Uropathogenic Isolates Research Articles

Molecular and phenotypic characterization of biofilm formation and antimicrobial resistance patterns of uropathogenic staphylococcus haemolyticus isolates in Casablanca, Morocco

This study aimed to establish the correlation between antibiotic resistance and biofilm formation by Staphylococcus haemolyticus and to examine the impact of sub-inhibitory concentrations of antibiotics (sub-MICs) on biofilm formation.Antibiotic susceptibility testing was conducted using the disk diffusion method, and biofilm formation was determined using Congo red agar and microtiter plate methods. Antibiotic resistance and biofilm-associated genes were detected using polymerase chain reaction.The majority of the twenty-one S. haemolyticus isolates were multidrug-resistant, methicillin-resistant (MRSH) and biofilm producers, including 43 % of moderate biofilm producers. A significant correlation was observed between MRSH and MSSH isolates in terms of biofilm production. Vancomycin, gentamicin, and ciprofloxacin at their sub-MICs tended to promote biofilm formation. The eno gene was present in 76.2 % of strains, followed by aap, and atlE.This study revealed a strong correlation between the biofilm-forming ability and antibiotic resistance in S. haemolyticus, which underlines a crucial public health issue.

Evaluation of Fosfomycin in-vitro susceptibility among gram negative isolates from urine culture in a tertiary care hospital in Lucknow

The rise of bacteria that are Multidrug- resistant or Extended Drug Resistant (MDR or XDR) and the lack of novel antibiotics have wreaked havoc on patient treatment options. Fosfomycin has just recently come to light because of the development of resistance to existing drugs. This study aims to evaluate the Fosfomycin susceptibility of Gram- negative isolates in vitro. A prospective study done in the Department of Microbiology, Integral Institute of Medical Sciences of Research, Lucknow, over a period of six months from April 2023 to September 2023. A total of 1328 urine samples were processed in microbiology lab and after identification of urinary isolates, antibiotic susceptibility testing was performed, and results were interpreted following the Clinical and Laboratory Standards Institute guidelines (CLSI). Fosfomycin sensitivity was tested by the Kirby-Bauer disc diffusion method. 353 of the 1328 processed urine samples showed a growth of pathogens. 184 (52.1%) of the isolates were Gram-negative, while 169 (47.8%) were Gram-positive. Fosfomycin (7%) and Nitrofurantoin (13%) showed lower rates of resistance among these isolates. Relatively higher rates of resistance were observed for Doripenem (17%), Meropenem (17%), Imipenem (18%), Amikacin (18%), Gentamicin (27.9%). Norfloxacin, Aztreonam, Cefepime, Ciprofloxacin and Levofloxacin and Cotrimoxazole showed a high resistance rate of 46.2%, 48.8%, 50%, 60.4%, 61% and 70% respectively. Fosfomycin's low resistance (7%) to the antibiotic indicates that it works well as a urinary antibiotic. Uropathogenic Enterobacteriaceae isolates exhibited an excellent level of in vitro susceptibility to Fosfomycin. These in vitro results highlight the unexplored possibilities of Fosfomycin as a superior therapeutic option for the treatment of UTIs, and it has a good chance of expanding into a safe and effective oral alternative treatment that can be used in inpatient as well as outpatient settings.

Incidence of Bacterial Uropathogens and their Antibiotic Susceptibility Pattern Isolated from Urinary Tract Infection in Female Patients

Urinary tract infection (UTI) is considered as one of the highly prevalent infections worldwide. Regarding its prevalence, UTI is more common in women. The outcome of the research is expected to predict the severity of the urinary tract infection. The study of prevalence and antibiotic susceptibility helps to provide data on the occurrence of uropathogens in different age groups and helps to treat the infection with effective antibiotics to prevent further progression of infection. The study has been carried out to identify and investigate the prevalence of uropathogens and to determine their antibiotic susceptibility potential. Overall, 713 urine samples were collected, MacConkey agar, Blood agar, CLED agar and Luria-Bertani agar were used for isolation of uropathogens by calibrated loop streak method and incubated at 37°C. Antibiotic susceptibility was carried out using the Kirby Disc diffusion method. A total of 665 showed positive bacteriuria. E. coli (37.3%) and K. pneumoniae (32.03%) were the most common uropathogens followed by E. fergusonii (17.9%), P. aeruginosa (8.4%), and A. baumannii (4.4%). The study found that above 70% of antibiotic susceptibility was observed in fluoroquinolones followed by imipenem, while all isolates showed high resistance to ampicillin. The organisms E. coli, E. fergusonii, and P. aeruginosa exhibited the least susceptibility (>50%) for third-generation cephalosporins. P. aeruginosa and A. baumannii showed no susceptibility to nitrofurantoin, whereas other isolates were least susceptible. The study concludes that K. pneumoniae and E. coli were highly prevalent within the study group and that fluoroquinolone and imipenem can be effective for treatment.

