Clean Catch Research Articles

Molecular detection of Staphylococcus aureus in urine in patients with S. aureus bacteremia: an exploratory study.

Staphylococcus aureus bacteremia (SAB) is associated with a 90-day mortality of 28-34%. Many SAB-patients (7.8-39%) have a secondary S. aureus bacteriuria (SABU) mainly without symptoms of a urinary tract infection. Due to high morbidity and mortality, there is an interest in rapid detection of S. aureus bacteremia. Here, we compared a rapid nucleic acid amplification test (NAAT) with conventional culture to detect S. aureus in urine and to identify cases with increased risk for SAB. In a cross-sectional study, we assessed urine samples (mid-stream, clean catch and catheter urine) of patients with SAB and bacteremia other than SAB (non-SAB). Urine samples were collected ± 3 days to the collection of the positive blood culture and were cultured on a set of selective and non-selective agar plates. NAAT was performed using a commercial test (Xpert® SA Nasal Complete G3, Cepheid) from a sterile swab soaked in urine. We included samples from 100 patients (68% male, median age: 67.4 years) with SAB and 20 patients (75% male, median age: 65.84 years) with non-SAB. The sensitivity of detecting SAB from urine samples was 47% (specificity: 90%) for NAAT, when applying a Ct-value of ≤ 37.4 for positive results. Urine culture had a sensitivity of 25% and a specificity of 95%. Molecular and culture methods showed a moderate agreement (80%, Cohens kappa: 0.55). NAAT from urine has a higher sensitivity than culture in patients with SAB and could potentially identify cases with increased risk for SAB. Future studies should investigate whether this characteristic could translate into a clinical benefit through rapid detection of SAB.

328 - The association between clean catch and catheterized urine among obese female patients

328 - The association between clean catch and catheterized urine among obese female patients

Concentration of kidney markers and detection of exosomes in urine samples collected in cotton wool balls in preterm and term neonates

Collecting urine samples in neonates by catheterisation or suprapubic puncture causes trauma, whereas self-adhesive collection bags can damage fragile skin. An alternative method is the collection of samples from urine-soaked cotton wool balls placed in diapers. The aim of this study was to compare the concentration of albumin, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and uromodulin between clean-catch urine and samples collected in cotton balls in neonates and assess the efficiency of exosome extraction. Standard clean-catch urine samples (SSs) were assayed for albumin, creatinine, NGAL, and uromodulin using commercial ELISA kits. Concentrations were compared to the same urine samples extracted immediately from soaked cotton wool balls (sample 2, S2) or the urine extracted from cotton wool balls placed in diaper in a warm incubator for 2 h before extraction (sample 3, S3). Exosomes were extracted from all three samples of one patient for visualisation by electron microscopy. Twenty-six infants (17 males) of median gestational age at birth of 32+1 weeks had urine collected at a median age of 29 days at 37+6 weeks corrected age. Concentrations in S2 and S3 were within 10% of the concentration of SS in 46% and 35% of specimens for albumin, 69% and 58% for creatinine, 12% and 12% for NGAL, and 27% and 15% for uromodulin, respectively, without consistent positive or negative bias. Urine albumin/creatinine ratios (UACRs) were 4.3% less in S2 and 4.5% less in S3 than in SS. Exosomes were extracted and visualised from all three sample types. Neonatal urine samples extracted from cotton wool balls can be used to screen for relevant albuminuria ​but provide imprecise estimates of NGAL and uromodulin. The proof of exosome extraction from urine collection in cotton wool balls opens the potential to examine exosomal cargo.

