Cysteine Lactose Electrolyte Deficient Medium Research Articles

Prevalence of Multi Drug Resistant Coagulase Negative Staphylococci among some Pregnant Women Attending Antenatal Clinic in Yola, Nigeria

Study’s Novelty/Excerpt This study presents findings on the prevalence and characterization of coagulase-negative staphylococci (CoNS) among pregnant women in public health facilities in Yola, revealing a significant prevalence rate of 26.97%. The research highlights the high susceptibility of CoNS to certain antibiotics and the alarming presence of multi-drug resistant and extended spectrum beta-lactamase (ESBL) producing strains. This underscores the necessity for routine screening of pregnant women for CoNS to prevent potential gestational complications, providing crucial data for public health interventions and antibiotic stewardship programs. Full Abstract Coagulase negative staphylococci have been reported to be a frequent agent of uncomplicated UTI in young sexually active women which can also lead to symptomatic infection, low birth weight (LBW) babies and preterm delivery. This study was undertaken to determine the prevalence and characterize coagulase negative staphylococci among pregnant women in public health facilities in Yola. A total of 250 urine samples were collected from pregnant women attending antenatal clinic at Specialist Hospital and Boshang Clinic and Maternity both in Yola. The samples were cultured on cysteine lactose electrolyte deficient medium and isolates characterized using phenotypic methods. The prevalence of coagulase negative staphylococci from this study was 26.97%, Staphylococcus aureus 16.29% and Escherichia coli 36.51%. The frequency of CoNS was highest among age group of 36-40 years and least among 16-20 years (12.5%). CONS isolated from this study demonstrated high susceptibility to pefloxacin, ciprofloxacin, erythromycin, ceftriaxone and streptomycin. Some isolates showed high resistance to ampiclox, cefuroxime and amoxicillin. About 83% of the isolates had multiple antibiotic resistant indexes greater than 0.2 with about 25% of the antibiotic resistance being plasmid mediated. Furthermore, phenotypic screening using the double disk synergy test showed that 20 (40%) of the isolates were extended spectrum beta lactamase (ESBL) producing. This study revealed the presence of multi-drug resistant and ESBL producing coagulase negative staphylococci among pregnant women in the study area. There is therefore the need for pregnant women to be screened for coagulase negative staphylococci to avoid complications during gestation period.

