Antimicrobial Resistance Of Uropathogens Research Articles

Empiric therapy for community acquired urinary tract infection in an era of increasing antimicrobial resistance

Community-acquired urinary tract infections (CA-UTIs) are widespread bacterial infections often necessitating empirical antibiotic therapy. However, the escalating antimicrobial resistance (AMR) poses a grave threat to treatment efficacy. This study aims to assess the prevalence of AMR in uropathogens causing CA-UTIs and its implications for empirical therapy. The study analyzed data from a tertiary care hospital, to determine AMR rates in common uropathogens, including and . Resistance levels to key antibiotics, such as Ampicillin, Ciprofloxacin, and Norfloxacin, were evaluated. Significant resistance rates were observed in uropathogens, with and showing marked resistance. Notably, resistance to commonly prescribed antibiotics like Ampicillin, Ciprofloxacin, and Norfloxacin was widespread, highlighting the severity of the AMR crisis. The increasing AMR in CA-UTIs calls for a comprehensive approach. Strategies including local resistance pattern monitoring, antimicrobial stewardship programs and the recommendation of drugs like nitrofurantoin (with lower drug resistance potential) are crucial to maintain the effectiveness of empirical therapy. This study underscores the urgent need for collaborative efforts to address AMR, ensuring effective CA-UTI management and safeguarding public health.

Prevalence and antimicrobial resistance of uropathogens in Karachi, Pakistan

Urinary tract infections (UTIs) are one of the major healthcare concerns causing an alarmingly high medical and financial burden in both developing and developed countries. There is a significant rise in multidrug-resistant (MDR) uropathogens, both in hospitalized and community settings, which threatens safe and effective therapy of these infections. The increased rates of resistance in UTIs requires the continuous surveillance of uropathogens in the specific area to inform safe and effective therapy. The present, retrospective, cross-sectional, descriptive study was carried out using samples collected between 01/06/2019 and 31/05/2020 in Karachi, Pakistan, during which, n = 1500 urine samples were collected. The samples were processed on Cystine Lactose Electrolyte Deficient (CLED) agar, identification was carried out by using standard biochemical tests and API 20E/20NE strips. Antimicrobial susceptibility testing was performed using standard disk diffusion test protocol, as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Overall, n = 1189 urine samples (79.27%) showed significant bacterial growth. The median age of affected patients was 56 years (range: 1-100) with n = 811 females (68.21%), with patients between 61-80 years (n = 384; 32.29%) as the most numerous age group. Regarding uropathogen distribution, the overwhelming majority were Gram-negative bacteria (n = 986; 82.93%), the most common causative agent being Escherichia coli (n = 648; 54.49%), followed by Klebsiella spp. (n = 206; 17.33%) and Enterococcus spp. (n = 118; 9.92%). Resistance rates were highest for the tested fluoroquinolones (>70% for most species), trimethoprim-sulfamethoxazole, broad-spectrum penicillins, and cephalosporins, while fosfomycin, carbapenems and colistin largely retained their efficacy. The mitigation of UTIs and the emergence of resistance may be impeded by taking appropriate measures for the better management of patients; these interventions include improvements in the treatment recommendations, provision of health education, and continuous antimicrobial surveillance.

ANTIBIOTIC PRESCRIPTION AND ANTIMICROBIAL RESISTANCE RATES OF UROPATHOGENS IN CHILDREN WITH URINARY TRACT INFECTIONS

The current study aimed to evaluate the antibiotic treatment of UTIs and antimicrobial resistance of uropathogens in children with UTIs. A retrospective study was conducted in the Pediatrics Department of different centers from November 2021-November 2022. A total of 100 children with febrile or afebrile urinary tract infections were included in the study. UTIs were categorized as febrile and afebrile. Antibiotics were prescribed according to the UTI and pathogen identified. E.coli was the most common pathogen (80%) found in patients of both groups, while Citrobacter sp and gram-positive cocci were only found in one case each. Amikacin was mostly prescribed in both groups (54 for fUTIs and 8 for aUTIs). 60% of the E.coli isolates were resistant to ampicillin, 10% to AMC (amoxicillin and clavulanic acid), and 15% to SAM (Sulfacetamide sodium). The highest resistant rates of E.coli were observed against SXT, i.e., 25%. Based on the results, it can be concluded that there is a need for antimicrobial resistance stewardship programs to control the increasing prevalence of resistance among UTI-causing pathogens.

