Major Cause Of Urinary Tract Infections Research Articles

Comparison of Clinical, Etiological and Antibiotic Sensitivity Patterns of UTI in CAKUT and Non CAKUT Children

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of UTIs in this population. Objective: To compare clinical, etiological and antibiotic sensitivity patterns of UTIs in CAKUT and non-CAKUT children. Study Design: Prospective comparative study. Place and Duration: The study was conducted at the department of Pediatric Nephrology, The Children's Hospital Lahore from August 2023 to January 2024. Methods: 68 children with and without CAKUT having UTI were evaluated. Data regarding demographics, clinical presentation and antibiotic sensitivity pattern was collected. Susceptibility testing was done according to CLSI recommendations. Results: 34 patients with UTI in CAKUT group (Group A) had male predominance (73.5%) while children without CAKUT (Group B) were predominantly females (55.9%). Mean age in Group A (38.9 months) was less than that in Group B (53.9 months). The common presentations in both the groups were pyelonephritis and cystitis. Vesico-ureteric reflux (32.4%) and posterior urethral valves (29.4%) were the most common CAKUT findings. Majority of patients with CAKUT had Pseudomonas UTI (32.4%) while E. coli (35.3%) was common in children without CAKUT. Fosfomycin, Colistin, Linezolid and Polymyxin B had low resistance amongst both groups. The association between CAKUT and atypical uropathogens was not found to be statistically significant (p = 0.287). Conclusion: Differences exist in clinical presentation, etiology and antibiotic sensitivity patterns specific to UTI in CAKUT and non-CAKUT children. A high resistance pattern was found amongst common antibiotics.

Combined functional genomic and metabolomic approaches identify new genes required for growth in human urine by multidrug-resistant Escherichia coli ST131.

Uropathogenic Escherichia coli (UPEC) cause ~80% of all urinary tract infections (UTIs), with increasing rates of antibiotic resistance presenting an urgent threat to effective treatment. To cause infection, UPEC must grow efficiently in human urine (HU), necessitating a need to understand mechanisms that promote its adaptation and survival in this nutrient-limited environment. Here, we used a combination of functional genomic and metabolomic techniques and identified roles for the metabolism of small peptides, amino acids, nucleotides, and L-lactate, as well as the stringent response pathway, lipopolysaccharide biosynthesis, and fluoride resistance, for UPEC growth in HU. We further demonstrated that pathways involving nucleotide metabolism and the stringent response are required for UPEC colonization of the mouse bladder. The UPEC genes and metabolic pathways identified in this study represent targets for the development of innovative therapeutics to prevent UPEC growth during human UTI, an urgent need given the rapidly rising rates of global antibiotic resistance.

BlaCTX-M Mediated Extended Spectrum Beta-lactamase Production in Escherichia coli from Urine Samples

Objective: To assess the antimicrobial pattern of Escherichia coli isolates from urine samples, determine the proportion of multidrug resistant (MDR) and extended spectrum beta-lactamase (ESBL) and blaCTX-M gene of E. coli from the urine samples. Methods: A total of 2452 urine samples were collected and processed from April to October 2023 in clinically suspected urinary tract infection (UTI) patients attending B&B Hospital Pvt. Ltd to identify possible bacteria using standard microbiological procedures. E coli isolates were further subjected to antimicrobial susceptibility testing using Kirby Bauer disk diffusion method. Combination disk method was used to identify the ESBL phenotypes. Molecular detection of blaCTX-M gene was performed using conventional polymerase chain reaction. Results: A total of 338 (13.7%) samples showed significant bacterial growth. Maximum bacterial growth was found in outpatients (70.4%) and in patients above 60 years of age. Gram negative bacteria (87.8%) were predominant and E. coli (54.4%) was the most frequent. Nitrofurantoin, Aminoglycosides, Carbapenems and Polymixins were effective antibiotics. Among 184 E. coli isolates, 54 (29%) were MDR, 30 (16.3%) were ESBL producer. blaCTX-M gene was detected in 90% of the phenotypically confirmed ESBL producers. Conclusion: E. coli is the major cause of UTI and blaCTX-M is a prime contributor of ESBL production. High rate of resistance to third-generation Cephalosporins, Flouroquinolones and Cotrimoxazole make these antibiotics unsuitable for the treatment of UTI.

Uropathogenic Escherichia coli biofilms

Urinary tract infection (UTI) is one of the most common infectious diseases, with a global annual incidence of ~175 million cases. Uropathogenic Escherichia coli (UPEC) is the major cause of UTI (>80%) and increasingly associated with rising antibiotic resistance. UPEC form biofilms during infection of the urinary tract, either on the luminal surface of the bladder, intracellularly within bladder superficial epithelial cells, or on the surface of indwelling catheters. This lifestyle of sessile growth promotes enhanced resistance, persistence and increased rates of recurrent UTI. UPEC employ a range of virulence factors to form biofilms, including fimbrial adhesins for attachment and autotransporters to promote cell-to-cell aggregation. In addition, UPEC biofilms are encased in an extracellular matrix comprised of proteins such as curli amyloid fibres and polysaccharides such as cellulose, which together form a hydrating glue that provides structural support for the biofilm and protects its component cells. Here, we describe the key features of UPEC biofilms and their importance for UPEC pathogenesis of the urinary tract.

