Urinary Tract Infection Pathogens Research Articles

Study of the prevalence and antibiotics susceptibility patterns in clinically significant isolates among urine sample in a tertiary care centre

Urinary tract infections (UTIs) are prevalent bacterial infections. Gram-negative bacilli are frequently isolated as the causative pathogens in UTIs, and antibiotics are commonly used to treat them. However, the overuse of antibiotics has led to the development of resistance in some uropathogens. : To find the prevalence and antimicrobial susceptibility patterns in clinically significant isolates among urine sample in a tertiary care centre.: Fresh mid-stream urine samples were collected aseptically in sterile containers. The samples were inoculated on 5% sheep blood agar and MacConkey agar. The isolates were identified to the species level using biochemical tests/Vitek 2 compact.: A total of 5847 specimens were examined for significant bacteriuria, out of which 1160 showed bacterial growth in urine cultures. The most commonly isolated pathogens were (57.67%) and (18.63%). The antibiotics aminoglycosides (84%), carbapenems (79%), and nitrofurantoin (63%) displayed a high rate of sensitivity against these pathogens.: Due to the variability of drug sensitivity among bacterial pathogens over time, regular surveillance and monitoring are essential to provide physicians with updated information for the most effective empirical treatment of UTIs.

Correlation of procalcitonin and c-reactive protein levels with pathogen distribution and infection localization in urinary tract infections

Aimed to explore the relationships between infection localization, bacterial species, and procalcitonin (PCT) and C-reactive protein (CRP) levels in urinary tract infections (UTIs). A retrospective study included 314 UTI hospitalized patients divided into two groups (268 with lower UTI, 46 with upper UTI) in a tertiary care hospital. PCT and CRP were performed. Bacterial isolates were identified using standard microbiological techniques, and statistical analyses were performed to assess associations between infection localization, bacterial species, PCT, and CRP levels. Age and gender showed no significant differences between the lower and upper UTIs. Escherichia coli dominated as the leading UTI pathogen. A positive correlation (r = 0.646, P < 0.001) between PCT and CRP levels was found. The subgroup with ureteritis in the upper UTI category exhibited the highest PCT and CRP levels. PCT and CRP exhibited favorable diagnostic potential in predicting upper UTIs, with AUCs of 0.644 and 0.629, respectively. The optimal cutoff values were 0.21 ng/mL for PCT and 60.77 mg/L for CRP. Sensitivities were 69.03% and 77.99%, while specificities were 56.52% and 47.83%, respectively. E. coli emerged as the predominant bacterium in UTIs. PCT and CRP demonstrated moderate diagnostic efficacy in distinguishing between upper and lower UTIs. Notably, PCT and CRP exhibited enhanced utility in identifying ureteritis.

B-236 Portable 2 Hour Sample-to-Answer Multi-pathogen Phenotypic Antibiotic Susceptibility Test (AST)

Abstract Background Antimicrobial Resistance is a rapidly growing issue worldwide, arising from the overuse and misuse of antibiotics. The strongest tool the medical community has available to combat AMR is rapid, correct application of antibiotics to identified bacterial infections. Clinics and physician offices seek on-site rapid solutions to speed the pathway to timely and appropriate antibiotic therapies. GeneCapture is prototyping a rapid, sample-to-answer product to provide antibiotic susceptibility results directly from infected urine or wound samples. The test provides a susceptible vs non-susceptible call in under two hours and can be applied to samples with single or mixed pathogens. With support from the Defense Health Agency, a portable table-top instrument and disposable cartridge are being engineered to run this test at the point of care, allowing same-day prescriptions. The process is currently operational on the lab bench. Methods Fluorescent labeling of bacterial species, followed by optical counting, determines population growth with/without a suite of antibiotics. An on-board algorithm instantly converts raw cell numbers into a differential call of Susceptible or Non-susceptible for each bug/drug pair. A disposable cartridge with on-board antibiotics has been designed and is being finalized for fabrication. The optical counting is operating in a desktop device. Results Testing to date includes 124 strains from 7 of the most common Urinary Tract Infection and wound pathogens against a panel of six antibiotics. A total of 541 antibiotic/bacterial strain pairs in single or multiple pathogen antibiotic susceptibility testing (AST), are producing an initial 88.7% agreement to gold standard culture results. These results are all generated in two hours or less of assay time and represent a strong preliminary data set. Conclusion This 2-hour portable, novel, phenotypic AST profiling will produce informed and effective treatment options for medics, clinics and physician offices long before existing AST methods could return results.