Frequency and antibiotic resistance of bacteria isolated in urinary tract infections at Amirou Boubacar Diallo National Hospital, Niamey-Niger

Title: Frequency and antibiotic resistance of bacteria isolated in urinary tract infections at Amirou Boubacar Diallo National Hospital, Niamey-Niger Introduction: Cytobacteriological examination of urine represents the most requested microbiological examination. It allows the diagnosis of urine tract infections (UTI). This study aimed to determine the bacteriological profile and antibiotic sensitivity pattern of patients with urinary tract infections at Amirou Boubacar Diallo National Hospital (HNABD). Methodology: This was a cross-sectional study that covered 6 months from January 1 to June 30, 2022. All patients who have benefited from urine cytobacteriological examination (UCBE) during the study were included Results: A total of 1739 patients were included in this study. Male patients were predominant with 1167 cases either a frequency of 67.11%. Most patients were men, aged from 45 to 60 years. The sex ratio was 2.16. The median age was 25 years with extreme of 4 days and 99 years. Clean–catch midstream urine collection was the most urine sampling. Of 1739 cytobacteriological examination of urine performed, 619 were positive with a frequency of 31.0% (n=619). Among positive cultures, 28% (n=488) were monomicrobial. Female patients were proportionally more affected by UTIs. However, there was no statistically significant difference between gender and UTI occurrence (p= 0.09). Patients aged from 45 to 60 years old were significantly more affected by UTI (p=0.0001). Among 488 monomicrobial cultures, Gram-negative bacillus (73%, n=356) were, so far, most represented; then followed by Gram-positive cocci (26%, n=127) and yeast (1%, n=5). Escherichia coli was the most isolated bacterium followed by Serratia odorifera and Klebsiella pneumoniae, with 35.29% (n=198); 8.38% (n=47), and 6.95% (n=39), respectively. Clinical isolates of Escherichia coli were sensitive to imipenem, cefoxitin, ceftriaxone, aminoglycosides, and nitrofurantoin. However, this bacterium was less sensitive to amoxicillin, amoxicillin-clavulanic acid, and ticarcillin. Conclusion: The prevalence of UTIs was relatively high at the HNABD. E. coli was the most frequently isolated bacterium in UTIs, regardless of the age, sex, or origin of the patients. While requests for cytobacteriological examination of urine were much more frequent in men, UTIs were proportionately more frequent in women and mainly concerned patients aged between 45 and 60. These data raise the question of the relevance of certain requests for cytobacteriological examination of urine in Niger. Keywords: Urinary Tract Infection, Escherichia coli, antibiotic resistance, Niger.

Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Care

The complication associated with bacteriuria during pregnancy not only result increase morbidity of the mother but also have detrimental effects on the fetus which may result in preterm labor, fetal growth retardation, hypertension and anemia. Studies have shown that the fetal mortality rate was 2.4 times higher than in pregnancy associated with urinary tract infection.This study conducted to determine the prevalence of asymptomatic bacteriuria in pregnant women. A cross-sectional study carried out during the year 2017 at a tertiary care hospital Alkhadra in Tripoli/Libya. 200 pregnant women aged between 19-43 years attending the obstetrics and gynecology clinics were included in this study. From these patient’s mid- stream clean catch urine samples were collected and processed. The following information were obtained from the patients; demographic data, parity, abortion history, history of UTI, history of DM, Urine culture result, type of organism. The minimum age was 19 years and the oldest was 43 years old. The mean maternal age of the cases was 29.2 ± 3.1 years. The multiparous cases were 61% and 48% of women had positive history to UTI before the study, also only 4% of cases were diabetic, regarding the time of diagnosis 18% were diagnosed at first trimester and 46% at the 2nd trimester while 36% diagnosed at the 3rd trimester. Regarding the urine culture results only 23% of cases had significant bateriuria and 8% had insignificant bateriuria, 14% the result was contaminated and 55% of cases their results were sterile, E. coli was the most predominant organism in the current study. The prevalence of asymptomatic bacteriuria in pregnant women (23%) was comparable with similar studies in other countries. The most common uropathogens isolated in this study were E.coli followed by K. pnuemoniae.