Uro-pathogens: Multidrug resistance and associated factors of community-acquired UTI among HIV patients attending antiretroviral therapy in Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Urinary tract infections are common bacterial and fungal infections in humans, occurring both in the community and in immunocompromised patients in healthcare settings. Urinary tract infections have a significant health impact on HIV-infected patients. Nowadays, drug-resistant pathogens are widespread poses a serious clinical risk, and causes urinary tract infection. The common agents of bacteria and fungi that cause urinary tract infection are Escherichia coli followed by Klebsiella pneumonia, Staphylococcus saprophyticus, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus and Candida. albicans. This study aimed to investigate uro-pathogen, multidrug resistance pattern of bacteria, and associated factors of community-acquired urinary tract infection among HIV-positive patients attending antiretroviral therapy in Dessie comprehensive specialized hospital, Northeast Ethiopia from February 1, 2021, to March 30, 2021. An institutional-based cross-sectional study was conducted at Dessie Comprehensive Specialized Hospital. Socio-demographic and clinical data were collected by using structured questionnaires from HIV patients suspected of community-acquired urinary tract infections. About 10 ml of clean-catch midstream urine was collected and inoculated into Blood agar, MacConkey, and Cysteine lactose electrolyte deficient media. Yeasts were identified by using Gram stain, germ tube test, carbohydrate fermentation, assimilation tests, and chromogenic medium. Gram stain and biochemical tests were performed to identify isolates and an antimicrobial susceptibility pattern was performed on disc diffusion techniques. Data were entered and analyzed using SPSS version 25. Both bivariate and multivariable logistic regression analysis was performed and a P value of < 0.05 with an adjusted odds ratio with their 95% confidence interval (CI) was used as statistically significant associations. From the total 346 study participants, 92 (26.6%) were culture positive 75 (81.52%) were bacterial and 17 (18.48%) were fungal pathogens. From a total of 75 bacteria isolates 51(68%) were Gram-negative bacteria and the most commonly isolated bacteria were E. coli 16 (21.33%) followed by K. pneumoniae 11(14.67%) and enterococcus species 10(10.87. Of the 17 fungal isolates of fungi, 8(47.1%) were represented by C. tropicalis. Of the isolated bacteria, 61(81.3%) were resistant to three and above classes of antibiotics (drug classes). About 13 (81.3%) of E. coli, 9(81.8%) of K. pneumoniae, 8(80%) of Enterococcus species, 7 (77.8%) of P. aeruginosa, and CoNs 7(87.5%) were the most frequently exhibited three and above classes of antibiotics (multi-drug resistance). Amikacin and gentamicin were effective against Gram-negative Uro-pathogens. Participants aged>44year, female, being daily labor, being farmer, unable to read and write, patients with CD4 count of ≤ 200 cells/mm3 and CD4 count of 201-350 cells/mm3, who had chronic diabetics, patients having a history of hospitalization and who had urgency of urinations were statistically significant association with significant urinary tract infections. The burden of community-acquired urinary tract infections among HIV patients is alarmingly increased. Therefore, behavior change communications might be considered for promoting the health status of HIV patients. Moreover, CD4 level monitoring and therapeutics selection based on microbiological culture are quite advisable for the management of urinary tract infections of HIV patients.

Prevalence of antibiotic-resistant gram-negative bacteria among patients with urinary tract infection at a facility in Ado Ekiti, Ekiti-State, Nigeria

Urinary Tract Infections (UTIs) constitute a huge public health burden especially in developing countries. This study was carried out to determine the current incidence of antibiotic resistance among Gram-negative bacteria recovered from urine of patients with UTI. This study used a cohort study design wherein one hundred and twenty one (121) mid-stream urine samples were collected and cultured onto sterile Cysteine Lactose Electrolyte Deficient medium (CLED) and MacConkey agar plates. All bacteria recovered were tested for resistance to the selected antibiotics as follows: ceftazidime (30 μg), ceftriaxone (30 μg), gentamicin (1 0μg), ampicillin (10 μg), meropenem (10 μg), ertapenem (10 μg), tetracycline (30 μg), norfloxacin (10 μg) and pefloxacin (5 μg). Twenty (20) isolates were chosen for detection of extended spectrum beta-lactamase producers using the double disk synergy test (DDST). All the bacteria were tested for biofilm production and haemolysis. Among the one hundred and twenty-one (121) mid-stream urine samples collected from patients, forty-six (46) samples grew significant bacteria. The bacteria recovered were Klebsiella pneumonia17 (37.0%), Klebsiella oxytoca 2 (4.3%), Escherichia coli (32.6%) and Proteus mirabilis (26.0%). Overall, the bacteria showed the highest resistance to pefloxacin (97.8%) and least resistance to meropenem (34.7%). The bacteria also showed high multiple resistance. All the bacteria subjected to DDST were confirmed as extended-spectrum beta-lactamase ESBL producers. Forty (43.6%) bacteria were designated as strong biofilm producers while 17.4 % bacteria showed hemolysis. The findings obtained in this study have ramifications for clinical management of UTI and public health public health in general. There should be strict enforcement of antibiotic stewardship.

