Community-acquired Urinary Tract Infections Research Articles

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection.

Bacteremia has been associated with severity in some infections; however, its impact on the prognosis of urinary tract infections (UTIs) is still disputed. Our goal is to determine the risk factors for bacteremia and its clinical impact on hospitalized patients with complicated community-acquired urinary tract infections. We conducted a prospective observational study of patients admitted to the hospital with complicated community-acquired UTIs. Clinical variables and outcomes of patients with and without bacteremia were compared, and multivariate analysis was performed to identify risk factors for bacteremia and mortality. Of 279 patients with complicated community-acquired UTIs, 37.6% had positive blood cultures. Risk factors for bacteremia by multivariate analysis were temperature ≥ 38 °C (p = 0.006, OR 1.3 (95% CI 1.1-1.7)) and procalcitonin ≥ 0.5 ng/mL (p = 0.005, OR 8.5 (95% CI 2.2-39.4)). In-hospital and 30-day mortality were 9% and 13.6%, respectively. Quick SOFA (p = 0.030, OR 5.4 (95% CI 1.2-24.9)) and Barthel Index <40% (p = 0.020, OR 4.8 (95% CI 1.3-18.2)) were associated with 30-day mortality by multivariate analysis. However, bacteremia was not associated with 30-day mortality (p = 0.154, OR 2.7 (95% CI 0.7-10.3)). Our study found that febrile community-acquired UTIs and elevated procalcitonin were risk factors for bacteremia. The outcomes in patients with bacteremia were slightly worse, but without significant differences in mortality.

O03 The effect of antibiotic selection on collateral susceptibility and evolvability of uropathogenic Escherichia coli

Abstract Urinary tract infections (UTIs) are a common infection in healthy adult women and as such account for 1%–3% of all medical consultations and the second most common reason for prescribing antimicrobials in the UK. Escherichia coli is a frequent aetiological agent of uncomplicated UTIs, causing 75% of cases, associated with recurrence of infection (40%) and a major source of bacteraemia (∼40%). Trimethoprim and nitrofurantoin are currently recommended as first-line antibiotics for the treatment of uncomplicated UTIs. However, 48700 deaths in Europe in 2019 have been associated with antimicrobial-resistant UTIs and resistance to trimethoprim in community-acquired UTIs caused by E. coli is high (33.4%). With little to no antimicrobial development in recent years, new strategies are therefore required to maintain efficacy in currently available antibiotics. One such strategy is to use evolutionary principles to understand how antimicrobial resistance (AMR) to one antibiotic can affect the activity and probability of resistance development to a second antibiotic. Effect on antimicrobial activity can be assessed through collateral susceptibility, where prior resistance to one antibiotic either increases or decreases susceptibility to a second, unrelated class of antibiotic. While the probability of resistance development can be assessed by the mutant selection window (MSW), an antibiotic concentration range where AMR mutations can be selected for. This ranges from the MIC (the lowest concentration to select for resistance) to the mutant prevention concentration (MPC, the highest concentration to select for resistance). In this study, we aimed to determine the effect trimethoprim resistant derivatives of three clinical strains of uropathogenic E. coli on collateral susceptibility and MSWs to nitrofurantoin. We found that trimethoprim-resistant mutants conferred the expected decrease in susceptibility to trimethoprim and an increase in the MSW. This suggests prior selection with trimethoprim increases the probability of treatment failure and the selection of further mutations conferring high-level resistance to trimethoprim. We also observed collateral resistance to nitrofurantoin in the trimethoprim-resistant mutants. Importantly, however, there was a reduction in the MPC, and therefore a narrowing of the MSW, reducing the probability of selection of higher levels of nitrofurantoin resistance. This suggests that using nitrofurantoin after trimethoprim may reduce the probability of developing nitrofurantoin resistance compared with using nitrofurantoin first. These data provide a potential evidence base to use evolutionary principles when designing antimicrobial regimens to limit AMR development and improve treatment success.

Influence of Sepsis on the Middle-Term Outcomes for Urinary Tract Infections in Elderly People.

Urinary tract infection (UTI) is a common condition that predominantly affects elderly people, who are particularly susceptible to developing sepsis. Previous studies have indicated a detrimental effect of sepsis on short-term outcomes in elderly patients with UTI, but there is a lack of data about the middle-term prognosis. The aim of this study was to investigate the influence of sepsis on the middle-term prognosis of patients aged 65 years or older with complicated community-acquired UTIs. A prospective observational study of patients admitted to a hospital with UTI. We conducted a comparison of epidemiological and clinical variables between septic and nonseptic patients with UTI, as well as their 6-month case-fatality rate. A total of 412 cases were included, 47.8% of them with sepsis. Septic patients were older (83 vs. 80 years, p < 0.001), but did not have more comorbidities. The short-term case-fatality rate was higher in septic patients and this difference persisted at 6 months (34% vs. 18.6%, p = 0.003). Furthermore, age older than 75 years, Barthel index <40 and healthcare-associated UTI were also associated with the middle-term case-fatality rate. In conclusion, the detrimental impact of sepsis is maintained on the middle-term prognosis of elderly patients with UTI. Age, functional status and healthcare-associated UTIs also play significant roles in shaping patient outcomes.