Infant urinary tract infection in Sweden — A national study of current diagnostic procedures, imaging and treatment

BackgroundUrinary tract infection (UTI) in infants is a common, potentially life-threatening bacterial infection, and must be managed carefully through the entire chain of care from diagnosis, choice of treatment, follow-up and risk stratification of future complications. This Swedish nationwide study of infant UTI was conducted to evaluate the current management of infant UTI, yield of investigations and the Swedish UTI guidelines’ ability to detect abnormalities of importance in the urinary tract.MethodsInfants < 1 year with a first episode of UTI were included in a prospective multicenter study. Treatment and follow-up were provided by local pediatricians. Clinical and laboratory findings and imaging results were reported to the coordinating center. The current management and results were compared with a previous Swedish study.ResultsOne thousand three hundred six infants were included. Urine sampling was performed with clean catch technique in 93% of patients. Initial oral antibiotic treatment was used in 63%, predominantly third generation cephalosporines. Permanent kidney abnormalities were found in 10% and dilating vesicoureteral reflux (VUR) in 8%. Higher rates of male gender, non-E. coli infection and ultrasound dilatation were seen in infants < 1 month. UTI recurrences were reported in 18%.ConclusionsInfant UTI is still generating a considerable amount of follow-up examinations. There is a significant shift towards clean catch as the main urine sampling method. Voiding cystourethrography is performed less frequently reducing the findings of low grade VUR. The incidence of renal scarring is comparable with earlier studies which suggests that the Swedish guidelines are able to identify individuals with risk for long-term complications.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

PREVALENCE OF ASYMPTOMATIC BACTERIURIA AND ITS MICROBIOLOGICAL PROFILE IN PREGNANCY AT TERTIARY CARE HOSPITAL, JABALPUR

Objective: To determine the prevalence of asymptomatic bacteriuria (ASB), microbiological profile, and pregnancy outcome in asymptomatic pregnant women. Methods: Pregnant women attending outpatient clinic were selected randomly. Urine sample by clean catch method collected and battery of tests were performed. Prevalence of ASB and pregnancy outcome studied. Results: Total 114 pregnant women were studied, out of which 6 cases were positive for urine culture. Prevalence rate in our study found to be 5.3%. Study depicted that 33.4% women with asymptomatic bacteriuria had premature rupture of membranes, 16.7 % women had pre-eclampsia and 16.7% had severe anemia. 50 % babies were premature, 33.4% had fetal growth restriction and 16.7% developed acute respiratory distress syndrome. Conclusion: Urinary tract infections are common during pregnancy. Asymptomatic bacteriuria can progress to pyelonephritis and may result in adverse pregnancy outcome. Prevalence rate found to be 5.3%. Premature rupture of membranes and premature births were major adverse pregnancy outcome. E. coli was most common bacterial isolate found in the study and was highly sensitive to cefuroxime sodium. Pregnancy complications may be avoided by using regular screening with urine cultures.

Nitrofurantoin susceptibility profile versus other antibiotics tested in uropathogens- a retrospective study from India

Introduction. Urinary Tract Infection (UTI) is one of the most common bacterial infections encountered by clinicians worldwide. The emergence of multidrug-resistant uropathogens necessitates a review of their susceptibility profiles. This study aims to assess the susceptibility trends of uropathogens to a panel of drugs, with special emphasis on Nitrofurantoin (NFT). Methods. A retrospective analysis was conducted on 2,099 mid-stream clean catch urine samples processed by standard microbiological methods. Clinical and Laboratory Standards Institute (CLSI) guidelines (2019) were followed. Statistical analysis was performed. Results. Out of all samples, 212 were culture positive. Escherichia coli (34.9%) and Enterococcus spp. (15.1%) were the most common Gram-negative and Gram-positive organisms, respectively. Gram-negative isolates were most susceptible to Colistin (97.38%), followed by NFT (69.35%). Gram-positive uropathogens were most sensitive to Linezolid (100%), followed by Vancomycin and NFT, each with 92.45% susceptibility. Conclusion. The increase in antibiotic resistance among various uropathogens underscores the need for surveillance data to inform the appropriate selection of antibiotics. Our study highlights that, among the panel of antibiotics tested, NFT appears to be a viable alternative for treating multidrug-resistant uropathogens.

