Antibiotic Resistance In Urinary Tract Infections Research Articles

Trends of Antibiotic Resistance among Uropathogens in Medical vs. Non-Medical Departments of Al-Shifa Medical Complex in Gaza Strip: A Retrospective, Cross-Sectional Study

Antibiotic resistance is a growing global crisis, straining healthcare systems and leaving us with limited options to combat drug-resistant bacteria. This retrospective, cross-sectional study examines the prevalence of antibiotic resistance patterns among urinary tract infections (UTIs) in Al-Shifa Hospital’s medical departments in comparison with non-medical departments using data from microbiology laboratory archives over a one-year period. From the examined urine cultures about 25% were obtained from internal medicine departments and double the number was obtained from non-medical departments. The positive rate was around 35% and about two-thirds of the samples were collected from female patients. Among all departments, Enterobacteriaceae spp. were found to be the most frequently isolated uropathogens, accounting for 80% of cases. However, resistance rates varied depending on the specific organism and antibiotic used. For instance, E. coli showed a resistance rate of only 5% against meropenem, while amoxicillin-clavulanic acid exhibited a resistance rate exceeding 95%. Importantly, the study revealed a significant disparity in resistance rates between medical and non-medical departments, specifically concerning third-generation cephalosporins. In internal medicine departments, resistance rates were alarmingly high, with cefotaxime, ceftriaxone, and ceftazidime showing resistance rates of 75%, 75% and 66.5% respectively. In contrast, non-medical departments displayed lower resistance rates, approximately 60%, 60% and 40%, respectively. In summary, this research sheds light on the escalating problem of antibiotic resistance in UTIs and emphasizes the discrepancy in resistance rates between medical and non-medical departments. Urgent efforts are required to address this issue and find effective solutions to prevent the rise of untreatable bacterial infections.

A Cross-sectional Study on Microbiological Patterns Associated with Urinary Tract Infections in Hospitalised Women: Analysis of Their Antimicrobial Sensitivity and Clinical Risk Factors

Introduction: Urinary Tract Infections (UTIs) are one of the most common infections, with a predominance in females. To overcome the menace of antibiotic resistance in UTIs, it is important to delineate and follow the local antibiotic resistance patterns of these pathogens. This helps in formulating institutional infection control policies and providing guidance for antibiotic therapy. Knowledge of risk factors for UTIs in hospitalised patients is used to formulate preventive measures for admitted patients. Aim: To study the microbiological patterns and antimicrobial sensitivity of UTIs in female patients admitted to a tertiary care centre. Materials and Methods: A cross-sectional study was conducted collaboratively between the Department of Microbiology and the Department of Obstetrics and Gynaecology at RKDF Medical College Hospital and Research Centre, Bhopal, Madhya Pradesh, India. Urine samples were collected from all admitted female patients who were prescribed culture and sensitivity testing by the treating clinicians from November 2020 to October 2022. Demographic and clinical data of patients were collected, and urine samples were sent for culture-sensitivity testing. Identification and antimicrobial susceptibility testing were done using the VITEK2-compact system. Results were analysed using Statistical Packages for the Social Sciences (SPSS) version 23.0. Results: Out of 508 urine samples sent for culture-sensitivity testing, a culture positivity rate of 16.31% was observed. Diabetes was associated with 25 out of 83 patients. Among all UTI cases, 57.8% (n=48) had a urinary catheter. In catheterised patients, the predominant associated conditions were pregnancy, cardiovascular failure, followed by respiratory issues. Gram- negative isolates constituted 77.1% of the total bacterial isolates, Gram-positive isolates formed 12%, and fungal isolates comprised 10.8% of the total cultures. E. coli was the most frequently encountered species, comprising 55.4% of the isolates. The study found carbapenems to be the most effective against E. coli. In the present study, Extended Spectrum Beta-Lactamase (ESBL) production was similar in uropathogenic E. coli and K. pneumoniae, 65.9% and 64.7%, respectively. The present study study showed that aminoglycosides and nitrofurantoin are the optimal drugs for ESBL-producing organisms. Conclusion: UTIs prevalent in hospitalised women are associated with prolonged catheterisation and co-morbidities such as diabetes and cardiovascular conditions. Gram-negative bacteria are the predominant species, and their susceptibility pattern is increasingly shifting towards higher antibiotics.