Machine learning model for predicting ciprofloxacin resistance and presence of ESBL in patients with UTI in the ED

Increasing antimicrobial resistance in uropathogens is a clinical challenge to emergency physicians as antibiotics should be selected before an infecting pathogen or its antibiotic resistance profile is confirmed. We created a predictive model for antibiotic resistance of uropathogens, using machine learning (ML) algorithms. This single-center retrospective study evaluated patients diagnosed with urinary tract infection (UTI) in the emergency department (ED) between January 2020 and June 2021. Thirty-nine variables were used to train the model to predict resistance to ciprofloxacin and the presence of urinary pathogens’ extended-spectrum beta-lactamases. The model was built with Gradient-Boosted Decision Tree (GBDT) with performance evaluation. Also, we visualized feature importance using SHapely Additive exPlanations. After two-step customization of threshold adjustment and feature selection, the final model was compared with that of the original prescribers in the emergency department (ED) according to the ineffectiveness of the antibiotic selected. The probability of using ineffective antibiotics in the ED was significantly lowered by 20% in our GBDT model through customization of the decision threshold. Moreover, we could narrow the number of predictors down to twenty and five variables with high importance while maintaining similar model performance. An ML model is potentially useful for predicting antibiotic resistance improving the effectiveness of empirical antimicrobial treatment in patients with UTI in the ED. The model could be a point-of-care decision support tool to guide clinicians toward individualized antibiotic prescriptions.

Activity of Fosfomycin against the Spectrum of Uropathogens Causing Cystitis

Background: Urinary tract infections (UTIs) are the most frequent bacterial infections commonly seen in females. A high degree of antimicrobial resistance in uropathogens has challenged the use of therapeutic agents. Fosfomycin, which is an old antibiotic with distinctive characteristics, seems to be a promising novel therapeutic agent with a good bactericidal activity towards multi-drug resistant (MDR) uropathogens. Objective: The main objective of the study is to evaluate the antibacterial activity of fosfomycin among uropathogens causing cystitis. Methods: The study was carried out between 2017-2018. A total of 2060 UTI suspects from outpatient departments (OPDs) and inpatient departments (IPDs) were screened. Out of 2060 screened patients, 1658 were IPD patients, and 402 were OPD patients. The patient’s midstream urine samples were collected aseptically and processed according to standard protocols. The frequency of extendedspectrum- beta lactamases (ESBLs) producer and carbapenem resistance were estimated, respectively. Cultures with significant growth of uropathogens were identified, and minimum inhibitory concentration (MIC) to fosfomycin was determined by agar dilution (AD) and by E-test methods. Results: 184 out of 2060 (8.9%) urine samples showed significant growth of uropathogens. Uropathogenic Escherichia coli (UPEC) (64%, 118/184) was found to be the most isolated uropathogen. Among these Gram-negative uropathogens, 80% were ESBLs producers, 43.2% were carbapenemresistant, and 78% isolates were found to be MDR. The fosfomycin susceptibility for UPEC was 95% by the AD method. Conclusions: This study suggests that fosfomycin is reasonably effective and can be used in the treatment of MDR uropathogens along with uncomplicated UTIs.

Retrospective Review on the Safety and Efficacy of Nitrofurantoin for the Treatment of Cystitis in the Veteran Population With or Without Renal Insufficiency

The emergence of antimicrobial resistance in uropathogens has generated interest in the use of nitrofurantoin in controversial populations, such as in males and those with renal dysfunction. The purpose of this study was to compare the efficacy and safety of nitrofurantoin for the treatment of cystitis in males and females with variable degrees of renal dysfunction. A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting. The primary outcome was clinical cure compared between males and females and across various renal function groups (creatinine clearances [CrCl] >60 mL/min, 30-60 mL/min, and <30 mL/min) following nitrofurantoin treatment. The secondary outcome was adverse events. A total of 446 patients were included, with 278 females and 168 males. The overall clinical cure rate was 86.5% (95% CI, 83.0%-89.4%; n = 386). The clinical cure rate did not vary between genders (odds ratio [OR], 0.6; 95% CI 0.35-1.04; P = .085) or between patients with a CrCl >60 mL/min compared with those with CrCl 30-60 mL/min (OR, 1.01; 95% CI, 0.40-2.44; P = 1). The 1 patient with a CrCl <30 mL/min was not included in the analysis. A history of benign prostatic hyperplasia (OR, 0.5; 95% CI, 0.26-0.99; P = .045) or cirrhosis (OR, 0.21; 95% CI, 0.06-0.82; P = .025) was associated with decreased odds of clinical cure. Adverse events occurred in 2% (n = 9) of patients. There was no statistically significant difference in clinical cure with nitrofurantoin between genders or various renal functions.

