Uropathogenic Isolates Research Articles

Comparative Study of Hicrome Agar Medium with Conventional Culture System for the Isolation of Uropathogens

Objective: The present study was done to compare the performance of chromogenic agar medium and conventional culture media for the isolation and presumptive identification of uropathogen.Methodology: A total 300 sample were collected from Rajshahi Medical College Hospital, Bangladesh during January to June, 2008. Urine samples of the suspected UTI cases, showing pus cells >5/HPF on microscopic examination were included for urine culture simultaneously onto 2 conventional media (Blood agar and MacConkey agar) and chromogenic agar medium (HiCrome UTI agar medium). Results: Culture yielded 139 (46.33%) bacterial growth among them, 133 (44.33%) showed single organism and remaining 06 (2.00%) showed mixed growth of two organisms in different combinations. It is evident from the present study that both HiCrome UTI agar and Blood agar (BA) media supported growth of all 145 bacteria, while MacConkey (MAC) agar yielded 133(91.72%) bacterial growths. The rate of presumptive identification of the isolates was found significantly higher (97.24%) on HiCrome UTI agar when compared with the MacConkey agar (80.68%) and Blood agar (27.58%) media. Out of 91 E. coli isolated, 88(96.70%) could be identified differentially on HiCrome UTI agar medium in contrast to 85(93.40%) on MacConkey agar and only 06(06.59%) on Blood agar. Again, all 06 (100%) of the isolate-pairs of mixed growth were identified distinctly on HiCrome UTI agar, whereas both Blood agar and MacConkey agar media could revealed only 01(16.66%) of the polymicrobial growth.Conclusion: HiCrome UTI agar medium has been documented for its very high yielding rate, rapid presumptive identification of both single and polymicrobial growths with greater precision and avoidance of biochemical tests for further identification of uropathogens. Thus it can be recommended as primary urine culture medium to be used by the clinical microbiology laboratories.TAJ 2011; 24(2): 128-135

Prevalence and Antibiotic Resistance of Bacteria Isolated from Urinary Tract Infections of Pregnant Women in Baghdad Hospitals

The aim of this study was investigating the drug resistance patterns of bacteria isolated from pregnant women with urinary tract infections (UTIs). This study included 1140 pregnant women attending two of main hospitals in Baghdad, Iraq, between September 2016 and August 2017. The isolation and identification of uropathogenic bacteria conducted by standard microbiological methods and Vitek2 system. The disc diffusion test was used to determine the antimicrobial resistance patterns of the isolated bacteria. The present study revealed that three hundred and fifty six isolates were positive for significant bacterial growth. Escherichia coli were the predominant bacteria (34 %) followed by Staphylococcus aureus (22.2 %), Klebsiella spp. (14.6 %), non-coagulase Staphylococcus (11.5 %), Proteus spp. (4.5 %), Pseudomonas spp. (3.7 %), Acinetobacter spp. (2.8 %), Citrobacter (2.8 %), Enterococcus (2.5 %) and Enterobacter (1.4 %). High resistance to Ampicillin (85.6 %), Co-trimoxazole (72.2 %) and Tetracycline (71.3 %) was observed. Also, It was found a moderate resistance to Ceftazidime, Ciprofloxacin, Amoxicillin-clavulanic acid and Ceftriaxone. Imipenem was the most active antibiotic against isolated uropathogens. Among the 356 uropathogenic isolates, 196 (55 %) were from women in the 21 to 30 years old age group, and this rate was higher than other age groups. In conclusion, urinary tract infections are frequent among pregnant women. Early detection and continuous monitoring of antibiotic resistance pattern is very important to determine the appropriate treatment of UTIs among pregnant women without complications.