Bacteriology of Urinary Tract Infection in Children Attending Federal Staff Hospital in Abuja

Urinary tract infection (UTI) is a term applied to a variety of clinical conditions ranging from asymptomatic presence of bacteria in the urine to severe infection of the kidney with resultant sepsis. The study was designed to identify the bacteria associated with urinary tract infection among children attending Federal staff hospital, Abuja and to ascertain their antibiogram. Mid-stream urine samples were collected from the subjects enrolled into the study and were cultured into Cysteine Lactose electrolyte deficient medium and Blood agar and incubated appropriately. The plates were read and isolated were subjected to biochemical reactions and antibiogram were carried out on pathogenic organisms. The results showed the overall prevalence of 10.8% urinary tract infections among the studied subjects. The females subject had the highest prevalence of 91.7% while the male counterpart recorded 8.3%. The age groups 1-5 years had the highest prevalence of 50.0% while least prevalent of 16.7% were recorded by age group 6 to 10 years old. Escherichia coli was the highest isolated with 51.7% while Proteus Species and Streptococcus faecalis recorded the prevalence of 2.5% respectively. This study concluded that urinary tract infections is very common among children attending Federal staff hospital in Abuja. Keywords: BA- Blood agar, CLED-Cysteine Lactose, Electrolyte deficient medium, FSH-Federal Staff Hospital, UTI- Urinary Tract Infection.

Extended-Spectrum β-Lactamase and Carbapenemase-Producing Gram-Negative Bacteria and Associated Factors Among Patients Suspected of Community and Hospital-Acquired Urinary Tract Infections at Ayder Comprehensive Specialized Hospital, Tigrai, Ethiopia.

Little is known about bacteria that produce extended-spectrum beta-lactamases (ESBLs) and carbapenemase in patients with urinary tract infections (UTIs) in Tigrai, Ethiopia. The aim of this study was to describe the magnitude of ESBL- and carbapenemase -producing gram-negative bacteria among patients suspected of community- and hospital-acquired UTIs at a referral hospital in Tigrai, Ethiopia. A cross-sectional study was conducted at Ayder Comprehensive Specialized hospital from January 2020 to June 2020. A 10-20 mL sample of morning mid-stream and catheter urine was collected from consenting participants. Urine samples were cultured on cysteine lactose electrolyte deficient medium and MacConkey agar, and bacteria were identified using standard microbiological protocols. The Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing. The combination disk and modified Hodge tests were used detect ESBL and carbapenemase production, respectively. The data was entered into EPI 3.1 software and analyzed using SPSS version 21. Overall, 67 gram-negative bacteria were recovered from 64 participants. Escherichia coli was the predominant isolate (68.6%), followed by Klebsiella pneumoniae (22.4%), while ESBL production was found in both Escherichia coli and Klebsiella pneumoniae (52.2% and 86.7%, respectively). Isolates recovered from patients with hospital-acquired UTIs were more likely to produce ESBLs (AOR= 16.2; 95% CI: 2.95-89.5). Carbapenemase was produced by 4.3% of E. coli and 20% of Klebsiella pneumoniae isolates. High resistance rates were found against tetracycline (84.8%), ampicillin (78.3%), amoxicillin/clavulanic acid (58.7%) for Escherichia coli isolates and against ampicillin (93.3%), sulphamethexazole trimethoprim (93.3%), cefotaxime (86.6%), and ceftazidime (86.6%), and tetracycline (73.3%) for Klebsiella pneumoniae. Most UTIs were caused by ESBL-producing bacteria, especially those that were related to healthcare. Microbiological-based therapy for patients with UTIs is essential at our study site due to high rates of ESBL and significant carbapenemase production with concomitant high rates of drug resistance to several antibiotics.

Evaluation of an automated rapid urine culture method for urinary tract infection: Comparison with gold standard conventional culture method.

