Epidemiology Of Urinary Tract Infections Research Articles

Unraveling the epidemiology of urinary tract infections in neonates: Perspective from a Brazilian NICU

BackgroundUrinary tract infections (UTIs) can lead to neonatal complications like sepsis, worsened by empirical treatment, contributing to antimicrobial resistance (AMR). This study examined the incidence, etiology, risk factors, and antimicrobial susceptibility of uropathogens in a Neonatal Intensive Care Unit (NICU) in Brazil. MethodsMedical records of neonates hospitalized in the NICU from January 2015 to June 2022 were retrospectively analyzed through the National Healthcare Safety Network system. ResultsAmong 1,474 neonates, 3.9% developed UTI, with an alarming 24-fold increase in incidence from 2015 to 2021. Genitourinary complications (odds ratio = 4.8) were a major risk factor. Of the 71 uropathogens, 74.6% were Gram-negative bacteria (GNB), 21.2% Gram-positive bacteria (GPB), and 4.2% Candida albicans. AMR was notable, with 13.3% of GPB and 20.7% of GNB exhibiting multidrug-resistant (MDR), while 6.6% of GPB and 1.9% of GNB showed extensive drug-resistant (XDR). UTI was associated with prolonged hospitalization (16-59 days). In 57 neonates with UTI, 40.3% had bloodstream infections, elevating the risk of death (odds ratio = 1.8). ConclusionsThe study underscores the urgency of implementing infection prevention and control measures in the NICU to curb rising UTI incidences, combat AMR, and mitigate severe complications in critically ill neonates.

A Cross-Sectional Study on the Epidemiology of Urinary Tract Infection in Children and its Associated Risk Factors

Background: Urinary tract infection (UTI) is one of the most challenging and un-noticed infections in children, due to the migration of microbial flora from the fecal material to the urethra via perineum. Objectives: The study aimed to determine the incidence of UTI in children and their associated risk factors. Study Design: 362 patients were investigated and classified according to their age and gender. Methodology: Pediatric patients' urine samples were collected for urinalysis and urine culture for the confirmation of UTI. Place and Duration: This retrospective cross-sectional study was conducted at DHQ Teaching Hospital, Dera Ismail Khan, in 2020-21 and 2021-22. Results: Positive results were observed in 31 of 362 samples (10.22%); prevalence was higher among female children (12.39%) than males (6.25%). There was a statistically significant difference (P<0.05) across three age groups, infants being the most susceptible (14.90%), followed by children aged 1-5 years (7.08%) and 5-10 years (5.40%). Conclusion: Considering the high frequency of UTI in children and the difficulty in its diagnosis, due to the lack of specific symptoms, the study recommended that all pediatric patients with fever without obvious cause, the only clinical indicator, should be evaluated for UTI. Keywords: Dysurea; Pyrexia; Uncircumcised boys; Urosepsis.

Epidemiology of urinary tract infection in adults caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae – a case–control study from Qatar

Community-acquired urinary tract infection (UTI) is the most common infection caused by extended-spectrum beta-lactamase (ESBL)-producing organisms. to estimate the prevalence of ESBL-UTI in adults and to identify potential risk factors that may predispose to ESBL-UTI. A retrospective study involving adult patients with UTI caused by ESBL-producing organisms was undertaken. Patients with UTI caused by non-ESBL-producing organisms represented the control group. In total, 1100 UTI isolates were included in the study, 277 of which were ESBL positive. The prevalence rate was 25.2%. The mean age of patients was 55.87 years. On univariate analysis, prior history of UTI or ESBL-UTI, invasive urological procedure within preceding 3 months, hospital admission within preceding 3 months, and exposure to antibiotics were found to be significant risk factors for ESBL-UTI. On multi-variate analysis, use of cephalosporins [adjusted odds ratio (OR) 1.61, P=0.048], previous ESBL-UTI (adjusted OR 2.67, P<0.001), and invasive urological procedure in the preceding year (adjusted OR 1.61, P=0.022) were found to be independent risk factors for ESBL-UTI. In Qatar, the prevalence of ESBL-UTI in adults is modest. Recent exposure to antibiotics, previous ESBL-UTI and invasive urological procedures were found to be independent risk factors for ESBL-UTI.