Assessment of the Antimicrobial Sensitivity Pattern of Bacterial Pathogens Causing Uncomplicated Urinary Tract Infection in Female Patients at a Tertiary Level Hospital

Introduction: Urinary tract infection (UTI) is a common infectious disease which affects both, men and women. It is a significant health concern due to multidrug-resistant (MDR) organisms. Therefore, it is necessary to have a current understanding of the antibiotic susceptibility (AS) pattern of uropathogens to manage UTI effectively. Objective: This study aims to assess the antimicrobial sensitivity pattern of bacterial pathogens causing uncomplicated urinary tract infection in female patients. Methods: A prospective study was conducted at the Department of Pharmacology &amp; Therapeutics in collaboration with the Department of Microbiology at SBMC, the Outpatient Department of Medicine, and Gynae &amp; Obstetrics at Sher-E-Bangla Medical College, Barishal, Bangladesh, from January 2017 to December 2017. Clean catch midstream urine samples were collected and processed using standard guidelines for microbiological procedures. Positive microbiological cultures were found in 200 of the 314 patients, Data on socio-demographic, clinical, and risk factors were collected using a structured questionnaire. Results: In this study, the age of the subjects ranged from 15 to 75 years, majority of subjects (38.4%) belonged to age group of 45-60 years. The mean age was found 42.6±11.4 years. Out of 200 cases, E. coli was the most predominant gram-negative bacteria. Antibiotic susceptibility testing revealed that the pathogenic bacteria isolated from urine samples were MDR organisms. Aminoglycoside antibiotics such as Amikacin and gentamycin were the most effective drugs. Conclusion: Urinary tract infections are prevalent, affecting 64% of cases, with all isolates showing resistance to commonly used antibiotics. Therefore, it is recommended to provide health education on the transmission and causes of urinary tract infections.

Enhanced Labor Management: Implementing WHO Recommendations in Oyo State Nursing Practice

Introduction: An increase in the incidence of Urinary tract infections due to Candida species has been observed. The higher rate of Candiduria due to Non albicans Candida is now being reported than due to Candida albicans.The emergence of drug resistance in Candida species has complicated the patient management. Aim: to observe the prevalence of Candida species in UTIs and their antifungal susceptibility pattern in a tertiary care hospital. Materials and Methods: An observational study was conducted fora period of three months in NIMS, Jaipur. Symptomatic patients belonging to all age groups were included in the study. Catheterized or clean catch midstream urine were centrifuged and the sediment was plated on Sabouraud’s Dextrose Agar slants with and without Chloramphenicol. A wet mount preparation was also made and looked for the presence of pus cells, yeast cells, pseudohyphae, etc. Yeast were identified by using germ tube, Chromogenic agar, chlamydospore formation and carbohydrate assimilation tests. Antifungalsusceptibility testing was performed on Muller Hinton Methylene Blue Agar. Result: The Candida species were isolated in only 24 (4.8%) samples. Only 8 cases yielded Candida albicans(33.33%). The highest cases were found to be of Candida tropicalis (n=14) while remaining two cases has growth of Candida krusai (n=1) and Candida glabrata (n=1). Keywords: WHO guidelines, labor management, and patient care &amp; outcomes.

Prediction Model for Pregnancy Success in IVF Program in the Poor Prognosis Group

Introduction: An increase in the incidence of Urinary tract infections due to Candida species has been observed. The higher rate of Candiduria due to Non albicans Candida is now being reported than due to Candida albicans.The emergence of drug resistance in Candida species has complicated the patient management. Aim: to observe the prevalence of Candida species in UTIs and their antifungal susceptibility pattern in a tertiary care hospital. Materials and Methods: An observational study was conducted fora period of three months in NIMS, Jaipur. Symptomatic patients belonging to all age groups were included in the study. Catheterized or clean catch midstream urine were centrifuged and the sediment was plated on Sabouraud’s Dextrose Agar slants with and without Chloramphenicol. A wet mount preparation was also made and looked for the presence of pus cells, yeast cells, pseudohyphae, etc. Yeast were identified by using germ tube, Chromogenic agar, chlamydospore formation and carbohydrate assimilation tests. Antifungalsusceptibility testing was performed on Muller Hinton Methylene Blue Agar. Result: The Candida species were isolated in only 24 (4.8%) samples. Only 8 cases yielded Candida albicans(33.33%). The highest cases were found to be of Candida tropicalis (n=14) while remaining two cases has growth of Candida krusai (n=1) and Candida glabrata (n=1). Keywords: Infertility, prediction model, In Vitro Fertilization, Logistic Regression, Endometrial Thickness, Poor Prognosis, Clinical Pregnancy

Clinician and parent views on urine collection in precontinent children in the UK: a qualitative interview study

ObjectiveTo explore the experiences of healthcare professionals (HCPs) and parents of urine collection methods, to identify barriers to successful sampling and what could improve the process.DesignQualitative research, using individual semistructured...