BACTERIOLOGICAL ANALYSIS OF URINARY TRACT INFECTIONS AT HYDERABAD, SINDH

Urinary Tract Infections (UTI) is a condition in which micro-organisms multiply within the tract to establish infection. The aim of this study was to assess bacteriological profiling of UTI in Hyderabad, Pakistan. Isolation and identification of bacterial uropathogens were carried out using standard microbiological methods such as microscopic analysis, cultural characteristics, and biochemical testing. A total of 320 urine samples were investigated for bacteriological analysis. Among them, 116 (36.26%) urine samples yielded bacterial growth, which included 74 (23.12%) female and 42 (13.13%) male patients. Bacterial distribution revealed that the most frequent isolate was Escherichia. coli which accounted 60.34% (n=70) of the isolates followed by Klebsiella pneumoniae 13.79% (n=16), Pseudomonas aeruginosa 7.76% (n=9), Enterococcus spp. 7.76% (n=9), Streptococcus spp. 4.31% (n=5), Staphylococcus aureus 3.4% (n=4), Proteus mirabilis 2.59% (n=3). It is concluded that the, bacteriological profiling of urine samples revealed seven different uropathogens circulating in Hyderabad with high prevalence of E. coli.

Polyphosphate kinase regulates LPS structure and polymyxin resistance during starvation in E. coli.

Polyphosphates (polyP) are chains of inorganic phosphates that can reach over 1,000 residues in length. In Escherichia coli, polyP is produced by the polyP kinase (PPK) and is thought to play a protective role during the response to cellular stress. However, the molecular pathways impacted by PPK activity and polyP accumulation remain poorly characterized. In this work, we used label-free mass spectrometry to study the response of bacteria that cannot produce polyP (Δppk) during starvation to identify novel pathways regulated by PPK. In response to starvation, we found 92 proteins significantly differentially expressed between wild-type and Δppk mutant cells. Wild-type cells were enriched for proteins related to amino acid biosynthesis and transport, while Δppk mutants were enriched for proteins related to translation and ribosome biogenesis, suggesting that without PPK, cells remain inappropriately primed for growth even in the absence of the required building blocks. From our data set, we were particularly interested in Arn and EptA proteins, which were down-regulated in Δppk mutants compared to wild-type controls, because they play a role in lipid A modifications linked to polymyxin resistance. Using western blotting, we confirm differential expression of these and related proteins in K-12 strains and a uropathogenic isolate, and provide evidence that this mis-regulation in Δppk cells stems from a failure to induce the BasRS two-component system during starvation. We also show that Δppk mutants unable to up-regulate Arn and EptA expression lack the respective L-Ara4N and pEtN modifications on lipid A. In line with this observation, loss of ppk restores polymyxin sensitivity in resistant strains carrying a constitutively active basR allele. Overall, we show a new role for PPK in lipid A modification during starvation and provide a rationale for targeting PPK to sensitize bacteria towards polymyxin treatment. We further anticipate that our proteomics work will provide an important resource for researchers interested in the diverse pathways impacted by PPK.

Antibiotic resistance profiles of uropathogenic bacterial isolates in Haut-Sassandra Region, Côte d’Ivoire from January 2019 to December 2022

Antibiotic resistance profiles of uropathogenic bacterial isolates in Haut-Sassandra Region, Côte d’Ivoire from January 2019 to December 2022

Prevalence and Risk Factors of Uropathogens in Diabetic and Non-Diabetic Patients Attending a University Medical Centre in Awka Anambra State

