Multidrug-resistant Uropathogens Research Articles

Comprehensive assessment of holding urine as a behavioral risk factor for UTI in women and reasons for delayed voiding

BackgroundWomen of reproductive age group have greater predilection to urinary tract infections (UTI). Various risk factors increase the prevalence in women. Emergence of multidrug resistant uropathogens make clinical management of UTI challenging. Here we assess holding of urine as risk factor of UTI in women and reasons for delayed voiding. We also investigate the relationship between frequency of UTIs and overall behavioural features, menstrual hygiene and attitude of women towards their own health issues.MethodsA questionnaire based cross-sectional study was performed with 816 hostel residents with written consent. Self-reported data was statistically analysed using SPSS software. Urinalysis and urine culture were done for 50 women by random sampling to obtain the information on leading causative agents of UTI in the study population and their antimicrobial resistance profile.ResultsThe prevalence of UTI among the participants without risk factors was found to be 27.5 (95% CI: 24.4–30.7). Attitude of women towards their own personal health issues and use of public toilets showed a correlation with prevalence of infection. Delay in urination on habitual basis was found to be associated with UTI. Uropathogens isolated by random sampling were resistant to multiple drugs that are generally used to treat UTI.ConclusionsHolding urine for long time had proven to be an important risk factor and amongst different reasons of holding urine, holding due to poor sanitary condition of public toilets was the most common. Higher frequency of self-reported UTIs is related to holding of urine, behavioural features and attitude of women.

Crude metabolites from endophytic fungi inhabiting Cameroonian Annona muricata inhibit the causative agents of urinary tract infections

Urinary tract infections (UTIs) are common bacterial infections. The global emergence of multidrug-resistant uropathogens in the last decade underlines the need to search for new antibiotics with novel mechanisms of action. In this regard, exploring endophytic fungi inhabiting medicinal plants used locally against urinary tract infections could be a promising strategy for novel drug discovery. This study investigates crude metabolites from endophytic fungi isolated from Annona muricata as potential sources of antibiotic drugs to fight against uropathogens and reduce related oxidative stress. Crude ethyl acetate extracts from 41 different endophytic fungi were screened against three bacterial strains using the broth microdilution method, and fungi producing active crude extracts were identified using ITS1-5.8S rRNA-ITS2 nucleotide sequences. The antibacterial modes of action of the five most active extracts were evaluated using Staphylococcus aureus ATCC 43300 and Klebsiella oxytoca strains. The DPPH and FRAP assays were used to investigate their antioxidant activity, and their cytotoxicity against the Vero cell line was evaluated using the MTT assay. Out of the 41 crude extracts tested, 17 were active with minimum inhibitory concentrations (MICs) ranging from 3.125 μg/mL to 100 μg/mL and were not cytotoxic against Vero cell lines with a cytotoxic concentration 50 (CC50) >100 μg/mL. The more potent extracts (from Fusarium waltergamsii AMtw3, Aspergillus sp. AMtf15, Penicillium citrinum AMf6, Curvularia sp. AMf4, and Talaromyces annesophieae AMsb23) significantly inhibited bacterial catalase activity, lysed bacterial cells, increased outer membrane permeability, and inhibited biofilm formation, and the time-kill kinetic assay revealed concentration-dependent bactericidal activity. All seventeen extracts showed weak ferric iron-reducing power (1.06 to 12.37 μg equivalent NH2OH/g of extract). In comparison, seven extracts exhibited DPPH free radical scavenging activity, with RSA50 ranging from 146.05 to 799.75 μg/mL. The molecular identification of the seventeen active fungi revealed that they belong to six distinct genera, including Aspergillus, Curvularia, Fusarium, Meyerozyma, Penicillium, and Talaromyces. This investigation demonstrated that fungal endophytes from Cameroonian Annona muricata, a medicinal plant used locally to treat bacterial infections, might contain potent antibacterial metabolites with multiple modes of action. The antibacterial-guided fractionation of these active extracts is currently ongoing to purify and characterise potential antibacterial active ingredients.