Etiological features of urinary tract infections in pregnant women: current state of the problem

Background. Urinary tract infections in pregnant wo­men occupy a leading place in the structure of extragenital patho­logy. The purpose of the study is to determine the etiological features of urinary tract infections in pregnant women. Materials and ­methods. The study included 89 pregnant women with urinary tract infections. The material for microbiological research was urine, the samples of which were collected on the day of hospitalization of a pregnant woman before treatment. Identification of microorganisms was carried out with the use of ­MIKROLATEST® test systems (Erba Lachema, Czech Republic). Preparation of bacterial suspensions with a certain concentration of microbial cells was carried out using Densi-La-Meter electronic device (PLIVA-Lachema a.s., Czech Republic) according to the McFarland scale. Optical density was measured using a Multiskan EX microplate reader (type 355). Results. Escherichia coli, Proteus mirabilis, Proteus vulgaris, Streptococcus pyogenes, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa are the leading pathogens of urinary tract infections in pregnant women of the Kharkiv region; Escherichia coli, Proteus mirabilis, Streptococcus pyogenes are predominant ones. The selected spectrum of etiological factors of urinary tract infections does not depend on the age of a pregnant woman. In the etiological structure of the urinary tract infections in pregnant women, Escherichia coli and Proteus mirabilis take the first and the second place during the first three trimesters of pregnancy. The third place in the first trimester belongs to Enterococcus faecalis, in the second trimester — to Proteus vulgaris and Streptococcus pyogenes, in the third trimester — to Streptococcus pyogenes. The etiological structure of urinary tract infections in pregnant women is determined by the topography of the inflammatory process. Thus, in women with asymptomatic bacteriuria, Proteus mirabilis takes the first place, Escherichia coli — the second place, Proteus vulgaris and Enterococcus faecalis — the third place; in acute pyelonephritis, the first place belongs to Escherichia coli, the second place to Streptococcus pyogenes, the third place to Proteus mirabilis, Enterococcus faecalis, Klebsiella pneumoniae; in urethritis, Escherichia coli takes the first place, Enterococcus faecalis, Klebsiella pneumoniae — the second place, Proteus mirabilis, Proteus vulgaris — the third place; in cystitis, the first place belongs to Escherichia coli, the second place to Proteus mirabilis, Proteus vulgaris, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa. Conclusions. The etiological features of urinary tract infections with different topography of the inflammatory process of bacterial etiology determined by the authors must be taken into account in the treatment of this category of pregnant women.

Antimicrobial efficacy of Mentha piperata-derived biogenic zinc oxide nanoparticles against UTI-resistant pathogens

Misuse of antibiotics leads to the worldwide spread of antibiotic resistance, which motivates scientists to create new antibiotics. The recurring UTI due to antibiotics-resistant microorganism’s challenges scientists globally. The biogenic nanoparticles have the potential to meet the escalating requirements of novel antimicrobial agents. The green synthesis of nanoparticles (NPs) gained more attention due to their reliable applications against resistant microbes. The current study evaluates the biogenic ZnO NPs of Mentha piperata extract against resistant pathogens of urinary tract infections by agar well diffusion assay. The biogenic ZnO NPs revealed comparatively maximum inhibition in comparison to synthetic antibiotics against two bacterial strains (Proteus mirabilis, Pseudomonas aeruginosa) and a fungal strain (Candida albicans).The synthesized biogenic ZnO NPs alone revealed maximum activities than the combination of plant extract (PE) and ZnO NPs, and PE alone. The physiochemical features of ZnO NPs characterized through UV–Vis spectroscopy, FTIR, XRD, SEM, and EDX. The UV–Vis spectroscopy revealed 281.85 nm wavelengths; the XRD pattern revealed the crystalline structure of ZnO NPs. The FTIR analysis revealed the presence of carboxylic and nitro groups, which could be attributed to plant extract. SEM analysis revealed spherical hollow symmetry due to electrostatic forces. The analysis via EDX confirmed the presence of Zn and oxygen in the sample. The physiochemical features of synthesized ZnO NPs provide pivotal information such as quality and effectiveness. The current study revealed excellent dose-dependent antimicrobial activity against the pathogenic isolates from UTI-resistant patients. The higher concentration of ZnONPs interacts with the cell membrane which triggers oxidative burst. They may bind with the enzymes and proteins and brings epigenetic alteration which leads to membrane disruption or cell death.