Identification and Ranking of Clinical Compounds with Activity Against Log-phase Growing Uropathogenic Escherichia coli.

Uropathogenic Escherichia coli (UPEC) is a major cause of Urinary Tract Infections (UTIs). Due to increasing antibiotic-resistance among UPEC bacteria, new treatment options for UTIs are urgently needed. To identify new agents targeting growing bacteria that may be used for the treatment of antibiotic-resistant UTIs. We screened a clinical compound library consisting of 1,524 compounds using a high throughput 96-well plate assay and ranked the activities of the selected agents according to their MICs against the UPEC strain UTI89. We identified 33 antibiotics which were active against log-phase clinical UPEC strain UTI89. Among the selected antibiotics, there were 12 fluoroquinolone antibiotics (tosufloxacin, levofloxacin, sparfloxacin, clinafloxacin, pazufloxacin, gatifloxacin, enrofloxacin, lomefloxacin, norfloxacin, fleroxacin, flumequine, ciprofloxacin), 15 beta-lactam or cephalosporin antibiotics (cefmenoxime, cefotaxime, ceftizoxime, cefotiam, cefdinir, cefoperazone, cefpiramide, cefamandole, cefixime, ceftibuten, cefmetazole, cephalosporin C, aztreonam, piperacillintazobactam, mezlocillin), 3 tetracycline antibiotics (meclocycline, doxycycline, tetracycline), 2 membrane-acting agents (colistin and clofoctol), and 1 protein synthesis inhibitor (amikacin). Among them, the top 7 hits were colistin, tosufloxacin, levofloxacin, sparfloxacin, clinafloxacin, cefmenoxime and pazufloxacin, where clinafloxacin and pazufloxacin were the newly identified agents active against UPEC strain UTI89. We validated the key results obtained with UTI89 on two other UTI strains CFT073 and KTE181 and found that they all had comparable MICs for fluoroquinolones while CFT073 and KTE181 were more susceptible to cephalosporin antibiotics and tetracycline antibiotics but were less susceptible to colistin than UTI89. Our findings provide possible effective drug candidates for the more effective treatment of antibiotic-resistant UTIs.

Sensitivity of microorganisms associated with urinary tract infections to some antibiotics among patients in hospitals within Makurdi metropolis, Nigeria

Urinary Tract Infections (UTI) constitute serious health problems affecting all ages and sexes. The microorganisms implicated in urinary tract infections from four different hospitals in Makurdi Metropolis, Nigeria were investigated. Two hundred midstream urine samples were collected from both male and female patients for analysis by Kirby Bauer’s method following the definition of the National Committee of Clinical Laboratory Standards. The microorganisms present in the urine samples that were identified to cause UTI in four hospitals within Makurdi Metropolis included Escherichia coli (43.8%), Staphylococcus aureus (23.9%), Klebsiella spp (10.74%), Streptococcus pyogenes (9.09%), Pseudomonas aeruginosa (8.26%) and Proteus species (4.13%). The result showed that 39.5% of the urine samples collected had no microorganism. The isolates in female patients were higher (77%) compared to the male patients (44%). Antimicrobial drugs such as gentamicin and erythromycin tested on the isolated microorganisms showed higher efficacy to all isolates, while streptomycin, tetracycline and ampicillin showed lower efficacy to the probable isolates. This research showed that Escherichia coli are the major cause of UTI.

59. Urinary tract infection in children after cardiac surgery: Incidence, risk factors and outcome

Background/Aim Urinary tract infection (UTI) can prolong hospitalization, and increase morbidity. Catheter associated UTI (CAUTI) is a major cause of UTI. The aim of this study is to determine the incidence, risk factors, etiology and outcome of UTI in postoperative cardiac children. Methods This is retrospective cohort study. All post-operative patients admitted to PCICU during 2012 were included. Patients were divided into: group (1) Patients who developed and group (2) patients who did not develop UTI. The two groups were compared for demographic and other variable predictors for UTI. Results 413 post-cardiac surgical children were included. Group 1 had 29 patients (7%) all had CAUTI. Foley catheter utilization ratio was 44%. CAUTI density rate was 18 per 1000 catheter days. Logistic regression analysis demonstrated that risk factors for developing UTI were: duration of Foley ( P P = 0.01) and prolonged PCICU and hospital stay ( P Conclusions Foley catheter duration, presence of syndrome and prolonged PCICU and hospital stay were the main risk factors for CAUTI in postoperative pediatric cardiac patients. Resistant Gram-negative were the main cause for BSI with one third of CAUTI cases caused by MDRO or ESBL organisms. The cases with CAUTI were generally sicker and with more morbidity. The study will establish a baseline clinical indicator for monitoring quality improvement and the future measures to minimize CAUTI incidence, and its co-morbidity.

