Urine Culture Isolates Research Articles

2241. Antibiotic Use Before and After Hospital Admission Among Hospitalized Patients with Acute Febrile Illness in Bangladesh

Abstract Background The inappropriate use of antibiotics is common in Bangladesh, contributing to the significant burden of antimicrobial resistance. The WHO has categorized Access, Watch, and Reserve groups of antibiotics (AWaRe classification) to promote optimal use. We explored antibiotic use among hospitalized patients with acute febrile illness (AFI) at five tertiary-level hospitals in Bangladesh. Methods From September 2021 to February 2023, 1544 patients were randomly selected among all hospitalized patients with measured fever (≥100.4°F) or a history of fever in the past 14 days. Blood and urine culture isolates were analyzed for antibiotic sensitivity using the VITEK-2 system. Results Of enrolled AFI patients, 835 (54%) reported the use of antibiotics prior to hospitalization, with 79% of reported antibiotics from the Watch group, 16% from the Access group, and none from the Reserve group. Five percent of the antibiotics prescribed were not recommended by WHO for clinical practice. The top five frequently reported antibiotics before hospitalization were cefixime (24%), azithromycin (19%), ceftriaxone (16%), amoxicillin (6%), and cefuroxime (5%). Bacterial infection was diagnosed among 205 patients (13% of all enrollees) through Rapid diagnostic tests, culture and Rt-PCR. In-hospital, 1385 (90%) patients received at least one antibiotic. The most frequently prescribed antibiotics were from the Watch group (84%), followed by the Access group (15%) and none from the Reserve group. The top five antibiotics prescribed in-hospital were ceftriaxone (64%), amoxiclav (7%), ceftazidime (3.4%), clarithromycin (2.8%), and moxifloxacin (2.6%). Antibiotic susceptibility testing (AST) results from blood and urine culture isolates showed high resistance pattern to ceftriaxone (45% and 56%) and ceftazidime (63% and 50%). Of blood culture isolates 80% were sensitive to amoxiclav, while 46% of urine culture isolates were resistant to amoxiclav. At least one bacterial organism was identified in only 13% of enrolled patients. List of antibiotics that were reported to be received by the enrolled AFI patients before Hospitalization Before hospitalization, 132 patients reported receiving antibiotics from Access group, while 662 patients received antibiotics from WATCH group List of antibiotics received by the enrolled AFI patients during hospitalization During hospitalization, 211 patients received antibiotics from Access group and 1169 patients received antibiotics from Watch Group List of 235 bactrial organisms which were identified from clinical samples of 205 AFI patients (some patient had co-infection) Conclusion In conclusion, antibiotics were used in nine of ten patients. The frequent and inappropriate use of Watch group antibiotics in outpatient settings likely contributes to decreased effectiveness and demonstrates the need for improved antimicrobial stewardship. Disclosures All Authors: No reported disclosures

What did we learn about tocilizumab use against COVID-19? A single-center observational study from an intensive care unit in Serbia.