Spectrum and Antibiotic Resistance in the Community and Hospital-Acquired Urinary Tract Infected Adults

Background: Urinary tract infection (UTI) is the most common infection in the community. The causative agents and antibiotic resistance differ between community-acquired and hospital-acquired urinary tract infections.&#x0D; Objectives: This study aimed at identifying the etiologic agents in both community-acquired as well as hospital-acquired urinary tract infections and to determine the antibiotic resistance pattern of the most frequent organisms.&#x0D; Methods: This is a retrospective cross sectional study of positive urine cultures of adult patients attending An-Najah National University Hospital (NNUH) between the period of Jan 2019 and Dec 2020.&#x0D; Each patient’s age, sex, and urine culture results were obtained from the microbiology lab of NNUH. Microbiology reports included the isolated microorganisms and their antibiotic susceptibility patterns.&#x0D; Results: A total of 798 patients were included in the study, of which 472 (59.1%) were female. Escherichia coli was the most common uropathogen, accounting for 37.8% of the CAUTI and 25.1% of the HAUTI. In CAUTI, E. coli was followed by E. faecalis (16.4%), Klebsiella pneumoniae (13.7%), E. faecium (6.5%), and Streptococcus agalactia (4.9%). Among HAUTIs, the second most common was Klebsiella pneumoniea (21.4%) followed by E. faecium (19.3%), E. faecalis (13.4%), and Pseudomonas aeruginosa (7%). The rates of ESBL-producing strains of E. coli were similar between CAUTI (54.1%) and HAUTI (53.2%).&#x0D; &#x0D; coli from CAUTI and HAUTI was sensitive to carbapenems, amikacin, and nitrofurantoin. The antibiotics with the highest resistance rates were ampicillin, cefuroxime, cotrimoxazole, and ciprofloxacin. Resistance rates were higher in HAUTI than in CAUTI.&#x0D; &#x0D; Conclusions: The UTI etiological profiles and antibiotic resistance patterns varied between CAUTI and HAUTI; thus, a different antibiotic therapy for various categories should be considered when initiating empirical antimicrobial therapies.

Short- and Long-Read Sequencing Reveals the Presence and Evolution of an IncF Plasmid Harboring blaCTX-M-15 and blaCTX-M-27 Genes in Escherichia coli ST131.

Escherichia coli sequence type 131 (ST131) has contributed to the spread of extended-spectrum beta-lactamase (ESBL) and has emerged as the dominant cause of hospital- and community-acquired urinary tract infections. Here, we report for the first time an in-depth analysis of whole-genome sequencing (WGS) of 4 ESBL-producing E. coli ST131 isolates recovered from patients in two hospitals in Armenia using Illumina short-read sequencing for accurate base calling to determine their genotype and to infer their phylogeny and using Oxford Nanopore Technologies long-read sequencing to resolve plasmid and chromosomal genetic elements. Genotypically, the four Armenian isolates were identified as part of the H30Rx/clade C2 (n = 2) and H41/clade A (n = 2) lineages and were phylogenetically closely related to isolates from the European Nucleotide Archive (ENA) database previously recovered from patients in the United States, Australia, and New Zealand. The Armenian isolates recovered in this study had chromosomal integration of the blaCTX-M-15 gene in the H30Rx isolates and a high number of virulence genes found in the H41 isolates associated with the carriage of a rare genomic island (in the context of E. coli ST131) containing the S fimbrial, salmochelin siderophore, and microcin H47 virulence genes. Furthermore, our data show the evolution of the IncF[2:A2:B20] plasmid harboring both blaCTX-M-15 and blaCTX-M-27 genes, derived from the recombination of genes from an IncF[F2:A-:B-] blaCTX-M-15-associated plasmid into the IncF[F1:A2:B20] blaCTX-M-27-associated plasmid backbone seen in two genetically closely related H41 Armenian isolates. IMPORTANCE Combining short and long reads from whole-genome sequencing analysis provided a genetic context for uncommon genes of clinical importance to better understand transmission and evolutionary features of ESBL-producing uropathogenic E. coli (UPEC) ST131 isolates recovered in Armenia. Using hybrid genome assembly in countries lacking genomic surveillance studies can inform us about new lineages not seen in other countries with genes encoding high virulence and antibiotic resistance harbored on mobile genetic elements.

Epidemiological screening of pathogenicity factors associated with multidrug-resistant bacteria isolated in uroculture of hospitalized neonates in the lakes region from Rio de Janeiro.

