Urinary Tract Pathogens with a Special Reference to Mucoid Pseudomonas Aeruginosa at Aflaj General Hospital

Abstract

Letters to the EditorUrinary Tract Pathogens with a Special Reference to Mucoid Pseudomonas Aeruginosa at Aflaj General Hospital Tolu Odugbemi, MD, PhD, MRCPath, FWACP N. Anandan, and MS, FRCS Olivia F. LinaBSMT Tolu Odugbemi Aflaj General Hospital, Aflaj, Riyadh 11912, Saudi Arabia Search for more papers by this author , N. Anandan Aflaj General Hospital, Aflaj, Riyadh 11912, Saudi Arabia Search for more papers by this author , and Olivia F. Lina Aflaj General Hospital, Aflaj, Riyadh 11912, Saudi Arabia Search for more papers by this author Published Online:1 Nov 1992https://doi.org/10.5144/0256-4947.1992.581SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: In recent articles [1,2], various microorganisms responsible for urinary tract infections from hospitals in Saudi Arabia were reported. The most frequently isolated etiological agents of urinary tract infections with Escherichia coli, Klebsiella-Enterobacter group and Pseudomonas sp.[2]; and because many of the gram-negative organisms were found to be resistant to ampicillin, but susceptible to augmentin, it was suggested that ampicillin resistance was probably due to beta-lactamase production by the pathogens.We report our observation on urinary tract pathogens isolated between April 1991 and October 1991 from urine specimens submitted to the Pathology Laboratory, Aflaj General Hospital. This is a modern 110-bed general hospital situated in the Central Province of Saudi Arabia. It provides general medical, pediatric, and various surgical specialty services to the population of Aflaj and surrounding area.All clinical urine samples were collected into sterile universal containers and were received for bacteriological processing within 30 minutes of collection. Urinalysis including macroscopic and microscopic examinations were carried out. Specimens were aseptically inoculated onto CLED (Cystine lactose electrolye-deficient agar, oxoid). All inoculated agar plates were incubated at 37°C for 18 to 48 hours. Culture plates showing evidence of significant bacteriuria (greater 105 colony forming units (CFU/ml) were identified using standard method [3]. Further identification of bacterial isolates included the use of API 20E and API 20NE (Analytic Profile Index System, La Balme Les Grottes, France). Beta-lactamase production was determined using white-bond starch-paper technique [4].A total of 144 urine specimens (12.2%) out of 1183 clinical urine samples had significant bacteriuria.Table 1 shows the type of organisms isolated with Escherichia coli accounting for 51.0% of all the 144 clinical isolates. Other frequently isolated organisms in our study were Klebsiella-Enterobacter group and Pseudomonas sp. It is worth noting that the majority of urinary tract pathogens were beta-lactamase producers (Table 1). These findings confirm the report [2] that beta-lactamase could have accounted for prevalent ampicillin-resistance mentioned earlier.Table 1. Types of microorganisms isolated from urine and their beta-lactamase activity at Aflaj General Hospital.Table 1. Types of microorganisms isolated from urine and their beta-lactamase activity at Aflaj General Hospital.It is also interesting to note that a highly mucoid strain of Pseudomonas aeruginosa and a mucoid Escherichia coli were isolated from urine samples in our study. The two bacterial isolates had similar appearance to culture of Klebsiella which are usually mucoid. Sonnenwirth [5] highlighted the fact that mucoid Pseudomonas aeruginosa often isolated from sputum of patients with cystic fibrosis could be misidentified as Klebsiella. Careful interpretation of bacteriological tests including Oxidase test, Indole, Methyl-red, Voges-Proskauer, and Oxidation-fermentation of glucose could be useful in differentation of the mucoid microorganisms [5].This preliminary report is to share our experience on the need for further studies on the prevalence of beta-lactamase producing organisms and mucoid strains of Pseudomonas in clinical bacterial isolates in Saudi Arabia.ARTICLE REFERENCES:1. El-Tahawy AT, Khalaf RMF. "Urinary tract infection at university hospital in Saudi Arabia: incidence, microbiology and antimicrobial susceptibility" . Ann Saudi Med. 1988; 8(4):261–6. Google Scholar2. El-Bashier AM. "Bacteriuria, incidence, causative micro-ogranism, and susceptibility pattern at Qatif Central Hospital" . Ann Saudi Med. 1991; 11(4):429–34. Google Scholar3. Cowan ST. In: Cowan and Steel's manual for identification of medical bacteria, ed 2. Cambridge: Cambridge University Press, 1974. Google Scholar4. Odugbemi TO, Hafiz S, McEntegart MG. "Penicillinase-producing Neisseria gonorrhoeae: detection by starch-paper technique" . Br Med J. 1977; 2:500. Google Scholar5. Sonnenwirth AC. Gram-negative bacilli, vibrios and spirilla. In: Sonnenwirth AC, Jarrett L. eds. Gradwohl's clinical laboratory methods and diagnosis, ed 8. St. Louis, Toronto, London: CV Mosby Company; 1980:1731–852. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 12, Issue 6November 1992 Metrics History Published online1 November 1992 InformationCopyright © 1992, Annals of Saudi MedicinePDF download