Biofilm formation in uropathogenic Escherichia coli strains; Relationship with virulence factors and antimicrobial resistance

Background: Urinary tract infection (UTI) is a clinical condition with characteristic symptoms, colonization and multiplication of bacteria in significant numbers. At this juncture, antimicrobial resistance in uropathogens has become one of the major concerns globally. Therefore, the present study aimed to demonstrate the biofilm formation in uropathogenic Escherichia coli strains; characterize the phenotypic & genotypic virulence factors and their relationship with antimicrobial resistance. Methods and materials: In this study, 1000 suspected UTI cases were included. Urine samples were processed for culture and antimicrobial drug susceptibility testing. Only Escherichia coli isolates were further studied for production of biofilm, ESBL and haemolysin enzymes by phenotypic methods. Virulence genes, papEF, traT & PAI were detected by multiplex PCR. Molecular confirmation & characterization of virulence genes was done by Sanger sequencing. Results: From the 1000 urine samples, 395 E. coli were isolated. Higher resistance was observed with antibiotics - ampicillin (82.53%), cefuroxime (72.41%), amoxicillin-clavulanic acid (71.90%), ceftriaxone (66.58%), ciprofloxacin (65.82%) and cefepime (57.47%). In-vitro biofilm was formed by 71.39% isolates. Biofilm-forming strains developed higher resistance towards ampicillin, cefuroxime, amoxicillin-clavulanic acid, ciprofloxacin, cefepime and ceftriaxone. Phenotypic methods detected 62.3% isolates as ESBL producers and 40.2% were β-haemolytic. Virulence gene characterization revealed presence of traT in 73.2% strains, PAI & papEF among 62.9% and 33.5% strains. ESBL & Hemolysin producing UPEC exhibited higher resistant to ampicillin, amoxicillin-clavulanic acid, aztreonam, cefriaxone, cefuroxime, cefepime, ciprofloxacin, chloramphenicol & gentamicin. Statistically proved association was seen with gene RPAI and traT with antibiotics nitrofurantoin and amikacin. All the isolates were sensitive to nitrofurantoin, piperacillin-tazobactam, and imipenem. Strains showed 99% sequence identity and no mutations were detected. Conclusion: Increase in trend of resistance was observed with antibiotics which were routinely used to treat UTI. Results indicated significant correlation between phenotypic and genotypic virulence factors and antibiotic resistance. Antibiotics nitrofurantoin, piperacillin - tazobactam, and imipenem can be effective for severe UTIs. This study concludes that expression of virulence factors by UPEC strains is responsible for increased antibiotic resistance. Hence, characterizing the UPEC strains help clinicians to reach a better therapeutic outcomes and treatment regimens in this region.

Резистентность возбудителей внебольничных инфекций мочевыводящих путей: уроки российских многоцентровых микробиологических исследований

The review describes large-scale microbiological studies performed in Russia over the past 20 years to study urinary tract infections (UTIs). The article analyzes data on the structure of UTI pathogens, as well as on the antibiotic resistance of the main uropathogens, compares the data with similar foreign studies. From 1999 year, 7 large multicenter microbiological studies were carried out in Russia to obtain the data of the antimicrobial resistance of uropathogens caused community-acquired UTIs. An analysis of the data allows described trends in antimicrobial resistance - high level of resistance of uropathogens to aminopenicillins, co-trimoxazole, fluoroquinolones, an increase antimicrobial resistance to amoxicillin / clavulanate, and third generation cephalosporins. In review discussed a critical assessment of various approaches to the use of data on the sensitivity of uropathogens to antimicrobial drugs when antimicrobial therapy is provided. The necessity of comparing not only microbiological data obtained from different sources, but also clinical data, characteristics of pharmacodynamics and pharmacokinetics of antimicrobial drugs is discussed. The review discusses the difficulties associated with the clinical interpretation of data on the sensitivity of microorganisms, primarily in the limited objective information describing the correlation of in vitro data with the clinical efficacy of therapy. The publication substantiates the need for a wider conduct of not only microbiological, but also clinical studies to obtain data on the comparative efficacy of the used antimicrobial drugs.