The discovery of antimicrobials revolutionized the treatment of infectious diseases caused by bacteria, as they are drugs that contribute to reducing morbidity and mortality rates associated with infectious diseases (JANEBRO, et al., 2008). However, the irrational use of antimicrobial drugs represents one of the main concerns worldwide, since the misuse of these drugs accelerates the natural process of bacteria resistance to antibiotics (ZIMERMAN, 2010). In view of all these problems, the objective of this study was to evaluate the profile of resistance of bacteria identified in the urine culture of neonates who are hospitalized, based on the records of the Laboratory of Clinical Analysis of a hospital in the lakes region from Rio de Janeiro. To do so, we used the following methodologies: (i) literature review for contextualization of the problem and basis for discussion; (ii) and monitoring of a descriptive observational study that had as instrument the reports of records containing results of urine culture and antibiogram of neonatal patients, referring to the period from January 2020 to September 2021. The results showed a higher incidence of Escherichia coli (44% - 2020; 56% - 2021) among the microorganisms isolated in the analyzed urine cultures, followed by Klebsiella pneumoniae (14% - 2020; 28% - 2021). Antimicrobials from the β-lactam group caused high bacterial resistance, among the strains of different microorganisms analyzed, increasingly indicating the need for the replacement of these drugs in the clinic, in order to choose a better therapy for the patient. As in any infectious pathology, to establish appropriate prevention and treatment of community-acquired urinary tract infections, effective and continuous research is needed, with the goal of defining in detail the etiology and profile of bacterial resistance in regional, national, and international standards. It is hoped that these new data profiling the level of resistance in which microorganisms isolated from neonatal patients admitted under hospital regimen are found will be of great value to the academic community and to health professionals, providing users with increasingly accurate and quality treatment.

Are Empirical Treatments Compatible with the Pattern of Antibiotic Sensitivity in Urinary Tract Infections?

Considering the importance of empirical antibiotic treatment before obtaining urine culture results, it is necessary to know the pattern of microbial sensitivity to antibiotics to properly manage urinary tract infection (UTI). The present research aimed at determining type of pathogens causing UTI and the pattern of antibiotic sensitivity in urine cultures of hospitalized patients in Hamadan, Iran. This cross-sectional study was conducted on 120 individuals (including 60 cases as hospital-acquired infection and 60 cases as community-acquired infection group). The urine samples were cultured and processed for subsequent uropathogens isolation. The specimens were cultivated on Muller-Hinton Agar (Merck, Germany) and incubated at 37 °C for 24 h. The antibiotic sensitivity was determined using disc diffusion method by antibiogram discs (English MAST Company, recommended by the Clinical and Laboratory Standards Institute (CLSI) guideline) in two groups of outpatients and inpatients simultaneously. According to the results, most isolates were resistant to commonly used antibiotics in the treatment of UTIs. A significant increase was observed in drug resistance to ciprofloxacin, levofloxacin, cotrimoxazole, and ceftriaxone, especially in community-acquired cases. In community-acquired UTIs from the gram-negative pathogen, E. coli showed the highest drug sensitivity to imipenem (100%) and fosfomycin (95%), and the highest drug resistances were observed for ciprofloxacin (62.5%) and levofloxacin (60%). In the cases of E. coli acquired from the hospital, resistance to fluoroquinolones, ceftriaxone, and cefepime increased, while the sensitivity to meropenem, imipenem, and piperacillin-tazobactam was 80.6%, 87.1%, and 90%, respectively. Urinary tract infection was highly prevalent in the study area and all uropathogens isolated developed resistance against mostly used antibiotic.

Association Between Uropathogenic Escherichia coli Virulence Genes and Severity of Infection and Resistance to Antibiotics.

Urinary tract infection (UTI) is the most frequent bacterial infection. Some uropathogenic Escherichia coli (UPEC) genes have been associated with disease severity and antibiotic resistance. The aim was to determine the association of nine UPEC virulence genes with UTI severity and antibiotic resistance of strains collected from adults with community-acquired UTI. A case-control study (1:3) (38 urosepsis/pyelonephritis and 114 cystitis/urethritis) was conducted. The fimH, sfa/foc, cvaC, hlyA, iroN, fyuA, ireA, iutA, and aer (the last five are siderophore genes) virulence genes were determined by PCR. The information of antibiotic susceptibility pattern of the strains was collected from medical records. This pattern was determined using an automated system for antimicrobial susceptibility testing. Multidrug-resistant (MDR) was defined as resistance to three or more antibiotic families. fimH was the most frequently detected virulence gene (94.7%), and sfa/foc was the least frequently detected (9.2%); 55.3% (83/150) of the strains were MDR. The evaluated genes were not associated with UTI severity. Associations were found between the presence of hlyA and carbapenem resistance (Odds ratio [OR] = 7.58, 95% confidence interval [CI], 1.50-35.42), iutA and fluoroquinolone resistance (OR = 2.35, 95% CI, 1.15-4.84, and aer (OR = 2.8, 95% CI, 1.20-6.48) and iutA (OR = 2.95, 95% CI, 1.33-6.69) with penicillin resistance. In addition, iutA was the only gene associated with MDR (OR = 2.09, 95% CI,1.03-4.26). There was no association among virulence genes and UTI severity. Three of the five iron uptake genes were associated with resistance to at least one antibiotic family. Regarding the other four non-siderophore genes, only hlyA was associated with antibiotic resistance to carbapenems. It is essential to continue studying bacterial genetic characteristics that cause the generation of pathogenic and multidrug-resistant phenotypes of UPEC strains.