Antimicrobial Susceptibility Pattern of Uropathogens Isolated at a Private Hospital in Khulna, Bangladesh

Background &amp; objectives: Urinary tract infection (UTI) is one of the most common infectious diseases affecting all age &amp; sex groups, causing significant morbidity &amp; mortality with a substantial economic burden. Due to the irrational empiric use of antibiotics, resistance is increasing at an alarming rate. Bacteria causing UTIs &amp; their antimicrobial susceptibility pattern varies among different areas &amp; changes frequently over time. This study aimed to identify microorganisms causing UTI at a private hospital in the southern part of Bangladesh &amp; to determine their sensitivity pattern towards commonly used antibiotics. Methods: A cross-sectional study was conducted in the clinical pathology &amp; microbiology laboratory at Islami Bank Hospital (IBH), Khulna during the period of January’2021 to July’2021. Clean catch midstream urine samples (MSU) from 221 clinically suspected UTI cases of all age &amp; sex groups were included in the study. Uropathogens were isolated &amp; identified by standard microbiological techniques &amp; susceptibility was determined by Kirby Kirby-Bauer disc diffusion method. Results: Among 221 suspected UTI cases, 108 (48.8%) were positive for urine culture, of which 103 (95.37%) showed antimicrobial growth. The majority 75 (69.4%) of the culture-positive cases were female. E. coli 50(44.24%) was the most predominant bacterial isolate, followed by Klebsiella 18(15.92%) &amp; Enterococcus 16(14.15%). All Isolated gram-positive cocci (GPC) showed very high sensitivity to Vancomycin (83.3% to 100%), Linezolid (87.5% to 100%) &amp; moderate sensitivity to Meropenem (66.7% to 75%). However, they showed relatively lower sensitivity to Ciprofloxacin, Doxycycline, Gentamicin, and Amoxiclav &amp; very poor sensitivity to Nitrofurantoin (31.3% to 50% only). Levofloxacin had relatively better sensitivity against GPC (S. aureus- 83.3% &amp; CONS- 75%), except Enterococcus. All gram-negative bacilli (GNB) showed a very good sensitivity towards Amikacin &amp; Meropenem, ranging from 77.8% to 100%. E. coli &amp; Pseudomonas were highly sensitive to Piperacillin-Tazobactam (90% &amp; 88.9% respectively). GNB were poorly sensitive to commonly used 3rd generation cephalosporins, Azithromycin, Amoxiclav &amp; Ciprofloxacin. Except for Pseudomonas &amp; Klebsiella, Levofloxacin showed relatively good sensitivity against other GNB. Nitrofurantoin showed lower sensitivity against GNB, except for Pseudomonas (66.7%) &amp; Enterobacter (75%). Conclusion: E. coli remains the most predominant uropathogen. Vancomycin, linezolid, Levofloxacin &amp; Meropenem were very effective against GPC whereas Amikacin, Piperacillin- tazobactam &amp; Meropenem showed good responses against GNB. Empiric antibiotics must be selected based on the current antibiogram of uropathogens in a particular area to prevent the increasing trends of antimicrobial resistance. Mediscope 2024;11(1): 01-12

Phenotypic characterization of ESBL-producing urinary isolates of E. coli and Klebsiella spp. in a tertiary care children's hospital in Nepal