PREVALENCE OF URINARY TRACT INFECTIONS AMONG FEMALES OF REPRODUCTIVE AGE GROUP IN TERTIARY CARE TEACHING HOSPITAL

Objective: The purpose of the current study is to isolate, characterize, and evaluate the antibiotic susceptibility profile of the pathogenic bacteria causing urinary tract infections (UTIs) in females of reproductive age. Methods: This is a cross-sectional descriptive study carried out in a Tertiary care teaching hospital for 1 year. A total of 100 urine samples from female patients in the reproductive age range of 15–44 years constitute the study’s sample size. Clean catch midstream urine samples were taken in sterile containers and inoculated on a different culture medium, such as cysteine, lactose, and electrolyte-deficient agar, to isolate the UTI pathogen. MacConkey agar was inoculated in parallel to target the growth of Gram-negative bacilli. Thereafter, using the common microbiological procedures, all positive cultures with significant bacteriuria were identified at the species level based on the colony features, Gram-staining reaction, and pattern of biochemical profiles. To investigate the pattern of antibiotic susceptibility, the disc diffusion method was used. Results: Among the 100 study cases, the prevalence of UTI was seen in 38% of individuals and UTI was absent in 62% of individuals. Among the females (38% cases) who had UTI, 81% had symptomatic UTI and 19% had asymptomatic UTI. Among the 81% symptomatic individuals of UTI, all they showed burning micturition followed by 74% of individuals showed dysuria Among the uropathogens isolated, majority were Escherichia coli (40.7%) followed by CONS (22.3%) Majority of the E. coli isolates showed sensitivity to piperacillin/tazobactam and nitrofurantoin. Conclusion: If left untreated, UTI is a significant public health issue. Early detection and timely treatment will lower the risk of developing further UTI complications, as well as the patient’s pain, length of stay in the hospital, and economic loss.

Bacteremia and antimicrobial resistance pattern of uropathogens causing febrile urinary tract infection in a Pediatric University Hospital.

Febrile urinary tract infections (UTIs) in children are among the most serious bacterial infections. Inadequate treatment can lead to kidney scarring and permanent kidney damage. Eight to ten percent of children with UTIs could have concomitant bacteremia. The study aimed to estimate the prevalence of UTI-associated bacteremia and identify common organisms causing UTIs and their antimicrobial susceptibility patterns to help guide empiric antimicrobial therapy. The current study was conducted over a 6-month period on children admitted with febrile UTIs at Alexandria University Children's Hospital. Blood and urine samples were collected for culture and antimicrobial susceptibility. A total of 103 children with a median age of 12 months (IQR 6.0-24.0) were included in the study. Concomitant bacteremia was present in 63.1% (n=65). The median temperature of 38.40°C (IQR 38.15-38.60) and the median creatinine level of 0.18 mg/dL (IQR 0.14-0.25) were significantly higher in the bacteremic group compared to the non-bacteremic group (p=0.005, p=0.034, respectively). E. coli (n=51; 49.5%) and Klebsiella pneumoniae (n=30; 29.1%) were the most common isolated organisms. Most (n=68; 66%) of the isolated organisms were multidrug-resistant (MDR), followed by extensively drug-resistant (XDR) (n=16; 15.5%), and pan-drug-resistant (PDR) organisms (n=1; 1%). E. coli showed lower resistance to gentamicin and ceftriaxone (9.8 % and 13.7%, respectively). E. coli remains the most important UTI pathogen. Ceftriaxone and gentamicin are good empiric options for febrile UTIs in our hospital.

