Common Urinary Tract Infection Pathogens Research Articles

Nitrofurantoin: properties and potential in treatment of urinary tract infection: a narrative review.

Nitrofurantoin (NF), a wide-spectrum antibiotic accessible since 1953, is utilized widely to treat urinary tract infections as it usually stays active against drug-resistant uropathogen. The use of Nitrofurantoin has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI). To, although fluoroquinolones are usually used to re-evaluate the first- and second-line therapies for treating uncomplicated UTI, their level of utilization is thought to be inappropriately excessive and will eventually have a detrimental impact; thus, we hypothesize that NF might be the best choice for this condition, because of its low frequency of utilization and its high susceptibility in common UTI pathogens. It can be concluded from this review that NF can be considered as the most effective drug in the treatment of acute urinary infection, but due to the long-term side effects of this drug, especially in elderly patients, it is essential to introduce some criteria for prescribing NF in cases of chronic UTI.

890. Bundled Antimicrobial Stewardship Intervention Reduces Inpatient Third Generation Cephalosporin Use without Restriction

Abstract Background The use of third generation cephalosporins (3GC) has been linked to collateral damage such as increased risk of infection with C. difficile, ESBL-producing organisms, VRE, and MRSA. Reduction in use of 3GC has been shown to reduce prevalence of these infections, particularly with C. difficile and ESBLs. An increase in 3GC use was observed at our facility in 2019 and 2020, likely due to targeted fluoroquinolone reduction initiatives in 2019 and COVID-19 surges in 2020. A multifaceted intervention targeting 3GC reduction without restriction was implemented starting in December 2020. Figure 1Monthly third generation cephalosporin use (Days of Therapy per 1000 patient days) from January 2019 to December 2021. Methods We conducted a retrospective quasi-experimental study evaluating the impact of a combination of interventions intended to reduce 3GC use. The intervention included modification of local clinical guidelines for urinary tract infection (UTI) and community acquired pneumonia (CAP), provider education, and daily review of active 3GC orders in 2021. Local guideline changes include preferred use of ampicillin/sulbactam and amoxicillin/clavulanate for CAP and cefazolin and cephalexin for UTI over 3GCs. Use of first generation cephalosporins for UTI was supported by local antibiogram susceptibilities for common UTI pathogens. Days of therapy (DOT) per 1000 patient days were collected monthly and yearly for ceftriaxone, ceftazidime, cefpodoxime, and cefdinir for pre-intervention (January 2019 to December 2019 and January to December 2020) and post-intervention (January 2021 to December 2021) periods. Results 3GC use significantly decreased from 89.52 DOT per 1000 patient days in 2020 to 53.06 in 2021, a 40.73% reduction. To account for increases in antibiotic use during COVID-19 surges in 2020 as a potential confounding variable, 2019 3GC use was also compared to 2021 use. A 31.40% decrease was seen, with 77.35 DOT per 1000 patient days in 2019. This effect was sustained through COVID-19 surges in January and August 2021 (Figure 1). Conclusion A combination of interventions without restriction of 3GC was successful in reducing inpatient use of this class of antibiotics, including through two COVID-19 surges in 2021. Further study is required to determine impact on clinical outcomes, such as C. difficile and antimicrobial resistance rates. Disclosures All Authors: No reported disclosures.

Urinary Tract Infection in Parkinson's Disease.

Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson’s disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.

Antimicrobial Sensitivity Pattern of Bacterial Pathogens Associated with Urinary Tract Infection