Selection of effective and safe therapy for management of patients with coronavirus disease is challenging. Tocilizumab (TZB) has emerged as a potential treatment option for COVID-19. Several aspects regarding Tocilizumab treatment remain uncertain, such as the optimal timing for its administration and the safety profile, including the potential risk of infections. The aim of the study is to present the clinical characteristics of patients with COVID-19 following the application of Tocilizumab. This is a retrospective analysis of 121 patients with severe forms of COVID-19 previously treated with Tocilizumab was conducted. All patients were admitted to intensive care units (ICUs). Of 121 patients, the majority were men 72 (59.5%) with a median age at presentation of 65 ± 13 years. Only 9 (7.43%) patients were without comorbidities, while the other 112 (92.55%) had two or more comorbidities. Almost all of the 120 patients (99.2%) needed oxygen therapy, such as nasal cannulas in 110 (90.9%) patients, high flow nasal catheter (HFNC) in 4 (3.3%) patients, and continuous positive airway pressure (CPAP) in 5 (4.1%) patients while 1 patient was intubated at the time of hospital admission. The average time from Tocilizumab application to admission to the ICU was 3 days. During clinical deterioration, almost half 57 (47.1%) of the patients were intubated, and 52 (82.5%) of these intubated patients (p < 0.001) had lethal outcomes. The most significant predictors for a lethal outcome according to multivariate analysis were diabetes mellitus (p < 0.001) followed by a subsequent elevation in C-reactive protein levels (CRP; p < 0.002) and ferritin (p < 0.013) after Tocilizumab application. Bloodstream infections were found in 20 (16.5%) patients, most frequently with Gram-negative pathogens like Acinetobacter spp. as in 12 (18.6%) patients, Klebsiella spp. in 6 (8%) patients, and Pseudomonas spp. in 2 (3.2%) patients. Urine culture isolates were found in 9 (7.43%) patients, with Candida spp. being most frequently isolated in 7 (5.8%) patients, followed by Klebsiella spp. and Pseudomonas spp. in 1 patient each (0.8%). Significantly lower survival was seen in patients with proven infection. The benefit of tocilizumab was not found in our study. The high mortality rate among intubated patients after Tocilizumab use suggests appropriate patient selection and monitoring and emphasizes the risk of superinfections. Diabetes mellitus, increased levels of CRP, and ferritin were identified as the most significant predictors of poor outcomes in contrast to increased levels of IL-6.

Escherichia coli resistance to amoxiclavulanate therapy in pediatric urinary tract infections: a rising problem.

Urinary tract infections (UTIs) are a frequent disorder of childhood, mainly caused by Escherichia coli. The aim of this study was to evaluate the antimicrobial susceptibility trend in bacterial isolates in urine cultures in pediatric environment, analyzing data from our laboratory in a 6-year period. A retrospective study was performed in AO SS. Antonio e Biagio e Cesare Arrigo (Pediatric Hospital) of Alessandria in Piedmont, North Ital. From 2015 to 2020, in a 6-year period, 1299 urinocultures were collected. Data collection was focused on demographic characteristics (age and sex) and laboratory findings (positive urocultures, antibiogram). Positive urocultures were 577, in which Escherichia coli represented most isolates (428, 74.2%). We found a statistically significant trend toward amoxiclavulanate resistance in the E. coli positive urinoculture comparing the period 2015-2018 vs. 2019-2020. Actual guidelines mostly recommend for amoxicillin-clavulanate prescription as first-line option for pediatric UTI management, this indication might be partially reconsidered. Our data underline the importance to conduct surveillance studies to determine local prevalence of antibiotic resistance to optimize therapeutic management.

Prevalence and Antimicrobial Susceptibility Pattern of Urine Culture Isolates from a Tertiary Care Hospital, Dhaka, Bangladesh

Urinary tract infections are known as the most common bacterial infections, affecting a significant number of people every year. The study was designed to highlight the common bacterial pathogens causing urinary tract infections and to determine antimicrobial susceptibility patterns of the most frequent urine culture isolates. From the total of 436 samples, 183 isolates were found. Among all isolates, E. coli was the most predominant (40%) urinary tract infection pathogens followed by Enterococcus sp. (23%), Staphylococcus sp.( 15%), Klebsiella sp.( 13%), Proteus sp.( 5%), Pseudomonas sp.( 2%) and Acinetobacter sp (2%). Rate of isolation was higher in female patients (76%) rather than male (24%). Out of all 76% isolates from females, highest (36.69%) rate of isolation among females of 21-40 years age group followed by 41-60 years age group (33.81%). In the case of male, the rate of isolation was more in the age group of 41-60 years (38.64%). E. coli showed a remarkable amount of sensitivity against Amikacin (95%), followed by Nitrofurantoin (89%) , Imipenem (77%) and Meropenem (70%) respectively. Now a days, complicated urinary tract infections and antimicrobial resistance pose a major threat in the treatment of this type of infection. It is therefore suggested that the problem of antimicrobial resistance can be reduced through appropriate use of antimicrobial agents and increasing awareness among the population.