Antimicrobial Resistance and Predisposing Factors Associated with Catheter-Associated UTI Caused by Uropathogens Exhibiting Multidrug-Resistant Patterns: A 3-Year Retrospective Study at a Tertiary Hospital in Mogadishu, Somalia.

Background: Widespread and rapidly emerging multidrug-resistant uropathogens, particularly carbapenem-resistant pathogens, are a public health concern that impairs the determination of empirical therapy. This study aims to evaluate the antimicrobial susceptibility profile and factors associated with catheter-associated urinary tract infection (CA-UTI). Method: This retrospective study was carried out on a total of 779 urine cultures over a 3-year period. Antimicrobial sensitivity tests were performed using the standard Kirby–Bauer disk diffusion method. Results: The prevalence of CA-UTI in our study was 12.7%; a total of 47% of cultures had multi-drug-resistant (MDR) uropathogens, and 13% of the cultures showed extended-spectrum beta-lactamase (ESBL)-producing pathogens. Elderly patients, intensive care unit admissions, and associated comorbidities were correlated with higher rates of CA-UTI caused by multidrug-resistant uropathogens (p < 0.021, 95% CI: 0.893–2.010), (p < 0.008, 95% CI: 1.124–5.600), (p < 0.006, 95% CI: 0.953–2.617). Latex catheters and prolonged catheterization time were associated with increased risk of CA-UTI (p < 0.0001, 95% CI: 0.743–1.929, p = 0.012, 95% CI: 0.644–4.195). Patients with MDR uropathogens had prolonged hospital stays, i.e., 49% in more than 2 weeks (p < 0.04, 95% CI: 0.117–3.084). E. coli was the most common pathogen (26.3%), followed by Acinetobacter baumannii (24.3%). Acinetobacter baumannii showed the highest MDR pattern (88.5%), followed by Pseudomonas aeruginosa (68%). Acinetobacter baumannii and Klebsiella pneumoniae were associated with prolonged hospital stays (>2 w at 73.1 and 69%, respectively). Higher antimicrobial resistance against ceftriaxone (85.7%), meropenem (54.3%), ertapenem (50%), ciprofloxacin (58.5%), amikacin (27%), tigecycline (7.6%), and colistin (4.6%), was revealed in the study. Conclusion: Aside from the higher antimicrobial resistance against cephalosporins and fluoroquinolones, the findings of this study revealed that carbapenems are facing increased rates of antimicrobial resistance and are associated with substantial morbidity, prolonged hospitalization times, and increased healthcare expenses.

Detection of tem-1 and class-1 integrons in multidrug resistant uropathogens from HIV patients with asymptomatic bacteriuria in a Tertiary Care Hospital, SouthWest Nigeria.

Human immunodeficiency virus (HIV) infected individuals are at increased risk of asymptomatic bacteriuria (ASB) due to immune suppression. The increasing resistance of uropathogens necessitates the need for regular monitoring of their profile to reduce drug resistance. We determined the prevalence of ASB and the characteristics of antibiotic-resistant uropathogens isolated from HIV patients. Mid-stream urine samples from 100 HIV positive and 100 HIV negative healthy individuals were cultured for significant bacteriuria. The isolates were identified by standard techniques and their susceptibility patterns determined by the Kirby-Bauer disc diffusion technique. All the Gram-negative isolates were screened for ESBL production by combined disc method, ESBL genes and class 1 integrons by Polymerase chain reaction. Nine (9%) HIV positive individuals and 4 (4%) healthy individuals had ASB yielding a total of 13 (6.5%) uropathogens dominated by Escherichia coli (53.9%). All isolates were multidrug resistant. Five isolates harboured both the blaTEM-1 gene and class 1integrons while Serratia liquefaciens produced ampC. There is a higher burden of ASB characterized by multi-drug resistant uropathogens among HIV patients. Thus emphasizing the need for continuous resistance surveillance and antibiotic stewardship in our environment to reduce drug resistance and prevent treatment failure.