Antibiogram of the Common Uropathogenic Bacteria among Yemeni Patients in Sana’a City: A Recent Report

Aims: This study aimed to identify the prevalence and antimicrobial susceptibility of the commonly isolated uropathogens in Sana’a city, Yemen.
 Study Design: A cross-sectional and descriptive study.
 Place and Duration of Study: The study was carried out at the hospitals and clinics of Sana'a city, Yemen between October 2016 and March 2017.
 Methodology: Clean-catch mid-stream urine samples were collected to detect the most common uropathogenic bacteria and their antibiotic susceptibility using Kirby Bauer standardized method.
 Results: Urine cultures yielded 170 significant bacterial growths of uropathogens. Escherichia coli was the most often isolated pathogen (43.5%), followed by Klebsiella pneumoniae (24.7%), Pseudomonas aeruginosa (20.0%) and Staphylococcus aureus (11.8%). The overall sensitivity was high to an excellent pattern for Carbapenems, Nitrofurantoin, Amikacin, and Piperacillin-Tazobactam. Escherichia coli shows an excellent sensitivity (88%) for Nitrofurantoin and Imipenem, followed by (85%) Ertapenem. Pseudomonas aeruginosa exhibited moderate resistance to Carbapenems, Moxifloxacin, and Piperacillin-Tazobactam in this study. Staphylococcus aureus was more vulnerable to all Quinolones except Nalidixic acid and it displays a high sensitivity pattern, 90% for both Nitrofurantoin and Gentamicin, 83% for Penicillin, 80% for both Minocycline. Antibiogram of isolated organisms revealed that there was resistance to two and more antimicrobials.
 Conclusion: In this study, we observe a high resistance rates to Beta-lactam, Quinolones, and Macrolides antibiotics. Nevertheless, most uropathogenic isolates were still sensitive to Nitrofurantoin, Imipenem, Ertapenem, and Amikacin, they considered as a proper antibiotics for empirical therapy of UTIs. Establishment of antibiogram of locally isolated organisms is necessary to avoid indiscriminating use of antibiotic and to decrease the resistance rate in our community.

Clinical Utility of Antibiotic against Uropathogen Isolated at a Tertiary Care Hospital of Dhaka City

Background: The antibiotic sensitivity pattern of uropathogenic bacteria is varied with different frequency. Objective: The purpose of the study was to determine the pattern of antibiotic sensitivity against uropathogens isolated from a tertiary care hospital of Dhaka City. Methodology: A cross-sectional study was conducted in the Department of Microbiology at Shaheed Suhrawardy Medical College, Dhaka, Bangladesh during period of January 2016 to December 2016. Among 307 consecutive urine samples were collected from patients of UTI in the microbiology laboratory. Samples were mid-stream urine specimens obtained by clean catch method received from various outpatient departments and inpatient wards were transported to the microbiology laboratory in sterile leak proof container were processed immediately. Bacteria were isolated and identified by standard laboratory procedure. Results: Of the 307 urine samples processed 170(55.4%) gave significant growth of pathogens. The prevalence of UTI is high among females (58.2%) than males (41.8%). The commonest isolates were Escherichia coli (71.2%), Pseudomonas (12.4%), Staphylococcus aureus (10.6%), Acinotobactor (4.1%) and Klebsiella (1.8%). Majority (92.4%) of (uropathogens) isolates were found to be MDR. Conclusion: The study revealed that E. coli is the predominant uropathogens of UTIs.

Prevalence and antibiotic susceptibility of Uropathogens from cases of urinary tract infections (UTI) in Shashemene referral hospital, Ethiopia

BackgroundUrinary tract infection (UTI) remains to be one of the most common infectious diseases diagnosed in developing countries. And a widespread use of antibiotics against uropathogens has led to the emergence of antibiotic resistant species. A laboratory based cross-sectional survey was conducted in Shashemene referral hospital to determine the prevalence and antibiotic susceptibility of uropathogens.MethodsWe have collected 384 clean catch mid-stream urine samples from all suspected UTI outpatients using sterile screw capped container. The urine samples were cultured and processed for subsequent uropathogens isolation. The isolated pure cultures were grown on BiOLOG Universal Growth agar (BUG) and identified using GEN III OmniLog® Plus ID System identification protocols. The identified species were then exposed to selected antibiotics to test for their susceptibility.ResultsThe overall prevalence of urinary tract infection in the area was 90.1%. Most frequently isolated uropathogen in our study was Escherichia coli (39.3%). While, Staphylococcus species (20.2%), Leuconostoc species (11.4%), Raoultella terrigena/Klebsiella spp./ (8.4%), Salmonella typhimurium (6.3%), Dermacoccus nishinomiyaensis (6.3%), Citerobacter freundii (5.2%) and Issatchenkia orientalis/Candida krusei/ (2.7%) were the other isolates. We find that the relationship between uropathogens and some of UTI risk factors was statistically significant (P < 0.05). Gentamicin was the most effective drug against most of the isolates followed by chloramphenicol and nitrofurantoin. In contrast, amoxicillin, vancomycin and cephalexin were the antibiotics to which most of the isolates developed resistance.ConclusionUrinary tract infection was highly prevalent in the study area and all uropathogens isolated developed a resistance against mostly used antibiotics.

