Cause Of Urinary Tract Infections Research Articles

Capture and Electrochemical Detection of Pathogenic E. coli

Pathogenic E. coli are a significant threat both as a foodborne pathogen and a leading cause of urinary tract infections. Conventional methods to detect these microbes require centralized laboratory facilities and specialized equipment, as well as hours to days to complete. We have developed a sensitive electrochemical sensor to covalently capture, detect, and quantify viable pathogenic E. coli from complex matrices with a detection limit of 12 CFU/mL and a linear range of detection up to 107 CFU/mL. The technology enables quantification within two hours on disposable electrodes, even from milk and artificial urine. Endogenous E. coli were successfully detected from commonly-contaminated samples, including eggs, raw chicken, spinach, and romaine lettuce, in addition to an infected urine sample. The E. coli quantification tracked well with the current gold-standard of colony counting. This platform represents a major step in the development of field-deployable sensors to detect these dangerous microbes.

Molecular Detection of Ampicillin Resistant Genes in E. coli Isolates from ‎Dogs in India

The most common cause of urinary tract infection in dogs is uropathogenic Escherichia coli (UPEC). This condition often presents with vaginal discharge, dribbling of urine, straining or vocalization while urinating due to pain. Furthermore, the following signs are also noticeable: hematuria, lethargy, proteinuria, dysuria, cystitis, and oliguria. The aim of this research was to investigate the genes of ampicillin resistance in E. coli isolates from dogs with urinary tract infections. Out of 103 urine samples cultured (Blood agar, MacConkey’s lactose agar and Eosin methylene blue agar), 24.3% were positive for uropathogenic Escherichia coli. The positive isolates were further subjected to antimicrobial sensitivity test and PCR analysis. All the uropathogenic Escherichia coli isolates were resistant to ampicillin while 96% were resistant to Cloxacillin and Oxytetracycline. Susceptibility to Meropenem, Gentamicin and Amikacin were 64 %, 44 % and 40% respectively. All the 25 strains of the E. coli were identified to be resistant to two or more antibiotics. The PCR result showed the presence of blaAMPC in all the samples and 60 % had blaTEM genes responsible for ampicillin resistance. However, none of the isolates were positive for the blaSHV gene.The presence of the blaAMPC and blaTEM genes in the dogs studied resulted in ampicillin resistance, with blaAMPC being the most commonly detected ampicillin gene in Escherichia coli in the study area. Meropenem was also found to be a good choice for treating uropathogenic E. coli infection in dogs.

Virulence and Resistance Characterization of Staphylococci-associated Urinary Tract Infection in Pregnant Women in Lagos, Nigeria

Background: Urinary Tract Infection (UTI) is the most prevalent bacterial infection in developing countries. UTI is sometimes asymptomatic. The occurrence of UTI in pregnancy can result in complications such as premature or low-birth-weight babies. Escherichia coli is the most common cause of UTI followed by Staphylococci species. However, E.coli associated UTI has been well studied while there is paucity of data on the virulence and resistance of Staphylococci-associated UTIs in women. This study aimed to characterize the virulence and resistance genes in Staphylococci species isolated from the urine of pregnant women. Methods: This was a cross-sectional study involving pregnant women attending ante-natal clinic in Lagos State, Nigeria. Clean catch midstream urine specimens were collected from the women and cultured on appropriate agar. Bacteria were identified using both biochemical and molecular methods and evaluated for resistance to antibiotics. Polymerase chain reaction was used to detect the mecA and blaZ resistance genes and the PVL and TSST virulence genes. Results: Staphylococci species were isolated from 21 (26.25%) of the 80 urine samples of which 7 (29%) were Staphylococcus aureus and 17 (71%) coagulase-negative staphylococcus (CoNS). S. epidermidis and S. saprophyticus were the most commonly isolated CoNS. All the isolates tested were resistant to cotrimoxazole, cloxacillin, erythromycin, ampicillin, amoxicillin-clavulanate, and tetracycline. Both blaZ and the mecA genes were detected in the isolates that were phenotypically susceptible to methicillin and cefoxitin. There was an occurrence of the mecA, blaZ and PVL genes in S. saprophyticus in patients who were co-infected with S. aureus. Conclusion: UTI caused by Staphylococci is common among pregnant women. There is a need to consider staphylococcal associated UTI screening in both symptomatic and asymptomatic cases of UTI in pregnant women.