Outburst of Food Poisoning among Hostellers of Certificate Level Nursing Students at Janaki Medical College, Dhanusha

Background &amp; Objective: Food poisoning is the result of eating contaminated, spoiled or toxic food and frequently felt in our society. There are more than 250 food borne diseases. Some of them causes complications even to death. It is worldwide public health burden as well. Causative agents werebacterial, protozoal, possible chemicals and some confounders. This study aims to evaluate the causative agents and treat the patients with protocol in Emergency. Material and Methods: A purposive descriptive observational study of food poisoning in Proficiency Certificate level Nursing students in Janaki Medical College was done. All students and staffs were under survey by admitting in the Emergency ward and maintaining the treatment in observational ward. Proper history taking, Physical examination and investigations were done. Knowledge, Attitude and Practices of causation, safety risk, control measure and prevention of food handling were sensed by valid questionnaires. Data were analyzed using SPSS version 20.0. Results: All patients (n=51) were female of 20 districts. 92% cases were of emerging adults. BMR ranges 17.5-25. 83% cases were admitted in observational ward and 5.4% cases were self-limited. Clinical features were abdominal pain (70%), diarrhea (70%), fever with chills (70%), headache (52%), Nausea (35%) and vomiting (31%). Hemogram showed 52% cases were of leukocytosis. Neutrophilia (88%), lymphocytosis (52%), anaemia (46%), hypoglycemia(72%), hyponatraemia (16%) and hypernatraemia (6%).Stool RE/ME showed loose stool(100%), green(100%) in colour, mucoid (10%) consistency in physical examination while plenty of pus cell (100%), undigested food particle (40%), microscopic RBCs(20%), Entamoeba histolytica (10%) were seen in microscopic examination. Stool culture showed 80% cases were of pathogenic E.coli. and 10% cases were of shigella. Three cases were urine culture isolates with E. coli. Overall, questionnires to Knowledge, Attitude and Practices of food handling, safety and risk about food poisonings were found satisfactory. Conclusion: The causative agents were EPEC (clinically), shigella dysentery and E. histolytica. The sensitivity patterns of antibiotics were of ceftriaxone, ciprofloxacine, meropenum, chloramphenicol, clindamycin, Piperacillin with Tazobactam. Overall assessment of Knowledge, Attitude and Practices about food handling, safety and risk factors were found satisfactory. The responsible departments were emphasized to take appropriate actions in specific way for further control and prevention of food poisoning.

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.

Molecular characterization of multiresistant enterobacteria in two departments of the Peruvian jungle

ResumenIntroducción. La aparición de enterobacterias multirresistentes y productoras de betalactamasas de espectro extendido (BLEE) en pacientes de consulta externa con infecciones urinarias, representa un problema de salud pública en Perú.Objetivos. Caracterizar molecularmente enterobacterias multirresistentes aisladas de pacientes con diagnóstico de infección urinaria y procedentes de dos departamentos de la selva peruana.Materiales y métodos. Se hizo un estudio descriptivo, observacional y retrospectivo de 61 aislamientos de urocultivo procedentes de la selva peruana durante 2017 y 2018. Los perfiles de resistencia se identificaron utilizando el sistema automatizado MicroScan™ y para la detección de los genes bla TEM , bla CTX-M , bla SHV se empleó una reacción en cadena de la polimerasa (PCR) convencional.Resultados. Las enterobacterias positivas para BLEE más frecuentes por departamento fueron Escherichia coli en Madre de Dios (25%, 10/40) y Ucayali (76,2%, 16/21). En ambos departamentos, el gen blaCTX-M fue el más frecuente (25/61; 41), seguido por bla TEM (15/61; 24,6%) y bla SHV (10/61; 16,4%). En el perfil de sensibilidad antimicrobiana, se detectó 72,6% de resistencia contra ampicilina, 82,3 % contra cefalotina y 88,7% contra nitrofurantoína.Conclusiones. El porcentaje de cepas de enterobacterias multirresistentes productoras de BLEE en ambos departamentos fue del 57,4% y el gen bla CTX-M fue el más frecuente.

Resistance Patterns from Urine Cultures in Children Aged 0 to 6 Years: Implications for Empirical Antibiotic Choice.