Assessment of the comparability of CLSI, EUCAST and Stokes antimicrobial susceptibility profiles for Escherichia coli uropathogenic isolates

Background: As many clinical laboratories convert between Stokes, Clinical and Laboratory Standards Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) methods, the problem of comparing differently derived sets of antimicrobial susceptibility testing (AST) data with each other arises, owing to a scarcity of knowledge of inter-method comparability. The purpose of the current study was to determine the comparability of CLSI, EUCAST and Stokes AST methods for determining susceptibility of uropathogenic Escherichia coli to ampicillin, amoxicillin-clavulanate, trimethoprim, cephradine/cephalexin, ciprofloxacin and nitrofurantoin.Methods: A total of 100 E. coli isolates were obtained from boric acid urine samples from patients attending GP surgeries. For EUCAST and CLSI, the Kirby-Bauer disc diffusion method was used and results interpreted using the respective breakpoint guidelines. For the Stokes method, direct susceptibility testing was performed on the urine samples.Results: The lowest levels of agreement were for amoxicillin-clavulanate (60%) and ciprofloxacin (89%) between the three AST methods, when using 2017 interpretive guidelines for CLSI and EUCAST. A comparison of EUCAST and CLSI without Stokes showed 82% agreement for amoxicillin-clavulanate and 94% agreement for ciprofloxacin. Discrepancies were compounded by varying breakpoint susceptibility guidelines issued during the period 2011–2017, and through the inclusion of a definition of intermediate susceptibility in some cases.Conclusions: Our data indicate that the discrepancies generated through using different AST methods and different interpretive guidelines may result in confusion and inaccuracy when prescribing treatment for urinary tract infection.

Antibiotics Resistance Profile of Uropathogens Isolated from Al Buraimi Hospital, Sultanate of Oman

BACKGROUND: Urinary tract infections (UTIs) is a worldwide problem of all age groups and gender. Emerging resistance to antibiotics making difficult in the choice of treatment and management of UTI cases. This study sought to determine the gender wise prevalence of common uropathogens from UTI patients and the resistance profile of uropathogens against commonly used antibiotics.METHOD: This cross sectional study was conducted in Al Buraimi Hospital, Sultanate of Oman. The data of UTI patients visited hospital was analyzed for the isolation of uropathogens from positive urine culture and antimicrobial sensitivity test was performed by disc diffusion method. Descriptive statistics was used to analyze the data using SPSS 21.0 and Microsoft Excel.RESULT: Total 4,480 urine samples were analyzed for isolation of uropathogens and significant bacteriuria were found in total 846 (19%) samples. Overall 728 (86%) Gram-negative and 118 (14%) Gram positive uropathogens were isolated from total (846) positive urine samples and the highest prevalence of isolates was observed in females 542(74%) than males 186(26%). E.coli was found the highest prevalent (50.3%) uropathogens followed by Klebsiella species (13.9%), Pseudomonas (6.3%), A.baumannii (4%), E.Cloacae (2.2%), Proteus species (1.4%), Citrobacter species (1.2%), M. morgani (0.3%) and Serratia species (0.1%). The highest (34.3%) antibiotic resistance was noticed in E.coli against Nalidixic Acid, however, susceptiblity was found against Ceftriaxone, Ceftazidime, Ciprofloxacin and Nitrofurantoin among female and males.CONCLUSION: Overall, β- lactam antibiotics, Cephalosporins, Fluroquiolones, Macrobids would be the first line of drugs and the most effective for the empirical treatment of Gram-negative and Gram-positive uropathogens; however Aminoglycosides, Carbapenems and Polymyxin could be used for the treatment of UTI infections as the second choice.