CHILDHOOD URINARY TRACT INFECTION: CLINICAL SIGNS, BACTERIAL CAUSES AND ANTIBIOTIC SUSCEPTIBILITY

Background and objective: Urinary tract infections (UTIs) are the neglected infection in children from the side of study its clinical symptoms, causative organisms and their antibiotic sensitivity. This investigation searches for determine clinical symptoms frequency, prevalence rate, bacterial features, and antibiotic sensitivity of bacterial urinary tract infection in children attending private children’s health center in Sana’a city. Methods: In a prospective study carried out over a 24-month period, 1925 samples from children patients suspected of having a UTI were investigated, of which 175 were culture-positive. Clinical and demographic data were collected. Isolated bacteria were identified by standard tests, and antibiotic susceptibility was performed by the disk diffusion method. Results: Fever was the most frequent symptom that occurred (88%) while other UTI symptoms were less frequent than that reported in adult patients for UTI. The most common etiological agent was Escherichia coli (89.7%), followed Staphylococcus aureus (3.4%), Klebsiella spp (2.9%), Proteus spp (2.3%), and beta haemolytic streptococci (1.7%). Results of antimicrobial resistant for E. coli, as the most prevalent cause of UTI, to commonly used antibiotics are ranged from less than 3% for levofloxacin, gentamicin, amikacin and cefoxitin to more than 75% for tetracycline, nalidixic acid, doxycycline, co-trimoxazol and amoxicillin . Conclusions: The results show the most common symptom of UTI are fever and lack of more obvious symptoms of UTI in adult patients. The antimicrobial resistance patterns of the causes of UTI are highly changeable and constant surveillance of trends in resistance patterns of uropathogens among children is essential. Peer Review History: Received: 11 July 2021; Revised: 13 August; Accepted: 5 September, Available online: 15 September 2021 Academic Editor: Ahmad Najib, Universitas Muslim Indonesia, Makassar, Indonesia, ahmad.najib@umi.ac.id UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Nuray Arı, Ankara University, Turkiye, ari@ankara.edu.tr Dr. Salfarina Ramli, Department of Pharmacology and Pharmaceutical Chemistry, Faculty of Pharmacy, Universiti Teknologi MARA, 42300 Puncak Alam, Selangor, Malaysia. salfarina2892@uitm.edu.my Dr. Wadhah Hassan Ali Edrees, Hajja University, Yemen, edress2020@gmail.com Dr. Asia Selman Abdullah, University of Basrah, Iraq, asia_abdullah65@yahoo.com Similar Articles: URINARY TRACT INFECTIONS IN POST OPERATIVE PATIENTS: PREVALENCE RATE, BACTERIAL PROFILE, ANTIBIOTIC SENSITIVITY AND SPECIFIC RISK FACTORS BIOFILM FORMATION AND ANTIBIOTIC SUSCEPTIBILITY OF UROPATHOGENS IN PATIENTS WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS IN IBB CITY -YEMEN

Detection of extended-spectrum beta-lactamase genes among Escherichia coli isolates from urinary tract infection in Mashhad

Urinary tract infections (UTIs) are known as one of the most important infections around the world, and Escherichia coli is the most important cause of UTI. Also, the empiric treatment and misusing of antimicrobial agents has led to increasing multi-drug resistance around the world which is a worldwide concern. Extended-spectrum beta-lactamase (ESBLs) is an enzyme group that is produced by the Enterobacteriaceae family. The three main ESBLs enzyme are as follow: bla CTX-M , bla TEM , and bla SHV , additionally, there are several types of each of them by the same mechanism. This study was conducted to evaluate the prevalence of ESBL genes among E. coli isolated from UTI patients. A total of 105 isolates were collected from UTI patients at two hospitals in Mashhad from 2017 to 2019. Bacterial identification was performed by standard microbiologic methods. The assessment of antimicrobial susceptibility was accomplished by the disk diffusion method. The presence of ESBL genes was investigated by multiplex-PCR. The prevalence of UTI, among females, was identified more than males. Furthermore, the bla TEM and bla CTX-M genes were detected in all isolates, but only six isolates (5.7%) were harboring bla SHV . The considerable role of E. coli in UTI infection, as well as the presence of ESBL genes in E. coli strains, emphasize the need for surveillance of antimicrobial therapy to prevent the extension of resistance among clinical strains.