Diabetes is the most endocrinological disease associated with different life-threatening infections. Urinary Tract Infections (UTIs) are one of the most common infections affecting diabetic patients and a major cause of hospitalization and even death. The purpose of the study includes determining the prevalence of UTI, isolation and characterization of the different bacterial uropathogens and comparative evaluation of the risk factors associated with UTIs for both diabetic and nondiabetic patients attending Nnamdi Azikiwe University Medical center Awka, Anambra state. A total of 200, clean catch midstream urine (MSU) samples were collected aseptically (100 each from diabetic and 100 from non-diabetic patients). The samples were cultured in different nutrient media. These plates were incubated at 37℃ for 24hrs. The isolates were identified using colony morphology, Gram staining reaction and biochemical tests. The demographic data was obtained from the result of the structured standardized questionnaires and data collated where statistically analysed using statistical package (SPSS) to show their relationship with UTI. This study revealed the overall UTI prevalence of 72/200 (36%) among diabetic and non-diabetic patients from 18years and above. The prevalence among diabetic participants is (61.1%) and that of the non-diabetic is (38.9%). Escherichia coli was the most prevalent bacterial uropathogen with (34.6%) in diabetics and (46.43%) in non-diabetics, followed by Staphylococcus saprophyticus (31.8%) in diabetics and (14.39%) in non-diabetics. Klebsiella pneumoniae (11.4%) for diabetics, (10.71%) in non-diabetics. Pseudomonas aeruginosa (9.1%) for diabetics and (17.86%) for non-diabetics. Proteus mirabilis 4(9.1%) for diabetics and (10.7%) for non-diabetics. The findings demonstrated that age, female gender, married individuals, diabetes, and hospitalization were all statistically associated with UTI and UTI was more prevalent in diabetic patients than non-diabetic patients. Proper knowledge of risk factors of UTI in diabetic and nondiabetic patients may allow intervention and easy management of UTI in diabetic patients.

Molecular study of blaCTX-M profile among uropathogenic Proteus mirabilis isolates

Abstracts Background: Proteus mirabilis are the most prevalent uropathogens associated with urinary tract infections (UTIs). Infection occurs only when the pathogenicity of the bacteria surpasses the host’s regular defensive systems. A lifetime incidence of between 50% and 60% among adult women, increasing with age. Materials and Methods: Collected 450 (325 male and 125 female patients) with UTIs. These patients ranged in age from (17 to 70) years from four Iraqi hospitals (Merjan Hospital, Shomali General Hospital, Al-Hilla Surgical Teaching Hospital, and Babylon Hospital for Maternal and Pediatrics) from the period from July 2021 to the end of October 2022. The identification of bacterial isolates were carried out using standard bacteriological procedures. The antibiotics susceptibility test was carried out by using 12 antibiotics from different classes The molecular identification was done by using polymerase chain reaction amplification of the three bla CTX-M gene (bla CTX-MI, bla CTX-MIV, bla CTX-MII(. Results: The percentage of samples positive for P. mirabilis based on culture, biochemical, and Gram stain results was 70 (15.5%) of the total 450 samples. The percentage of P. mirabilis isolated from male patients was 21 (30%), whereas the percentage of P. mirabilis isolated from female patients was 49 (70%) of the total 70 isolates. The result of antibiotic susceptibility showed the high resistance against nitrofurantoin (92.8%), while the higher resistance was against amikacin (10%), imipenem (4.2%), aztreonam (2.8%), and meropenem (1.4%). The result of the current study showed the percentage of bacterial sample positive to the bla CTX-MI, bla CTX-MII, bla CTX-MIV was 9 (12.85), 56 (80), and 40 (57), respectively, among 70 bacteria isolates. Conclusions: The result of the study showed the prevalence of antibiotic resistant gene and multidrug resistant among P. mirabilis isolated from UTIs.

Dynamics of antimicrobial resistance of uropathogenic isolates of Escherichia coli