Correction: On 10th August 2017 due to typographical errors, the period of the study was changed from May 2016 to June 2017 and the caption of the red segment in Figure 1 was changed from No UTI, 41% to UTI, 59%Background: Urinary tract infection (UTI) is one of the common bacterial infections in mankind. The changing antimicrobial sensitivity in UTI demands use of appropriate antibiotics.Objective: This study was conducted to determine the distribution and antimicrobial susceptibility of uropathogens.Materials and method: This was a prospective study conducted in Bangladesh Medical College & Hospital, Dhaka, Bangladesh between May 2016 and June 2017 to identify the organisms causing UTI and their antibiotic susceptibility. Clean catch midstream urine samples were collected from 95 patients presenting with symptoms of UTI. Antimicrobial susceptibility was performed by disc diffusion method.Results: Out of 95 urine samples, 56 (58.9%) were found positive. The prevalence was significantly higher in females than in males (females: 58.9%; males: 41%). Age group of >48 years showed higher prevalence of UTI. The most common organisms isolated were Escherichia coli, Klebsiella, Pseudomonas, Proteus and Staphylococcus aureus. These represented 44.6%, 21.4%, 14.3%, 12.5%, and 7.14% of isolates respectively. Imipenem and Meropenem were found the most susceptible drug against isolated uropathogens.Conclusion: Most powerful antibiotics in our study were imipenem and meropenem. In conclusion, one can truly affirm that the choice of drugs in the treatment of UTI is becoming quite narrow today due to the wide scale resistance that the common UTI pathogens show to drugs which have been used previously.Delta Med Col J. Jul 2017 5(2): 57-62

Development of a panel of recombinase polymerase amplification assays for detection of common bacterial urinary tract infection pathogens

To develop and evaluate the performance of a panel of isothermal real-time recombinase polymerase amplification (RPA) assays for detection of common bacterial urinary tract infection (UTI) pathogens. The panel included RPAs for Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa and Enterococcus faecalis. All five RPAs required reaction times of under 12min to reach their lower limit of detection of 100 genomes per reaction or less, and did not cross-react with high concentrations of nontarget bacterial genomic DNA. In a 50-sample retrospective clinical study, the five-RPA assay panel was found to have a specificity of 100% (95% CI, 78-100%) and a sensitivity of 89% (95% CI, 75-96%) for UTI detection. The analytical and clinical validity of RPA for the rapid and sensitive detection of common UTI pathogens was established. Rapid identification of the causative pathogens of UTIs can be valuable in preventing serious complications by helping avoid the empirical treatment necessitated by traditional urine culture's 48-72-h turnaround time. The routine and widespread use of RPA to supplement or replace culture-based methods could profoundly impact UTI management and the emergence of multidrug-resistant pathogens.

Antivirulence effects of pomegranate peel extracts on most common urinary tract infection pathogens in pregnant women

Objective This study includes the investigation of antibacterial and antivirulence activities of three types of pomegranate peel extracts andthen determines the interaction between the extracts and antibiotic in vitro.Methods The ability of most common isolated bacteria from urinary tract infection (UTI) to produce different virulence factors were testedand the effect of plant extracts on virulence factors were determined; in addition the correlation between extracts and antibiotics wereevaluated by using fractional inhibitory concentrations.Results The inhibition zones diameters of the pomegranate peel extracts against most common isolated bacteria (Staphylococcus aureus andEscherichia coli) increase significantly with increase in concentrations. There is no effect of the extracts on the ability of studied bacteria toproduce hemolysin and protease enzymes, while both studied bacteria lost its ability to produce β-lactamase enzyme after treating with MIC.In addition, extracts were affected largely on adherence activity and biofilm forming ability of tested bacteria. The results found that thepomegranate peel extracts effect alone against pathogenic bacteria was good than they interacted with antibiotics, in most of the results.Conclusion The alcohol extract was the best solvent in its effects on bacterial pathogen and its effect was largely on the ability of the studiedbacteria to form biofilm and adhesion on the epithelial cell. The pomegranate peel extracts were high synergism with some antibioticsagainst pathogenic bacteria.

Rapid and Accurate Detection of Urinary Pathogens by Mobile IMS-Based Electronic Nose: A Proof-of-Principle Study