Incidence And Characteristics Of Urinary Tract Infections Among Febrile Children In Early Childhood

Introduction: Fever is the most common cause for concern for parents and a reason to seek help from a GP or emergency centers. The high temperature in children in most cases is short-lived and is a protective reaction that stops or slows down the development of many microorganisms, stimulates the immune response, and provides rest to the sick child. Negative effects are dehydration, hypovolemia, hyperthermic seizures in childhood, hypotension to collapse. Urinary tract infections (UTIs) can occur only with fever or with fever and non-specific symptoms such as malaise, vomiting, abdominal pain, and jaundice. Antibiotic treatment for fever without a proven cause may mask an existing urinary tract infection. Aim : The aim of this article is to review the scientific literature for a period of 40 years on the incidence of UTIs in infancy and early childhood in children with fever. Methods: Analysis of Bulgarian and foreign literature sources according to the PubMed and Google Scholar databases for a period of 40 years has been conducted. Results: The analysis of the data from the scientific literature showed that the frequency of UTI varies depending on gender and age. In most studies, the incidence of UTI in febrile children under 24 months of age, both sexes, with or without additional symptoms of UTI, was between 5% and 15%. In boys, the prevalence is highest in the first 3 months of life and then shows a declining trend, while in girls the prevalence is highest in the first 12 months of life. There is evidence in the literature that fever (rectal temperature ≥ 39°C) and uncircumcised status are more likely to be linked to UTI in boys. E. coli is the most common bacterial infection in early childhood and is the leading cause of UTI in this age group. Conclusion : The GP needs to make efforts to educate parents on the diagnosis, consequences and appropriate treatment of obscure febrile conditions, and UTI should be excluded. It is necessary to pay attention to the method of measuring the temperature, the differences in the values in the different measuring points. In this aspect, the GP should perform an in-depth analysis for early diagnosis of UTI in all boys under 12 months of age and girls under 24 months of age with unexplained fever, temperature above ≥ 38°C measured rectally for 3 minutes.

OXA-48 Carbapenemase-Encoding Transferable Plasmids of Klebsiella pneumoniae Recovered from Egyptian Patients Suffering from Complicated Urinary Tract Infections.

Simple SummaryGram-negative bacteria are common causes of urinary tract infections (UTIs), some of which can resist treatment by antibiotics, including carbapenems, which are last resort treatment options. This study aimed to report the resistance of some Gram-negative bacteria causing complicated UTIs to carbapenems at two important hospitals in Cairo, Egypt, and to determine the possible transfer of this resistance to other bacterial species. The collected bacteria were tested for antibiotic resistance and detection of the genes responsible for this resistance. A total of 256 Gram-negative bacterial clinical isolates were collected, 65 (25.4%) of which showed carbapenem resistance. The detected carbapenem resistance genes were blaOXA-48, blaVIM, blaKPC, and blaNDM genes. The blaOXA-48, among other genes, was successfully transferred to a previously susceptible bacteria, making it resistant. The study concluded that the rate of carbapenem resistance among Gram-negative bacteria causing UTIs in Cairo, Egypt is relatively high and can be transferred among bacterial hosts.Gram-negative bacteria are common causes of urinary tract infections (UTIs). Such pathogens can acquire genes encoding multiple mechanisms of antimicrobial resistance, including carbapenem resistance. The aim of this study was to detect the carbapenemase-producing ability of some Gram-negative bacterial isolates from urine specimens of patients suffering from complicated UTIs at two vital tertiary care hospitals in Cairo, Egypt; to determine the prevalence of carbapenemase genes among plasmid-bearing isolates; and explore the possibility of horizontal gene transfer to other bacterial species. The collected isolates were subjected to antimicrobial susceptibility testing, phenotypic analysis of carbapenemase production, and molecular detection of plasmid-borne carbapenemase genes, then the extracted plasmids were transformed into competent E. coli DH5α. A total of 256 Gram-negative bacterial clinical isolates were collected, 65 (25.4%) isolates showed carbapenem resistance of which 36 (55.4%) were carbapenemase-producers, and of these 31 (47.7%) harbored plasmids. The extracted plasmids were used as templates for PCR amplification of blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP carbapenemase genes. The blaOXA-48 gene was detected in 24 (77.4%) of the tested isolates while blaVIM gene was detected in 8 (25.8%), both blaKPC and blaNDM genes were co-present in 1 (3.2%) isolate. Plasmids carrying the blaOXA-48 gene from 4 K. pneumoniae clinical isolates were successfully transformed into competent E. coli DH5α. The transformants were carbapenemase-producers and acquired resistance to some of the tested antimicrobial agents as compared to untransformed E. coli DH5α. The study concluded that the rate of carbapenem resistance among Gram-negative bacterial uropathogens in Cairo, Egypt is relatively high and can be transferred horizontally to other bacterial host(s).

Characteristics of Women with Urinary Tract Infection in Pregnancy.