BackgroundThe production of extended-spectrum beta-lactamases (ESBLs) among uropathogens, particularly E. coli and Klebsiella spp., poses a severe public health concern. This study explored the epidemiology of ESBL-producing E. coli and Klebsiella spp. isolated from urine samples obtained at a tertiary care children's hospital in Nepal.MethodsA cross-sectional study was conducted from August 2016 to February 2017. A total of 745 clean catch urine samples were obtained from pediatric patients under the age of 13 and subjected to semiquantitative culture. E. coli and Klebsiella spp. were identified using standard laboratory protocols. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and ESBL producers were phenotypically identified using the combined disk method.ResultsAmong the bacterial isolates, E. coli predominated, accounting for 139 (81.8%) positive cases. Notably, E. coli showed high susceptibility to nitrofurantoin, with 117 (84.2%) isolates being susceptible. Meanwhile, K. pneumoniae showed high susceptibility to gentamicin, with 21 (91.3%) isolates being susceptible. Of the 163 isolates of E. coli and Klebsiella spp., 62 (38.0%) were identified as multidrug-resistant (MDR), with 42 (25.8%) confirmed as phenotypic ESBL producers. Remarkably, all 41 (100%) ESBL-producing E. coli isolates were susceptible to imipenem.ConclusionsThe prevalence of ESBL producers among E. coli and K. pneumoniae isolates from pediatric patients underscores the importance of antimicrobial stewardship. Nitrofurantoin and gentamicin emerge as effective empirical treatment choices against these pathogens in children. However, the high rates of multidrug resistance and ESBL production highlight the necessity for routine surveillance, and early detection strategies to manage such infections effectively.

Prevalence and Risk Factors of Uropathogens in Diabetic and Non-Diabetic Patients Attending a University Medical Centre in Awka Anambra State

Diabetes is the most endocrinological disease associated with different life-threatening infections. Urinary Tract Infections (UTIs) are one of the most common infections affecting diabetic patients and a major cause of hospitalization and even death. The purpose of the study includes determining the prevalence of UTI, isolation and characterization of the different bacterial uropathogens and comparative evaluation of the risk factors associated with UTIs for both diabetic and nondiabetic patients attending Nnamdi Azikiwe University Medical center Awka, Anambra state. A total of 200, clean catch midstream urine (MSU) samples were collected aseptically (100 each from diabetic and 100 from non-diabetic patients). The samples were cultured in different nutrient media. These plates were incubated at 37℃ for 24hrs. The isolates were identified using colony morphology, Gram staining reaction and biochemical tests. The demographic data was obtained from the result of the structured standardized questionnaires and data collated where statistically analysed using statistical package (SPSS) to show their relationship with UTI. This study revealed the overall UTI prevalence of 72/200 (36%) among diabetic and non-diabetic patients from 18years and above. The prevalence among diabetic participants is (61.1%) and that of the non-diabetic is (38.9%). Escherichia coli was the most prevalent bacterial uropathogen with (34.6%) in diabetics and (46.43%) in non-diabetics, followed by Staphylococcus saprophyticus (31.8%) in diabetics and (14.39%) in non-diabetics. Klebsiella pneumoniae (11.4%) for diabetics, (10.71%) in non-diabetics. Pseudomonas aeruginosa (9.1%) for diabetics and (17.86%) for non-diabetics. Proteus mirabilis 4(9.1%) for diabetics and (10.7%) for non-diabetics. The findings demonstrated that age, female gender, married individuals, diabetes, and hospitalization were all statistically associated with UTI and UTI was more prevalent in diabetic patients than non-diabetic patients. Proper knowledge of risk factors of UTI in diabetic and nondiabetic patients may allow intervention and easy management of UTI in diabetic patients.

Pediatric Uropathogens and their Antimicrobial Susceptibility Pattern: Experience from an Impoverished District of Karachi, Pakistan.