Bacterial Uropathogens and their Antibiotic Sensitivity Pattern at a Tertiary Care Hospital in Birgunj, Nepal

Urinary tract infection is the second most common infection following respiratory tract infection. Among the outdoor and the indoor patients it is one of the common clinical state of affairs. For the effective management of this common clinical condition isolation of the common bacterial uropathogens and their antibiotic sensitivity profile is obligatory. In this present brief work an effort has been made to isolate the common bacterial uropathogen and their susceptibility pattern to the regularly used antimicrobial agents. We carried out this work in the Microbiology department of National Medical College from June 2016 to December 2016. In our study beside clean catched mid stream urine sample, catheterized urine sample and suprapubic aspirates are also collected. In our study we included a total of 516 UTI samples of patients. In our work 319 (62%) culture positive urine samples were from outpatient patient department while 197 (38%) were from inpatient department. Among both the outdoor and the indoor patient E. coli was the predominant organism followed by Klebsiella, Staphylococci, Enterococci and Pseudomonas. In our present work we found that the common bacterial isolates from the indoor patient showed higher degree resistance towards Aminopenicillin, Piperacillin, Nitrofurantoin, Ciprofloxacin and Nalidixic acid. Common bacterial uropathogens were found to be sensitive against Norfloxacin, Nitrofurantoin and Cephalosporins like Cefuroxime and Ceftazidime. It has also been found that beside E. coli other bacterial uropathogens were effective against third generation Cepahalosporins and Amikacin. This study clearly denotes that antibiotic sensitivity test should be carried out for determination of optimal treatment regimen against UTI.Med Phoenix Vol.2(1) July 2017, 74-77

Correlation between Biofilm Production and Bacterial Urinary Tract Infections: New Therapeutic Approach

BIOFILMS production during bacterial urinary tract infections (UTIs), being responsible for persistence and relapses. Bacterial producing biofilms are difficult to be eradicated as they reveled antibiotics resistant phenotype that correlated to provided protections by biofilms. The present study revealed that the gram negative bacteria (G-ve) were the most common uropathogenic bacteria causing UTIs with 64.28% biofilm producing ability especially Escherichia coli and Klebsiella pneumoniae. While, gram positive bacteria (G+ve) represented 23.63% of UTIs with 57.69% biofilm producing ability. The isolated uropathogenic bacteria demonstrated a high and widespread resistance (50% to 95 %) to all used antibiotics except Nitrofurantoin and Imipenem. The most antibiotics resistant uropathogenic isolates were biofilm producers and some of them revealed haemolytic activity. The present study indicated the importance of studying biofilm producing ability of uropahogenic bacteria as it represented 62.72% during UTIs. The anti-biofilm activity of cell free supernatant of Lactobacillus plantarum subsp. plantarum DSMZ 20174 and Lactobacillus acidophilus DSMZ 20079T against biofilms of both G-ve and G+ve uropathogenic bacteria beside their acid and bile salt tolerance gave potentiality for their use during UTIs as a beneficial tool for dissociation or prevention of biofilms and enable antimicrobial drugs from eradication of infections.

Antibiotic Sensitivity Pattern of Uropathogens at Khwaja Yunus Ali Medical College Hospital