Background: Urinary tract infection (UTI) is the most common bacterial infection in pregnancy. Known risk factors for UTI in pregnancy include diabetes and certain urologic conditions. Other maternal characteristics might also be associated with risk and could provide clues to the etiology of UTI in pregnancy. Our objective was to identify maternal characteristics associated with UTI in pregnancy. Materials and Methods: We used data from pregnant women participating in the National Birth Defects Prevention Study, a population-based study of risk factors for major structural birth defects in 10 U.S. sites, from 1997 to 2011. In cross-sectional analyses, we used multivariable log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations between self-reported maternal characteristics and UTI in pregnancy. Results: In our sample of 41,869 women, the overall prevalence of reported UTI in pregnancy was 18%, but ranged from 11% to 26% between study sites. In adjusted models, diabetes was moderately associated with higher UTI prevalence (PR 1.39, 95% CI: 1.24-1.57). Higher UTI prevalence was associated even more strongly with low educational attainment (PR 2.06, 95% CI: 1.77-2.40 for some high school vs. graduate school), low household income (PR 1.64, 95% CI: 1.46-1.84 for <$10,000 vs. ≥$50,000), and race/ethnicity (PR 1.45, 95% CI: 1.13-1.80 for American Indian or Alaska Native vs. White women). Conclusions: About one in six women reported UTI in pregnancy but the prevalence varied markedly by geography and maternal characteristics. This variability could provide clues to the causes of UTI in pregnancy.

Microbiological profile and antimicrobial susceptibility pattern among patients with urinary tract infection in northern Tanzania

Background: Urinary tract infection (UTI) is the most common bacterial infection, it causes morbidity as well as financial burden. There is a role of empirical treatment of UTI while awaiting urine culture and sensitivity result. The type of empirical antibiotics given varies from place to place depending on susceptibility pattern of the particular area. According to Tanzania standard treatment guidelines and essential medicine list of 2013, cystitis in adult is treated by ciprofloxacin while pregnant women and children are treated by amoxicillin/clavulanate. In case of pyelonephritis, women of reproductive age who does not require referral are treated by ciprofloxacin while all other cases that fulfill criteria for referral are given single dose of ceftriaxone before referral. However, most studies have shown increasing resistance to commonly used antibiotics as a result of misuse and overuse. The study aimed at describing the microbiological profile and susceptibility pattern among patients with UTI at KCMC. Methods: This was a seven-month hospital based descriptive, cross-sectional study conducted from June 2016 to December 2016 by using structured data extraction sheet. Data analysis was performed using SPSS after cleaning and checking for error(s). Results: A total of 270 samples that tested positive for UTI were analyzed. Majority 233(86.3%) of the sample were obtained from male subjects, age of study subjects ranged from 1-94 years with the median of 64 years. Majority 235 (87%) of the sample came from urology department with E. coli being most common cause of UTI (39.3%), followed by Klebsiella spp, 20%. E. coli demonstrated high sensitivity against amikacin, ceftazidime and Nitrofurantoin Conclusion: The commonest cause of UTI in our set up is E. coli that showed high resistance against most commonly used antibiotics in our setting.

Frequency of hlyA, hlyB, hlyC and hlyD genes in uropathogenic Escherichia coli isolated from UTI patients in Shiraz.

Background and objectives: One of the most important causes of urinary tract infections (UTI) is Escherichia coli. The infection is mainly due to the uropathogenic strain (UPEC), which has key virulence factors, including hemolysis. In this study, we evaluated the frequency of hlyA, hlyB, hlyC and hlyD genes in UPEC strains isolated from clinical samples from Shiraz city, Iran.Materials and methods: 130 urine samples with suspected UTI were collected from Shiraz medical centers and cultured on blood agar and EMB media. Colonies were then characterized by biochemical methods. The genomes were extracted and the presence of hemolysis genes was detected by polymerase chain reaction (PCR) using hly gene specific primers and 16S rRNA. Drug resistance was assessed by using 10 antibiotic disks in the disk diffusion method, according to CLSI criteria.Results: Out of the 130 collected UTI samples, 100 were identified as UPECs. Within isolates, the hlyD gene had the highest frequency – 95% – and hlyC had the lowest, with 23%. The frequencies of hlyA and hlyB genes were calculated as 50% and 43%, respectively. The rates of antibiotic resistance to Azithromycin, Ampicillin, Cefotaxime, Nalidixic Acid, Tetracycline, Trimethoprim-Sulfamethoxazole, Cefepime, Aztreonam, Gentamicin, and Nitrofurantoin were 95%, 86%, 68%, 66%, 65%, 64%, 51%, 46%, 44%, 14%, respectively. 98% of these isolates belonged to the MDR group.Conclusion: This study shows diversity of hemolysis virulence factor in UPECs and unique UPEC drug resistance that would indicate a high antibiotic use in the general population.