Urinary tract infection is one of the most prevalent disease affecting people from all age groups. For its diagnosis, conventional culture and antibiotic susceptibility is the gold standard. However, its major limitation is that the results take minimum of 24​h and antibiotic susceptibility is available after 48​h. Automated culture methods having comparable sensitivity and specificity as compared to conventional culture should be evaluated for routine diagnostics. With this aim we evaluated the diagnostic accuracy of automated urine culture method HB&L uroquattro by comparing with the gold standard conventional culture method. A total of 1220 urine samples were included in the study. Semi-quantitative urine culture was performed using standard methods on cysteine lactose electrolyte deficient medium. For the automated culture, HB&L Uroquattro (Alifax, Polverara, PD, Italy), standard guidelines given in the manual of the instrument were followed. Diagnostic performance in terms of sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values were calculated. Based on the final interpretation of conventional culture for the total 1220 samples, 26 samples (2.1%) showed major non-concordance as they were identified as sterile by HB&L but had significant growth by conventional culture and 19.9% showed minor non-concordance. At 100-999 colony forming unit/ml, HB&L has high negative predictive value i.e. 96.6% with 95% CI (95.2%-97.6%) and sensitivity i.e. 92.66% with 95% CI of (89.42%-95.15%). The HB&L Uroquattro seems to be a reliable instrument to obtain urine microbiological results in a timely manner. This technique can give presumptive report to the clinician within 5​h only for initiation of empirical antibiotics in cases of positive results.

Bacterial profile and extended spectrum beta lactamase screening of urinary tract infection among asymptomatic and symptomatic pregnant women attending antenatal care in ALERT Hospital, Addis Ababa, Ethiopia.

The occurrence of extended spectrum beta lactamase-producing uropathogens, especially in pregnant women can result in life-threatening condition and morbidity for both the mother and the newborn due to very limited drug options for treatment of these pathogens. The aim of this study was to determine the bacterial profile, associated factors, and their antimicrobial susceptibility patterns and to identify extended spectrum beta lactamase-producing bacterial uropathogens. A hospital-based cross-sectional study was conducted from July to September 2018 on a total of 177 pregnant women with and without symptoms of urinary tract infection at ALERT Hospital, Addis Ababa, Ethiopia. From these study participants, 72 have symptoms, whereas 105 have no symptoms. All urine samples were inoculated onto cysteine lactose electrolyte deficient medium and MacConkey agar. Colonies were counted to check the presence of significant bacteriuria. Pure isolates of bacterial pathogen were characterized and identified at species level by colony morphology, gram stain, and standard biochemical procedures. All Gram-negative isolates were put into Muller-Hinton agar plates for antibiotic susceptibility test by Kirby-Bauer disc diffusion technique. Extended spectrum beta lactamase was detected using double-disk synergy methods on Muller-Hinton agar. The data were double entered into epidemiological Information system and analyzed using Statistical Package for Social Science version 26. The overall proportion of urinary tract infection among pregnant women was 14.7% (n = 26/177). Klebsiella pneumoniae was the predominant bacterial etiologic agent of urinary tract infection 26.9% (n = 7/26). The proportion of extended spectrum beta lactamase among Gram-negative isolates was 50% (n = 6/12). Among extended spectrum beta lactamase-producing isolates (100%), all are resistance to amikacin and gentamicin while intermediate level resistance rate of 66.7% was observed among trimethoprim-sulphamethoxazole. They were susceptible for some limited drugs, and these were Nitrofurantoin (83.3%) and Chloramphenicol (83.3%). Majority of extended spectrum beta lactamase-producing isolates exhibited co-resistance to other commonly prescribed antibiotics. This indicates that the option of treatment for these pathogens rapidly decreased from time to time which results serious life-threatening conditions, especially in mother and newborn unless the appropriate measure is taken.