Increasing resistance among urinary tract pathogens to conventional drugs is found alarming worldwide. The aim of this study was to obtain data on susceptibility patterns of isolated uropathogens from urine samples of patients attending at Khwaja Yunus Ali Medical College Hospital, Enayetpur, Sirajgonj, Bangladesh a tertiary health care center of remote area to currently used antimicrobial agents. A total of 656 urine samples were studied of which 163 (24.8%) were culture positive. Among 163 culture positive cases all uropathogenic isolates were identified. Among the isolates, E. coli was the most predominant 116 (71.1%) followed by Pseudomonas aeruginosa 29 (17.8%). Staphylococcus saprophyticus 12 (7.4%) and Klebsiella pneumoniae 4 (2.4%) and Acenatobacter sp. 2 (1.2%). The majority of isolated E. coli were sensitive to Meropenam (58.6%) and Amikacin (57.7%) followed by gentamicin (52.6%), amoxiclav (43.1%), ciprofloxacin (42.2%). Sensitivity &amp; resistance rate in Staphylococcus saprophyticus were same (50%) in Cephradine . Where complete (100%) resistanc e was shown to Ampicillin in Pseudomona s aeruginosa , Klebsiella pneumoniae and Acenatobacter sp. However most of isolates were poorly sensitive to ampicillin (1.7%), erythromycin (2.5%), cefuroxin (3.4%) and amoxicillin (9.5%). This area-specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for UTIs and their resistance patterns may help the clinician to choose the right empirical treatment. Meropenem, amoxiclav, amikacin, gentamicin, second-generation of both cephalosporins and quinilones are found the most sensitive against the common uropathogens which might be used in the treatment of UTI.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 610-613

Detection of CTX-M-15 Among Uropathogenic Escherichia coli Isolated from Five Major Hospitals in Tripoli, Libya.

Multidrug resistance (MDR) and emergence of extended-spectrum β-lactamases (ESBLs) among uropathogenic Escherichia coli have been reported worldwide, but there was no information on the detection of blaCTX-M-15 in major teaching hospitals in Libya. The aim of the study was to investigate the occurrence of CTX-M-15 β-lactamases producers isolated from five teaching hospitals in Tripoli, Libya. A total of 346 urine samples were collected from hospitalized patients in five teaching hospitals with a diagnosis of urinary tract infection (UTI). Phenotypic confirmation of ESBLs was confirmed by E-test strip; all ESBL-producing E. coli isolates were screened for the blaCTX-M-15 gene. The distribution of ESBL-producing E. coli varied among the five hospitals. The highest proportion was identified in Tripoli Medical Centre (67.6%). There were extremely high proportions of isolates resistant to ceftriaxone, cefepime, and ceftazidime (93.0-100.0%) among ESBL producers compared to non-ESBL producers (2.2-4.7%). MDR was detected in 22.2% of isolates. The majority of isolates (85.9%) in which blaCTX-M-15 was identified were ESBL producers. There was a correlation (p < 0.001) between expression of CTX-M-15 and resistance to ceftazidime. The isolation of MDR ESBL-producing uropathogens expressing the CTX-M-15 gene will limit the choices clinicians have to treat their patients with UTIs. Continued surveillance and implementation of efficient infection control measures are required.

Plasmid-Mediated Quinolone Resistance (PMQR) Genes and Class 1 Integrons in Quinolone-Resistant Marine Bacteria and Clinical Isolates of Escherichia coli from an Aquacultural Area.

Antimicrobial usage in aquaculture selects for antimicrobial-resistant microorganisms in the marine environment. The relevance of this selection to terrestrial animal and human health is unclear. Quinolone-resistance genes qnrA, qnrB, and qnrS were chromosomally located in four randomly chosen quinolone-resistant marine bacteria isolated from an aquacultural area with heavy quinolone usage. In quinolone-resistant uropathogenic clinical isolates of Escherichia coli from a coastal area bordering the same aquacultural region, qnrA was chromosomally located in two E. coli isolates, while qnrB and qnrS were located in small molecular weight plasmids in two other E. coli isolates. Three quinolone-resistant marine bacteria and three quinolone-resistant E. coli contained class 1 integrons but without physical association with PMQR genes. In both marine bacteria and uropathogenic E. coli, class 1 integrons had similar co-linear structures, identical gene cassettes, and similarities in their flanking regions. In a Marinobacter sp. marine isolate and in one E. coli clinical isolate, sequences immediately upstream of the qnrS gene were homologous to comparable sequences of numerous plasmid-located qnrS genes while downstream sequences were different. The observed commonality of quinolone resistance genes and integrons suggests that aquacultural use of antimicrobials might facilitate horizontal gene transfer between bacteria in diverse ecological locations.