Urinary tract infection (UTI) is a common disease with significant morbidity and economic burden, accounting for a significant part of the workload in clinical microbiology laboratories. Current clinical chemisty point-of-care diagnostics rely on imperfect dipstick analysis which only provides indirect and insensitive evidence of urinary bacterial pathogens. An electronic nose (eNose) is a handheld device mimicking mammalian olfaction that potentially offers affordable and rapid analysis of samples without preparation at athmospheric pressure. In this study we demonstrate the applicability of ion mobility spectrometry (IMS) –based eNose to discriminate the most common UTI pathogens from gaseous headspace of culture plates rapidly and without sample preparation. We gathered a total of 101 culture samples containing four most common UTI bacteries: E. coli, S. saprophyticus, E. faecalis, Klebsiella spp and sterile culture plates. The samples were analyzed using ChemPro 100i device, consisting of IMS cell and six semiconductor sensors. Data analysis was conducted by linear discriminant analysis (LDA) and logistic regression (LR). The results were validated by leave-one-out and 5-fold cross validation analysis. In discrimination of sterile and bacterial samples sensitivity of 95% and specificity of 97% were achieved. The bacterial species were identified with sensitivity of 95% and specificity of 96% using eNose as compared to urine bacterial cultures. In conclusion: These findings strongly demonstrate the ability of our eNose to discriminate bacterial cultures and provides a proof of principle to use this method in urinanalysis of UTI.

Microbiological investigation of an antibacterial sandwich layer system.

To allow medical application of an artificial bladder made of biocompatible polyurethane, a long-term stable antibacterial coating is required. Alone, the artificial bladder exhibits no defense against microorganisms. Silver coating provides long-term antibacterial protection by the continuous release of silver ions into aqueous solutions. To control and to prolong the rate of silver ion release, the deposited silver film has to be protected by an inert film of biocompatible polyparylene by means of chemical vapor deposition. In this study, an antibacterial artificial bladder surface was developed by the formation of a sandwich structure consisting of silver and a biocompatible polymer (polyparylene) as a diffusion barrier. Specifically, this study analyzed the correlation between polyparylene thickness and silver release to determine optimal concentrations to combat common bacteria in vitro. The release of silver from sandwich structures was investigated in vitro by testing different thicknesses of polyparylene (0, 190, 540, and 1000 nm) as a diffusion barrier. The best result was demonstrated with a thickness of 190 nm of polyparylene, which yielded a silver dispense rate of 650 pg/(cm(2)⋅min), which would yield bacteriozidal concentrations above 30 μg/l in the bladder volume. The authors confirmed the antibacterial effect in vitro against common urinary tract infection pathogens, namely, Escherichia coli and Staphylococcus cohnii. Inhibition of bacterial growth could be detected within 8 h. A diffusion assay with spherical silver spots showed concentric zones free of bacterial growth. Our results suggest the possible utility of silver-polyparylene coatings as antibacterial agents.

Drug susceptibility and treatment response of common urinary tract infection pathogens in children

To document the trends of sensitivity and to find whether it is necessary to change antibiotics in selected patients according to the sensitivity test results in our clinical practice. We collected urine culture results from 0-18-year-old patients in the National Taiwan University Hospital from January 1, 2003 to October 31, 2012. Their medical chart was reviewed to identify true pathogens responsible for their urinary tract infection (UTI). We checked the percentage of susceptibility of these pathogens to ampicillin, amoxicillin-clavulanate (AMC), cefazolin, cefmetazole, ceftriaxone, gentamicin, and trimethoprim-sulfamethoxazole (TMP-SMX) according to the Clinical and Laboratory Standards Institute (CLSI) guideline. The extended-spectrum-beta-lactamases (ESBLs) rate was also checked. In addition, we reviewed the treatment response of different antibiotics. Defervescence within 48 hours after initial antibiotics use was considered responsive. A total of 7758 urine cultures positive for Escherichia coli infection were collected during the 10-year period. The E. coli cefazolin susceptibility rate was 62-73% during 2003-2010, but it dropped to 23% in 2011 and 28% in 2012 after the new CLSI guideline (M100-S21) was released. However, other antibiotics did not show a significant difference. In UTI caused by E. coli, on average, the sensitivity rates for various antibiotics were as follows: cefmetazole, 90%; ceftriaxone, 85%; gentamicin, 77%; AMC, 61%; TMP-SMX, 47%; and ampicillin, 20%. The ESBL rate was also found to increase (2-11%; p < 0.01). The overall response rate of UTI caused by E. coli to first-line antibiotics such as first-generation cephalosporin and/or gentamicin was 78%. The susceptibility of common urinary tract pathogens to cefazolin has decreased dramatically since 2010. This trend may be due to the change in the CLSI guideline. Although the susceptibility rate to first-line empirical antibiotics shows a decreasing trend, we found that the clinical response was acceptable for our first-line empirical antibiotics.