Trends in the epidemiology of urinary tract infections in pregnancy at a tertiary hospital in Johannesburg: Are contemporary treatment recommendations appropriate?

BackgroundUrinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications. Empiric antibiotic choices in pregnancy require consideration of efficacy and safety, resulting in limited oral options. With rapidly evolving antibiotic resistance, surveillance to guide empiric treatment recommendations is essential.MethodsA retrospective analysis of urine culture isolates from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Obstetrics Department for 1 January 2015 to 31 December 2020 was performed.ResultsThe top 3 pathogens were Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae. For E. coli susceptibility to cefuroxime declined (95% to 81%, p < 0.0001). Similarly, the E. coli extended spectrum beta-lactamase rate increased from 5% to 10% (p = 0.04). E. coli susceptibility to nitrofurantoin (93%) and fosfomycin (96%) remained high. In 2019, carbapenem-resistant K. pneumoniae emerged. Ampicillin susceptibility was high amongst the E. faecalis isolates. Amoxicillin-clavulanate demonstrated high levels of activity against the top 3 uropathogens.ConclusionThe Essential Drug List recommended antibiotics for lower UTIs, nitrofurantoin and fosfomycin, are appropriate empiric options for E. coli, the most common uropathogen in the CMJAH obstetric population. The high rate of E. faecalis susceptibility to nitrofurantoin reported from other Gauteng tertiary obstetric patients, suggests that nitrofurantoin will provide adequate empiric cover for a large proportion of UTIs. However, the determination of the E. faecalis nitrofurantoin and fosfomycin susceptibility rates in the CMJAH obstetric population will provide useful data. Periodic surveillance at the various levels of antenatal care in different regions of South Africa and the determination of risk factors for infections with resistant uropathogens is needed.

Epidemiology of urinary tract infections in children: Causative bacteria and antimicrobial therapy.

Urinary tract infections (UTIs) are the most common bacterial infections in children. This study aimed to review characteristics of causative bacteria and the effectiveness of antimicrobial therapy in children with febrile UTIs. Clinical records of 108 patients (130 episodes) with febrile UTIs admitted to the Kawasaki Medical School Hospital between July 2009 and October 2016 were retrospectively reviewed. The characteristics of the causative bacteria, antibacterial therapy, and therapeutic effect were verified. Patients were aged between 0 and 183months (median age: 3months). Seventy-three (67.6%) were males. Sixty-three episodes (48.5%) were diagnosed with complicated UTIs. Forty-seven episodes (36.2%) were observed in patients aged <3months; 15 of them had complicated UTIs. Escherichia coli (E.coli) was the most common pathogen, followed by Enterococcus faecalis (E.faecalis). Blood cultures were positive in three episodes. Among the 130 episodes, 62 (47.7%) were treated with a combination of ampicillin and third-generation cephalosporins, followed by third-generation cephalosporins (31 episodes, 23.8%) and sulbactam sodium / ampicillin sodium (15 episodes, 11.5%). In case of patients with uncomplicated/complicated UTIs and patients aged <3 and ≥3 months, the most common pathogen was E.coli, followed by E. faecalis. There was no difference in therapeutic effects between "combination ampicillin and third-generation cephalosporins" and "third-generation cephalosporin monotherapy" administered for the treatment of UTIs caused by E.coli. Escherichia coli is the most common pathogen among pediatric UTIs. For antibacterial therapy, third-generation cephalosporin monotherapy is effective and may not require combination therapy with ampicillin.

1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

BackgroundUrinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting.MethodsWe used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization.ResultsThere were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively.Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common.Disclosures All Authors: No reported disclosures

Serratia Fonticola microbe presented as a community-acquired urinary tract infection (UTI): a case report