Antibiotic Resistance and Virulence Phenotypes of Recent Bacterial Strains Isolated from Urinary Tract Infections in Elderly Patients with Prostatic Disease.

Acute bacterial prostatitis is one of the frequent complications of urinary tract infection (UTI). From the approximately 10% of men having prostatitis, 7% experience a bacterial prostatitis. The purpose of this study was to investigate the prevalence of uropathogens associated with UTIs in older patients with benign prostatic hyperplasia and to assess their susceptibility to commonly prescribed antibiotics as well as the relationships between microbial virulence and resistance features. Uropathogenic Escherichia coli was found to be the most frequent bacterial strain isolated from patients with benign prostatic hyperplasia, followed by Enterococcus spp., Enterobacter spp., Klebsiella spp., Proteus spp., Pseudomonas aeruginosa, and Serratia marcescens. Increased resistance rates to tetracyclines, quinolones, and sulfonamides were registered. Besides their resistance profiles, the uropathogenic isolates produced various virulence factors with possible implications in the pathogenesis process. The great majority of the uropathogenic isolates revealed a high capacity to adhere to HEp-2 cell monolayer in vitro, mostly exhibiting a localized adherence pattern. Differences in the repertoire of soluble virulence factors that can affect bacterial growth and persistence within the urinary tract were detected. The Gram-negative strains produced pore-forming toxins—such as hemolysins, lecithinases, and lipases—proteases, siderophore-like molecules resulted from the esculin hydrolysis and amylases, while Enterococcus sp. strains were positive only for caseinase and esculin hydrolase. Our study demonstrates that necessity of investigating the etiology and local resistance patterns of uropathogenic organisms, which is crucial for determining appropriate empirical antibiotic treatment in elderly patients with UTI, while establishing correlations between resistance and virulence profiles could provide valuable input about the clinical evolution and recurrence rates of UTI.

Comparative Study Between Different Types of Media used for the Isolation of Uropathogens with Special Reference to E. coli

Escherichia coli is the greatest cause of primary urinary tract infections. The present study aimed Urinary tract infection in female with special reference Escherichia coli and its antibiotic susceptibility pattern. A total of 100 urine samples were collected from different hospitals of Allahabad. The samples were cultured on Cystein lysine electrolytes deficiency media, MacConkey’s agar, Nutrient agar and Hicrome UTI agar media. Based on the results it was found that different media had different properties and Hicrome UTI agar was the best and convenient media for the isolation of Escherichia coli and other uropathogens. Further it was also observed that Escherichia coli was the most common organism for UTI in female.

Screening of ESBL Producing Multidrug Resistant E. coli from Urinary Tract Infection Suspected Cases in Southern Terai of Nepal

Background and objectives: Multidrug-resistant E. coli expressing extended-spectrum β-lactamase pose serious challenges to clinicians for the therapeutic management of clinical cases in urinary tract infection. The ability of beta-lactamase to cause resistance varies with its activity, quantity, cellular location of gram-negative organisms and its permeability of the producer strain. Therefore, this study was focused to determine the dominance of MDR E. coli and evaluation of status of β-lactamase enzyme produced by MDR E. coli. Materials and methods: A total of 321 successive midstream urine samples were processed among suspected cases of urinary tract infection. Standard microbiological techniques were used for isolation and identification of uropathogens. The antimicrobial susceptibility pattern of bacterial isolates was determined by Kirby-Bauer Disc Diffusion technique. The MDR E. coli isolates were screened for ESBL by double disc synergy test and confirmed with combined disc diffusion test. The p- value<0.05 was considered as statistically significant. Results: The maximum numbers of MDR E. coli isolates were isolated as of female patients with 55.75% than male of 44.24%. Most of the MDR E. coli isolates were isolated from less than 20 years with 30.97% and was dropped in between 40-60 years with 20.35%. The MDR E. coli isolates in association with gender and age group was found to be statistically insignificant (p=0.310). Among 69 suspected ESBL E. coli isolates, 62.31% were confirmed as ESBL producer. Conclusion: E. coli isolates showed shocking rate of drug resistance to the frequently prescribed drugs. The high rate of ESBL-producing MDR E. coli was also observed. There is an increasing need for periodic monitoring of drug susceptibility pattern to prevent the spread and development of antimicrobial resistant strains and ESBL producers.