Analysis of Etiology of Community-Acquired and Nosocomial Urinary Tract Infections and Antibiotic Resistance of Isolated Strains: Results of a 3-Year Surveillance (2020-2022) at the Pediatric Teaching Hospital in Warsaw.

Urinary tract infections (UTIs) remain the most common infections diagnosed in outpatients and hospitalized patients. This study was designed to determine the patterns of antibiotic resistance and the prevalence of uropathogens causing UTIs in pediatric patients hospitalized between 1 January 2020 and 31 December 2022 at Teaching Hospital in Warsaw. The most frequent species isolated from urine samples were E. coli (64.5%), Klebsiella spp. (11.6%), and Enterococcus spp. (6.1%). UTIs caused by Enterobacter spp., Enterococcus spp., and Klebsiella spp. were significantly more common in children younger than three months of age than in children older than three months (p < 0.001). Trimethoprim and trimethoprim-sulfamethoxazole were the least active compounds against Enterobacterales with the resistance of E. coli, Klebsiella spp., P. mirabilis, and Enterobacter spp. in the range of 26.7/25.2%, 48.4/40.4%, 51.1/40.4%, and 15.8/13.2% respectively. Ampicillin was also found to have resistance rates for E. coli of 54.9% and P. mirabilis of 44.7%. Cefalexin and cefuroxime were highly active towards Enterobacterales except for Klebsiella spp., in which the resistance level reached 40%. Regarding third- and fourth- generation cephalosporins, resistance in E. coli and P. mirabilis was observed in approximately 2-10% of the isolates, but in Klebsiella spp. and Enterobacter spp. ranged over 30%. The resistance of Enterobacterales to carbapenems, nitrofurantoin, and fosfomycin was below 1%. The quinolones resistance was very high for Klebsiella spp. (31.1%) and P. mirabilis (29.8%) and three times lower for E. coli (11.9%), P. aeruginosa (9.3%), Enterobacter spp. (2.6%), and E. faecalis (4.6%). Resistance to multiple antibiotic classes was identified in 396 Enterobacterales strains, 394 of which were multi-drug resistant (MDR) and 2 were extensive drug-resistant (XDR). In the case of E. coli, 30% of isolates were MDR, with the proportion of strains having this exact resistance pattern similar in all of the analyzed years; no E. coli XDR strains were isolated. The number of Klebsiella spp. MDR strains was much higher in 2022 (60%) than in 2021 (47.5%). In the analyzed time, only one strain of K. pneumonia XDR, producing New Delhi metallo-β-lactamase, was isolated. Monitoring infection trends is essential to improve control and limit the rise of bacterial resistance.

Association of Virulence Markers With Resistance to Oral Antibiotics in Escherichia coli Isolates Causing Uncomplicated Community-Acquired Cystitis.