Objective. To evaluate the dynamics of antimicrobial resistance of Escherichia coli isolates from the urine of patients hospitalized in medical institutions of Tashkent city from 2018 to 2021. Materials and Methods. The study included 1020 E. coli isolates from the urine of patients with clinical symptoms of urinary tract infections admitted to the reference laboratory of the Antimicrobial Resistance Research Center (ARRC) from three medical institutions in Tashkent city for the period 2018– 2021. Determination of sensitivity to 15 antimicrobial agents was carried out by disc-diffusion method in accordance with the guidelines of the European Committee for the Determination of Sensitivity to Antimicrobial Agents (EUCAST v.8-v.12, depending on the year of isolates isolation and testing). Results. A high level of resistance to aminopenicillins, including inhibitor-protected ones (88.0–91.1%), 3–4 generation cephalosporins (84.5–87.7%) and fluoroquinolones (74.2–81.8%) was detected. Carbapenems showed the highest activity among the tested antimicrobials: resistance to imipenem, meropenem and ertapenem was 0%, 0.8% and 18%, respectively. Notable increase in resistance to ampicillin and ceftazidime was found, but a consistently high level of resistance to piperacillin-tazobactam. A statistically significant increase (p < 0.001) was found between 2018–2021 in resistance to the aminoglycoside antibiotics amikacin and gentamicin from 3.2% and 37.8% to 85.4% and 80.6%, respectively. Conclusions. In our study, for most antibiotic groups, the level of resistance remained relatively stable from 2018 to 2021, except for an explosive increase in the frequency of resistance to aminoglycosides, as well as a further increase in resistance to ampicillin and ceftazidime. The need for monitoring and tracking of antibiotic pathogens when choosing treatment regimens for various infections is obvious.

Clinico-microbiological profile on multidrug-resistant enterococci in urinary tract infection patients in a tertiary care hospital

Abstract Background: Considering enterococci as an emerging important cause of nosocomial infections, and antibiotic resistance by Enterococcus as a major obstacle for treatment, determination of the prevalence of various Enterococcus species and their antibiotic resistance pattern among urinary isolates is very crucial and need of the hour. The present study tried to identify the burden of urinary tract infections (UTIs) caused by Enterococcus species and analyze the current antibiotic susceptibility patterns of the uropathogenic isolates and evaluate the risk factors. Methods: A cross-sectional study included all clinico-microbiologically diagnosed cases of admitted UTI cases. Hospital records were analyzed for the clinical background of the UTI cases, and urine sample was collected and processed for antibiotic susceptibility testing. Data were statistically analyzed. Results: Out of the 372 urine samples, Enterococcus spp. was identified in 13.44% of isolates as the causal uropathogen. Enterococcus faecalis was the predominant species identified, followed by Enterococcus faecium. Cases were mostly observed in clinical settings of sepsis followed by pyelonephritis and cystitis. Antimicrobial susceptibility profile showed that resistance was most frequently observed with norfloxacin followed by levofloxacin, ciprofloxacin, ampicillin, and high-level gentamicin. Linezolid showed maximum sensitivity, followed by vancomycin, nitrofurantoin, and others. Conclusion: The rise of multidrug-resistant (MDR) Enterococcus species is of particular concern in terms of antibiotic therapy. Speciation along with routine culture and sensitivity is essential to gather knowledge about the available antibiotics in MDR uropathogenic Enterococcus species, particularly oral choices.

Comparison of phylogenetic and virulence factors between Escherichia coli isolated from biliary tract infections and uropathogenic Escherichia coli

Escherichia coli is a gram-negative intestinal commensal that can also cause various infections, including urinary tract infections, biliary tract infections, neonatal meningitis, and septicemia. Although the characteristics of uropathogenic E. coli and the mechanisms of urinary tract infection have been well studied, the genetic distinctions among E. coli isolates from different types of infections have not yet been determined. This study compared the phylogenetic and virulence factors of E. coli isolates from bacteremic biliary tract infections with those from bacteremic urinary tract infections. The phylogenetic B2 group was the most prevalent in both pathogenic groups (68 % in biliary pathogenic isolates and 85 % in uropathogenic isolates), but the frequency pattern of the phylogenetic group was different. Half of the uropathogenic isolates belonged to ST95 and ST131 (51 %). Among the biliary pathogenic isolates, ST131 was the most prevalent, while the remaining half belonged to other STs outside the four major STs. The frequency of some virulence factors, such as papC, papG2, hlyA, tcpC, fyuA, kpsMT2, sat, and traT, was lower in the biliary pathogenic isolates than in the uropathogenic isolates. The frequency of phylogenetic groups and STs in MLST differed between E. coli isolates from bacteremic biliary tract infections and urinary tract infections. Additionally, some virulence factors, including adhesion and toxin gene groups, showed lower frequencies in the biliary pathogenic group than in the uropathogenic group. Studying the differences in E. coli pathovars from different infection sites is important for developing pathovar-specific targeted therapies such as vaccine therapy.

Antibiotic Resistance Profiling and Phylogenicity of Uropathogenic Bacteria Isolated from Patients with Urinary Tract Infections.