Extended-Spectrum Beta-Lactamase (ESBL) Producing, Multidrug-Resistant (MDR) Uropathogens and Their Antimicrobial Susceptibility Profile: A Tertiary Care Hospital Experience

Objective: To determine extended-spectrum beta-lactamase (ESBL) producing, multidrug-resistant (MDR) uropathogens and their antimicrobial susceptibility profile in various age groups and gender.&#x0D; Study Design: Comparative cross sectional study.&#x0D; Place and Duration of Study: Department of Pathology, Combined Military Hospital Abbottabad, from Jan to Dec 2018.&#x0D; Methodology: A total of 727 urine samples were collected and inoculated on cysteine lactose electrolyte deficient (CLED) agar plates (Oxoid). Plates were incubated for 24-48 hours at 37°C ±2 aerobically. Growth was identified by standard techniques. Antimicrobial susceptibility was determined.&#x0D; Results: The rate of positive culture was 19%. Uropathogens spectrum showed that there were Escherichia coli 82 (59.85%), Klebsiella pneumoniae 37 (27.01%), Serratia spp. 4 (2.92%), Enterobacter spp. 4 (2.92%), Citrobacter spp. 3 (2.19%), Pseudomonas aeruginosa 2 (1.46%), Staphylococcus saprophyticus 3 (2.19%) and Enterococcus spp. 2 (1.46%). Susceptibility was as follows: Ampicillin (2.92%), Co-amoxiclav (26.28%), Ceftriaxone (64.69%), Cefepime (58.39%), Tazobactum-piperacillin (63.50%), Imipenem (82 %), Ciprofloxacin (27.01%), Co-trimoxazole (29.93%), Amikacin (74.45%), Nitrofurantoin (81.75%) and SulbactumCefoperazone (54.48%). Among 130 Gram negative bacilli (GNB) from urinary isolates 71(54.6%) were ESBL producer and 59 (44.3%) were non-ESBL producers. No isolate of Serratia spp, Enterobacter spp. and Citrobacter spp. Were producing ESBL. Out of130, Gram negative bacilli 92 (70.8%) were MDR and 38 (29.2%) were non-MDR.&#x0D; Conclusion: Extended-spectrum beta-lactamase production and MDR is significantly high in uropathogens. Empirical treatment followed by a de-escalation of antimicrobial is suggested after culture report in order to combat the problem of emerging antibiotic resistance.Keywords: ,

Activity of Fosfomycin against the Spectrum of Uropathogens Causing Cystitis

Background: Urinary tract infections (UTIs) are the most frequent bacterial infections commonly seen in females. A high degree of antimicrobial resistance in uropathogens has challenged the use of therapeutic agents. Fosfomycin, which is an old antibiotic with distinctive characteristics, seems to be a promising novel therapeutic agent with a good bactericidal activity towards multi-drug resistant (MDR) uropathogens. Objective: The main objective of the study is to evaluate the antibacterial activity of fosfomycin among uropathogens causing cystitis. Methods: The study was carried out between 2017-2018. A total of 2060 UTI suspects from outpatient departments (OPDs) and inpatient departments (IPDs) were screened. Out of 2060 screened patients, 1658 were IPD patients, and 402 were OPD patients. The patient’s midstream urine samples were collected aseptically and processed according to standard protocols. The frequency of extendedspectrum- beta lactamases (ESBLs) producer and carbapenem resistance were estimated, respectively. Cultures with significant growth of uropathogens were identified, and minimum inhibitory concentration (MIC) to fosfomycin was determined by agar dilution (AD) and by E-test methods. Results: 184 out of 2060 (8.9%) urine samples showed significant growth of uropathogens. Uropathogenic Escherichia coli (UPEC) (64%, 118/184) was found to be the most isolated uropathogen. Among these Gram-negative uropathogens, 80% were ESBLs producers, 43.2% were carbapenemresistant, and 78% isolates were found to be MDR. The fosfomycin susceptibility for UPEC was 95% by the AD method. Conclusions: This study suggests that fosfomycin is reasonably effective and can be used in the treatment of MDR uropathogens along with uncomplicated UTIs.