Urinary tract infection (UTI) is the most common infection of the pediatric age group. Several factors linked to higher prevalence include poor personal hygiene, improper sanitation, lower socioeconomic status, and malnourishment. In addition to having a worse quality of life, the 1.8 million children who live in Karachi's Korangi district are routinely exposed to such factors. The study aims to evaluate the frequency of UTI and distribution of uropathogens along with their antimicrobial susceptibility pattern in patients presenting to a pediatric tertiary care center in the Korangi district of Karachi, Pakistan. The study employed an observational cross-sectional design. The study was conducted at the Microbiology laboratory of Sindh Institute of Child Health and Neonatology, Karachi, Pakistan from 1st January to 15th August 2023. Urine samples of patients 1 to 16 years of age were collected via midstream clean catch method and of patients from birth up to 1 year were collected in urine collection bags. The samples were cultured on Cystine Lactose Electrolyte Deficient (CLED) agar and antibiotic susceptibility testing was performed using the Kirby-Bauer Disc Diffusion method. A total of 457 urine samples were collected, of which 90 (19.7%) were positive for significant uropathogens. With a mean age of 4.6 years, majority of the culture-positive patients were female (n = 72; 80%). Enterobacterales were the most frequently isolated (n = 88; 95.6%), of which Escherichia coli was the most common (73.9%; n = 68). Citrobacter (n = 7; 7.6%), Klebsiella (n = 6; 6.5%), Serratia (n = 4; 4.3%), Proteus (n = 2; 2.2%), Salmonella (n = 2; 2.2%), and Enterobacter (n = 1; 1.1%) were among the other Enterobacterales isolated. Meropenem and imipenem were the most effective in isolates from Enterobacterales (n = 88) followed by amikacin (n = 84), ciprofloxacin (n = 75), and piperacillin-tazobactam (n = 70). Ceftriaxone and cefixime exhibited moderate susceptibility (n = 69 and 52) whereas, amoxicillin-clavulanate was the least susceptible (n = 3). We report high frequency of UTI in our pediatric population with uropathogens and associated antimicrobial susceptibility pattern confirming to the existing trends of pediatric UTIs in Pakistan. In addition to valuable insights for treating patients under similar conditions, our study serves as a catalyst for further multi-center research in this area.

A Prospective Study to Identify Asymptomatic Bacteriuria: The Causative Organisms, Antibiotic Sensitivity and its Safety in Pregnant Females

Introduction: The common procedure of urinary catheterization during childbirth may introduce bacteria that can cause urinary tract infections. Immune function is relatively compromised during pregnancy. The current study was aimed to identify antenatal patients with bacteriuria, the causative organism and its antibiotic sensitivity in patients with bacteriuria. Materials and Methods: The current prospective crosssectional study involved antenatal patients who were being admitted to the delivery room. A clean catch midstream urine sample was collected in a sterile container of which 5 to 10 mL of the sample was obtained in a separate sterile vial (container 1) for screening tests for leucocyte esterase and nitrite, and the remaining sample (container 2) was taken for routine microscopy, culture, and sensitivity. The reports were collected and tabulated, and bacteriuria was confirmed and statistically analyzed. Results: A total of 200 patients were evaluated, and 40 of them had asymptomatic bacteriuria. In this study positive leukocyte esterase test and nitrite test results were considerably higher in the cases than the controls (p &lt; 0.05) at 10.0 and 47.5%, respectively. Escherichia coli was found to be the most prevalent bacteria in this study, followed by, Pseudomonas, Enterococcus faecalis, Candida albicans, and coagulasenegative Streptococcus and Klebsiella. Most of the E. coli isolates (100.0%) were sensitive to amikacin, a category D drug. The majority of Pseudomonas isolates (100.0%) were sensitive to colistin, a category C drug. Amongst category A drugs, Pseudomonas was sensitive to – cefoperazone-sulbactam, meropenem and piperacillin-tazobactam. Conclusion: It is a standard practice to send urine routine and microscopy test in antenatal patients. As most patients are asymptomatic, investigations are required for early diagnosis of significant bacteria like leucocyte esterase, nitrite and culture and sensitivity. This will help us to institute appropriate treatment and improve maternal and fetal outcomes.