Bacterial Pathogens and Resistance Patterns in Children With Community-Acquired Urinary Tract Infection: A Cross Sectional Study

Background: Recent studies on bacterial pathogens causing urinary tract infection (UTI) in children have shown high levels of antibiotic resistance in clinical settings. Objectives: We determined the common bacterial pathogens causing UTI and their antimicrobial resistance patterns in Iranian children. Patients and Methods: The study subjects were 114 children (female subjects, 58.8%) with culture-proven UTI categorized in the following 3 age groups: neonates ( 2 years, n = 28). Sensitivity testing was performed using the disc diffusion technique. Results: The most frequently cultured pathogens included Escherichia coli (71.7%) and Enterobacter (28.9%). UTI caused by Enterobacter was more commonly detected in neonates (60.6%) than in infants (21.2%) and children (18.2%). Imipenem was the most active agent against E. coli isolates (susceptibility, 97.3%), followed by ciprofloxacin (90.4%) and amikacin (82.9%). Trimethoprim-sulfamethoxazole, cefalotine, and cephalexin were the least active agents, with 76.3%, 75.0%, and 73.7% of E. coli isolates exhibiting resistance, respectively. Imipenem and ceftizoxime were the most effective antimicrobial agents against Enterobacter, with sensitivity rates of 85.2% and 71.4%, respectively. Nitrofurantoin, ceftazidime, and cefalotine were the least active antimicrobial agents against Enterobacter, with resistance rates of 92.3%, 66.7%, and 62.5%, respectively. Conclusions: The low susceptibility of common UTI pathogens to cephalosporins may be because of their high rate of administration to children with UTI in our population. A change in empiric therapy should be considered, especially in neonates. Implication for health policy/practice/research/medical education: Most of the recent studies, on antimicrobial susceptibility of bacterial pathogens causing UTI in children showed high levels of resistance to antibiotics. The present study determined the common types of bacterial pathogen causing UTI in children and their antimicrobial resistance patterns at a sample of Iranian children. Our results could be useful for pediatrician, children nephrologists, and infection diseases specialists.

Bacterial Pathogens and Resistance Patterns in Children With Community-Acquired Urinary Tract Infection: A Cross Sectional Study

Background: Recent studies on bacterial pathogens causing urinary tract infection (UTI) in children have shown high levels of antibiotic resistance in clinical settings. Objectives: We determined the common bacterial pathogens causing UTI and their antimicrobial resistance patterns in Iranian children. Patients and Methods: The study subjects were 114 children (female subjects, 58.8%) with culture-proven UTI categorized in the following 3 age groups: neonates (< 28 days,n = 45), infants (28 days to 2 years, n = 41), and children (> 2 years, n = 28). Sensitivity testing was performed using the disc diffusion technique. Results: The most frequently cultured pathogens included Escherichia coli (71.7%) and Enterobacter (28.9%). UTI caused by Enterobacter was more commonly detected in neonates (60.6%) than in infants (21.2%) and children (18.2%). Imipenem was the most activeagent against E. coli isolates (susceptibility, 97.3%), followed by ciprofloxacin (90.4%) and amikacin (82.9%). Trimethoprim-sulfamethoxazole, cefalotine, and cephalexin were the least active agents, with 76.3%, 75.0%, and 73.7% of E. coli isolates exhibiting resistance,respectively. Imipenem and ceftizoxime were the most effective antimicrobial agentsagainst Enterobacter, with sensitivity rates of 85.2% and 71.4%, respectively. Nitrofurantoin,ceftazidime, and cefalotine were the least active antimicrobial agents against Enterobacter,with resistance rates of 92.3%, 66.7%, and 62.5%, respectively. Conclusions: The low susceptibility of common UTI pathogens to cephalosporins may be because of their high rate of administration to children with UTI in our population. A change in empiric therapy should be considered, especially in neonates.