Slime production among uropathogenic bacterial isolates: Evaluating different phenotypic detection methods.

Background: Biofilms are surface associated bacterial communities surrounded by a matrix of Exo -polymers. Biofilms contribute to the development of chronic urinary infections, refractory to antibiotic therapy. Methods: This prospective study was done on 150 non-repetitive urine samples from catheterized patients. Semi-quantitative bacterial culture was performed and isolates were identified by standard biochemical tests. Biofilm formation was detected by Congo Red Agar Method (CRA), Tube Method (TM) and Tissue Culture Plate Method (TCP). Result: Significant bacteriuria was observed among 113/150(74.66%) samples. Gram negative bacteria (GNB) were predominant isolates 101(89.38%) and among GNB, Escherichia coli was commonly isolated 30/101(29.70%).Non E.coli Enterobacteriaceae (NECE) isolates include Klebsiella spp . 25/101(24.75%), Citrobacter spp 07/101(6.93%), Proteus spp . 17/101(16.83%) among non-fermenter bacteria Pseudomonas aeruginosa 21/101(20.79%).Gram positive (GPB) constitute 12/113(10.61%) among total isolates. Biofilm producers detected by TCP 79(69.91%), TM 60(53.09%) and CRA 11(9.73%) respectively. Conclusion: Detection of biofilms can be recommended for recurrent and recalcitrant infections before institution of empirical antibiotics. TCP method with good reproducibility and specificity which can be used for detection of biofilms in resource limited settings. DOI: 10.21276/apalm.2017.1064

Clinical profile and gram negative bacterial profile of urinary tract infection in children attending a tertiary care hospital of Tamilnadu, India

Background: Urinary tract infection (UTI) is one of the most common infections caused by bacterial pathogens seen mostly in developing countries. This study was done to assess the clinical and gram negative bacterial profile of pathogens causing urinary tract infection, which helps the clinician to diagnose early and give presumptive antibiotic to prevent complications.Methods: Specimen was collected in sterile, leak proof container by clean catch mid-stream technique. Isolation of uropathogens was performed by a surface streak procedure on both blood agar and Mac Conkey Agar (Himedia, India) using semi quantitative method by using standard loop technique and Identified as per standard CLSI guidelines. Antibiogram of the isolates was performed and read as per standard manufacturer’s instructions.Results: UTI was more common in female children than male, and half were in the age group 1-5 years. Fever is the most common presentation (58.6%) followed by dysuria (46.4%) abdominal pain (45%) and decreased appetite (23.6%). Escherichia coli was the most common (73.6%) isolate followed in order by Klebsiella sps (15.7%), Citrobacter sps (2.1%) Proteus sps (5%) and Pseudomonas sps (3.5%). Nitrofurantoin (86%) was the most sensitive antibiotic followed by cefexime (84.7%), gentamicin (82%) and ciprofloxacin (81%) for E. coli. Klebsiella was sensitive to gentamycin, ciprofloxacin. Greater degree of resistance was noted to ampicillin, cotrimoxazole and nalidixic acid.Conclusions: The common clinical feature assosciated with UTI was fever and commonest causative organism for UTI was E. coli. The appropriate antibiotic in-vitro were cefexime and gentamicin in this study. Higher degree of resistance was found in antibiotics such as amipicllin, cotrimioxazole, cephalexin, nalidixicacid.

Assessment of urinary tract infection and their resistance to antibiotics in diabetic and non-diabetic patients