Genetic analysis of resistance and virulence characteristics of clinical multidrug-resistant Proteus mirabilis isolates.

Proteus mirabilis is the one of most important pathogens of catheter-associated urinary tract infections. The emergence of multidrug-resistant (MDR) P. mirabilis severely limits antibiotic treatments, which poses a public health risk. This study aims to investigate the resistance characteristics and virulence potential for a collection of P. mirabilis clinical isolates. Antibiotic susceptibility testing revealed fourteen MDR strains, which showed high resistance to most β-lactams and trimethoprim/sulfamethoxazole, and a lesser extent to quinolones. All the MDR strains were sensitive to carbapenems (except imipenem), ceftazidime, and amikacin, and most of them were also sensitive to aminoglycosides. The obtained MDR isolates were sequenced using an Illumina HiSeq. The core genome-based phylogenetic tree reveals the high genetic diversity of these MDR P. mirabilis isolates and highlights the possibility of clonal spread of them across China. Mobile genetic elements SXT/R391 ICEs were commonly (10/14) detected in these MDR P. mirabilis strains, whereas the presence of resistance island PmGRI1 and plasmid was sporadic. All ICEs except for ICEPmiChn31006 carried abundant antimicrobial resistance genes (ARGs) in the HS4 region, including the extended-spectrum β-lactamase (ESBL) gene blaCTX-M-65. ICEPmiChn31006 contained the sole ARG blaCMY-2 and was nearly identical to the global epidemic ICEPmiJpn1. The findings highlight the important roles of ICEs in mediating the spread of ARGs in P. mirabilis strains. Additionally, these MDR P. mirabilis strains have great virulence potential as they exhibited significant virulence-related phenotypes including strong crystalline biofilm, hemolysis, urease production, and robust swarming motility, and harbored abundant virulence genes. In conclusion, the prevalence of MDR P. mirabilis with high virulence potential poses an urgent threat to public health. Intensive monitoring is needed to reduce the incidence of infections by MDR P. mirabilis.

P20 Rapid 15 min test to identify the three most common Gram-negative uropathogens in urinary tract infections

Abstract Background Every year, 6.2 million cases of urinary tract infection (UTI) are reported in England and Wales and have the second highest antibiotic prescription rate. The absence of fast and sensitive diagnostic tests has increased empirical antibiotic use and has contributed to the rise of antibiotic-resistant infections. To address this challenge, we have developed NANOPLEX™: a rapid 15 min test that uses glycan-functionalized-latex nanoparticles, microscopy and image-analysis software to identify and enumerate samples with bacteria. In this work, we show that NANOPLEX™ can correctly identify the three most common uropathogens using lab reference strains, clinical isolates and clinical urine samples. Materials and Methods The NANOPLEX™ assay was performed as per Vendeville et al. 2021.1 ACS Biomater 2022; 8, 1:242-252. Clinical isolates of Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were obtained from an NHS clinical microbiology lab waste stream. N=30 isolates (per species) were tested via single-blind study protocols at concentrations of 10³–108 cfu/mL and compared with microbial culture to define performance metrics (sensitivity, specificity, PPV, NPV and accuracy) of each probe. Results A total of 90 isolates were tested against their target probes and demonstrated &amp;gt;90% accuracy (sensitivity 88%–90%, specificity 94%–98%, PPV 93%–98%, NPV 88%–90%, accuracy 91%–94%) for all probe-bacteria combinations at clinically significant concentrations (105 cfu/mL). Conclusions NANOPLEX™ was able to successfully detect the top three common Gram-negative pathogens in UTI at clinically relevant concentrations. A compact hardware and single-use cartridge system is under development to enable urologists to conduct rapid and accurate UTI testing in point-of-care environments. Larger clinical studies are planned to clinically validate these results.

Epidemiology and Antimicrobial Resistance Patterns of Urinary Tract Infections: A Cross-Sectional Study from Southwestern Saudi Arabia.