Anti-biofilm potential of Lactobacillus plantarum Y3 culture and its cell-free supernatant against multidrug-resistant uropathogen Escherichia coli U12

Uropathogens develop biofilms on urinary catheters, resulting in persistent and chronic infections that are associated with resistance to antimicrobial therapy. Therefore, the current study was performed to control biofilm-associated urinary tract infections through assaying the anti-biofilm ability of lactic acid bacteria (LAB) against multidrug-resistant (MDR) uropathogens. Twenty LAB were obtained from pickles and fermented dairy products, and screened for their anti-biofilm and antimicrobial effects against MDR Escherichia coli U12 (ECU12). Lactobacillus plantarum Y3 (LPY3) (MT498405), showed the highest inhibitory effect and biofilm production. Pre-coating of a microtitre plate with LPY3 culture was more potent than co-incubation. Pre-coating with LPY3 culture generated a higher anti-biofilm effect with an adherence of 14.5% than cell free supernatant (CFS) (31.2%). Anti-biofilm effect of CFS was heat stable up to 100 °C with higher effect at pH 4–6. Pre-coating urinary catheter with LPY3 culture reduced the CFU/cm2 of ECU12 attached to the catheter for up to seven days. Meanwhile, CFS reduced the ECU12 CFU/cm2 for up to four days. Scanning electron microscope confirmed the reduction of ECU12 adherence to catheters after treatment with CFS. Therefore, Lactobacillus plantarum can be applied in medical devices as prophylactic agent and as a natural biointervention to treat urinary tract infections.

Oxidative stress, DNA, and membranes targets as modes of antibacterial and antibiofilm activity of facile synthesized biocompatible keratin-copper nanoparticles against multidrug resistant uro-pathogens.

Escherichia coli and Enterococcus faecalis are two of the most prevalent uro-pathogens and are difficult to treat as they acquire multidrug-resistant traits. In this study, the main objective was to develop biocompatible copper nanoparticles using chicken feather keratin protein (CuNPs-K) and to investigate their impact on multidrug-resistant (MDR) uro-pathogens, E. coli and E. faecalis, under both single and mixed culture conditions. CuNPs-K were characterised by UV-Vis spectroscopy, dynamic light scattering, X-ray diffraction, Fourier transform infrared spectroscopy, and docking experiments. The MIC values of CuNPs-K against single and mixed planktonic cultures were 50μg/ml and 75μg/ml, respectively. CuNPs-K efficiently disrupted the biofilm of single and mixed uro-pathogen cultures by eliminating sessile cells. This biofilm disruption may be attributed to a decline in the production of extracellular polymeric substances in both single and mixed bacterial cultures treated with CuNPs-K. Moreover, selective antimicrobial activity was determined by selectivity assays using T24 cells. CuNPs-K targets both the bacterial membrane and DNA with elevated reactive oxygen species (ROS) as their bactericidal mode of action. This comprehensive antimicrobial activity of CuNPs-K was further confirmed in vivo by using the zebra fish model. In this study, CuNPs-K effectively reduced bacterial load with increased survivability of infected zebrafish. All these results suggest that CuNPs-K can be explored as an exceptional antibacterial agent against MDR uro-pathogenic E. coli and E. faecalis.

Prevalence and Phenotypic Profile of Antimicrobial Resistance Pattern of Multidrug Resistant Uropathogens in a Rural Tertiary Care Hospital, Gujarat, India