UropathogenicEscherichia coli(UPEC) strains equipped with putative virulence factors (VFs) are known to cause approximately 90% of lower urinary tract infections (UTIs) or cystitis affecting individuals of all age groups. Only limited laboratory-based data on the correlation of antimicrobial resistant patterns and VFs of UPEC are available. A total of 100 non-duplicate E. coli isolates associated with community-acquired UTIs in sexually active women were analysed for antimicrobial susceptibility patterns and putative virulence-associated genes. Antimicrobial susceptibility testing (AST) was carried out by the Kirby-Bauer disk diffusion method, and results were interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The isolates non-susceptible to ≥1 agent in ≥3 different antimicrobial categories were considered multidrug-resistant (MDR). Multiplex polymerase chain reaction assay was performed on each E. coli isolateto characterize putative virulence genes (VGs) such as papA, malX, PAI, ibeA, fimH, fyuA, sfa/focDE, papGIII, iutA, papGI, kpsMTII, hlyA, papGII, traT, afa/draBC, cnf1, vat, and yfcV. Results: Capsule synthesis gene kpsMTII (59%)was the most predominant VG present, followed by serum resistance-associated transfer protein gene traT (58%) and adhesin gene fimH (57%); however, adhesin gene papGI (2%) was the least present. The prevalence of antimicrobial resistance was relatively high for commonly used oral antimicrobials of UTItreatment, such as trimethoprim-sulfamethoxazole (68%) and fluoroquinolones (63%). The majority of isolates were MDR (78%) and resistant to extended-spectrum cephalosporins (63.5%). Isolates resistant to norfloxacin and trimethoprim-sulfamethoxazole were also resistant to almost all available oral antimicrobials. Isolates resistant to extended-spectrum cephalosporins showed increased resistance to aztreonam and trimethoprim-sulfamethoxazole (84.6% each)and fluoroquinolones (ciprofloxacin and norfloxacin; 81.5% each). Fosfomycin and nitrofurantoin were the most sensitive antimicrobials for all these resistant isolates. In a multivariate analysis, it was found that MDR isolates were associated with many of the VGs; fimH (65.4%) being the most frequent followed by traT (64.1%). traT (66.2%) and iutA (60.3%) were most commonly present in E. coli isolates resistant to trimethoprim-sulfamethoxazole, while66.7% norfloxacin-resistant isolates have them.Isolates resistant to extended-spectrum cephalosporins were most commonly associated with fimH and traT (66.2% each). However, E. coli isolates positive for sfa/focDE and vat were more sensitive to norfloxacin and trimethoprim-sulfamethoxazole and were non-MDR strains predominantly (p < 0.05). Only two VGs (fimH and traT)were significantly associated with MDR strains. The results of the present study clearly show the association of VFs with some of the commonly used oral antibiotics emphasizing the need for further molecular studies and surveillance programs to monitor drug-resistant UPEC so as to form optimized diagnostic stewardship and appropriate regimen for patient treatment. The reason behind this phenomenon of association has not been studied in much detail herebut it can be assumed that genes responsible for drug resistance may share neighbouring loci with VGs on the mobile genetic elements (e.g., plasmid), which transfer together from one bacterium to another.

In-vitro activity of oral third-generation cephalosporins plus clavulanate against ESBL-producing Enterobacterales isolates from the MERINO trial

Extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales as a cause of community-acquired uncomplicated urinary tract infection (UTI) is on the rise. Currently, there are minimal oral treatment options. New combinations of existing oral third-generation cephalosporins paired with clavulanate may overcome resistance mechanisms seen in these emerging uropathogens. Ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae containing CTX-M-type ESBLs or AmpC, in addition to narrow-spectrum OXA and SHV enzymes, were selected from blood culture isolates obtained from the MERINO trial. Minimum inhibitory concentration (MIC) values of third-generation cephalosporins (cefpodoxime, ceftibuten, cefixime, cefdinir), both with and without clavulanate, were determined. One hundred and one isolates were used with ESBL, AmpC and narrow-spectrum OXA genes (e.g. OXA-1, OXA-10) present in 84, 15 and 35 isolates, respectively. Susceptibility to oral third-generation cephalosporins alone was very poor. Addition of 2 mg/L clavulanate reduced the MIC50 values (cefpodoxime MIC50 2 mg/L, ceftibuten MIC50 2 mg/L, cefixime MIC50 2 mg/L, cefdinir MIC50 4 mg/L) and restored susceptibility (33%, 49%, 40% and 21% susceptible, respectively) in a substantial number of isolates. This finding was less pronounced in isolates co-harbouring AmpC. In-vitro activity of these new combinations may be limited in real-world Enterobacterales isolates co-harbouring multiple antimicrobial resistance genes. Pharmacokinetic/pharmacodynamic data would be useful for further evaluation of their activity.

Antimicrobial Resistance Rates and Risk Factors for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli-Associated Urinary Tract Infections in Older Outpatients in East Anatolia from 2011 - 2019

Background: Community-acquired urinary tract infection is among the most common infections in older adults. Regardless of age, the most frequently detected causative microorganism is Escherichia coli. In parallel with the increase in antibiotic use, the frequency of community-acquired extended-spectrum beta-lactamase-producing E. coli (ESBL-E. coli) has reached critical levels. The use of empirical antibiotic therapy is determined by assessing patient-based risk factors. Therefore, knowing the risk factors and the frequency of antimicrobial resistance can guide the treatment to shape the treatment. Objectives: This study aimed to determine the risks and resistance frequencies to guide the empirical treatment selection for ESBL-E. coli-associated urinary tract infection (UTI) in elderly patients. Methods: This study is a retrospective cohort study. It was carried out between 2011 - 2019. Escherichia coli growth of ≥ 105 colony-forming units (cfu)/mL in urine culture was included in 815 patients aged 65 and over who applied to outpatient clinics. Results: Two hundred and sixty (31.9%) of the patients had ESBL-E. coli. In ESBL-E. coli, antimicrobial resistance rates were highest (100%) for penicillins + β-lactamase inhibitors. The lowest resistance rates were determined for carbapenems, aminoglycosides, phosphonic acid, and nitrofurantoins. Risk factors for ESBL-producing bacteria were determined. These were the presence of benign prostatic hypertrophy, antibiotic use in the last three months, history of UTI in the last year, urinary catheter uses in the last year, male gender, and hospitalization in the last year (P &lt; 0.05). The only independent risk factor was a history of UTI in the last year, which increased the risk of ESBL by 2.8 times. Conclusions: Carbapenems can be chosen as parenteral options, and phosphonic acids and nitrofurantoin as oral options for empirical antibiotic treatment, especially in patients with a history of UTI in the past year.