Background: Urinary tract infections (UTIs) are a prevalent form of urinary tract diseases affecting individuals of all ages and genders. In the Kingdom of Saudi Arabia (KSA), UTIs are a significant burden on the healthcare system, comprising 10% of all infections and ranking as the second leading cause of emergency department admissions. Despite this, limited research has been conducted in Saudi Arabia, particularly in Jazan Province, located in the southwestern region. Methods: This retrospective, cross-sectional study encompassed individuals with positive urine cultures who sought care at a tertiary hospital in Jazan between January 2022 and March 2023. A standardized data collection form was utilized to retrieve relevant information from microbiology lab test results and patients' electronic medical records. Variables such as sex, urine sample collection date, bacterial isolates, antibiotic sensitivity, and resistance were collected using the data collection form. Data were analyzed using SPSS software, version 23.0 (IBM Corp., Armonk, NY, USA). Results: A total of 1082 urinary bacterial samples were isolated and identified. Females accounted for more bacterial infections (62.66%) than males (37.34%). Gram-negative bacteria represented 94% of all isolated strains. The most prevalent pathogens associated with UTIs were Escherichia coli (47.97%), Klebsiella pneumoniae (24.58%), and Pseudomonas aeruginosa (11.55%). Antimicrobial resistance patterns indicated the presence of extended-spectrum beta-lactamase (ESBL) (30.13%), carbapenemase-resistant Enterobacter (CRE) (1.94%), methicillin-resistant Staphylococcus aureus (MRSA) (0.74%), and vancomycin-resistant Enterococci (VRE) (0.18%). UTI incidence demonstrated a higher prevalence in September (13%) compared to other months in 2022. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the predominant Gram-negative multidrug-resistant organisms (MDRO), accounting for 34.42%, 13.95%, and 1.63% of the population. Conclusions: The prevalence of UTIs caused by antibiotic-resistant microbes is notable in Jazan. Consistent with findings from other regions, Escherichia coli remains the most common causative pathogen of UTIs, displaying a seasonal pattern that warrants attention. Approximately 35% of reported cases involve MDRO, with ESBLs accounting for 30%. These results should raise concerns among healthcare officials, highlighting the necessity for further investigations into factors contributing to the circulation of MDRO in Jazan.

Quantitative multiplex PCR in copies ml-1 linearly correlates with standard urine culture in colonies ml-1 for urinary tract infection (UTI) pathogens.

Standard urine culture (SUC) is the current standard method for confirmation of a urinary tract infection (UTI). SUC identifies microorganisms in urine samples and semi-quantifies these as colony-forming units (CFU) ml-1. In contrast, quantitative multiplex polymerase chain reaction (q-MPCR) is a culture-independent assay in which the microbes are quantified by targeting genomic sequences and reported as cells ml-1, calculated from copies ml-1. Using serial dilutions within the 104-105 cells ml-1 range, the usual reporting range of SUC, this study compared the quantification results based on SUC and q-MPCR for four uropathogens with the control hemocytometer counts. The results revealed a linear relationship and a 1:1 correlation between the q-MPCR and SUC results. Additional q-MPCR quantification of 36 uropathogenic non-fastidious and fastidious bacteria and yeast indicated a reproducible linear correlation in a 1:1 manner with the control counts over a range of cell densities (103-106). The results confirm that the quantifications by q-MPCR in cells ml-1 and by SUC in CFU ml-1 are comparable and answer to the lingering question of how the results of these two methods correlate. Moreover, q-MPCR provided accurate quantification of various microorganisms over wider cell density ranges without the time required for microbial growth.

Nitrofurantoin: properties and potential in treatment of urinary tract infection: a narrative review.

Nitrofurantoin (NF), a wide-spectrum antibiotic accessible since 1953, is utilized widely to treat urinary tract infections as it usually stays active against drug-resistant uropathogen. The use of Nitrofurantoin has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI). To, although fluoroquinolones are usually used to re-evaluate the first- and second-line therapies for treating uncomplicated UTI, their level of utilization is thought to be inappropriately excessive and will eventually have a detrimental impact; thus, we hypothesize that NF might be the best choice for this condition, because of its low frequency of utilization and its high susceptibility in common UTI pathogens. It can be concluded from this review that NF can be considered as the most effective drug in the treatment of acute urinary infection, but due to the long-term side effects of this drug, especially in elderly patients, it is essential to introduce some criteria for prescribing NF in cases of chronic UTI.