High Prevalence of Multi-Drug Resistance and Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Among Hospitalized Patients Presumptive for Bacterial Infection at Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

BackgroundMulti-drug resistant Enterobacteriaceae (MDR-E), primarily extended-spectrum beta-lactamase producers (ESBLs), have emerged as a major public health concern. This study aimed to determine the prevalence of multi-drug resistance and extended-spectrum beta-lactamase-producing Enterobacteriaceae among hospitalized patients presumptive for bacterial infections at Debre Berhan Comprehensive Specialized Hospital, Ethiopia.MethodsA hospital-based cross-sectional study was conducted from January to May 2021. A total of 384 hospitalized patients presumptive for bacterial infections were included in the study. Urine, wound, blood, stool, and sputum samples were collected and cultured on MacConkey agar, Cysteine Lactose Electrolyte Deficient medium, and Blood agar. Identification was done using a panel of biochemical tests. The antimicrobial susceptibility test was done by disc diffusion. Screening of ESBL production was done by using cefotaxime and ceftazidime and confirmed by the combination disk method per clinical laboratory standard institute guidelines. Data analysis was performed by Statistical Package for Social Sciences software version 25, and a P-value ≤0.05 was considered as statistically significant.ResultsOut of 384 study participants, a total of 164 Enterobacteriaceae were isolated. The overall multi-drug resistance rate (MDR) was 92.1%. The overall prevalence of ESBL-PE was 104 (63.4%). E. coli 50 (30.5%) and K. pneumoniae 24 (14.6%) were the predominant ESBL producers. The highest ESBL producers E. coli (13.4%) and K. pneumoniae (6.1%) were isolated from urine sample. History of antibiotic use for the last three months (P-value=0.01), admission in neonatal intensive care unit (P-value=0.02), history of hospital stays (P-value=0.01), and chronic disease (P-value=0.04) showed statistically significant association with ESBL-PE infection.ConclusionThe prevalence of MDR-E and ESBL-PE was high. Therefore, strong infection prevention and control measures and careful selection of antibiotics are needed in the study area to block the transmission and infection in the healthcare setting.

OCCURRENCE AND ANTIBACTERIAL SUSCEPTIBILITY PATTERN OF UROPATHOGENS AMONG STUDENTS OF MODIBBO ADAMA UNIVERSITY OF TECHNOLOGY, YOLA

In order to assess the occurrence and antimicrobial profile of urinary tract pathogens, 80 early morning mid-stream urine samples were collected from students of Modibbo Adama University of Technology Yola, and cultured on Cysteine Lactose electrolyte deficient medium using standard microbiological methods. A total 43 urine samples representing an occurrence of 65% yielded significant growth of uropathogens. It was observed that females were more infected than the males with an occurrence rate of 40 % and 25 % respectively. Common uropathogens isolated in this study include: Staphylococcus aureus (26.1%), E coli (23.1%), Klebsiella spp (17.3%), Pseudomonas aeruginosa (11.5%), Enterococcus spp (9.6%),, Proteus spp (7.6%) and Staphylococcus saprophyticcus (5.8%). The highest occurrence of the isolates was among age groups 21-25 years (80.6%) followed by age groups 26-30 years (65.2%). Risk behaviours and predisposing factors like hygiene, sexual activity and contraception are possible reasons for the high incidence among the study population. The isolates were predominantly very sensitive to gentamycin, ciprofloxacin, norfloxacin and levofloxacin and therefore strongly recommended for the treatment of UTI as indicated in the study. Also, to reduce the incidence of urinary tract infections among the study population, improved personal hygiene and public facilities like toilets should be provided and students should abstain from risky behaviours that predispose them to uropathogen.

Asymptomatic bacteriuria in an apparently healthy population and its relation to hypertension