Antimicrobial Susceptibility of Community-acquired Urine Bacterial Isolates in French Amazonia.

Bacterial resistance in community-acquired urinary tract infections (UTIs) is increasing worldwide. Our study aimed to assess the microbiological epidemiology and antimicrobial susceptibility patterns of community-acquired urine bacterial isolates in French Amazonia. Our study is retrospective. It was conducted from January 2015 to December 2019 in the microbiology laboratory of the Cayenne General Hospital (French Guiana). It includes all positive urine samples from adult (> 18 years) outpatients (N = 2,533). Isolated microorganisms were Gram-negative rods in 83.9%, mainly Enterobacterales (98.4%). The main isolated bacteria were Escherichia coli (58.7%) and Klebsiella pneumoniae (13.3%). Among the isolated E. coli, 37.2% were susceptible to amoxicillin, 77.9% to amoxicillin/clavulanic acid, 94.9% to cefotaxime, 78.9% to ofloxacin, and 98.9% to nitrofurantoin. In 106 cases (5.1%), isolated Enterobacterales were extended-spectrum β-lactamase producers (5% of E. coli and 8.9% of K. pneumoniae). Overall, high levels of cross- and co-resistance were registered. The main isolated Gram-positive bacteria was Staphylococcus saprophyticus (28.9%). It was resistant to oxacillin in 52.5% of cases and susceptible to nitrofurantoin in 99.1% of cases. Patients with S. saprophyticus were young women in almost all cases. In conclusion, the most isolated microorganisms from outpatient urinalyses were E. coli and K. pneumoniae. They showed a high resistance rate to amoxicillin, but they were susceptible to the most remaining antibiotics. S. saprophyticus was isolated mainly in young women and was resistant to oxacillin in half of the cases. Interestingly, nitrofurantoin was active against most isolated organisms and can be considered as empirical treatment in uncomplicated UTIs.

Chitosan improves the efficacy of gentamicin against MDR and biofilm-forming URO pathogenic E. coli

Uropathogenic E. coli is the most common cause of urinary tract infections (UTIs), accounting for 80-90% of community-acquired UTIs and 30-50% of hospital-acquired UTIs. Uropathogenic E. coli that form biofilms are linked to chronic and persistent inflammation, resulting in severe and recurring UTIs. Biofilms promote antibiotic resistance and the horizontal transfer of virulence genes, promoting the formation of multidrug-resistant organisms. This study aimed to combine low-molecular-weight chitosan with aminoglycoside gentamicin to improve its efficacy against biofilm formation and MDR E. coli. Different strains of bacteria were isolated from urine samples of different patients at the Ayub Teaching Hospital, Abbottabad, out of which 16 were identified as E. coli by API (Analytical Profile Index) 20E. The antibiotic sensitivity profile was determined using the disk diffusion method, and the results showed that a total of 10 isolates were found to be multidrug-resistant MDR (N=62.5%). Biofilm formation was tested using the TCP method, a total of 7 isolates were found to be strong biofilm producers (N=44%). Gentamicin exhibited the highest inhibitory activity against 10 isolates of E.coli, with MIC-p ranges of 4 and 2 µg/ml, respectively, while 6 isolates showed resistance to gentamicin with MIC-p ranges &gt;512 µg/ml.

A Study on Escherichia Coli Isolated from Urogenital Tract Infections, Emphasizing their Occurrence and Antibiograms

Background: Urinary tract infections (UTIs), which are among the most prevalent infections both in the general population and in health care facilities, are ranked second only to upper espiratory tract infections in terms of the prevalence of the disease. Methodology: Samples for the current investigation were gathered from severalprivate and public hospitals. Based on colony morphology, these samples were identified via Gramstaining and biochemical analysis. Following CLSI 2019 standards, these isolates were nexttested for antibiotic susceptibility using Kirby-disc Bauer's diffusion assay. Results: For the presence of Escherichia coli, 48(26.6%) of the 180 sample stested negative, while 132(73.3%) test edpositive. Escherichia coli isolates were found to be highly resistant to ciprofloxacin, Amoxicillin-Clavulanic acid, Gentamicin, Ofloxacin, Piperacillin-Tazobactam, Meropenem, Imipenem, Tobramycin, Amikacin, andColistin, according to the antimicrobial susceptibility pattern. Imepenem, meropenem, amikacin,gentamicin, amoxicillin-clavulanic acid, cefixime, cefotaxime, ciprofloxacin, and cefoperazone were all highly effective against the isolates. Clinical Implication: The clinical implication of the study is to isolate the E.coli from community-acquired UTI and also to enlighten the antimicrobial resistance pattern regarding E. coli. Conclusion: Antimicrobial susceptibility testing results should be heeded when prescribing treatment for urinary tract infections to avoid the possibility of Escherichia coli'sgrowingresistancetoseveralantimicrobialmedications. Keywords: Urinary tract infections (UTIs), Antimicrobial Activities, Healthcare, Antibiotics