PurposeUrinary tract infection (UTI) is a frequent disorder of childhood, caused mainly by Gram negative Enterobacterales. The aim of this study is to evaluate etiology and antimicrobial susceptibility patterns of bacterial isolates in urine cultures of children under the age of 6 and to analyze the relationship between previous hospitalization or antibiotic prescriptions and antimicrobial resistance rates.Patients and MethodsA retrospective study on positive urine cultures from 13 public laboratories in Tuscany, Italy was conducted. Data were obtained by reviewing records of the “Microbiological and Antibiotic-Resistance Surveillance System” (SMART) in Tuscany, Italy. A total of 2944 positive urine cultures were collected from 2445 children.ResultsEscherichia coli represented the majority of isolates (54,2%), followed by Enterococcus faecalis (12,3%), Proteus mirabilis (10,3%) and Klebsiella pneumoniae (6,6%). Isolated uropathogens showed high resistance rates to amoxicillin-clavulanate (>25%), particularly in children under one year of age or hospitalized within the 12 months before the sample collection. High susceptibility rates were reported of aminoglycosides, cephalosporins and quinolones (>90%). Previous antibiotic prescriptions by general pediatricians did not increase resistance rates.ConclusionOur results show a rate of amoxicillin-clavulanate resistance of 25%. Higher resistance rates were reported in children under one year of age and with previous hospitalization. Hence, amoxicillin-clavulanate should be used carefully in young children and those with severe symptoms.

Antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infections in a tertiary care hospital

Aim: To determine etiological microorganisms from urine samples in patients diagnosed with UTI and to detect the antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae in a Tertiary Care Hospital.Materials and Methods: A cross-sectional study was conducted using urine culture samples and sensitivity reports collected retrospectively from our laboratory records over a period from Jan 2013 to Dec 2017.Results: A total of 729 urine culture isolates from 660 patients were included. Two-hundred eighty-four (41.8%) of the patients were male and 384 (58.2%) were female. The most common microorganisms were 46.4% E. coli, 18.2% K. pneumoniae and 12.1% Enterococcus spp., respectively. A total of 284 urine culture isolates produced extended spectrum beta-lactamases (ESBL), of which 186 (65.5%) were E. coli and 98 (34.5%) were K. pneumoniae. The most susceptible antimicrobials are meropenem, imipenem, amikacin, and fosfomycin, respectively. We determined that the antimicrobial drugs with the lowest susceptibility rates for both E. coli and K. pneumoniae were amoxicillin-clavulanate (24.5%), trimethoprim-sulfamethoxazole (30.7%) and ceftriaxone (43.2%). Additionally, their susceptibilities have gradually decreased. Ertapenem susceptibility has decreased more in K. pneumoniae isolates than E. coli.Conclusion: Antimicrobial resistance and ESBL-producing for both E. coli and K. pneumoniae have been increasing over the years. Our findings may contribute to choosing the proper antibiotic for the empirical treatment of UTI and preventing treatment failure.

1698. Trends in antimicrobial resistance among outpatient urine E. coli isolates in US females ≥12 years of age: A multicenter evaluation from 2011 to 2019