Antibiogram of Catheter Associated Bacterial Pathogens in Urinary Tract Infection among Pediatrics Patients in Pakistan

Background: Antimicrobial resistant (AMR) pathogens causing Urinary Tract infection is a serious public health concern in our clinical setting. Methodology: Therefore the current study was designed to investigate AMR profiles and prevalence of bacterial pathogens in catheterized pediatric patients. A total of 200 catheter tips were collected from the different wards (medical, surgical, urology) at the Children’s hospital Faisalabad. Samples were streaked on nutrient agar plates and the positivity of the samples was noted after 24 hours. Positive samples were processed further for the identification of K. pneumoniae, P. aeruginosa, S. aureus, and E. coli using culture identification, microscopy, and biochemical profiling on basis of culture characterization, microscopy, and biochemical profiling and antibiotic susceptibility testing. Results: 76 (38%) of the samples showed growth on nutrient agar. In processed samples, the high prevalence was marked for P. aeruginosa (24/200; 12%) followed by E. coli (22/200; 11%) and S. aureus (19/200; 9.5%) while 11 K. pneumoniae isolates (5.5%) were identified in this study. In antibiotic susceptibility profiling of P. aeruginosa highest susceptibility was found for colistin (100%) and imipenem (70.83%) followed by gentamicin (54.17%) while the highest resistance was found for tobramycin (54.17%) followed by meropenem, ceftazidime, and cefotaxime (50%). In antibiotic susceptibility profiling of K. pneumonia highest susceptibility was found for colistin (100%) and imipenem (72.73%) followed by gentamicin and ciprofloxacin (45.45%) while the highest resistance was found for cefotaxime (63.63%) followed by meropenem, tobramycin and amikacin (54.54%). In antibiotic susceptibility profiling of E. coli highest susceptibility was found for colistin (100%) and imipenem (63.64%) followed by ciprofloxacin (54.55%) while the highest resistance was found for gentamicin (54.55%) followed by tobramycin, meropenem, ceftazidime, and amikacin (50%). In antibiotic susceptibility profiling of S. aureus highest susceptibility was found for vancomycin (100%) clindamycin, cefoxitin, and trimethoprim-sulfamethoxazole (57.89%) while the highest resistance was found for erythromycin and ampicillin (47.37%). Conclusion: Advance studies are needed to investigate the real investigations of bacterial contamination; resistance to treatment options and resistance to antibiotics are needed.

Assessing the urinary concentration of nitrofurantoin and its antibacterial activity against Escherichia coli, Staphylococcus pseudintermedius, and Enterococcus faecium isolated from dogs with urinary tract infections.

Nitrofurantoin, a broad-spectrum nitrofuran class antibiotic, is applied as a first-line antibiotic in treating human urinary tract infections (UTIs) due to its great efficacy and high achievable concentration. The interest in using this antibiotic in companion animals has increased due to the growing demand for effective antibiotics to treat UTIs caused by multidrug-resistant bacteria. Currently, the susceptibility interpretations for nitrofurantoin are based on the breakpoints set for humans, while the canine-specific breakpoints are still unavailable. In this study, we assessed the concentration of nitrofurantoin reaching the dog's urine using the recommended oral dosing regimen. In addition, we examined the efficacy of this breakpoint concentration against the common canine UTI pathogens, Escherichia coli, Staphylococcus pseudintermedius, and Enterococcus faecium. Eight experimental beagle dogs were treated with ~5 mg/kg of nitrofurantoin macrocrystal PO 8qh for 7 days. The urine samples were collected via cystocentesis at 2, 4, and 6 h after administration on day 2 and day 7 and used to quantify nitrofurantoin concentrations by ultra-high performance liquid chromatography. The results showed that 26.13-315.87 μg/mL nitrofurantoin was detected in the dogs' urine with a mean and median concentration of 104.82 and 92.75 μg/mL, respectively. Additionally, individual dogs presented with urinary nitrofurantoin concentrations greater than 64 μg/mL for at least 50% of the dosing intervals. This concentration efficiently killed E. coli, and S. pseudintermedius, but not E. faecium strains carrying an MIC90 value equal to 16, 16, and 128 μg/mL, respectively. Taken together, these results suggest that the value of 64 μg/mL may be set as a breakpoint against UTI pathogens, and nitrofurantoin could be an effective therapeutic drug against E. coli and S. pseudintermedius for canine UTIs.