Background: The case we are presenting is about one of the rare pathogens, Serratia Fonticola (SF) that may cause urinary tract infection. &#x0D; Case Presentation: A 58 years-old female presented with dysuria, suprapubic pain, frequency of micturition, and change in urine color. The patient was afebrile on physical examination; however, the urine culture was positive to SF as the sole isolate. The patient received levofloxacin tables (750 mg) once a day for 5 days along with supportive instructions to improve hygiene. On follow-up, she was free of symptoms and the repeated urine culture was negative.&#x0D; Conclusion: This case can be considered globally the third that diagnosed in the urine culture of the asymptomatic patient.&#x0D; &#x0D; References&#x0D; &#x0D; Geerlings SE. Clinical presentations and epidemiology of urinary tract infections. Microbiol. Spectr. 4, 2016. https://doi.org/10.1128/9781555817404.ch2&#x0D; Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May;13(5):269-84. https://doi.org/10.1038/nrmicro3432&#x0D; Gavini F, Ferragut C, Izard D, Trinel PA, Leclerc H, Lefebvre B, Mossel DA. Serratia fonticola, a new species from water. International Journal of Systematic and Evolutionary Microbiology. 1979;29(2):92-101. https://doi.org/10.1099/00207713-29-2-92&#x0D; Aljorayid A, Viau R, Castellino L, Jump RL. Serratia fonticola, pathogen or bystander? A case series and review of the literature. IDCases. 2016 May 24; 5:6-8. https://doi.org/10.1016/j.idcr.2016.05.003&#x0D; Müller HE. Isolation of Serratia fonticola from birds. Zentralblatt Bakteriol Mikrobiol Und Hyg - Abt 1 Orig A 1986; 261:212–8. https://doi.org/10.1016/s0176-6724(86)80038-4&#x0D; Garcia ME, Lanzarot P, Costas E, Lopez Rodas V, Marín M, Blanco JL. Isolation of Serratia fonticola from skin lesions in a Nile Crocodile (Crocodylus niloticus) with an associated septicaemia. Vet J. 2008 May;176(2):254-6. https://doi.org/10.1016/j.tvjl.2007.02.025.&#x0D; Bollet C, Gainnier M, Sainty JM, Orhesser P, De Micco P. Serratia Fonticola isolated from a leg abscess. J Clin Microbiol 1991; 29:834–5. https://doi.org/10.1128/JCM.29.4.834-835.1991&#x0D; Farmer JJ 3rd, Davis BR, Hickman-Brenner FW, McWhorter A, Huntley-Carter GP, Asbury MA, Riddle C, Wathen-Grady HG, Elias C, Fanning GR, et al. Biochemical identification of new species and biogroups of Enterobacteriaceae isolated from clinical specimens. J Clin Microbiol. 1985 Jan;21(1):46-76. https://doi.org/10.1128/JCM.21.1.46-76.1985&#x0D; Stock I, Burak S, Sherwood KJ, Gruger T, Wiedemann B. Natural antimicrobial susceptibilities of strains of 'unusual' Serratia species: S. ficaria, S. fonticola, S. odorifera, S. plymuthica and S. rubidaea. J Antimicrob Chemother. 2003;51(4):865-85. https://doi.org/10.1093/jac/dkg156.&#x0D; Gorret J, Chevalier J, Gaschet A, Fraisse B, Violas P, Chapuis M, Anne JG. Childhood delayed septic arthritis of the knee caused by Serratia fonticola. Knee 2009; 16 (6):512–4. https://doi.org/10.1016/j.knee.2009.02.008&#x0D; Hai PD, Hoa LTV, Tot NH, Phuong LL, Quang VV, Thuyet BT, Son PN. First report of biliary tract infection caused by multidrug-resistant Serratia fonticola. New Microbes New Infect. 2020; 36:100692. https://doi.org/10.1016/j.nmni.2020.100692&#x0D; &#x0D; Conclusion: This case can be considered globally the third that diagnosed in the urine culture of the asymptomatic patient.

Epidemiology of Urinary Tract Infection and Antibiotic Resistance Pattern in Patients Referred to Amiralmomenin Hospital of Gerash City in 2018

Background and Aims: Urinary tract infections are one of the most common human infections seen in all age groups and both sexes. Inappropriate use of antibiotics to treat urinary tract infection causes the resistance of the pathogens to the drug. The present study aimed to determine the frequency of gram-negative and gram-positive bacteria and antibiotic resistance patterns in patients with urinary tract infection. Materials and Methods: Samples were cultured on Blood Agar and Eosin Methylene Blue. Colonieschr('39') growth was identified by biochemical tests and standard microbiological and antibiotic sensitivity tests, which were performed with the disc diffusion method according to the Clinical and Laboratory Standards Institute 2016 Standard. Results and Conclusion: The isolated bacteria showed the highest susceptibility to imipenem (89.66%) and meropenem (87.21%) and the highest resistance to sulfamethoxazole (50.00%) and nalidixic acid (44.09%). So, using imipenem is recommended as the most effective antibiotic for the treatment of infection.