Diabetic patients are more susceptible to urinary tract infections (UTIs) than non-diabetic patients and due to the development of multidrug resistant uropathogenic strains, the choice of antibacterial agents is being limited. The study was undertaken to determine the influence of diabetes mellitus on the uropathogens and antibiotic sensitivity pattern among patients with UTIs. A cross-sectional study was conducted in which total of 400 patients were studied out of which 150 were diabetics and 250 were non-diabetics. Patients with negative urine culture (n = 240) were excluded from the study and 160 patients with positive culture of UTIs of which 80 were diabetics and 80 were non-diabetics, included in this study. Clinical data were obtained from individual study participant with informed written consent using pre-tested questionnaire. According to the clean-catch procedure, midstream urine samples were collected and cultured for the diagnosis and susceptibility of bacteriuria. Out of 160 uropathogenic isolates, E. coli was found as a leading pathogen i.e. 46.25% followed by Candida spp. 30.62%, S. Faecalis 15.62%, P. aeruginosa 3.13%, Pneumococcus. 1.25%, MSSA 1.25%, MRSA 0.63%, Proteus spp. 0.63% and Vancomycin resistant enterococcus spp. 0.63%. The results indicated that prevalence of UTIs was significantly higher in diabetic patients than in non-diabetic subjects. E. coli was found to be the most common isolate. It was observed that UTIs in diabetic patients was more in female diabetic patients than in male patients. Investigation of bacteriuria in diabetic patients for UTIs is an important tool for the treatment and prevention of renal complications.

Bacterial Etiologies and Antibiotic Susceptibility Pattern of Urinary Tract Infections at the Pediatric Ward of Dastgheib Hospital, Shiraz, Iran: A Three-Year Study (2009 - 2011)

Background: Urinary tract infection (UTI) is one of the most common infections in children. Timely diagnosis and appropriate treatment of UTI requires knowledge of etiologic agents and antibiotic resistance pattern of common uropathogens. Objectives: The aim of this study was to determine bacterial agents and their antibiotic susceptibility patterns at pediatric ward of Dastgheib hospital, Fars province, Shiraz, Iran. Patients and Methods: In this three-year (2009 - 2011) cross-sectional descriptive study, 2854 urine specimens were collected by midstream, urine bag, catheter and suprapubic methods from patients in the age range of 1 month to 14 years. For isolation of uropathogens, samples were cultured on differential and selective media and identified with biochemical tests. Antimicrobial susceptibility testing was then performed using the Kirby Bauer method, following the clinical and laboratory standard institute (CLSI) guidelines. All data were analyzed with the SPSS software (version 15). Results: The most common pathogen was Escherichia coli (65.2%) followed by Staphylococcus saprophyticus (10.9%). Escherichia coli isolates showed the highest and lowest resistance rates to cephalexin (60.5%) and imipenem (11.6%), respectively. Staphylococcus saprophyticus isolates were mostly susceptible to vancomycin (81%), followed by nitrofurantoin (76.8%); however, only 36% of staphylococcus saprophyticus isolates were susceptible to co-trimoxazole. Conclusions: In this study, like previous researches, E. coli was the most common pathogen. Our results suggested a high rate of antibiotic resistance to common antibiotics for treatment of UTI. Because of the high resistance to cephalexin, cefotaxime and cotrimoxazole, their use is not recommended for treatment of UTIs. Imipenem and vancomycin were the most active drugs against E. coli and Staphylococcus saprophyticus, respectively.

Measuring Escherichia coli Gene Expression during Human Urinary Tract Infections.

Extraintestinal Escherichia coli (E. coli) evolved by acquisition of pathogenicity islands, phage, plasmids, and DNA segments by horizontal gene transfer. Strains are heterogeneous but virulent uropathogenic isolates more often have specific fimbriae, toxins, and iron receptors than commensal strains. One may ask whether it is the virulence factors alone that are required to establish infection. While these virulence factors clearly contribute strongly to pathogenesis, bacteria must survive by metabolizing nutrients available to them. By constructing mutants in all major metabolic pathways and co-challenging mice transurethrally with each mutant and the wild type strain, we identified which major metabolic pathways are required to infect the urinary tract. We must also ask what else is E. coli doing in vivo? To answer this question, we examined the transcriptome of E. coli CFT073 in the murine model of urinary tract infection (UTI) as well as for E. coli strains collected and analyzed directly from the urine of patients attending either a urology clinic or a university health clinic for symptoms of UTI. Using microarrays and RNA-seq, we measured in vivo gene expression for these uropathogenic E. coli strains, identifying genes upregulated during murine and human UTI. Our findings allow us to propose a new definition of bacterial virulence.