Anti-urinary tract infection activity of selected herbal extract towards isolated Kosakonia cowanii (OQ 073698)

Urinary Tract Infection (UTI) is one of the most common types of infection caused by the gastrointestinal tract of humans. UTI is the most common in women because a women''s urethra is shorter. In the present investigation, four UTI-causing bacteria were isolated on MacConkeys as well as on UTI agar media which is selective for UTI pathogens only. The isolated bacteria were tested for antibiotic resistance towards the selective antibiotics Ampicillin (10µg), Penicillin (10µg), and Chloramphenicol (30µg). Based on antibiotic resistance and morbific nature, the organism was screened. On the basis of morphological, biochemical characteristics and the 16S r-RNA sequencing method the organism was identified as Kosakonia cowanii. The nucleotide sequence was deposited to NCBI and received a unique accession number (OQ 073698). The anti-UTI activity was performed towards selective medicinal herbs by using ethanol, methanol and water as solvent extraction methods. The Embilica officinalis ethanolic extract (1 mg/ml) and standard antibiotic chloramphenicol showed 1.8 mm zone of inhibition against K. cowanii (OQ 073698). From the present study, it is concluded that E. officinalis ethanolic extract was effective to treat UTI infection. Another core finding from the present study includes - an isolated pathogen that was earlier resistant to ampicillin but when combines with E. officinalis and Boerhavia diffusa ethanolic extracts separately showed 2.0 mm zone of inhibition.

Multiplex Polymerase Chain Reaction/Pooled Antibiotic Susceptibility Testing Was Not Associated with Increased Antibiotic Resistance in Management of Complicated Urinary Tract Infections.

To compare antibiotic resistance results at different time points in patients with urinary tract infections (UTIs), who were either treated based upon a combined multiplex polymerase chain reaction (M-PCR) and pooled antibiotic susceptibility test (P-AST) or were not treated. The M-PCR/P-AST test utilized here detects 30 UTI pathogens or group of pathogens, 32 antibiotic resistance (ABR) genes, and phenotypic susceptibility to 19 antibiotics. We compared the presence or absence of ABR genes and the number of resistant antibiotics, at baseline (Day 0) and 5-28 days (Day 5-28) after clinical management in the antibiotic-treated (n = 52) and untreated groups (n = 12). Our results demonstrated that higher percentage of patients had a reduction in ABR gene detection in the treated compared to the untreated group (38.5% reduction vs 0%, p = 0.01). Similarly, significantly more patients had reduced numbers of resistant antibiotics, as measured by the phenotypic P-AST component of the test, in the treated than in the untreated group (42.3% reduction vs 8.3%, p = 0.04). Our results with both resistance gene and phenotypic antibiotic susceptibility results demonstrated that treatment based upon rapid and sensitive M-PCR/P-AST resulted in reduction rather than induction of antibiotic resistance in symptomatic patients with suspected complicated UTI (cUTI) in an urology setting, indicating this type of test is valuable in the management of these types of patients. Further studies of the causes of gene reduction, including elimination of ABR gene-carrying bacteria and loss of ABR gene(s), are warranted.

Urinary Tract Infections: The Current Scenario and Future Prospects.

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, occurring in both community and healthcare settings. Although the clinical symptoms of UTIs are heterogeneous and range from uncomplicated (uUTIs) to complicated (cUTIs), most UTIs are usually treated empirically. Bacteria are the main causative agents of these infections, although more rarely, other microorganisms, such as fungi and some viruses, have been reported to be responsible for UTIs. Uropathogenic Escherichia coli (UPEC) is the most common causative agent for both uUTIs and cUTIs, followed by other pathogenic microorganisms, such as Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus spp. In addition, the incidence of UTIs caused by multidrug resistance (MDR) is increasing, resulting in a significant increase in the spread of antibiotic resistance and the economic burden of these infections. Here, we discuss the various factors associated with UTIs, including the mechanisms of pathogenicity related to the bacteria that cause UTIs and the emergence of increasing resistance in UTI pathogens.