Biofilm formation by uropathogenic Escherichia coli: a complicating factor for treatment and recurrence of urinary tract infections

Uropathogenic Escherichia coli (UPEC) are the principal cause of urinary tract infections (UTIs) which can be either hospital- or community-acquired. The most crucial factor in the persistence and recurrence of UTIs is the biofilm formation ability of UPEC, which protects them against antimicrobial treatment. To investigate the genetic relatedness, biofilm formation ability, and biofilm-related genes in UPEC isolated from hospital- and community-acquired UTI patients. Invitro biofilm formation ability of 100 UPEC isolates, collected from the urine samples of 49 inpatients and 51 outpatients with UTIs, was assessed by the microtitre plate method. The association between the presence of fimH, papC, sfa/focDE, csgA, crl, afa, flu, and bcsA genes and biofilm formation ability of UPEC was statistically analysed. The genetic relatedness of UPEC isolates was evaluated by enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Overall, 99% of the UPEC isolates showed invitro biofilm formation ability, and 27% of the isolates were moderate to strong biofilm producers. Only the presence of sfa/focDE gene was significantly associated with moderate and strong biofilm formation by the UPEC isolates. Analysis of dendrograms revealed higher genetic similarities among UPEC isolates of inpatients compared with outpatients. Based on the results, selection of effective therapeutic approaches, which can affect both biofilm formation and enclosed UPEC, is important for preventing recurrent UTIs. The common UPEC clones among inpatients in different hospital units emphasize the need for more rigid control measures to prevent the spread of UPEC in hospitalized patients and to reduce the occurrence of hospital-acquired UTIs.

A Study on Antibiotic Sensitivity Pattern in Children Hospitalized for Urinary Tract Infection in a Tertiary Care Hospital in South India

Abstract: Background: The etiology of urinary tract infection (UTI) and their antibiotic sensitivity pattern vary from time to time and across different areas in India. This study is designed to analyse the resistance of uropathogens to commonly used antibiotics. Aim: To study antibiotic resistance trends of uropathogens and assess the antimicrobial utilization pattern according to the antimicrobial susceptibility test in the paediatric department of a tertiary care hospital. Materials and Methods: It was an ambispective observational cohort study conducted in 144 patients admitted with UTI for a period of one year and observed for recurrent UTI for the next one year. Results: E. coli (50%) was found to be the most common cause of UTI followed by Klebsiella (22.22%). E. coli and other isolates were more sensitive to Meropenem and Amikacin compared to other antibiotics tested. These isolates show increasing resistance to commonly used antibiotics. Most (74.31%) children were given single antimicrobial agent. Majority of the children were prescribed with Cephalosporins (60.41%), followed by Penicillin derivatives (29.17%) and Carbapenems (11.11%). Out of 144 children, antibiotics were prescribed according to culture sensitivity report in only 31.94%. Among children whose antibiotics were not selected based on the culture report, 40 had recurrent UTI in the following year. Conclusion: Recurrent UTI can occur if adequate antimicrobial therapy based on antimicrobial susceptibility test is not administered during the initial UTI episode. Close cooperation between physicians, microbiologists and pharmacists is essential to ensure that UTI patients receive antimicrobial therapy, if required based on local susceptibility data. Key words: UTI, Uropathogens, Antimicrobials, Pediatrics, Antibiotic resistance.

Antimicrobial Resistance and Molecular Epidemiology of Uropathogenic Escherichia coli Isolated From Female Patients in Shanghai, China

Urinary tract infection (UTI) is one of the most common bacterial infections and UTI is the most common extraintestinal infectious disease entity in women worldwide. Uropathogenic Escherichia coli (UPEC) is the leading cause of UTI. While antimicrobial resistance has emerged as one of the principal problems of UTI, little is known about the epidemiology of UPEC isolated from female patients in Shanghai. This study aimed to describe the antimicrobial resistance and molecular epidemiology of UPEC isolated from female patients in Shanghai, China. UPEC isolates were collected from female patients from July 2019 to June 2020 in Shanghai and a total of 151 isolates were obtained randomly. Antimicrobial susceptibility testing was performed using the disk diffusion method. Multilocus sequencing type, phylogenetic groups, antimicrobial resistance genes, and virulence genes were detected by polymerase chain reaction. In our study, no carbapenem-resistant isolates were found, but fluoroquinolone-resistant and multi-drug resistant UPEC accounted for 62.25% and 42.38%, respectively. The phylogenetic group B2 (58.94%) predominated, followed by phylogenetic group D (26.49%). The most prevalent sequence type was ST1193 (25.83%), which was first reported in Shanghai. The rate of extended-spectrum β-lactamase (ESBL)-positive isolates was 39.74% and the dominant ESBL genotype was bla CTX-M-14 (21/60), followed by bla CTX-M-55 (12/60). Mutations in gyrA were detected in the majority of fluoroquinolone-resistant isolates (90/94), followed by parC (85/94) and parE (71/94). The aac (3) -IIa was also found in 85% of aminoglycoside resistance isolates. Among 151 UPEC isolates, the common virulence genes were csgA (97.35%), fimH (92.72%), sitA (82.12%), and malX (65.56%). In conclusion, the high antimicrobial resistance of UPEC isolated from female patients, harboring a series of virulence genes, are troublesome for medical practitioners in Shanghai. At present, the prevalent ST1193 and emerging bla CTX-M-55 make UTI therapy more challenging.