Prevalence and antibiotic susceptibility pattern of uropathogens in outpatients at a tertiary care hospital.

Globally, urinary tract infection (UTI) is considered a major public health concern and the second most common bacterial infection affecting individuals of different ages. Bacteria are responsible for about 95% of UTIs. The emergence of antimicrobial resistance in uropathogens may lead to poor treatment outcomes in individuals with UTIs. The knowledge of the microorganism involves and antibiograms are important for the empirical treatment of UTIs. A cross-sectional study was carried out over 7 months (January to July 2019) with a focus on the identification of bacterial pathogens causing UTI and the evaluation of their antibiogram. In total, 804 urine samples were collected from individuals with suspected UTIs and inoculated on recommended media. Isolation and identification of the bacterial strains were performed using standard microbiological protocols. Antibiotic susceptibility was carried out following CLSI recommended guidelines. Among the tested specimens, 290 (36.1%) had significant bacterial growth and 147 (50.7%) of the strains were isolated from female patients. The frequently identified isolates were Escherichia coli (68.9%), followed by Klebsiella pneumoniae (8.9%) and Staphylococcus aureus (6.7%). The highest percentages of resistance have been observed against tested antibiotics. The majority of the isolates were extended-spectrum β-lactamase producers (85.2%) and multidrug-resistant (98.3%). We observed that Gram-negative bacteria were the main cause of UTIs where the predominant microorganism was E. coli.

Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands

Antimicrobial resistance (AMR) is an increasing problem. The prevalence of antimicrobial resistance in general practice patients is expected to be relatively high in Rotterdam, the Dutch city with the largest proportion non-Western immigrants. The aim of this study was to assess the prevalence of antibiotic-resistant uropathogens (Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis) in general practices in Rotterdam, and to find a possible association between the prevalence of antibiotic-resistant E. coli and age, gender, and socioeconomic status (SES). A retrospective analysis was performed of urine samples from general practice patients in 2016. The prevalence of AMR in uropathogens was compared with national resistance data, as was the prevalence of highly and multidrug resistant and extended spectrum β-lactamase (ESBL) producing E. coli and K. pneumoniae. Univariate logistic regression was used to study associations between antibiotic-resistant E. coli and age, gender, and SES area score. No clinically relevant differences were observed in the prevalence of antibiotic-resistant uropathogens in Rotterdam compared with the national prevalence. For E. coli and K. pneumoniae, the prevalence was 3.6% for ESBL production (both pathogens together), while the prevalence ranged between 4.2%–5.0% for high resistance and between 1.2%–3.3% for multidrug resistance. Ciprofloxacin-resistant E. coli was significantly associated with higher age. Although Rotterdam has a high percentage of non-western immigrants and a low SES, AMR is low among general practice patients. This indicates that adherence to national guidelines in general practice enables maintenance of low AMR, even in high-risk populations.

Incidence and Etiology of Catheter Associated Urinary Tract Infection among Admitted Patients at Kabale Regional Referral Hospital, South Western Uganda