Urinary tract infections (UTIs) are healthcare problems that commonly involve bacterial and, in some rare instances, fungal or viral infections. The irrational prescription and use of antibiotics in UTI treatment have led to an increase in antibiotic resistance. Urine samples (145) were collected from male and female patients from Lower Dir, Khyber Pakhtunkhwa (KP), Pakistan. Biochemical analyses were carried out to identify uropathogens. Molecular analysis for the identification of 16S ribosomal RNA in samples was performed via Sanger sequencing. Evolutionary linkage was determined using Molecular Evolutionary Genetics Analysis-7 (MEGA-7). The study observed significant growth in 52% of the samples (83/145). Gram-negative bacteria were identified in 85.5% of samples, while Gram-positive bacteria were reported in 14.5%. The UTI prevalence was 67.5% in females and 32.5% in males. The most prevalent uropathogenic bacteria were Klebsiella pneumoniae (39.7%, 33/83), followed by Escherichia coli (27.7%, 23/83), Pseudomonas aeruginosa (10.8%, 9/83), Staphylococcus aureus (9.6%, 8/83), Proteus mirabilis (7.2%, 6/83) and Staphylococcus saprophyticus (4.8%, 4/83). Phylogenetic analysis was performed using the neighbor-joining method, further confirming the relation of the isolates in our study with previously reported uropathogenic isolates. Antibiotic susceptibility tests identified K. pneumonia as being sensitive to imipenem (100%) and fosfomycin (78.7%) and resistant to cefuroxime (100%) and ciprofloxacin (94%). Similarly, E. coli showed high susceptibility to imipenem (100%), fosfomycin (78.2%) and nitrofurantoin (78.2%), and resistance to ciprofloxacin (100%) and cefuroxime (100%). Imipenem was identified as the most effective antibiotic, while cefuroxime and ciprofloxacin were the least. The phylogenetic tree analysis indicated that K. pneumoniae, E. coli, P. aeruginosa, S. aureus and P. mirabilis clustered with each other and the reference sequences, indicating high similarity (based on 16S rRNA sequencing). It can be concluded that genetically varied uropathogenic organisms are commonly present within the KP population. Our findings demonstrate the need to optimize antibiotic use in treating UTIs and the prevention of antibiotic resistance in the KP population.

Evaluating the Bacteria Profile and Drug Susceptibility Patterns of Urinary Tract Infectious Pathogens in Pregnant Women in Abakaliki Metropolis, Nigeria

Patient’s demographic data were obtained from a well-structured questionnaire administered before sample collection. A total of two hundred (200) early morning mid-stream urine samples were collected from pregnant women attending Mile 4 hospital to determine the prevalence of UTIs among pregnant women. The collected samples were analysis using Standard Microbiology protocol for isolation and identification of uropathogens. Antibiogram studies of uropathogens were determined using the Kirby–Bauer disk diffusion method and the results were analyzed and were compared with the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints. Results of isolation and characterization revealed an overall occurrence rate of 68(34.0%) bacteria consisting of a high distribution of E. coli 27(13.5%) followed by S. aureus 22 (11.0%) and Klebsiella pneumoniae 19 (9.5%). Socio-demographic data of patients revealed that those aged 42-49 years had a high frequency of bacteria 7(70.0%) followed by those aged 34-41 years 50.0%, 18-25 years 31.1% while those aged 26-33 year had the least isolation rate of 26.3%. The occurrence of UTI was highly predominant among patients with no formal level of Education 24(64.9%) than those with formal level of education 17(26.9%). The result of antibiogram studies shows that the isolates exhibited a high percentage of resistance to colistin 100%, azetronam 100% clindamycin 100%, and tetracycline 77.3% but were 92.6%-100% susceptible to cefoxitin, imipenem and amikacin. However, with substantial evidence in this study, cefoxitin, imipenem, and amikacin as drugs of choice could be used for the treatment of UTI, and further studies should be conducted by using highly sensitive and specific techniques such as Polymerase Chain Reaction (PCR), which is the technique used to make numerous copies of a specific segment of the deoxyribonucleic acid quickly and accurately, including genotypic characterization of resistant determinant in bacteria causing UTI among pregnant patients in a larger sample size.