Diversity in the swimming motility and flagellar regulon structure of uropathogenic Morganella morganii strains.

In current times, the opportunistic pathogen Morganella morganii is increasingly becoming a cause of urinary tract infections. The condition has been further complicated by the multiple drug resistance of most isolates. Swimming motility plays an important role in the development of urinary tract infections, allowing bacteria to colonize the upper urinary tract. We determined the differences between the growth, swimming motility, and biofilm formation of two M. morganii strains MM 1 and MM 190 isolated from the urine of patients who had community-acquired urinary tract infections. MM 190 showed a lower growth rate but better-formed biofilms in comparison to MM 1. In addition, MM 190 possessed autoaggregation abilities. It was found that a high temperature (37°C) inhibits the flagellation of strains and makes MM 190 less motile. At the same time, the MM 1 strain maintained its rate of motility at this temperature. We demonstrated that urea at a concentration of 1.5% suppresses the growth and swimming motility of both strains. Genome analysis showed that MM 1 has a 17.7-kb-long insertion in flagellar regulon between fliE and glycosyltransferase genes, which was not identified in corresponding loci of MM 190 and 9 other M. morganii strains with whole genomes. Both strains carry two genes encoding flagellin, which may indicate flagellar antigen phase variation. However, the fliC2 genes have only 91% identity to each other and exhibit some variability in the regulatory region. We assume that all these differences influence the swimming motility of the strains.

Virulence factors and antimicrobial resistance of uropathogenic Escherichia coli (UPEC) isolated from urinary tract infections: a systematic review and meta-analysis

BackgroundUropathogenic Escherichia coli (UPEC) are amongst the most frequent causes of urinary tract infections. We report a systematic review and meta-analysis of virulence factors and antimicrobial resistance of UPEC isolated from urinary tract infections.MethodsA systematic review and meta-analysis were performed using PRISMA guidelines (Research Registry ref. 5874). Data were extracted from PubMed/MEDLINE and ScienceDirect databases for studies published from January 1, 2000 to December 31, 2019. Studies reporting antimicrobial resistance and virulence factors of UPEC isolated in confirmed urinary tract infections (≥105CFU/ml) were eligible. Prevalence of antimicrobial resistance and virulence factors of UPEC were estimated using random-effects meta-analysis model. Estimates with 95% confidence intervals, I-square (I2) statistic, and Cochran’s Q test were computed using the score statistic and the exact binomial method by incorporating the Freeman-Tukey double arcsine transformation of proportions.ResultsOur search returned 2504 hits, of which 13 studies were included in the meta-analysis, totalling 1888 UPEC isolates. Highest antimicrobial resistance rates were observed among the antibiotic class of tetracycline in 69.1% (498/721), followed by sulphonamides in 59.3% (1119/1888), quinolones in 49.4% (1956/3956), and beta-lactams in 36.9% (4410/11964). Among beta-lactams, high resistance was observed in aminopenicillins in 74.3% (1157/1557) and first generation cephalosporins in 38.8% (370/953). Meanwhile, virulence factors with highest prevalence were immune suppressors (54.1%) followed by adhesins (45.9%). Taken individually, the most observed virulence genes were shiA (92.1%), CSH (80.0%), fimH/MSHA (75.3%), traT (75.1%), sisA (72.2%), iucD (65.7%), iutA (61.8%), kpsMTII (60.6%), and PAI (55.2%).ConclusionsThe increased antibiotic resistance of UPEC isolates was demonstrated and suggested a need for reassessment of empirical therapies in urinary tract infections treatment caused by this pathogen. In addition, this pathotype exhibited diverse surface and secreted virulence factors.