Introduction: Catheter Associated Urinary Tract Infection is the most common hospital acquired infection worldwide. Urinary Tract Infections among catheterised patients are on rise regardless of antibiotic use and this is due to erratic use of antibiotics, treatment failure, antimicrobial resistance and emergency of Extended Spectrum Beta Lactamase producing bacteria leading to patient distress, increased healthcare costs, long hospital stay and poor patient response to antibiotics. In Uganda, no previous studies have sought to study the burden of CAUTI among catheterized patients, the bacterial pathogens involved and their antimicrobial susceptibility patterns yet there is upsurge in antimicrobial resistance of uropathogens. The effective management of patients suffering from Catheter Associated Urinary Tract infection (CAUTI) relays on the identification of uropathogens that cause CAUTI and the selection of an effective antibiotic agent to the uropathen in question. Objectives: The objectives of this study were to determine incidence, etiology and antibiotic susceptibility pattern among the uropathogens causing Catheter Associated Urinary Tract Infections among patients with indwelling catheters at Kabale Regional Referral Hospital. Methods: Using a descriptive prospective observational hospital-based study, the study was conducted on 150 catheterized patients recruited from Emergency, Obstetrics and gynecology, Medical, Maternity and Surgical wards at Kabale Regional Referral Hospital between April and May 2019. The urine samples from study participants were processed in Kabale RRH microbiology laboratory as per standard operating procedures. After isolation and identification, all the isolates were subjected to antibiotic susceptibility testing for commonly used antibiotics. Results: Following the urine culture from 150 catheterized patients, urine from 23 (15.3%) patients showed significant growth. The common bacterial isolates were Escherichia coli 12 (52%), followed by the Klebsiella pneumoniae 6 (26%), Staphylococcus aureus 3 (13%) and Pseudomonas spp. 2 (8.7%). All Gram-negative isolates were sensitive to Imipenem 20 (100%) while all S. aureus isolates (3) were 100% sensitive to Vancomycin and Cefoxitin. Isolates were sensitive to Gentamicin 20 (82.6), Ceftriaxone 16 (69.6), Ciprofloxacin 10 (43.5) and Nitrofurantoin 9 (39.1). All isolates were 100% resistant to Cotrimoxazole. 6 gram negative isolates were resistant to ceftazidime and were tested for Extended Spectrum Beta (s) Lactamase (ESBL), 5 (83.3%) were identified as ESBL-producing bacteria. K. pneumonia 3 (60%) presented the highest percentage of ESBLs as compared to E. coli 2 (40%). Conclusions: The Incidence of CAUTI among patients with indwelling urinary catheters at Kabale Regional Referral Hospital is high (15.3%) and is mostly caused by E. coli and K. pneumoniae. These bacteria are resistant to most commonly used antibiotics and thus there is a need to put more emphasis on CAUTI prevention strategies and use culture and sensitivity tests before prescription of antibiotics.

CZĘSTE BŁĘDY W POSTĘPOWANIU W ZAKAŻENIACH UKŁADU MOCZOWEGO

Urinary tract infections seems to be simple diseases. However, inappropriate diagnostic and therapeutic procedures may lead to serious complications such as systemic infection, while on the other hand contribute to increasing antimicrobial resistance of uropathogens which is a growing threat to global public health. Due to more frequent occurrence of multidrug resistance bacteria, popularization of guidelines and correct schemes among doctors of all specialities. In the following article the commonest errors made by doctors in their clinical practice that seem to cause a lot of problems are shortly reviewed.

1237. New York State Outpatient Regional Antibiogram for Urinary Pathogens: Have We Reached a Post Antibiotic Era for the Treatment of UTIs?

BackgroundOutpatient prescribing for acute uncomplicated cystitis is a significant driver of antimicrobial use. Empiric therapy should be based on local susceptibility data. However, there is limited guidance on regional susceptibility trends in outpatient settings. This study describes the epidemiology and prevalence of antimicrobial resistance in uropathogens in New York State outpatient settings to help inform empiric treatment decisions.MethodsRetrospective analysis of positive urine cultures sent to Quest Diagnostics in 2016 from outpatient settings. Cultures that grew ≥105 CFU/mL were included from 17 NYS counties. Bacterial identification and antimicrobial sensitivities were determined on the Vitek-2 using CLSI M-100 S-25 breakpoints. Data were summarized as proportions and stratified by age (<17, 18–64, ≥65) and sex.ResultsOver 78,000 isolates were included (Table 1). The most prevalent isolates were Escherichia coli (65.2%), Enterococcus spp. (11.9%), and Klebsiella pneumoniae (9.9%). E. coli was highly susceptible to nitrofurantoin (NTF, 97.2%) and cefazolin (CFZ, 89.9%) and less susceptible to trimethoprim–sulfamethoxazole (TMP-SMX, 72.9%) and ciprofloxacin (CIP, 78.0%). Enterococcus spp. was highly susceptible to NTF (99.0%) and ampicillin (99.8%). K. pneumoniae was highly susceptible to TMP-SMX (90.0%) and CIP (95.2%) and markedly less susceptible to NTF (42.0%). E. coli was more prevalent in females (69.7% vs. 39.6%, P < 0.001). Enterococcus was more prevalent in males (39.6% vs. 10.1%, P < 0.001). The prevalence of K. pneumoniae was similar in men and women (9.6% vs. 10.1%, P = 0.08). Resistance was more prevalent in males (NTF: 6.3% vs. 4.2%; TMP-SMX: 26.3% vs. 22.7%; CIP: 35% vs. 17.3%) and for adults ≥65 (NTF: 6.2% vs. 3.6%; TMP-SMX: 25.1% vs. 22.1%; CIP: 30.0% vs. 14.0%) P < 0.001 for all comparisons.ConclusionNTF appears to be the best empiric choice for outpatient treatment of acute uncomplicated cystitis in New York State. TMP-SMX and ciprofloxacin should be avoided empirically. These data also highlight the necessity to obtain uropathogen sensitivity data to confirm empiric therapy or make appropriate adjustments in the outpatient setting.Table 1. Summary of Antimicrobial Susceptibilities Disclosures T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.