Background E. coli is the predominant uropathogen isolated in uncomplicated urinary tract infections (UTI). Surveillance data suggest increasing antimicrobial resistance (AMR), although recent data from the outpatient setting are limited. Treatment is typically empiric and should be guided by local resistance rates; however, this is challenging in the absence of routine culture and assessment of regional AMR. We characterized AMR trends for E. coli isolated from females with outpatient UTI in the US, from 2011 to 2019.MethodsA retrospective multicenter cohort study of antimicrobial susceptibility using data from the BD Insights Research Database (Franklin Lakes, NJ) was conducted. The first E. coli urine culture isolates representing each distinct susceptibility pattern within 30 days of index urine from 2011–2019 were included from females ≥ 12 years old. E. coli isolates were identified as not-susceptible (NS) if intermediate or resistant to trimethoprim-sulfamethoxazole (TMP-SMX NS), fluoroquinolone (FQ NS), nitrofurantoin (NFT NS), ESBL+ (by commercial panels or intermediate/resistant to ceftriaxone, cefotaxime, ceftazidime or cefepime), and multi-drug resistant (MDR), defined as NS to ≥ 2 or ≥ 3 of FQ, TMP-SMX, NFT or ESBL+. Descriptive analyses characterized AMR (%) over time and generalized estimating equations were used to statistically assess AMR trends over time.ResultsA total of 1,513,882 E. coli isolates were tested at 106 to 295 US centers between 2011 and 2019. Over the study period, AMR remained persistently high (> 20%) for FQ and TMP-SMX and increased for the MDR (≥ 3 drugs) phenotype (from 3.1% to 4.0%) (Table). Prevalence of the ESBL+ phenotype increased year-on-year (from 4.1% to 7.3%). Modeling confirmed a significant increasing trend for the ESBL+ (7.7%/year) and MDR (≥ 3 drugs) phenotypes (2.7%/year) (P< 0.001), with decreasing or no trend change for NFT NS and other AMR phenotypes (Table).Table. Descriptive Statistics and Model-estimated Annual Change of AMR (count and % not-susceptible out of isolates tested) in E. coli among US Females (≥12 years of age) with Outpatient UTI ConclusionCharacterization of AMR trends for E. coli over the last decade, in outpatient E. coli isolates in US females, shows persistently high AMR to FQ and TMP-SMX, and increasing AMR trends for the ESBL+ and MDR (≥ 3 drugs) phenotypes.DisclosuresVikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Aruni Mulgirigama, MBBS, GlaxoSmithKline plc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Nicole Scangarella-Oman, MS, GlaxoSmithKline plc. (Employee, Shareholder) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Gang Ye, PhD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder)

Bacterial profile and antibiogram of urine culture isolates in a teritiary care center

Urinary tract infections (UTI) are the commonest infections, where people from all age groups including children to older age individuals experience in their life time. Though several microorganisms are attributed as causative agents of UTI like fungi, viruses, bacterial infections are responsible for &amp;#62; 95% of UTI cases.Untreated UTI can lead to high morbidity and long term complications like renal scarring, hypertension and chronic kidney diseases. There is diversity among uropathogens regionally and gradually becoming more and more difficult to treat leading to therapeutic dead end. And also because of evolving antibiotic resistance phenomenon among uropathogens, regular monitoring is utmost important to provide guidelines for empirical antimicrobial therapy. This is an observational study carried out in the department of Microbiology in Santhiram Medical college and General hospital for a period of three months from January 2019 to March 2019. A total of 550 midstream urine samples were processed from patients of all age groups with suspected UTI symptoms. Urine culture was done by semi quantitative technique.Results of urine culture were detected as significant and insignificant based on standard Kass criteria. A growth of &amp;#62;=105 colony forming units (CFU)/ml is considered as active UTI with significant bacteruria. Cultures having more than three types of colonies were considered as contaminants. Pathogenic organisms were identified by Gram stain, motility testing and biochemical reactions as per standard microbiological techniques. The antimicrobial sensitivity testing was done by Kirby-Bauer Disc diffusion method. A total of 550 urine samples were analysed, out of which 192(34.9%) samples were found to have significant bacteriuria and the rest 358 (65%) were either non significant bacteriuria or having very low counts of bacteria or sterile urine. Among the 192 positive samples, 125 (65.1%) were from females and 67 (34.8%) were from males. Predominantly Gram negative bacteria (79.1%) were isolated among culture positive samples followed by Gram positive bacteria (13.0%) and fungi i.e. Candida (5.7%).

Prevalence of E. Coli in Urinary Tract Infection of Children Aged 1-15 Years in A Medical College of Eastern Nepal