Combined effects of antibiotics and acidified nitrite on biofilm formation by beta-lactamase-producing uropathogenic bacteria

Background and objective: The increased prevalence of extended- spectrum beta-lactamase producing Enterobacteriaceae has increased the use of last-resort antimicrobial drugs like Carbapenems. An alternative idea is to use new combinations of common antibiotics. The aim of the present study is to examine whether acidified nitrite has the ability to enhance the activity of beta-lactam antibiotics against the biofilm formation and bacterial growth of beta-lactamase- producing uropathogenic isolates. Methods: In this cross-sectional study, a total of 37 beta-lactamase- producing uropathogens were collected from patients at Urology Department at Rizgary Teaching Hospital in Erbil/Iraq. Biofilm formation was determined using a 96-well tissue culture plate assay. The ability to produce beta-lactamase production was detected by a phenotypic confirmatory combination disk diffusion test. The sub-minimal inhibitory concentration of antibiotics alone and in combination with each of acidified nitrite, ascorbic acid and sodium nitrite towards biofilm formation were observed. Results: The combination of cefotaxime with each of acidified nitrite (P <0.001), ascorbic acid (P <0.001) and sodium nitrite (P = 0.003) significantly enhanced the effect of cefotaxime against the biofilm producing activity of beta-lactamase producing uropathogens. Furthermore, with ceftazidime identical synergistic results were obtained with ascorbic acid (P = 0.001) and acidified nitrite (P = 0.007). Conclusion: Acidified nitrite significantly improved the activity of beta-lactam antibiotics against the biofilm mass of beta-lactamase producing uropathogens.

Protective Role of Betulinic Acid against Cisplatin-Induced Nephrotoxicity and Its Antibacterial Potential toward Uropathogenic Bacteria.

Acute kidney injury (AKI) is one of the major side effects of cisplatin, a remarkable anticancer agent. Therefore, there is a growing need to find an agent that could mitigate cisplatin-induced nephrotoxicity. Betulinic acid (BA) is a natural compound isolated from Silene succulenta Forssk for the first time, with miraculous biological activities and no reports of its effect on the nephrotoxicity induced by cisplatin. Mice received BA orally with doses of 30 and 50 mg/kg before the intraperitoneal injection of cisplatin. Betulinic acid was found to decrease serum levels of creatinine and tissue levels of NGAL and kidney injury molecule (KIM-1) and improve the histological changes in the kidney. In addition, BA decreased the oxidative stress marker malondialdehyde (MDA), increased superoxide dismutase (SOD) antioxidative activity and suppressed the intensity of IL-1B and NFкB immuno-staining. Interestingly, betulinic acid enhanced autophagy by increasing beclin 1, ATG5, and LC3II and decreasing p62 expressions. Thus, our findings suggest betulinic acid as a potential agent that may protect from acute kidney injury by targeting inflammation, oxidative stress, and autophagy processes. Novel drugs are needed to combat the spreading of multidrug resistance between pathogenic bacteria, especially uropathogenic isolates. So, we elucidated the antibacterial properties of BA on Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae. Betulinic acid had minimum inhibitory concentration values (128 to 512 µg/mL). In addition, it adversely affected the membrane integrity of the tested isolates. Accordingly, betulinic acid should be clinically investigated in the future for urinary tract diseases.

Detection and Characterization of hly,cdtI and stxI genes, in MDR uropathogenic and intestinal E.coli isolates, Hilla city, Iraq.

Background:. Escherichia coli infections represent a considerable burden in human. Illness caused by E. coli have a significant burden on patients and the healthcare system, so prompt recognition, and appropriate treatment are necessary. Escherichia coli is the first bacterial pathogen in humans responsible for deaths associated with antibiotic resistance
 Aim of study: detection of hly, cdtI and stxI genes through molecular analysis in MDR E.coli isolates.
 Methods: From November 2021 to May 2022, atotal of 150 urine samples were collected from patients suffering from urinary tract infections were admitted and visit Maternity and Children Babylon Hospital in Al-Hilla city. 100 stool samples were (as control). The identification and antibiotic susceptibility profile of E.coli were done by vitek2 compact system.The isolates were subjected to PCR assays with specific primers for hly , cdtI and stxI .
 Results: Only 50(45.5%) E.coli isolates were recovered from the urine samples. In contrast, 60(60%) E.coli isolates from the stool samples. A high rate of MDR was detected among E. coli isolates, where it was( 60%) and (53.3%) in the uropathogenic and intestinal isolates, respectively.
 The PCR results were showed that MDR uropathogenic E. coli and intestinal E.coli were hardbourd hly gene (46.7%)and (90.6%), respectively. The cdtI gene was detected in (43.4%) of uropathogenic E. coli, and (40.6%) of intestinal E.coli. The stx gene was detected in (16.7%) of uropathogenic E. coli, and (43.7%) of intestinal E.coli.
 Conclusion: The presence of a high percentage of toxin in intestinal E.coli is a serious warning because of the possibility of their becoming virulent if the bacteria change their natural habitat or are exposed to a certain stress.