Detection of virulence factors, phylogroups, serogroups and biofilm formation among CTX-M-1 positive Escherichia coli isolated from patients with pyelonephritis

Objectives: Urinary tract infections are among the most frequent infections caused by Escherichia coli isolates. The aims of this study were determination of antibiotic susceptibility and detection of virulence genes, phylogroups, serogroups and biofilm formation of E. coli isolates from patients with pyelonephritis. Methods: A total of 20 E. coli isolates were isolated from pyelonephritis. The antimicrobial susceptibility test was performed for eleven antibiotic disks. The biofilm formation assay was performed with Microtitre Tissue Plate (MTP) assay. The CTX-M1 gene and virulence genes including fimH, fyuA, traT, iutA, papII, kpsMII, ompT, ibeA, sfa, iroN, iucD, afaC, papI and papIII and also phylogroups and serogroups were detected with specific primers. Results: In the biofilm assay, one isolate produced strong biofilm. Among virulence encoding genes, 19 (95%) isolates amplified the all fimH, fyuA and traT genes, followed by iutA (90%, n=18), papII (75%, n=17), kpsMII (60%, n=12), ompT (55%, n=11), ibeA (30%, n=6), sfa (20%, n=5), and iroN=iucD=afaC=15%, (n=3), but none for papI and papIII. The majority (50%, n=10) of E. coli isolates from pyelonephritis belonged to the phylogroup B2, followed by phylogroups D and A (each equal to 20%, n=4) and B1 (10%, n=2). Seroproups included O25 (20%, n=4), O1 (15%, n=3), O4=O18=O75 (each equal to 10%, n=2), and O2=O12=O15=O16=1 (0.05%). Conclusion: The adhesive virulence factors play a critical role in the pathogenesis of pyelonephritis as their prevalence was high. Continued and vigilant surveillance is necessary to monitor the dissemination of antimicrobial resistance in uropathogens.

Urinary pathogenic bacterial profile, antibiogram of isolates and associated risk factors among pregnant women in Ambo town, Central Ethiopia: a cross-sectional study

BackgroundUrinary tract infection (UTI) is a well-known bacterial infection posing serious health problem in pregnant women. A study was conducted in pregnant women with the objectives of estimating prevalence of UTI, determining antibiogram of the bacterial isolates and assessment of the potential risk factors associated with UTI.MethodsA cross-sectional study design was used to collect 300 mid-stream urine samples from pregnant women from March 2016 to December, 2016. Samples were inoculated into Cysteine Lactose Electrolyte Deficient medium (CLED). Colonies from CLED were subcultured onto MacConkey and Blood agar plates. A standard agar disc diffusion method was used to determine antimicrobial susceptibility. Chi-square (X2) test & logistic regression were used to show associations between UTI and explanatory variables & identify the predictors of UTI, respectively.ResultsThe age of pregnant women enrolled in this study ranges from 16 to 46 years (mean ± standard deviation = 25 ± 4.7 years).The overall prevalence of UTI in pregnant women was 18.7% (95% confidence interval [CI]: 14.4–23.54%).The prevalence of symptomatic and asymptomatic UTI was 20.4% (95% CI: 13.09–29.46%) and 17.8% (95% CI: 12.70–23.83%) respectively. The predominant bacteria identified were E. coli (46.4%), S. aureus (14.3%), coagulase negative Staphylococci [CoNS] (14.3%) and Proteus species (10.6%). Majority of Gram-negative bacteria isolates were resistant to ampicillin (70%), ceftriaxon (66%), gentamicin (68%) and nitrofurantoin (64%) while 75–100% of the Gram positive isolates were resistance to ampicillin. Multiple drug resistance was observed in all of the isolates. Multivariable logistic regression revealed that the odds of acquiring UTI was 4.78 times higher in pregnant women earning monthly income of ≤500 Ethiopian Birr (21.18 USD) as compared to those earning monthly income >2001 Ethiopian Birr [84.79 USD] (P = 0.046). Similarly, the risk of UTI was higher in those who eat raw meat (OR = 2.04, 95% CI: 1.09, 3.83, P = 0.026) and had previous UTI history (OR = 2.29, 95% CI = 1.15–4.56, P = 0.019) as compared to those who eat cooked meat and had no previous history of UTI.ConclusionsThe prevalence & antimicrobial resistance of uropathogens was high. Health education, continuous surveillance of UTI and their antimicrobial resistance pattern are essential to reduce the consequence of symptomatic and asymptomatic bacteriuria and multi-drug resistant bacteria in pregnant women.