Urinary tract infection is one of the commonest causes of childhood morbidity. Early diagnosis and appropriate choice of antimicrobials is essential. Hence, this study aims to identify the prevalence of Escherichia coli in childhood urinary tract infections. This was a hospital based descriptive cross-sectional study conducted in Nobel Medical College, Biratnagar over a period of one year. A total of 163 cases aged 1-15 years were included and clinical profile, laboratory reports including bacterial isolates in urine cultures and their sensitivity patterns were documented. The prevalence of Escherichia coli is 45 (53.57%) C.I. Escherichia coli was the most common organism isolated in bacterial cultures followed by Klebsiella 12 (14.29%), Enterococcus 10 (11.90%). Urinary tract infection was common among females with male: female ratio of 1:2.3. Fever 152 (93.2%) and abdominal pain 113 (69.3%) were the most common presenting symptoms. Escherichia coli was found most sensitive to Nitrofurantoin 43 (95.5%) followed by Ciprofloxacin 41 (91.1%) and Amikacin 40 (88.8%). Urinary tract infections in childhood require prompt attention and treatment to prevent significant morbidity and mortality. From this study it can be concluded that Escherichia coli is one of the most common isolates in urine culture and Aminoglycosides and Fluoroquinolones can be accepted as empirical treatment regimens for childhood Urinary tract infections.

Pseudo-Outbreak of Stenotrophomonas maltophilia Isolated from Kidney Stones and Attributed to Inadequate Sterilization: Investigation of Molecular Typing and Clonal Relationship

Stenotrophomonas maltophilia is a gram-negative bacterium. Hospitals can be a source of S. maltophilia because it adheres to nonliving surfaces and forms a biofilm. This study was performed to investigate the clonal relationship between S. maltophilia isolates obtained from kidney stone samples. Samples of kidney stones taken from patients and surrogate samples from nephroscopes, cleaning solution, disinfectant solution were included in the study. The clonal relationship between isolates was determined by PFGE. S. maltophilia was isolated from 34 of 94 kidney stone samples sent from the urology operating room between July 2017 and January 2018. A total of 26 S. maltophilia strains (21 from kidney stone samples, three from nephroscopes, and two from urine culture) were isolated. PFGE showed that the 21 kidney stone isolates and the 3 S. maltophilia isolates obtained from the nephroscope belonged to the same clone. The two urine culture isolates showed no clonal relationship to the outbreak isolates and were considered sporadic. Molecular typing confirmed that this pseudo-outbreak was attributed to inadequate disinfection of the nephroscopes. After disinfection protocols were reviewed and revised as needed, especially regarding the removal of organic material from nephroscopes after use, no further bacterial growth was detected from kidney stone specimens obtained with nephroscopes.

Frecuencia y susceptibilidad antimicrobiana en aislamientos urinarios de bacterias productoras de Blee en dos hospitales regionales en Ecuador

Introducción. La resistencia bacteriana es un problema muy antiguo, que en la actualidad representa un verdadero reto a la salud pública mundial. Objetivo. Identificar patrones de resistencia bacteriana de bacterias responsables de infecciones de vías urinarias (IVU) aisladas de urocultivos de pacientes de dos hospitales rurales en Santo Domingo y Pedro Vicente Maldonado, Ecuador para guiar en cierta manera el uso de antibióticos para terapia empírica en estas poblaciones.Metodología. El siguiente es un estudio descriptivo retrospectivo de los aislamientos de urocultivos de 572 pacientes que acudieron a consulta externa, emergencia u hospitalización al Hospital Saludesa en la ciudad de Santo Domingo y al Hospital Docente Pedro Vicente Maldonado en la ciudad el mismo nombre, Ecuador. Resultados. La mayoría (más del 97 %) correspondían a muestras de pacientes ambulatorios. Del total 481 aislamientos correspondieron a Escherichia coli (85 %) con patrones de resistencia similares a otros encontrados en otras partes del mundo destacando un 83 % de resistencia a ampicilina, 56 % de resistencia a doxiciclina, 53 % de resistencia a trimetoprim-sulfametoxazol, 37 % de resistencia a ciprofloxacina y 21 % de resistencia a gentamicina. Aún más importante encontramos que 145 (27%) correspondían a bacterias productoras de betalactamasas de espectro extendido (BLEE) confirmadas por métodos confirmatorios según las guías del CLSI 2018. De éstas 131 correspondían a Escherichia coli, 10 a Klebsiella pneumoniae y 4 a Proteus mirabilis. Conclusión Se evidencia una alta resistencia a antibióticos de uso ambulatorio y venta libre para el tratamiento de la infección de vías urinarias (IVU) no complicada de acuerdo a las guías de manejo estatales como son cefalexina (100%), ciprofloxacina (76 %), doxiciclina (71 %), trimetoprim-sulfametoxazol (81 %), gentamicina (45%) y nitrofurantoína (21%) lo que indica que por lo menos en 1 de cada 5 pacientes que empiezan terapia empírica para el tratamiento de su IVU no complicada sin un cultivo de respaldo presentarán fallo intratratamiento por presencia de bacterias productoras de BLEE a no ser que se modifique la terapia antibiótica en base a un hallazgo microbiológico.