Can Urinalysis and Past Medical History of Kidney Stones Predict Urine Antibiotic Resistance?

IntroductionUrinary tract infections (UTI) are one of the most common infections encountered in the emergency department (ED) with an estimated 2–3 million annual visits. Commonly prescribed antibiotics for UTIs have shown growing rates of resistance. Previous studies lack direction on improving UTI treatment based on the labs available to the bedside clinician.MethodsWe sought to determine if antibiotic resistance in UTIs was related to demographics, urinalysis, and history of renal failure or kidney stones. We conducted an analysis of 892 women ≥18 years of age discharged from the ED with a UTI diagnosis. We assessed predictors of nitrofurantoin resistance, cefazolin resistance, ciprofloxacin resistance, and trimethoprim-sulfamethoxazole resistance using unadjusted and multivariable logistic regression models.ResultsAntibiotic resistance was 13.6% for nitrofurantoin, 11.9% for cefazolin, 12.8% for ciprofloxacin, and 17.1% for trimethoprim-sulfamethoxazole. In multivariable analysis, significant independent associations with an increased likelihood of resistance to nitrofurantoin were observed for less urine blood (OR [per 1 category increase of score] 0.81; P = 0.02); greater mucous (OR [per 1 category increase of score] 1.22; P = 0.02); less specific gravity urine (OR [per 1 category increase] 0.87; P = 0.04), and presence of any history of kidney stones (OR 3.24; P = 0.01). There were no significant predictors for cefazolin resistance (all P ≥0.06); age was the only significant predictor of ciprofloxacin resistance (OR per 10 year increase] 1.10, P = 0.05), and lower specific gravity urine was significantly associated with an increased risk of resistance to trimethoprim- sulfamethoxazole (OR [per 1 category increase] 0.88, P = 0.04).ConclusionWomen with any history of kidney stones may have bacteriuria resistant to nitrofurantoin, suggesting that providers might consider alternative antibiotic therapies in this scenario.

Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study

BackgroundAntimicrobial drug resistance is one of the top ten threats to global health according to the World Health Organization. Urinary tract infections (UTIs) are among the most common bacterial infections and main reason for antibiotic prescription. The incidence of UTIs appears to be high among people living with HIV. We sought to determine the most common UTI pathogens among HIV infected patients and evaluate their susceptibility towards antibiotics.MethodsWe performed a cross-sectional study among HIV-infected patients aged ≥ 18 years presenting at an HIV care specialized clinic with symptoms suggestive of a urethritis. Urine cultures were subjected to antibiotic susceptibility testing according to Clinical Laboratory Standards Institute. The data was analyzed using STATA, we performed Pearson’s Chi-square and Fisher’s exact tests to compare differences between proportions.ResultsOut of the 200 patients, 123 (62%) were female. The median age was 41.9 years (IQR 34.7–49.3). Only 32 (16%) urine cultures showed bacterial growth. Escherichia coli was the most commonly isolated uropathogen (72%), followed by Klebsiella pneumoniae (9%). E. coli was completely resistant to cotrimoxazole and ampicillin; resistance to ciprofloxacin and ceftriaxone was 44% and 35% respectively; 9% to gentamicin; no resistance detected to nitrofurantoin and imipenem.ConclusionsOur findings are congruent with the Uganda national clinical guidelines which recommends nitrofurantoin as the first line antibiotic for uncomplicated UTI. Significant ciprofloxacin and ceftriaxone resistance was detected. In the era of emerging antibiotic resistance, understanding the local susceptibilities among sub-populations such as HIV infected patients is crucial. Further investigation is needed to address reasons for the low bacterial growth rate observed in the urine cultures.

Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania.