Epidemiology of urinary tract infection in South India

Urinary tract infection is one of the infectious diseases affecting both genders. The presence of drug resistant microbes in urinary tract infected cases is a major problem to solve. With this background the epidemiology of urinary tract infection among the population of Kanya kumari District, South India was traced. For the present study medical practitioners suspected cases visiting for clinical evaluation in a major clinical laboratory were chosen as samples. In a period of 6 months observation a total of 1824 cases were subjected to various clinical analysis. Among them 1029 were females and 795 were males. A clinical examination of the suspected cases showed culture positive in the samples taken from males (37.23%) and females (37.99%). The age wise study of the culture positive cases indicate that the UTI infection occurs from infants (1 month) to elderly people (90 – 100 years). In the study area the percentage of UTI is common in women in the reproductive age and post-menopausal stage. The pregnant women and newly married women in the age group 21 – 30 are more prone to UTI. The present study also reports pediatric UTI in both genders. Life Style changes, poor personal hygiene, nutritive problem, catheter use, unclean baby napkins and immune deficiency were identified as the factors favoring UTI in the study area. An analysis of UTI positive culture showed the presence of Escherichia coli, Klebsiella pneumoniae, Staphyllococcus saprophyticus, Margonella margonii, Streptococcus sp, Staphyllococcus aureus, Enterococcus sp, Proteus vulgaris, Chromobacterium violaceum, Serratia spp and the fungi Candida sp.

Epidemiology of urinary tract infection in South India

Epidemiology of urinary tract infection in South India

Comparative Epidemiology and Resistance Trends of Common Urinary Pathogens in a Tertiary-Care Hospital: A 10-Year Surveillance Study.

Background and Objective: Urinary tract infections (UTIs) are common in human medicine, affecting large patient populations worldwide. The principal cause of UTIs is uropathogenic Escherichia coli (UPEC) and Klebsiella, both in community and nosocomial settings. The assessment of local data on prevalence and resistance is essential to evaluate trends over time and to reflect on the national situation, compared to international data, using the methods of analytical epidemiology. Materials and Methods: The aim of this study was to assess resistance trends and epidemiology of UTIs caused by E. coli and Klebsiella species in inpatients and outpatients at a tertiary-care hospital in Hungary, using microbiological data. To evaluate resistance trends, several antibiotics were chosen as indicator drugs, based on local utilization data. Results: E. coli was the most prevalent isolate, representing 56.75 ± 4.86% for outpatients and 42.29 ± 2.94% for inpatients. For E. coli, the ratio of resistant strains for several antibiotics was significantly higher in the inpatient group, while in Klebsiella, similar trends were only observed for gentamicin. Extended-spectrum β-lactamase (ESBL)-producing isolates were detected in 4.33–9.15% and 23.22–34.22% from outpatient, 8.85–38.97% and 10.89–36.06% from inpatient samples for E. coli and Klebsiella, respectively. Conclusions: Resistance developments in common UTI pathogens (especially to fosfomycin, sulfamethoxazole-trimethoprim, fluoroquinolones, and 3rd generation cephalosporins), seriously curb therapeutic options, especially in outpatient settings.

Epidemiology of Urinary Tract Infections in The Preschool Children in Zagazig University Hospital

Background Urinary Tract Infection is one of the most common bacterial infections among children.. It is noted that the risk of renal damage from Urinary Tract Infection is greatest in children younger than 5 years, thus early diagnosis and prompt treatment are important. Aim of Work The aim of this study was to assess the prevalence of urinary tract infection in children attending Pediatric outpatient clinic in Zagazig University Children's Hospital. Also it aimed to determine, related risk factors, isolate the organisms that cause Urinary Tract Infection in children and antibiotics susceptibility patterns Patients and Methods This Cross sectional descriptive study, was conducted on 600 children, (377 males and 223 females) from 2 to 7 years old attending to pediatric outpatient clinic Zagazig University Children's Hospital, All patient groups were subjected to full medical history, physical examination, Dipstick analysis by using both nitrite and leukocyte esterase detector, Microscopic examinations and urine culture for positive cases. Results The prevalence of Urinary Tract Infection among children included in the current study was (7%). Leukocyte esterase positive were 56 (9.3%), Nitrite positive were 47 (7.8%) and both Leukocyte esterase and Nitrite positive were 17 (2.8%). Conclusion The prevalence of Urinary Tract Infection in our study was 7%. Escherichia Coli was the most common organism. Cefotaxime and Amikacin were the most common antibiotic sensitive to the isolates.