Analysis of urine culture isolates from microbiology laboratory of a tertiary care Hospital

The study of urine culture isolates was conducted on samples received to microbiology laboratory of GMERS Medical College attached General Hospital, Gandhinagar during the period of December 2015 to November 2016. Only isolates from urine samples of non catheterized patients having colony count of >105 CFU/mL were included for analysis. Analysis of the species distribution and antibiotic sensitivity pattern was done with the help of WHONET 5.6 software. Out of 160 isolates identified from 801 urine samples (positivity rate of 19.98%), most common were coliforms (71.88%) followed by pseudomonas spp. (8.75%), candida spp. (8.75%) etc. Female patients (22.81%) had higher rate of urinary tract infection as compared to males (17.45%). Enterobacteriaceae group was most resistant among all isolates. Amikacin (85%) and imipenem (82%) were most sensitive antibiotics in Enterobacteriaceae group while polymyxin-B (100%) and aztreonam (93%) were most sensitive in pseudomonas spp. Antimicrobial susceptibility testing and analysis was done for gram positive cocci also. Enterobacteriaceae are the leading cause of urinary tract infection worldwide and also most resistant among all isolates. Cautious usage of antimicrobial agents is required to reduce the burden of increasing drug resistance in UTI. Keywords: Urinary tract infection, Antimicrobial sensitivity, Coliform, Gender difference.

Salmonella isolates from urine cultures: serotypes and antimicrobial resistance in hospital settings.

This study investigated the serotypes and antimicrobial resistance of Salmonella isolates in urine cultures from 38 hospitalized patients. Nine serotypes were detected, and a large proportion was Typhimurium and Enteritidis. The strains presented resistance to 11 different antibiotics. Thirteen isolates (11 from serotype Typhimurium) exhibited multidrug resistance.

High Rates of Fosfomycin Resistance in Gram-Negative Urinary Isolates from Israel.

Increasing antimicrobial resistance is a major problem worldwide. Many urinary tract infection (UTI) isolates are resistant to all oral antimicrobial agents, necessitating intravenous treatment even for cystitis. Fosfomycin is a broad-spectrum antibiotic that achieves high and prolonged urinary drug concentration and is considered first-line treatment for uncomplicated cystitis. Our aim was to investigate fosfomycin susceptibility among urinary isolates and search for demographic or bacterial characteristics associated with fosfomycin nonsusceptibility. This is a retrospective study of all Gram-negative urinary isolates at Padeh-Poriya Medical Center in northern Israel. A total of 1503 isolates were tested for fosfomycin susceptibility, as well as susceptibility to other antimicrobial agents, by VITEK2 system and disk diffusion testing. Demographic and clinical data were obtained from patient electronic files. A total of 1,503 isolates from patients' urine were included. Mean patient age was 64.6 years, 937 (62.3%) were female, 913 (60.7%) were Jews, and in 1,058 (70.4%) cases, the infection was community acquired; 28.1% were extended-spectrum beta lactamase (ESBL)-positive. A total of 1099 (73.1%) isolates were susceptible to fosfomycin. Fosfomycin nonsusceptibility was significantly correlated to year: 124 (20.7%) in 2015 versus 280 (30.9%) in 2016; patient age: 17.6% in patients ≤50 years versus 30% in patients >50 years; hospital-acquired UTI: 34.2% versus 23.8%; and presence of ESBL positivity: 31.1% in ESBL-positive versus 20.9% in ESBL-negative isolates (p for all <0.001). Fosfomycin nonsusceptibility among urine culture isolates is a worrisome phenomenon that is on the rise and is more often found in elderly patients, patients with nosocomial UTI, and isolates that are ESBL positive.