Introduction: Multidrug Resistant (MDR) organisms have become a major problem for the treatment of various infections and are imposing the greatest challenge to public health worldwide. Uncomplicated Urinary Tract Infections (UTIs) are treated empirically sometimes with broad spectrum antibiotics without performing drug susceptibility tests that adds to drug resistance in bacteria. Aim: To identify the current prevalence and evaluate phenotypic profile of antimicrobial resistance pattern of MDR uropathogens. Materials and Methods: This was a cross-sectional descriptive study conducted from January 2019 to July 2021 at Parul Sevashram Hospital Vadodara, Gujarat, India. Total 960 uropathogens were analysed for prevalence, their phenotypic antimicrobial resistance mechanism and antibiotic sensitivity pattern. Isolated organisms, their phenotypic resistance pattern and antibiotic sensitivity data was entered in Microsoft excel and data were analysed using Statistical Package for the Social Sciences (SPSS) 25.0 version. Results: During the study period, total 960 urinary isolates were analysed of which 891 (92.8%) were gram negative bacilli, 69 (7.2%) were gram positive cocci. Probable antimicrobial resistance pattern in gram negative isolates causing UTI were 317 (35.6%) of Extended Spectrum Beta Lactamase (ESBL) producer, While carbapenemase (+ or - ESBL) were 328 (36.8%) and impermeability carba (+ESBL or +High-Level Ampicillinase C (HL AmpC)) were 311 (34.9%). Amikacin was highly sensitive antibiotic in 378 (75.3%) of Escherichia coli (E. coli) and 111 (52.9%) of Klebsiella pneumoniae (K. pneumoniae) isolates causing UTI. Conclusion: The study concluded that carbapenem resistance was more in K. pneumoniae isolates causing UTI than E. coli. Aminoglycosides like amikacin was highly effective for the treatment of UTI caused by E.coli and K. pneumoniae.

A novel probiotic strain of Lactobacillus fermentum TIU19 isolated from Haria beer showing both in vitro antibacterial and antibiofilm properties upon two multi resistant uro-pathogen strains.

Probiotics with antimicrobial activity are gaining interest as a topic in the research field. Urinary tract infections (UTIs), acquired in the hospital or the community, are among the most prevalent infections. The emergence of multidrug resistance (MDR) uro-pathogens has made the current situation more critical in terms of global public health.To face this situation, in this study, Lactobacillus fermentum TIU19 (L. fermentum TIU19) was isolated and characterized as a new probiotic strain of the rice-based fermented beverage Haria. Subsequently, we also investigated its application as a biological agent that inhibits the growth of multidrug-resistant uro-pathogens, Escherichia coli, and Enterococcus faecalis. The results showed that, the isolated strain L. fermentum TIU19 was sensitive to all antibiotics tested except vancomycin and was devoid of virulence factors, such as haemolytic and gelatinase activities. Therefore, it may be considered safe for public health. It has many probiotic properties, such as survival in simulated gastrointestinal fluid, antioxidant activity, β-galactosidase producing ability, high cell surface hydrophobicity, adhesion ability to epithelial cells, and strong biofilm producer. The growth inhibitory and antibiofilm activities were shown against two uro-pathogens. All these results suggest that L. fermentum TIU19 can be explored as a potential probiotic with antagonistic activity against MDR uro-pathogenic E. coli and E. faecalis.

Antimicrobial Susceptibility Profile of Fosfomycin and Nitrofurantoin despite Dissemination of Fluoroquinolones and Trimethoprim/ Sulfamethoxazole Resistant Urinary Tract Isolates

The widespread growth of multidrug-resistant (MDR), extended drug resistant (XDR) uropathogens and the shortage of new antimicrobials are the most significant obstacles challenging the treatment of urinary tract infections. The study is aimed to identify the antimicrobial susceptibility profile against MDR and XDR uropathogens. A total of 2485 urine samples were processed from 2267 patients, 361 uropathogens were grown. The antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion method, following the Clinical and Laboratory Standards Institute’s guidelines. Eighty-nine percent of the samples had Multidrug-resistant microorganisms, while 32% had XDR uropathogens. In comparison to fluoroquinolones and trimethoprim/sulfamethoxazole, fosfomycin and nitrofurantoin demonstrated a significantly higher sensitivity rate against uropathogens, including MDR and XDR uropathogens, in both gender groups with community-acquired and nosocomial UTIs (P&lt;0.001). Fosfomycin revealed the highest sensitivity rate, about 94.8%. Klebsiella pneumonia and E. coli showed the highest resistance rate against fosfomycin in 3.7% and 3.4% of the cases. Nitrofurantoin showed a similar sensitivity rate both in community and hospitalized patients in 86.1%. Fluoroquinolones (61%) and trimethoprim/sulfamethoxazole (86.6%) revealed the highest resistance rate against uropathogens. The prevalence of extended-spectrum beta-lactamases producing pathogens was 10.2%. Fosfomycin and nitrofurantoin revealed a higher sensitivity rate against gram-negative MDR uropathogens in community and nosocomial UTIs compared to fluoroquinolones and trimethoprim/sulfamethoxazole.

