AKI
Summary
Remains the third most frequent infectious disease next to respiratory and gastrointestinal infections.[1] Women are affected commonly and exhibit two incidence peaks during child bearing age and postmenopausal period with more than 50% of them infected with UTI at least once in their life time. UTI has a global prevalence about 150–250 million cases per year.[2]. E. coli is the most frequent uropathogen, followed by Klebsiella species across the globe.[3,4,5] Increased AMR in Enterobacteriaceae restrains the therapeutic options and affects clinical outcome. Development of AMR is a dynamic event and is a rapidly evolving event with regional differences based on local prescription practices and periodic assessment of antibiotic susceptibility patterns is warranted to facilitate the selection of therapy
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