Antibiotic resistance pattern of urine culture isolates from patients with community acquired UTI

Antibiotic resistance pattern of urine culture isolates from patients with community acquired UTI

Antimicrobial susceptibility of microorganisms that cause urinary tract infections in pediatric patients

IntroductionCumulative susceptibility reports are a valuable tool for the empirical treatment of urinary tract infections, especially in the current context of increasing resistance rates. Our objective was to analyze the antimicrobial susceptibility of bacterial isolates in urine cultures of pediatric patients during a five-year period. MethodsRetrospective study of urine cultures from 2011 to 2015. Identification and antimicrobial susceptibility tests were performed using the Vitek-2 system (BioMérieux®) and categorized according to EUCAST criteria. Antimicrobial susceptibility data were analyzed by gender and age groups (neonates, 1 month to 5 years, 5–15 years) before being compared with data obtained from patients over the age of 15 years. ResultsDuring the study period, 17164 urine cultures were processed from 7924 patients under 16 years of age. Antimicrobial susceptibility rates in these patients were: ampicillin 36.3%, amoxicillin/clavulanic acid 75.3%, cefuroxime 83.2%, co-trimoxazole 68.9%, ciprofloxacin 85.3%, fosfomycin 85.5%, nitrofurantoin 84.4% and 3rd generation cephalosporins 89–91%. Aminoglycosides (>92%) and carbapenems (95%) maintained the highest susceptibility rates. The prevalence of ESBL-producing isolates was significantly lower in children under the age of 16 years (1.5% vs. 4.1%). In patients under the age of 16 years, Escherichia coli isolates in girls were significantly more sensitive (p<0.0001) to ampicillin (41% vs. 30%) and amoxicillin/clavulanic acid (82% vs. 72%) than in boys. ConclusionsThe compilation of cumulative susceptibility reports disaggregated by age or gender reveals significant differences. In our setting, cefuroxime may be considered the first-line empirical treatment in pediatric patients.

RETRACTED ARTICLE: Antimicrobial misuse in pediatric urinary tract infections: recurrences and renal scarring

BackgroundIn children, urinary tract infection (UTI) is one of a common bacterial infection. This study was conducted to detect the uropathogen, antimicrobial susceptibility, pathogen associated with recurrences and renal scarring in children initially taken care from general practitioners and later presented to tertiary care.MethodsEvery inward UTI episode, culture and antimicrobial susceptibility was done while on past 6-month, history of infections and use of antimicrobials was collected using clinical records and demonstration of antimicrobials. Children with recurrent pyelonephritis was followed and in vitro bio film formation was assessed.ResultsFrequency of UTI was significantly high among infants (p = 0.03). Last 6-month, all (220) were exposed to antimicrobials. Cefixime was the commonly prescribed antimicrobial (p = 0.02). In current UTI episode, 64.5% (142/220) of children with UTI were consulted GPs’ prior to seek treatment from tertiary care pediatric unit (p = 0.02). While on follow up child who developed UTI, found urine culture isolates were significantly shifted from E. coli and K. pneumoniae to extended spectrum of beta-lactamase (ESBL) E. coli and K. pneumoniae. Out of 208 participants, 36 of them had re-current pyelonephritis (R-PN). Renal scarring (RS) was detected in 22 out of 70 patients with pyelonephritis following dimercaptosuccinic acid scan. Following each episodes of recurrent pyelonephritis 11% of new scar formation was detected (p = 0.02). Bio film forming E. coli and K. pneumoniae was significantly associated in patients with R-PN (p = 0.04).DiscussionMedical care providers often prescribe antimicrobials without having an etiological diagnosis. While continuing exposure of third generation cephalosporin and carbapenem leads to development of ESBL and CRE microbes in great. The empiric uses of antimicrobials need to be stream lined with local epidemiology and antimicrobial susceptibility pattern. R-PN in childhood leads to RS. In great, bio film formation act as the focus for such recurrences.