Genome profiling of uropathogenic E. coli from strictly defined community-acquired UTI in paediatric patients: a multicentric study

BackgroundUrinary tract infection (UTI) in children is a common bacterial infection. The emergence of extended-spectrum beta-lactamases (ESBLs) poses a major challenge against the treatment of uropathogens. We aimed to characterize the E. coli isolates recovered from children with UTI for their resistance profile and circulating sequence types (ST).MethodsChildren (> 1.5–18 years of age) from different community health centres of India with symptoms of UTI were enrolled. Isolates causing significant bacteriuria were identified by Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) and tested for antimicrobial susceptibility by the automated system, VITEK-2 (Biomeriux, Durhum, US). Nineteen E. coli isolates (15 ESBL positive and 4 ESBL negative) were sequenced in Oxford Nanopore platform followed by core-genome phylogeny, accessory genome cluster analysis, identification of sequence types, mobile genetic elements, genetic antimicrobial resistance markers. The correlation between detection of antimicrobial resistance genes with phenotypic resistance profiles was also investigated.ResultsEleven percent of children had significant bacteriuria [male:female—1:1, > 50% were 11–18 years of age group]. E. coli was predominant (86%) followed by K. pneumoniae (11%). Susceptibility of E. coli was highest against fosfomycin (100%) followed by carbapenems (90.7%) and nitrofurantoin (88.8%). ST131 (15.8%) and ST167 (10.5%) found as high-risk clones with the presence of plasmid [IncFIB (63.1%), IncFIA (52.6%)], and composite transposon [Tn2680 (46.6%)] in many isolates. Few isolates coharboured multiple beta-lactamases including blaNDM-5 (33.3%), blaOXA-1 (53.3%), blaCTX-M-15 (60%) and blaTEM-4 (60%).ConclusionsThis study highlights horizontal transmission of resistance genes and plasmids in paediatric patients at community centers across the nation harbouring multidrug-resistant genes such as blaNDM-5 and blaCTX-M-15 associated with high-risk clones ST131 and ST167. The data is alarming and emphasizes the need for rapid identification of resistance markers to reduce the spread in community. To our knowledge, this is the first multicentric study targeting paediatric UTI patients from the community setting of India.

Incidence of multidrug resistance and extended spectrum beta-lactamase expression in community-acquired urinary tract infection among different age groups of patients

Background and Aim: Escherichia coli was the most prevalent cause for urinary tract infections (UTIs). These bacteria also generate extended spectrum b-lactamases (ESBL), which inactivate penicillins and cephalosporins. The purpose of the current study is to determine the incidence of multidrug resistance and extended beta-lactamase expression in community-acquired urinary tract infection (UTIs) among patients of different age groups. Patients and Methods: This prospective cross-sectional study was conducted on 186 uropathogens investigated in the diagnostic center of Tertiary Care Hospital Peshawar from January 2022 to December 2022. Patients of either gender or any age with suspected UTIs associated with K. pneumoniae and E. coli were derived from urine specimen were enrolled. Identification and analysis of antimicrobial susceptibility was done using Disc diffusion method and Double Disc synergy test. SPSS version 27 was used for data analysis. Results: Of the total 186 Gram-negative uropathogens, there were 57 (30.6%) male and 129 (59.4%) female. The incidence of E. coli and K. pneumoniae was 138 (74.2%) and 48 (25.8%) respectively. The prevalence of uropathogens identified was in 71% females and 29% males.

Community-Acquired Urinary Tract Infection Among Sexually Active Women: Risk Factors, Bacterial Profile and Their Antimicrobial Susceptibility Patterns, Arba Minch, Southern Ethiopia

Globally, urinary tract infections (UTIs) are a common health issue among women. Investigating risk factors associated with culture-proven UTIs and the antimicrobial resistance profile of uropathogens would provide insight into planning prevention and control measures. To identify the risk factors associated with UTIs among sexually active women and determine antimicrobial susceptibility patterns of uropathogenic bacterial isolates. A case-control study was conducted from February to June 2021, involving 296 women (62 case group and 234 control group in a ratio of 4:1). Cases were defined as culture-confirmed UTIs, and controls were non-UTIs. A semi-structured questionnaire was used to collect demographic, clinical, and behavioral data. The antimicrobial susceptibility test was done by the Kirby-Bauer disc diffusion method. The data were analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were used to identify risk factors, and the strength of association was measured by adjusted odds ratios and a 95% confidence interval used at P-values < 0.05. The results revealed that recent coitus and frequency of coitus more than three times per week (P=0.001) were independent predictors of UTIs. Swabbing from back to front, a history of UTI and a delay in voiding were also independent predictors (P < 0.05). On the other hand, a daily water intake of 1 to 2 litres reduced the risk of UTI (P= 0.001). The predominant uropathogenic isolate was Escherichia coli (35.48%). Over 60% of isolates were resistant to cotrimoxazole, penicillin, cephalosporin, and fluoroquinolones. The most effective antibiotics included piperacillin-tazobactam, aminoglycosides, carbapenem, and nitrofurantoin. 85% and 50% of isolates were MDR and ESBL producers, respectively. The finding indicates the importance of public intervention targeting the identified risk factors and the resistance phenotype to reduce the burden of UTIs with antimicrobial resistance in the study area.