246Frequency of Occurrence and Antimicrobial Susceptibility of Gram-negative Organisms Isolated from Health Care–Associated (HCA) Urinary Tract Infections (UTI) in the United States: Results from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS)

■ Urinary tract infections (UTIs) are among the most frequent healthcare-associated (HCA) infections. Escherichia coli is the most common UTI pathogen observed in both the community and healthcare settings. In recurrent UTI, and especially when structural abnormalities of the urinary tract are present, the relative frequency of Klebsiella spp., Proteus spp., Pseudomonas spp., and Enterobacter spp. increases. Antimicrobial-resistant isolates are common in these complicated UTIs (cUTIs) in which instrumentation and repeat courses of antimicrobial therapy are frequently used. ■ Antimicrobial-resistant strains that produce extended-spectrum β-lactamases (ESBLs) are prevalent among Enterobacteriaceae, predominantly E. coli and Klebsiella spp., and have become endemic in many hospitals. Pseudomonas aeruginosa also represents a major cause of UTI, and often demonstrates decreased susceptibility to various antimicrobial agents. INTRODUCTION RESULTS (cont’d)

PO-0032 Urinary Tract Infection In Children After Cardiac Surgery: Incidence, Risk Factors And Outcome

Introduction Urinary tract infection (UTI) can prolong hospitalisation, and increase morbidity. Catheter associated UTI (CAUTI) is a major cause of UTI. Objective To determine the incidence, risk factors, aetiology and outcome of UTI in postoperative cardiac children. Patients and methods This is retrospective cohort study. All post-operative patients admitted to PCICU during 2012 were included. Patients were divided into: group (1) Patients who developed and group (2) patients who did not develop UTI. The two groups were compared for demographic and other variable predictors for UTI. Results 413 post-cardiac surgical children were included. Group (1) had 29 patients (7%) all had CAUTI. Foley catheter utilisation ratio was 44%. CAUTI density rate was 18 per 1000 catheter days. Logistic regression analysis demonstrated that risk factors for developing UTI were: duration of Foley (p Conclusion Foley catheter duration, presence of syndrome and prolonged PCICU and hospital stay were the main risk factors for CAUTI in postoperative paediatric cardiac patients. Resistant Gram-negative were the main cause for CAUTI with one third of CAUTI cases caused by MDRO or ESBL organisms. The cases with CAUTI were generally sicker and with more morbidity. The study will establish a baseline clinical indicator for monitoring quality improvement and the future measures to minimise CAUTI incidence, and its co-morbidity.

Antimicrobial susceptibility pattern of Gram negative bacterial isolates from urine in tertiary care hospital of Eastern Nepal

Background:Urinary tract infections (UTIs) are themost important cause of morbidity and mortality in the world affecting all age groups. It is estimated that 150million cases ofUTI occur onaglobal basis per year. Resistance to antibiotics is highly prevalent and growingas theglobal problem inmanagementofUTI. Knowledgeof pattern of antimicrobial agents among local isolates plays a major role for selecting appropriate and effective therapy. Objectives: The present study was conducted to determine in vitro susceptibility among Gram negative organisms obtained from urineagainst commonly used antimicrobials. Methods: Urine specimens submitted to the Department of Microbiology, BP Koirala Institute of Health Sciences (BPKIHS) Hospital for culture and sensitivity over one year periodwere evaluated. Isolation, identification and determination of antimicrobial susceptibility were done by standard microbiological techniques. Results: Out of 13011 urine specimens submitted, 2131(16.3%) comprises Gram negative uropathogens, among which the most prevalentwas Escherichia coli (66.3%) followed byKlebsilla pneumoniae (11.7%), Acinetobacter anitratus (6.8%), Enterobacter aerogens (3.3%) and Pseudomonas aeruginosa (2.5%), Morganella morganii (1.3%), Proteus mirabilis (1.2%), Citrobacter frundii (0.7%), Klebsiella oxytoca (0.7%), Proteus vulgaris (0.56%). The majority (65.3%) were from femalewhile (34.7%)weremale patients.Most of theGNB isolates were found to be resistant to ampicillin (90%), norfloxacillin (60%) and ofloxacin (57.17%) where as they were susceptible to cotrimoxazole (73.2%), nitrofurantoin (69%) and amikacin (68.4%). Conclusion: Gram negative organisms remain the major cause of UTI. Various degree of antimicrobial resistance was observed among the uropathogens prevalent in our hospital. Regular monitoring of the resistance in the local isolates against the routinely used antimicrobial may have significant impact for the effective management of UTI.