Background: Hypertension is a major health problem in sub-Sahara Africa. Several studies have suggested a role of asymptomatic bacteriuria (ASB) in the aetiology of hypertension, but there is a dearth of information on this association in Africa where the burden of hypertension is high. We investigated the prevalence of asymptomatic bacteriuria, its association with hypertension and determined the antibiotic resistance patterns of implicated bacterial isolates in an urban community of Ile-Ife. Methods: One hundred and seventy-four apparently healthy individuals were investigated for ASB. Relevant information was obtained from them with standard proforma. Their Blood pressure was measured with a standard mercury sphygmomanometer. All samples were processed on cysteine lactose electrolyte deficient medium and chocolate agar. Antimicrobial susceptibility testing was done using Kirby-Bauer disk diffusion technique. Results: Fifty (28.7%) individuals were positive for ASB. ASB was commonly detected among the female subjects ( X 2 =5.619; p-value = 0.01777), and among individuals in the age group of 50 59 years. Those that were hypertensive were two and a half times more likely to have ASB (Odd ratio=2.5; p-value=0.01369; CI=1.19-5.35). The highest percentage of hypertensive female participants with ASB was found in the age group of 30-39 years (33.3%) while among the male participants, the highest percentage was found in the age group of 60-69 years (9.5%). Escherichia coli (n=13; 26%) and Staphylococcus aureus (n=13; 26%) were the commonest organisms implicated in ASB. The majority of the isolates (>90%) were multidrug resistant. Isolates of Escherichia coli were commonly resistant to ampicillin (83.3%), ceftriaxone (72.7%) and cefepime (66.7%). Isolates of Staphylococcus aureus were all (100%) resistant to erythromycin, cloxacillin and streptomycin. All isolates were least resistant to cotrimoxazole (<8%). Conclusion: Women as well as men in the age group of 50-59 years were more likely to develop ASB. ASB could be contributing to the rising incidence of hypertension in this environment. Co-occurrence of hypertension and ASB portends a grave problem for apparently healthy individuals in this environment. Keywords: Asymptomatic bacteriuria, Hypertension, Escherichia coli , healthy individuals, urban community

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

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

Changing prevalence and antibiotic drug resistance pattern of pathogens seen in community-acquired pediatric urinary tract infections at a tertiary care hospital of North India.

AIMS AND OBJECTIVES:The aim and objective of this study was to assess the temporal changes in the microbiological profiles and antimicrobial resistance patterns of uropathogens in pediatric community-acquired UTI.MATERIALS AND METHODS:This is a retrospective analysis of data collected over a Scattered period of 5 years. The baseline data collected were from January to December 2009, and the second period considered for comparison was from January to December 2014. Urine specimens from children (<17 years) suspected of UTI were cultured by a semi-quantitative method on cysteine lactose electrolyte-deficient medium. Antibiotic sensitivity was put up by Kirby–Bauer disc diffusion method as per the Clinical and Laboratory Standard Institute guidelines.RESULTS:In the year 2009, 340 of 2104 (16.15%) urine specimens yielded significant colony count, whereas in 2014, it was 407 of 2212 (18.39%) (P = 0.051). Escherichia coli was the predominant pathogen and was significantly more prevalent in girls than in boys (P < 0.0001) during both periods. There was a significant overall increase in resistance to ampicillin (from 40.29% to 58.72%), amoxyclav (from 26.17% to 40.54%), nitrofurantoin (from 28.82% to 39.06%), and norfloxacin (from 30% to 41.42%). However, the maximum increase in the resistance was noted for co-trimoxazole from 35.58% in 2009 to 63.39% in 2014 (P = 0.0000058). The prevalence of extended-spectrum beta-lactamases (ESBLs) has also significantly increased from 21.7% to 33.16% (P = 0.0045).CONCLUSION:Although E. coli remains the prime pathogen in pediatric UTI, the prevalence of resistance has dramatically increased over the 5-year study period. Our study highlights the emergence of community-acquired ESBL-producing uropathogens in children proclaiming treatment challenges.

Fosfomycin for the treatment of drug-resistant urinary tract infections: potential of an old drug not explored fully.