Urinary bladder microbiome analysis and probiotic treatment options for women with recurrent urinary tract infections

Um die Frequenz rezidivierender Harnwegsinfektionen (rHWI) und die damit verbundene fortwährende Zunahme multiresistenter Uropathogene zu reduzieren, werden neuartige Präventionsmaßnahmen und Therapieansätze benötigt. Ziel dieser Übersichtsarbeit ist es, die aktuell verfügbare Evidenz über das Mikrobiom der Harnblase gesunder Frauen und solcher mit rHWI systematisch zu präsentieren. Außerdem werden relevante Studien zur Wirksamkeit von Probiotika bei rHWI strukturiert dargestellt. Hierdurch soll der gegenwärtige Stand der Forschung und ein Ausblick auf eine Therapie abseits der üblichen antimikrobiellen Behandlungsoptionen gegeben werden.

Fosfomycin susceptibility among ESBL producing gram negative bacilli causing urinary tract infections

Urinary tract infection is one of the common infection encountered in day to day practice. Due to emergence of drug resitance among uropathogens treatment options have become limited. Fosfomycin being a safe oral antibiotic is being used widely to treat multidrug resistant uropathogens. In the present study 831 (48.45%) samples that yielded significant growth were processed out of 1715 sample for ESBL detection by double disc synergy and phenotypic confirmatory method. E.coli constituted the predominant isolate (60.4%) followed by K.pneumoniae. 256 (30.80%) samples yielding growth were from out patients and 575 from inpatients. Over all 44% of isolates in the present study were ESBL producers. 50% of Ecoli were ESBL producers. 70.64% of ESBL isolates were susceptible to fosfomycin in vitro. Present study finding suggest that resistance to fosfomysin is on rise even though majority of ESBLs were sensitive to it. The current study recommends to use fosfomycin only after testing susceptibility among uropathogens.

Oral fosfomycin for treating lower urinary tract infections due to multidrug-resistant Escherichia coli in female adolescents

Fosfomycin trometamol (FT) has shown promising in vitro activity against multidrug-resistant (MDR) uropathogens; however, clinical data are limited in pediatric patients. We conducted a retrospective study to describe the clinical and microbiological outcomes of uncomplicated lower urinary tract infections (LUTIs) due to MDR Escherichia coli treated with oral FT in female adolescents. A total of 70 outpatients, with a median age of 13 years (range 12-16 years), were included. FT was initiated as definitive treatment of UTIs in all patients due to documented resistance against alternative oral agents. All patients received a single dose of 3 g oral FT. The post-treatment clinical and microbiological cure rates were 97% (68/70) and 94% (66/70), respectively. Only two (3%) patients reported mild, self-limited diarrhea. UTI relapse occurred in two (3%) patients. Our results suggest that oral FT might be an alternative option for outpatient treatment of uncomplicated LUTIs due to MDR E. coli in female adolescents.