Epidemiology Of Urinary Tract Infections In The Children In Zagazig University Children's Hospital

Epidemiology Of Urinary Tract Infections In The Children In Zagazig University Children's Hospital

Epidemiology of urinary tract infection and antimicrobial resistance in a pediatric hospital in Nepal

BackgroundUrinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance.MethodsThis cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18–24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique.ResultsOf 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates.ConclusionsE. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency.

Epidemiology of urinary tract infection in south India

Epidemiology of urinary tract infection in south India

Epidemiology of Urinary Tract Infection in Neonatal Intensive Care Unit of Mohammed VI University Hospital in Marrakech

Objective:The objective of our study is to estimate the extent of urinary infection among neonatal infectious diseases.Materials and Methods:This work concerns a retrospective study of 91 newborns with urinary tract infections, collected in the Mohammed VI neonatal resuscitation unit, Marrakesh.Results:The average age of our newborns at admission was 10.8 days. In 20 cases, there were signs of maternal urinary tract infections. The main reason for hospitalization was jaundice in 72.53% of cases. The symptomatology was dominated by fever in 16.48% of cases, followed by a refusal to suck in 5.5% of cases.Escherichia coliwas the predominant germ in 61.5% of cases. A probabilistic anti-biotherapy based on Ceftriaxone 3rdGeneration and aminoglycoside was instituted in all cases after it was adapted to the antibiogram data. Ultrasound revealed malformations in 21 cases.Conclusion:Neonatal urinary tract infection remains a common pathology. Its potential severity involving renal functional prognosis and the frequency of urinary tract malformations require early diagnosis and adequate management.

Epidemiology of Urinary Tract Infections in HIV Positive Patients at a Tertiary Care University Hospital in Central Europe (2011 - 2016).

There is limited published data concerning the recent epidemiology of urinary tract infections (UTI) in HIV-patients, thus we analysed independent risk factors for UTI in HIV positive individuals and antimicrobial resistance rates of E. coli to antimicrobial agents commonly used in UTI. To determine the prevalence of symptomatic urinary tract infections (UTI) in HIV-patients, we performed a retrospective case-control study. We included 313 HIV-patients, 101 with UTI and 212 age and gendermatched controls, attending the HIV outpatient clinic at the Vienna University Hospital (VUH) over a period from January 2011 to September 2016. The patients' specific data was gathered from the electronic database of the VUH. The statistical analysis was performed using SPSS Software Version 20.0. HIV infected individuals with CD4 count >200 cells/mm3 were less likely than HIV infected individuals with CD4 count <200 cells/mm3 to experience UTI (OR 0.811, 95% CI 0.712-0.923 vs. OR 2.555, 95% CI 1.553 - 4.205, respectively). The in vitro resistance rate of E. coli to antimicrobial agents was as follows: ciprofloxacin (41%), mecillinam (20.5%), trimethoprim (61%), ampicillin (67%), ampicillin/ clavulanic acid (23%), cefuroxime (17%), nitrofurantoin (2%), amikacin (0%) and gentamicin (9.5%). Immunological status (CD4 count) is an important parameter for risk assessment of UTIs in HIV-patients. The increased resistance rate of E. coli to commonly used antimicrobial agents needs to be considered when it comes to the management of UTI, additionally, surveillance strategies should be implemented in HIV-patients.