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

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

Phenotypic Detection of Virulence Factors of Uropathogenic Enterobacteriaceae

Members of the family Enterobacteriaceae are the major cause of nosocomial infections, including approximately 70% of gastrointestinal infections, 60% to 70% of urinary tract infections (UTIs), and septicemias. Since 1990, members of Enterobacteriaceae have emerged as predominant pathogens causing UTIs. In this study, we performed phenotypic testing of the virulence factors in uropathogens. A total of 118 uropathogens belonging to the family Enterobacteriaceae were isolated from suspected UTI cases in patients aged > 18 years. Uropathogens were tested for virulence factors, such as hemolysin, phospholipase, gelatinase, and lipase production, as well as for mannose resistance, mannose-sensitive hemagglutination (MRHA, MSHA), serum resistance, and cell surface hydrophobicity. Among 118 uropathogenic Enterobacteriaceae isolates, E. coli was the most prevalent (62,52.5%), followed by Klebsiella (28,23.7%), Citrobacter (23,19.5%), and, Proteus species (5, 4.2%). Serum resistance was the most common virulence factor and was seen in 54(87%) of E. coli, 24 (85.7%) of Klebsiella species, 22 (95.7%) of Citrobacter species, and 5(100%) of Proteus species isolates. Furthermore, 10 (16.1%) isolates of E. coli showed mannose resistance hemagglutination and 7(11.3%) showed mannose-sensitive hemagglutination. Two (8.7%) isolates of Citrobacter species showed mannose resistance and mannose-sensitive hemagglutination. Hemolysis was observed in 33(53.2%) isolates of E. coli, 11(39.3%) of Klebsiella species, 15(65.2%) Citrobacter species, and 1(20%) Proteus isolate. Gelatinase production was observed in 14(22.6%) of E. coli, 6(21.4%) of Klebsiella species, 7(30.4%) of Citrobacter species, and 5(100%) of Proteus isolates. All E. coli, Klebsiella species, and Citrobacter species isolates tested negative for phospholipase. This study showed that the Enterobacteriaceae family plays a role in UTIs by evading the host immune response through the production of various virulence factors.

Occurrence of antibiotic resistant bacteria causing UTIs among children under school age in Soran city, North of Iraq

The current study was carried out to investigate the occurrence of multidrug resistant uropathogens among children under school age (six years old) in Soran city, North of Iraq. A total number of 200 urine samples were taken from children under six years old suffering from UTIs, attending Ashti hospital and Childbirth hospitals in Soran city from July 2017 to march 2018. High frequency of UTIs was among children less than two years old (34.3%) and incidence of UTIs was significantly higher in little girls (57.1%) than in little boys. 70 bacterial uropathogens have benn isolated while 130 samples showed negative culture. The diagnosis of isolates showed that the most common uropathogen was E. coli constituting 27 (38.6%), while others included; Staphylococcus aureus 13 (18.6%), coagulase negative staphylococci 8 (11.4)%, Klebsiella pneumonia 7(10%), Enterococcus faecalis 6 (8.6%), Streptococcus spp. 4 (5.7%), Pseudomonas aeruginosa 2 (2.9%), Staphylococcus saprophyticus 2 (2.9%) and Proteus vulgaris 1 (1.4%). Most of uropathogenic isolates have resisted ampicillin, ceftazidime, ceftriaxone and cefotaxime. Other antibiotics differently showed moderate susceptibilities. The most effective antibiotics were quinolones (ciprofloxacin and levofloxacin) and carbapenems (impenem and meropenem) which showed high susceptibility percentages on all isolates under study. Six multidrug have been chosen resistant isolates to detect the presence of qnrA, qnrB, qnrS and blaKPC responsible for quinolones and carbapenem resistance by using RABD-PCR. The DNA profile showed that only the isolate K 61 (Klebsiella pneumoniae) was bearing qnrB.

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

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