Резистентность уропатогенов к антибактериальным препаратам у пациентов с острым обструктивным пиелонефритом

Резистентность уропатогенов к антибактериальным препаратам у пациентов с острым обструктивным пиелонефритом

Antimicrobial resistance in uropathogens and appropriateness of empirical treatment: a population-based surveillance study in Indonesia

Objectives: Urinary tract infections (UTIs) are a common reason for empirical treatment with broad-spectrum antibiotics worldwide. However, population-based antimicrobial resistance (AMR) prevalence data to inform empirical treatment choice are lacking in many regions, because of limited surveillance capacity. We aimed to assess the prevalence of AMR to commonly used antimicrobial drugs in Escherichia coli and Klebsiella pneumoniae isolated from patients with community- or healthcare-associated UTIs on two islands of Indonesia. Methods: We performed a cross-sectional patient-based study in public and private hospitals and clinics between April 2014 and May 2015. We screened patients for symptoms of UTIs and through urine dipstick analysis. Urine culture and susceptibility testing were supported by telemicrobiology and interactive virtual laboratory rounds. Surveillance data were entered in forms on mobile phones. Results: Of 3424 eligible patients, 3380 (98.7%) were included in the final analysis, and yielded 840 positive cultures and antimicrobial susceptibility data for 657 E. coli and K. pneumoniae isolates. Fosfomycin was the single oral treatment option with resistance prevalence <20% in both E. coli and K. pneumoniae in community settings. Tigecycline and fosfomycin were the only options for treatment of catheter-associated UTIs with resistance prevalence <20%, whilst the prevalence of resistance to meropenem was 21.3% in K. pneumoniae. Conclusions: Patient-based surveillance of AMR in E. coli and K. pneumoniae causing UTIs indicates that resistance to the commonly available empirical treatment options is high in Indonesia. Smart AMR surveillance strategies are needed to inform policy makers and to guide interventions.

THE ETIOLOGICAL SPECTRUM AND ANTIBIOTIC RESISTANCE PATTERN OF BACTERIA CAUSING UNCOMPLICATED URINARY TRACT INFECTIONS: A TEN-YEAR SURVEILLANCE STUDY (2005-2015)