Compared with Cotrimoxazole Nitroxoline Seems to Be a Better Option for the Treatment and Prophylaxis of Urinary Tract Infections Caused by Multidrug-Resistant Uropathogens: An In Vitro Study

The resistance of uropathogens to various antibiotics is increasing, but nitroxoline remains active in vitro against some relevant multidrug resistant uropathogenic bacteria. E. coli strains, which are among the most common uropathogens, are unanimously susceptible. Thus, nitroxoline is an option for the therapy of urinary tract infections caused by multiresistant bacteria. Since nitroxoline is active against bacteria in biofilms, it will also be effective in patients with indwelling catheters or foreign bodies in the urinary tract. Cotrimoxazole, on the other hand, which, in principle, can also act on bacteria in biofilms, is frequently inactive against multiresistant uropathogens. Based on phenotypic resistance data from a large number of urine isolates, structural characterisation of an MDR plasmid of a recent ST131 uropathogenic E. coli isolate, and publicly available genomic data of resistant enterobacteria, we show that nitroxoline could be used instead of cotrimoxazole for intervention against MDR uropathogens. Particularly in uropathogenic E. coli, but also in other enterobacterial uropathogens, the frequent parallel resistance to different antibiotics due to the accumulation of multiple antibiotic resistance determinants on mobile genetic elements argues for greater consideration of nitroxoline in the treatment of uncomplicated urinary tract infections.

Antibiotic prophylaxis for endourological interventions considering antibiotic stewardship

Perioperative antibiotic prophylaxis in endourology is used to reduce or avoid postoperative surgical site infections and complicated urinary tract infections. Special attention is paid to antibiotic stewardship strategies to avoid the continuing selection of antibiotics and multidrug-resistant uropathogens as well as collateral damage to the microbiome. The individual risk profile, the local resistance situation, the expected pathogen spectrum, the pharmacokinetics and the approval of each substance are important aspects to be considered in the indications and selection of perioperative antibiotic prophylaxis. Furthermore, applicable hygiene regulations and the surgical care of an intervention must be observed.

Efficacy and safety of oral fosfomycin for asymptomatic bacteriuria in kidney transplant recipients: Results from a Spanish multicenter cohort.

Current guidelines recommend against systematic screening or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of post-transplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR]: 1.1 - 10.5). Most episodes (96.4% [132/137]) were caused by gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended-spectrum β-lactamase-producing Enterobacterales [20.4%] and carbapenem-resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [95%CI]: 31.9 - 48.9) for the whole cohort and 42.3% (95%CI: 31.2 - 54.0) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR]: 2.42; 95%CI: 1.11 - 5.29; P-value = 0.027) and use of fosfomycin as salvage therapy (OR: 8.31; 95%CI: 1.67 - 41.35; P-value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse event were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.

Etiological Agents of Urinary Tract Infection and 7 Years Trend of Antibiotic Resistance of Bacterial Uropathogens in Sudan

Introduction: Bacterial infections of the urinary tract represent a major cause of outpatient visits as well as hospital-acquired infections. As the prevalence of multidrug-resistant uropathogens is increasing, updated knowledge of the commonest bacterial causes and their susceptibility patterns is crucial for the proper selection and use of antimicrobial drugs and the development of effective local prescribing guidelines. Methods: Handling of urine samples, identification of organisms and antimicrobial susceptibility testing were made according to guidelines in Monica Cheesbrough 2000, 2006. The prevalence of resistance of the pathogens against each antibiotic was calculated as the proportion of resistant isolates over the entire tested isolates. Data were analyzed using Epi info; the chi-square test and Fisher exact test were used to assess the statistical significance of results. Results: In this study, 774 samples were cultured from patients with suspected urinary tract infection (UTI), 705 (91%) urinary isolates showed significant growth (&gt;105 CFU /L) while the other 69 samples showed no significant growth. 431 (61%) of the patients were female, while the other 274 (39%) were males. 13 types of pathogens were identified in 705 urinary isolates. E.Coli was the main bacterial uropathogen identified. Microbiological susceptibility of a total of 28 antibiotics was tested; for each urinary isolate, different sets of these antibiotics were used. 601(96%) of the bacteria were resistant to at least one antibiotic. 17 antibiotics were found to have a bacterial resistance rate of more than 50%, including all B lactams (except cefuroxime), Nalidixic acid, Ciprofloxacin, Norfloxacin, Clindamycin, Co-Trimoxazole and Tetracyclines(Tetracycline and Doxycycline). Other antibiotics were found to have resistance rates of less than 50%. Amikacin &amp; Imipenem had the highest susceptibility rates. Throughout the 7 years, resistance to most of the antibiotics showed an incremental pattern. Conclusion: Current empirical antibiotic therapy for UTI should be modified, and new guidelines should be established based on local resistance rates. This study comes up with precious regional data for evidence-based empirical antibiotic treatment, but a national sentinel surveillance system and regional antibiograms should be established to track the bacterial susceptibility profiles in Sudan.