Increased emergence of bacterial resistance and the limited options of novel antimicrobial agents have necessitated the reintroduction of some old antimicrobial agents. One such drug is fosfomycin, but its potential has not been explored fully, especially in India. To analyze the in vitro activity of fosfomycin, against the urinary isolates and to compare it with in vitro activity of other orally administered antimicrobial agents. This was a prospective observational study conducted between July 2014 and June 2016. All consecutive, non-duplicate and clinically significant urinary isolates obtained from patients of all ages and both genders, diagnosed to have UTI, were included. Patients already on antibiotic therapy were excluded. Urine culture was performed by semiquantitative method on cysteine lactose electrolyte-deficient medium and the isolates obtained in significant count were subjected to antimicrobial sensitivity testing by the Kirby Bauer disk diffusion method as per CLSI guidelines. A total of 3947 non-repeating urinary isolates were included in the study, of which 2684 (68%) isolates originated from adult outpatients and remaining 1236 (32%) isolates from pediatric patients. Of these 2783 isolates were from enterobacteriaceae family. Out of these 2730 (98.1%) were sensitive to fosfomycin. Most [375 of 385 (97.4%)] Pseudomonas spp were also susceptible to fosfomycin. A majority of ESBL- (96.5%) and MBL (91.9%)-producing isolates were also susceptible to fosfomycin and so were of Gram-positive isolates [698/707 (96%)] and MRSA [61/69 (88.4%)] were susceptible to fosfomycin. Fosfomycin showed an excellent in vitro activity against all urinary pathogens, including the Gram-positive or Gram-negative, ESBL and MBL producers. Fosfomycin should be considered as a highly effective alternative in treatment UTIs in both adults and pediatric patients.

Preponderance of bacterial isolates in urine of HIV-positive malaria-infected pregnant women with urinary tract infection.

This study examined HIV and malaria co-infection as a risk factor for urinary tract infections (UTIs) in pregnancy. The study group included 74 pregnant women, 20 to 42 years of age, who attended the antenatal clinic at the Specialist Hospital at Akure, Ondo State, Nigeria. Forty-four of the pregnant women were either HIV seropositive with malaria infection (HIV+Mal+) or HIV seropositive without malaria (HIV+Mal-). The remaining thirty pregnant women served as controls and included women HIV seronegative but with malaria (HIV-Mal+) and women HIV seronegative without malaria. UTI was indicated by a bacterial colony count of greater than 10⁵/mL of urine, using cysteine lactose electrolyte deficient medium (CLED) as the primary isolation medium. Bacterial isolates were characterized using convectional bacteriological methods, and antibiotics sensitivity tests were carried out using the disk diffusion method. A total of 246 bacterial isolates were recovered from the cultures, with a mean of 3.53 isolates per subject. Women who were HIV+Mal+ had the most diverse group of bacterial isolates and the highest frequency of UTIs. The bacterial isolates from the HIV+Mal+ women also showed the highest degree of antibiotic resistance. While pregnancy and HIV infection may each represent a risk factor for UTI, HIV and malaria co-infection may increase its frequency in pregnancy. The higher frequency of multiple antibiotic resistance observed among the isolates, particularly isolates from HIV+Mal+ subjects, poses a serious public health concern as these strains may aggravate the prognosis of both UTI and HIV infection.

Assessment of a contact-plate sampling technique and subsequent quantitative bacterial studies in atopic dermatitis

The aerobic bacterial flora of 20 patients with atopic dermatitis and 19 control subjects was extensively sampled using the Williamson and Kligman scrub technique and a contact-plate method (cysteine lactose electrolyte deficient media). Comparison of the two quantitative techniques showed that the contact plate is a reliable and convenient alternative to the scrub technique for the quantification of Staphylococcus aureus, micrococci and coagulase negative staphylococci. Quantification of bacterial flora using both techniques showed high rates of colonization by S. aureus on both involved and clinically normal skin of patients with atopic dermatitis. A linear increase in S. aureus counts with increasing severity of dermatitis was found. In contrast, diphtheroids showed a trend of decreasing isolation rates and counts as the severity of the dermatitis increased. Isolation rates and absolute counts for micrococci/coagulase negative cocci were unaffected by the severity of the dermatitis.