Clinical, uropathogenic, and radiological profile of culture-positive urinary tract infections in children below 18 months of age

Background: Urinary tract infections (UTIs) are common in children and have the risk of renal scarring. To better identify this at risk group, the following study was carried out to analyze the clinical profile of children below 18 months of age with culture-positive UTI and the outcome of radiological investigations. The primary objective was to assess the clinical profile of culture-positive UTI children and diagnostic yield and correlation between radiological tests. The secondary objectives were to assess the prevalent uropathogens and their antibiogram. Materials and Methods: For this retrospective study, clinical details regarding radiological investigations, prevalent uropathogens and antibiograms, common antibiotics used in treatment, and uroprophylaxis were obtained through electronic medical records in children &lt;18 months of age admitted with culture-positive UTI. Results: In 225 children seen over a period of 36 months, a slight male predominance (56%) was observed. Ultrasonography (USG) was done in nearly all children, micturating cystourethrography (MCU) was performed in only 40% of patients, dimercaptosuccinic acid (DMSA), performed after 6 months of the index UTI, in one-fifths of the patients. All three investigations were performed in one out of six children. USG and MCU used in combination detected the highest number of significant abnormalities (39%) compared to USG and DMSA (32%). Escherichia coli was the predominant uropathogen identified. Significant meropenem resistance (52%) was observed in the community-acquired UTI. Conclusion: The evaluation and follow-up of infants and young children with UTI show inadequate radiological evaluation, which could increase the risk of undetected and untreated renal sequelae.

Antibiotic resistance of pathogens causing community-acquired urinary tract infections in pregnant women with diabetes mellitus

BACKGROUND: Urinary tract infections are among the most common infectious diseases in women and are the most frequent cause of infectious complications of pregnancy, especially in pregnant women with type 1 diabetes mellitus. For adequate treatment of urinary tract infections in pregnant women with type 1 diabetes mellitus, it is requisite to regularly monitor antimicrobial resistance of uropathogens in order to update empirical schemes of antibacterial therapy.&#x0D; AIM: The aim of this study was to determine the spectrum of uropathogens and the activity of antibacterial drugs against pathogens of community-acquired urinary tract infections in pregnant women with type 1 diabetes mellitus or without diabetes mellitus.&#x0D; MATERIALS AND METHODS: We analyzed 91 strains obtained from pregnant women with or without type 1 diabetes mellitus. The sensitivity of microorganisms to all antibacterial drugs was evaluated by the disk diffusion method.&#x0D; RESULTS: In the group of pregnant women with type 1 diabetes mellitus in the etiological structure of uropathogens, enterobacteria accounted for 84.8%, Escherichia coli (71.7%) and Klebsiella spp. (13.0%) being the most common. In the group of pregnant women without diabetes mellitus in the structure of uropathogens, enterobacteria accounted for 75.6%, while E. coli was the causative agent of urinary tract infections in 62.2% of women and Klebsiella spp. in 11.1%. Gram-positive uropathogens were isolated much less frequently. In the group of pregnant women with type 1 diabetes mellitus, piperacillin/tazobactam, carbapenems, nitrofurantoin, and amikacin (100%), as well as fosfomycin and gentamicin (97%), had the maximum antibacterial activity against E. coli. The sensitivity of E. coli to various cephalosporins varied in the range of 84.990.9%. In the group of pregnant women without diabetes mellitus and with urinary tract infections, the highest E. coli sensitivity rates were observed for piperacillin/tazobactam, carbapenems, fosfomycin, nitrofurantoin, gentamicin, and amikacin (100%). E. coli sensitivity to second and third generation cephalosporins varied in the range of 75.082.1%, and it was 96.4% to cefepime. Ampicillin and amoxicillin/clavulanate demonstrated the least activity against E. coli in the two study groups. The rate of extended spectrum beta-lactamase production by uropathogenic enterobacteria in pregnant women with type 1 diabetes mellitus was 15.8% of the strains, and in pregnant women without diabetes mellitus, it was 18.1%.&#x0D; CONCLUSIONS: There were no significant differences in the activity of antibacterial drugs against the pathogens of community-acquired urinary tract infections in pregnant women with or without diabetes mellitus.