Background and objective. Knowledge of local antimicrobial resistance pattern is very important for evidence-based empirical antibiotic prescribing. The main objective of the present study was to evaluate the prevalence and the antimicrobial resistance pattern of the main bacteria responsible for uncomplicated urinary tract infection (UTI) in Kyiv region (Ukraine), throughout a ten year period, in order to establish an appropriate empirical therapy.&#x0D; Materials and methods. A retrospective analysis of the etiological spectrum and antimicrobial resistance of uropathogens in urine samples isolated over the 10-year period, 2005 to 2015, in a single center was performed.&#x0D; Results. In total 380positive urine samples processed at our laboratory of which 193/380 (51 %) had E. coli as the infecting organism. Although E. coli was, as usual, the most common pathogen implicated in UTI, it were observed increasing the share of Enterococcus spp. - 82/380 (21.6%). Ampicillin and trimethoprim were the least-active agents against E. coli with resistance rates of 75% and 70%, respectively. Significant trends of increasing resistance over the 10-year period were identified for trimethoprim, fluoroquinolones ІІ and III generations, penicillins, and carbapenems. Nitrofuran derivative remains a reasonable empirical antibiotic choice in this community with a 10-year resistance rate of 8.3 %. Was&#x0D; determined that recurrent UTI is an independent risk factor for bacterial multidrug-resistance.&#x0D; Conclusions. Over the last 10 years, the proportions of fluoroquinolones resistant E. coli and multidrug-resistant bacteria have significantly increased. The fluoroquinolones shall not be used in the empirical treatment of uncomplicated&#x0D; UTI in Kyiv region patients. For the empirical treatment of uncomplicated UTI in women should be used nitrofuran derivative (furazydyn K). If required of parenteral administration of antibiotics should be used cephalosporins IVgeneration. This data will enable evidence-based empirical prescribing which will ensure more effective treatment and lessen the emergence of resistant uropathogens in the community.

Infants under two months of age with urinary tract infections are showing increasing resistance to empirical and oral antibiotics.

Data on antimicrobial resistance in uropathogens in infants up to the age of three months are limited. This study characterised resistance patterns in Gram-negative uropathogens in infants up to the age of two months. Previously healthy young infants with urinary tract infections (UTIs) were studied retrospectively. Antimicrobial susceptibility was evaluated. Multidrug resistance (MDR) was defined as resistance to at least three antibiotic classes. Clinical, laboratory and outcome data were compared between infants with UTIs caused by bacteria sensitive and resistant to empirical and to oral therapy. We evaluated 306 UTI episodes with 314 pathogens. The following resistance rates were observed: ampicillin 73.7%, cefazoline 22.1%, ampicillin/clavulanate 21.8%, cefuroxime 7.8%, gentamicin 7%; MDR 11.8%; resistant to empirical treatment 7.3% and resistant to available oral antibiotics 8.6%. Our study showed that pathogens resistant to empirical and oral therapy were more frequently isolated in non-Jewish (Arab) infants and in those of ≥30 days of age. Resistance to empirical treatment and oral antibiotics also resulted in longer mean hospital stays. Resistance to antibiotics challenges empirical therapy and compromises oral treatment options in young infants with UTIs. Antimicrobial resistance patterns should be monitored in infants to determine appropriate empirical antibiotic therapy protocols.

ANTIBIOTIC SUSCEPTIBILITY OF ORGANISMS CAUSING URINARY TRACT INFECTION IN PATIENTS PRESENTING AT KENYATTA NATIONAL HOSPITAL, NAIROBI.

Changes in susceptibility patterns of bacterial pathogens isolated from urinary tract infections emphasize the need for regional surveillance to generate information that can be used in management of patients. Knowledge on the current status of antimicrobial resistance in uropathogens, and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy formulations and encourage prudent use of antimicrobials. Identify bacterial pathogens causing UTI and determine the association between the pathogens isolated from patients attending KNH. Determine antimicrobial susceptibility patterns of the UTI pathogens and the prevalence of ESBL in the isolated pathogens. Laboratory-based study. Department of Medical Microbiology University of Nairobi and Kenyatta National Hospital microbiology laboratory, Nairobi, Kenya. Nine hundred and forty eight patients presenting directly to the Kenyatta National Hospital's diagnostic lab. Patients were only classified as in-patients if at the time of specimen collection they were being admitted to one of KNH wards. Out of the 948 urine samples processed, 189 in-patients and 37 out-patients samples had significant bacterial growth. The uropathogens identified from in-patient specimens were Escherichia coli (56), Klebsiellapneumoniae (33), Enterococcus spp. (34) and Entrobacter (16) making up 30%, 18%, 18% and 9% respectively. ESBL isolates were found to be resistant to the locally administered antibiotics; Augmentin (37%), Levofloxacin (37%), Cefoperazone (37%), Ampicillin (39%), Doxycyline (41%), Gentamicin (30%) and Nalidixic Acid (38%). The increased prevalence of multidrug resistant ESBL pathogens poses challenges for health care providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialized tests for detection of ESBL producing pathogens from isolates obtained from in-patients. Further studies on the mechanisms and pathways utilized by these bacteria to cause UTI will highlight other avenues in patient management.