Nitrofurantoin and fosfomycin for the carbapenem resistant Enterobacteriales and multi drug resistant uropathogens: are the choices still same?

Background: Urinary tract infection (UTI) is one of the most common bacterial infections, affecting 150 million people each year worldwide with substantial clinical and financial burden. With upcoming multi drug resistance (MDR) and carbepenem resistance among uropathogens there is urgent need to explore other new or old treatment options like nitrofurantoin and fosfomycin trometamol.Methods: This is a cross-sectional (descriptive study) conducted over 6 month’s period from October 2019 to March 2020. Out of 9045 urine samples, 1788 (19.8%) were positive (1721 samples with single organism and 67 samples with 2 organisms). Total 1855 isolates were identified and antimicrobial susceptibility was performed by Kirby-Bauer method and VITEK 2 system. Methicillin‑resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE), multi drug resistance (MDR) and metallo‑beta‑lactamases (MBL) production was detected.Results: E. coli 41.8% was found commonest followed by enterococcus species (21.6%). Methicillin resistance was 66% while 1.8% were VRE. 429 (34.5%) were CRE (carbapenem resistant enterobacteriales) out of which, 154 (36%) were MBL while 188 (44%) were detected as serine carbapenemase producers via modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM) testing. Among 742 (40%) MDR, fosfomycin was effective in 611 (82.3%) while 331 (77.1%) of the CRE isolates were susceptible to fosfomycin.Conclusions: Fosfomycin should be reserved for MDR and nitrofurantoin should be used cautiously otherwise resistance will increase to these drugs in the coming days.

Challenging multidrug-resistant urinary tract bacterial isolates via bio-inspired synthesis of silver nanoparticles using the inflorescence extracts of Tridax procumbens

The increasing drug resistance pattern in bacterial pathogens promotes the need to find out alternative strategies to ensure human health. In the imperative lookout for effective drugs to combat multidrug-resistant bacteria, silver nanoparticles (AgNPs) are given priorities. Hence in the present approach, AgNPs were synthesized using the extract of the inflorescence of a medicinal plant, and its antibacterial activity against multidrug-resistant uropathogens was studied. For the synthesis of AgNPs, the inflorescence of a medicinal plant Tridax procumbens was subjected to a microwave irradiation technique. The characteristics of the synthesized nanoparticles (NPs) were analyzed by using UV–visible spectroscopy (UV–Vis), Dynamic light scattering device (DSL), Scanning electron microscope (SEM), Fourier-transform infrared (FTIR) spectroscopy and Zeta potential analyzer. The synthesized AgNPs were with unique optical morphology and semi-spherical shape having irregular contour with the size range 40.0–52.5 nm. The bacterial isolates Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Gram-positive Staphyloccocus saprophyticus from urinary tract infected persons that showed resistance to more than ten antibiotics were chosen for AgNPs impact analysis. The mean diameter of zone of inhibition (in mm) for the different isolates at the dose of 50 µg/mL concentration showed a maximum for S. saprophyticus (21.0 ± 1.7 mm)followed by P. aeruginosa (18.0 ± 1.3 mm), K. pneumoniae (18.0 ± 0.09 mm) and E. coli (17.0 ± 1.70). The MIC values for the isolates showed a minimum for S. saprophyticus (2.5 µg/mL) and a maximum for E. coli (55.5 µg/mL). The results show that the T. procumbens phytochemicals inspired silver nanoparticles can be explored further to develop useful antibiotics.