Virulence characterization and clonal analysis of uropathogenic Escherichia coli metallo-beta-lactamase-producing isolates

BackgroundUropathogenic Escherichia coli (UPEC) is a major cause of urinary tract infection (UTI); however, treatment of UTI has been challenging due to increased antimicrobial resistance (AMR). One of the most important types of AMR is carbapenem resistance (CR). CR bacteria are known as an important threat to global public health today. Class B metallo-beta-lactamases (MBLs) are one of the major factors for resistance against carbapenems. We aimed to investigate the characteristics of UPEC isolates producing MBL.MethodsA cross-sectional study was conducted from October 2018 to December 2019 in Ahvaz; Iran. UPEC isolates were identified by biochemical and molecular methods. Metallo-beta-lactamase-producing isolates were detected using modified carbapenem inactivation method (mCIM) and EDTA-CIM (eCIM) tests. MBL genes, phylogenetic group, and virulence genes profile of carbapenem resistant isolates were determined. Conjugation assay and plasmid profiling were conducted to evaluate the ability of transferring of CR to other E. coli isolates. Clonal similarity of isolates were assessed using Enterobacterial intergenic repetitive element sequence (ERIC)-PCR.ResultsAmong 406 UPEC isolates, 12 (2.95%) carbapenem-resistant were detected of which 11 were phenotypically MBL-producing strains. Four isolates were resistant to all investigated antimicrobial agents and were considered possible pandrug-resistant (PDR). blaNDM, blaOXA-48, blaIMP-1, and blaIMP-2 genes were found in 9, 5, 1, and 1 isolates, respectively. Among 30 virulence genes investigated, the traT, fyuA followed by fimH, and iutA with the frequency of 8 (66.7%), 8 (66.7%), 7 (58.3%), and 7 (58.3%) were the most identified genes, respectively. Siderophore production was the main virulence trait among carbapenem-resistant UPEC isolates. Except for two, all other isolates showed weak to moderate virulence index. In all recovered isolates, CR was readily transmitted via plasmids to other isolates during conjugation experiments.ConclusionMBL and carbapenemase genes, especially blaNDM and blaOXA-48 are spreading rapidly among bacteria, which can be a threat to global public health. Therefore monitoring the emergence and dissemination of new AMR is necessary to continuously refine guidelines for empiric antimicrobial therapy. Understanding the mechanisms of resistance and virulence in this group of bacteria can play an effective role in providing new therapeutic methods.

A Review of Plant-Based Therapies for the Treatment of Urinary Tract Infections in Traditional Southern African Medicine.

Urinary tract infections (UTIs) are amongst the most common bacterial infections globally, with ∼11% of the world's population contracting at least one infection annually. Several South African plants are used in traditional healing systems to treat UTIs, yet the therapeutic potential of these plants against bacteria that cause UTI remains poorly explored. This study documents southern African plant species used traditionally to treat UTIs. An extensive literature review was undertaken to document the southern African plant species that are used in traditional South African medicine to treat UTIs, thereby highlighting gaps in the current research that require further study. One hundred and fifty-three southern African plant species that are used to treat UTIs were identified. Eighty-five southern African plants were identified as having noteworthy inhibitory activity against the major UTI-causing bacteria. Few of those studies screened against all of the bacterial causes of UTIs, and none of those studies examined the mechanism of action of the plant preparations. Furthermore, many of those studies did not test the toxicity of the plant extracts, so an evaluation of the safety for therapeutic usage was lacking. Substantial further research is to determine their potential for therapeutic use.

Phenotypic and Genotypic Characteristics of Uropathogenic Escherichia coli Isolates from Kenya.

Introduction: Uropathogenic Escherichia coli (UPECs) are a significant cause of urinary tract infections (UTIs). In Kenya, UTIs are typically treated with β-lactam antibiotics without antibiotic susceptibility testing, which could accelerate antibiotic resistance among UPEC strains.Aim: This study determined the occurrence of UPEC producing extended-spectrum β-lactamases (ESBLs), the genes conferring resistance to β-lactams, and the phylogenetic groups associated with ESBLs in Kenyan UPECs.Methodology: Ninety-five UPEC isolates from six Kenyan hospitals were tested for ESBL and plasmid-mediated AmpC β-lactamase (pAmpC) production by combined disk diffusion and disk approximation tests, respectively. Real-time and conventional polymerase chain reactions (PCRs) were used to detect three ESBL and six pAmpC genes, respectively, and phylogenetic groups were assigned by a quadruplex PCR method.Results: Twenty-four percent UPEC isolates were ESBL producers with blaCTX-M (95.6%), blaTEM (95.6%), and blaSHV (21.7%) genes detected. Sixteen isolates had blaCTX-M/TEM, whereas five had blaTEM/CTX-M/SHV. A total of 5/23 ESBLs were cefoxitin resistant, but no AmpC genes were detected. The UPECs belonged predominantly to phylogenetic groups B2 (31/95; 32.6%) and D (30/95; 31.6%), while groups B2 and A had the most ESBL producers.Conclusions: β-Lactam antibiotics have reduced utility for treating UTIs as a quarter of UPECs were ESBL producing. Single or multiple ESBL genes were present in UPECs, belonging primarily to phylogenetic groups B2 and A.