Bacterial Uropathogens causing Urinary Tract Infection at Hetauda Hospital

Introduction: Urinary tract infection is the infection of the uroepithelium that mainly affects kidney, ureter, urinary bladder and urethra. The causative agents of urinary tract infections are bacteria and fungi. Among these, bacteria are the most causative uropathogens of urinary tract infections. Objectives: The objective of this study is to isolate, identify, characterized and perform antibiotic sensitivity test from the bacterial isolates. Methods: A descriptive cross-sectional study was conducted from March 2023 to May 2023. Ethical approval was obtained from Institutional Review Committee (IRC), Madan Bhandari Academy of Health Sciences, IRC-32-079. Total of 1120 urine samples were collected during this study. Convenient sampling technique was used for this study. Clean catch or mid-stream urine was collected in a sterile container. All urine samples were submitted to Department of Microbiology for culture. A set of biochemical tests were done for bacterial identification. Antibiotic sensitivity test was performed by Kirby-Bauer disk diffusion method. Results: Total of 1120 urine samples were collected from patients suspected to Urinary Tract Infections. Total urine culture positive was 340 (30.36%). Of these bacterial isolates, Escherichia coli (248, 73%) was the most common species, followed by Klebsiella species (26, 7.6%), Staphylococcus saprophyticus (23, 6.76%) and Enterococcus fecalis (18, 5.3%). Conclusion: As prevalence of bacteria causing urinary tract infections is increasing day by day; so its proper isolation, identification, characterization with their antibiotic profile is necessary as it forms the base line for the clinicians to choose appropriate antimicrobial agents for empirical as well as rational treatment for UTIs.

First trimester "clean catch" urine and vaginal swab sample distinct microbiological niches.

Untreated asymptomatic bacteriuria (ASB) has been associated with adverse pregnancy outcomes, including pyelonephritis, preterm labor, and low birth weight infants. Thus, routine screening by standard urine culture (SUC) and treatment of ASB are currently recommended for all pregnant women. For this purpose, some researchers claim that vaginal swabs and urine samples can be used as proxies for each other. Because SUC often misses microbes, we used two more sensitive, recently validated detection methods to compare the composition of the urinary and vaginal microbiomes of pregnant females in their first trimester. Both methods yielded similar results. Vaginal and urinary microbial compositions for the same individual were significantly correlated; however, they were not equivalent. We argue that first trimester urinary and vaginal microbiomes are distinct enough to preclude their use as proxies for each other.

Isolation and Susceptibility of Microorganisms Responsible for Asymptomatic Antenatal Bacteriuria

Aim &amp; Objective: Determination of prevalence, bacterial profile and antibiotic sensitivity of microorganisms responsible for asymptomatic UTI during pregnancy.&#x0D; Methodology: The type of study is cross-sectional, Prospective type, was conducted at the PUMHS for Women Nawabshah (SBA) after approval from the Ethical Review Committee and the duration was 2 years from 1st Jan 2021-31st Dec 2022. Samples were collected by non-probability- convenient method from all pregnant women without any clinical complaints attending the Outpatient Department of Gynecology and Obstetrics PUMHS Hospital Nawabshah. The midstream urine collected by clean catch method in sterile containers was processed for DR of urine including physical, chemical, and microscopic examination. After the urine detailed report, the samples were sent for, culture by using the following media, blood, Macconkey’s, and CLED agar. Growth-positive samples were proceeding for gram staining, biochemical tests, and antibiotic sensitivity reports according to world standard methods for confirmation.&#x0D; Results: Out of 477 patients 96 (20%) were positive for ASB, with the mean age of the patient being 29.32±5.74 The most common microorganisms found in the study were E.coli 67 (69.7.%), followed by Klebisella in 4(4%), proteus 9(9%), pseudomonas 8(8.3%), staphylococcus aureus 2(2%), staphylococcus saprophyticus in 4(4%), streptococcus pyogen 2(2%).&#x0D; There was 100% sensitivity found for all isolated microorganisms following culture examination to following antibiotics: Ciprofloxacin, Cefuroxime, Imepenem, Ceftriaxone Amikacin, Meropenem, and Piperacillin-tazobactam; however, 52% and 45% sensitivity of E.coli and 100% sensitivity of streptococci were present for amoxicillin-clavulanic acid and ampicillin respectively.&#x0D; Conclusion: A rising number of silent antenatal bacteriuria was observed in younger age women with severe maternal and fetal complications in advanced stages of pregnancy and thereafter. It is therefore suggested to routinely perform urine cultures for every suspected pregnant lady during advanced antenatal visits to diagnose and properly treat the asymptomatic bacteriuria in terms of avoiding antibiotic resistance and materno-fetal complications in the near future.