One of the most frequent bacterial infections in children are urinary tract infections (UTIs). In recent years, an increasing incidence of UTIs caused by resistant bacterial strains has been observed, especially with extended-spectrum β-lactamase-producing Enterobacteriaceae that represent about 15% of UTIs. A retrospective study was performed comprising 331 pediatric cases with UTI. Our study aimed to detect the resistance of the uropathogens to common drugs used in UTI treatment. High resistance rates have been recorded for ampicillin, amoxicillin, trimethoprim/sulfamethoxazole (TMP/SMX), cefuroxime, and ciprofloxacin, among E. coli and Klebsiella. The multidrug-resistance (MDR) rate was detected in one-third of the uropathogens, among which more than half were isolated in patients with urinary tract abnormalities. Our study highlighted that nitrofurantoin, ceftriaxone, amikacin and carbapenem may be used for the empirical treatment for febrile or complicated UTI in children. This is the first comprehensive study that evaluates antibiotic resistance in UTIs in children, and their association with urinary tract abnormalities in Romania. As a result of this research, the protocol for initial empiric treatment of infants with febrile or complicated UTI should be modified considering a detailed and ongoing monitoring of local sensitivity of uropathogens to antimicrobial agents.

Urine cultures and antibiotics for urinary tract infections in Dutch general practice.

Urinary tract infections (UTIs) are common in general practice, and antibiotic resistance is often seen. Urine cultures are advised by the Dutch national UTI guideline for patients at high risk of UTI complications. Prudent use of antibiotics and taking into account national guidelines and urine culture results are important to combat antibiotic resistance in general practice. To identify subgroups of UTI patients in which the use of urine cultures and antibiotic prescriptions deviates from the national guidelines. We investigated associations of several characteristics with urine culture orders in patients with UTI in 2015 from seven Dutch general practices (n=1295). These included subgroups at risk for UTI complications, comorbidities, age and history of UTI recurrence. In addition, we assessed the level of adherence to the guideline for antibiotic prescriptions in subgroups at risks for UTI complications. Urine cultures were ordered in 17% (n=221) of patients, more frequently in high-risk patients (32%) than in low-risk patients (7%), for UTI complications (OR=6.4; 95% CI 4.6-9.0). In low-risk patients, 91% received antibiotics that were recommended in the guideline. For high-risk patients this percentage ranged widely, and was particularly low in the risk groups with signs of tissue invasion (29-50%). Diagnostic and therapeutic adequacy can still be improved by increasing the adherence to the guideline in UTI patients at high risk for complications. This may contribute to containing antibiotic resistance in UTI by ordering urine cultures and use the results to adjust prescriptions to antibiotic susceptibility of the uropathogen.

Can We Predict Antibiotic-resistance in Urinary Tract Infection: Evidence-based Medicine Viewpoint.

Can We Predict Antibiotic-resistance in Urinary Tract Infection: Evidence-based Medicine Viewpoint.

Antimicrobial Resistance Pattern of Gram-negative Bacteria Causing Urinary Tract Infection

Urinary tract infection (UTI) is a common and occasional recurrent bacterial illness with an increasing resistance to antimicrobials. Antibiotic resistance in UTI is a growing public health problem in the world including Bangladesh. The study objective was to examine the present incidence of UTIs in Bangladesh in a point period of time from January to December 2007. A retrospective data analysis of culture results of urinary pathogens was performed. The data was collected from the Clinical Microbiology Laboratory of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The data included culture results of 9,854 urine samples and only Gram-negative isolates irrespective of age groups were analyzed. The prevalence of UTI was observed in 24.14%. It was observed that out of 2,379 uropathogens Escherichia coli (66.92%) was the most prevalent isolate followed by Klebsiella spp. (13.45%), Proteus spp. (6.77%) and Pseudomonas spp. (6.77%). The percentage of resistance to different antibiotics was higher in E. coli, Klebsiella spp. and Pseudomonas spp. isolates compared to that of others. Among the total number of isolates the resistant rate of E. coli and Klebsiella spp. to ampicillin was 86.09% and 83.33% and to cotrimoxazole was 67.61% and 59.81%, their resistance rate to nalidixic acid was 83.28% and 61.54%. All other isolates also showed above 80% resistance to ampicillin and above 50% to cotrimoxazole whereas imipenem was found to be the most effective against the uropathogens followed by amikacin. Key Words: Urinary tract infection; Antimicrobial resistance; Uropathogens; Bacteriuria; Gram-negative bacteria DOI: 10.3329/sjps.v2i1.5815Stamford Journal of Pharmaceutical Sciences Vol.2(1) 2009: 44-50