Rapid Detection of Urinary Tract Infections via Bacterial Nuclease Activity

Rapid and accurate bacterial detection methods are needed for clinical diagnostic, water, and food testing applications. The wide diversity of bacterial nucleases provides a rich source of enzymes that could be exploited as signal amplifying biomarkers to enable rapid, selective detection of bacterial species. With the exception of the use of micrococcal nuclease activity to detect Staphylococcus aureus, rapid methods that detect bacterial pathogens via their nuclease activities have not beendeveloped. Here, we identify endonuclease I as a robust biomarker for E.coli and develop a rapid ultrasensitive assay that detects its activity. Comparison of nuclease activities of wild-type and nuclease-knockout E.coli clones revealed that endonuclease I is the predominant DNase in E.coli lysates. Endonuclease I is detectable by immunoblot and activity assays in uropathogenic E.coli strains. A rapid assay that detects endonuclease I activity in patient urine with an oligonucleotide probe exhibited substantially higher sensitivity for urinary tract infections than that reported for rapid urinalysis methods. The 3hr turnaround time is much shorter than that of culture-based methods, thereby providing a means for expedited administration of appropriate antimicrobial therapy. We suggest this approach could address various unmet needs for rapid detection of E.coli.

La sensibilité aux antibiotiques des bactéries uropathogènes dans la ville de Nouakchott – Mauritanie

A urinary tract infection (UTI) is a frequent pathology in outpatients and admitted patients as well. In recent years, there has been an increase in the resistance of germs responsible for UTI to tested antibiotics, particularly because of the emergence of Enterobacteria secreting extended-spectrum beta-lactamase (ESBL). The aim of this work was to study the epidemiology of germs responsible for urinary tract infections and their antibiotic sensitivity at three clinical laboratories in the city of Nouakchott (Mauritania) in all patients presenting to these laboratories for urine culture during a period of six months. This is a prospective study conducted at three clinical laboratories in Nouakchott, over a period of six months from January 1st to June 30th 2014 for all patients coming to these laboratories for urinalysis test during this period. The culture was performed according to the usual techniques, and the antibiogram was done according to the recommendations of the Antibiogram Committee of the French Society of Microbiology. The statistical analysis was performed using SPSS Statistics 20. From 3082 urine exam, 568 were positive, which means 18.4%. These infections were for hospitalized patients (17.8%) and outpatients in particular (82.2%). Sex ratio F/M was 1.6. The epidemiology of urinary tract infections in these three medical analysis laboratories is comparable to the past studies data regarding age, sex, and the bacteria, the most frequently responsible (Escherichia coli 64.4%). But differences in the resistance of E.coli are observed: higher resistance to beta-lactam antibiotics, the quinolones, the fluoroquinolones, and cotrimoxazol. UTI was common in patients with urinary catheter (64.9%), diabetics (52.4%), hospitalized patients (49.3%) and pregnant women (38.7%). The prevalence of urinary tract infections caused by Enterobacteria ESBL in our study was 12.8%, of all urinary tract infections caused by Enterobacteria; 10.4 and 20.4% of the E.coli and Klebsiella spp, respectively produced a ESBL. The distribution of germs in our study is comparable to the literature, however, antibiotic resistance is higher in our study, which is probably a result of the inappropriate use of these drugs in our country, therefore it is important for us to create a good strategy to supply and distribute these drugs, as well as the review of the empirical treatment of UTI in our country. 4.

Clinical Presentations and Epidemiology of Urinary Tract Infections

Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made based on a combination of symptoms and a positive urine analysis or culture. Most UTIs are uncomplicated UTIs, defined as cystitis in a woman who is not pregnant, is not immunocompromised, has no anatomical and functional abnormalities of the urogenital tract, and does not exhibit signs of tissue invasion and systemic infection. All UTIs that are not uncomplicated are considered to be complicated UTIs. Differentiation between uncomplicated and complicated UTIs has implications for therapy because the risks of complications or treatment failure are increased for patients with a complicated UTI. Asymptomatic bacteriuria (ASB) is defined as the presence of a positive urine culture collected from a patient without symptoms of a UTI. Concerning the complicated UTI, it is possible to make a differentiation between UTI with systemic symptoms (febrile UTI) and UTI in a host, which carries an increased risk to develop complications of this UTI. Febrile UTIs are urosepsis, pyelonephritis, and prostatitis. A complicated host is defined as one that has an increased risk for complications, to which the following groups belong: men, pregnant women, immunocompromised patients, or those who have an anatomical or functional abnormality of the urogenital tract (e.g., spinal cord-injury patients, renal stones, urinary catheter).