Molecular Characterization of Antibiotic Resistance Associated with TEM and CTX-M ESBL in Uropathogenic E. coli Strains Isolated from Outpatients

Background & Objective: Escherichia coli (E. coli) is a leading cause of urinary tract infections becoming resistant against beta-lactams and cephalosporins through different mechanisms, including ESBL production due to the presence of ESBL specific genes, including blaCTX-M and blaTEM. The purpose of the present study was to detect the uropathogenic E. coli strains producing the ESBL.Methods: A total of 100 isolates of uropathogenic E. coli were randomly selected in a period of 6 months and their resistances to a number of antibiotics including amoxicillin, amikacin, gentamicin, ciprofloxacin, ceftazidime, cefotaxime, ceftriaxone, ceftizoxime, nalidixic acid, and nitrofurantoin were determined. Then, DDT test was used to detect the presence of ESBL. Finally, the presence of blaCTX-M and blaTEM resistance genes was analyzed by PCR method.Results: The resistance profile of bacterial isolates to the antibiotics was as follows: amoxicillin: 16.7%, amikacin: 7.8%, gentamicin: 20.3%, ciprofloxacin: 35.5/%, ceftazidime: 35.0%, cefotaxime: 40.0%, ceftriaxone: 41.3%, nalidixic acid: 64.0%, nitrofurantoin: 9.7%, and ceftizoxime: 100%. Of these, 28 isolates (28%) were reported to be resistant to cefotaxime, ceftazidime, and ceftriaxone. In DDT test, 21 ESBL positive cases (21%) were detected. PCR results showed that the presence of blaCTX-M and blaTEM genes in the isolates were 21% and 20%, respectively. Conclusion: Regarding the production of ESBL by some E. coli isolates, phenotypic detection of ESBL-producing isolates is routinely suggested in the laboratories. Likewise, the treatment regimen should be selected regarding the ESBL production to avoid treatment failure.

Minimal Mortality Among Veterans with Urine Cultures Positive for Group B Streptococcus

Background: Group B Streptococcus (GBS) can cause life-threating invasive infections, yet GBS is also a normal component of the intestinal and genitourinary tract. Although it is regarded as a potential urinary pathogen, the morbidity and mortality associated with recovery of GBS from urine cultures of nonpregnant adults is not well understood. We evaluated characteristics and mortality among nonpregnant adults with urine cultures that grew GBS. Methods: Using administrative data from the Veterans’ Healthcare Administration (VHA), we conducted a retrospective cohort study of VA healthcare system users from January 1, 2008, through December 31, 2017, with monomicrobial urine cultures growing ≥100,000 colony-forming units of GBS. Urinary tract infection (UTI) cases were defined as urinalysis positive for leukocyte esterase and pyuria (≥10 white blood cells), an International Classification of Diseases (ICD) code for UTI, and an antibiotic prescription. Cases with colonization were defined as negative for leukocyte esterase and pyuria, no ICD code for UTI, and no antibiotic prescription. Cases not meeting either definition were deemed unclassifiable. We compared demographics, comorbidities, and all-cause mortality among these 3 groups. Results: Over the 10-year study period, 26,848 veterans had 30,740 urine cultures positive for GBS. Applying the definitions above, there were 2,807 cases of infection, 8,789 cases of colonization, and 15,252 cases that were unclassifiable. Patients with a GBS UTI were slightly older compared to those who were colonized, with a higher Charlson comorbidity index and greater burden of chronic renal disease (Table 1). Individuals with infection versus colonization had 30-day mortality rates of 1% and 0%, respectively, and 1-year mortality rates of 9% and 4%, respectively (Figure 1). Conclusions: The association of a greater burden of illness among veterans who met our definition of UTI compared to colonization might be more reflective of providers’ responses to patients with chronic medical conditions rather than a difference in GBS as a cause of UTI. Overall, the prospect of a urine culture that grows GBS does not appear to be associated with adverse long-term outcomes.Funding: NoDisclosures: None