Monitoring and features of antibiotic resistance during the COVID-19 pandemic

Background. Urinary tract infection (UTI) is an urgent problem in nephrology. The current state of antibiotic resistance to antimicrobial drugs complicates the empirical choice of antibacterial therapy, and indications for the use of antimicrobial drugs are not always clinically justified. The purpose of the study: to compare the antibiotic resistance of the main groups of UTI pathogens during coronavirus 2019 (COVID-19) pandemic in 2020–2022 with the results of 2014–2016 monitoring among children of the Chernivtsi region. Materials and methods. Urine samples were collected from 657 children (0–17 years old) who received specialized medical care in health care institutions of the Chernivtsi region (2014–2016). During 2020–2022, a clinical and laboratory examination of 180 children (0–17 years old) was conducted. Results. The results of the monitoring proved the wave-like nature of changes in antibiotic resistance to semi-synthetic penicillins and cephalosporins with the maintenance of a sufficient level of sensitivity to these antimicrobial drugs among the main groups of UTI pathogens; the data obtained give reason to suggest a negative trend to increasing resistance to fluoroquinolones, tetracyclines over time (2020–2022 — the period of the COVID-19 pandemic); a multidirectional and time-dependent differences were revealed in sensitivity to aminoglycosides: gentamicin, amikacin and kanamycin in children of Chernivtsi region, as well as a negative trend to increasing the share of carbapenem-resistant strains of uropathogens — 55.8 ± 5.1 % (imipenem — χ2 = 5.432; p = 0.020). Conclusions. The monitoring results indicate the need to comply with standards in the provision of medical care (prescribing antibacterial therapy taking into account the data of regional monitoring on antibiotic resistance to antimicrobial drugs), administration of antimicrobial drugs in health care institutions that provide medical care in outpatient and inpatient settings. High level of antibiotic resistance of UTI uropathogens to carbapenems (2020–2022), used for the treatment of severe bacterial infections, requires their exclusively targeted prescription in everyday pediatric practice.

Characterization of ESKAPE pathogens in urinary tract infections among Jordanian patients.

ESKAPE pathogens are a small group of pathogens of remarkable importance. The present study was carried out to determine the prevalence of ESKAPE pathogens in urinary tract infections (UTIs) and their antibiotic susceptibility patterns at the Jordan University of Science and Technology Health Center in Irbid, Jordan. A one-year retrospective study was conducted from April 2021 to April 2022. A total of 444 samples of "clean-catch" (midstream) urine from outpatients were studied. Our study showed that the vast majority of urinary tract infected patients were females (92%) compared to males (8%) and were most frequent in the age group 21-30 years old. The most associated co-morbidities with UTIs were hypertension followed by diabetes mellitus and hypothyroidism. ESKAPE pathogens were responsible for about 87.4% of the UTIs in this study, and all were identified in the urine samples except Acinetobacter baumannii. In this study, isolates were most sensitive to levofloxacin, ciprofloxacin, and third-generation cephalosporin's and least sensitive to doxycycline, amoxicillin, and clindamycin. This research work has shown that patients with UTI-associated ESKAPE pathogens in Jordan are at high risk of antibiotic resistance. To the best of our knowledge, this is the first study in the region that studies the association between ESKAPE pathogens and UTIs.

Antibiotic resistance of pathogens causing community-acquired urinary tract infections in pregnant women with diabetes mellitus

BACKGROUND: Urinary tract infections are among the most common infectious diseases in women and are the most frequent cause of infectious complications of pregnancy, especially in pregnant women with type 1 diabetes mellitus. For adequate treatment of urinary tract infections in pregnant women with type 1 diabetes mellitus, it is requisite to regularly monitor antimicrobial resistance of uropathogens in order to update empirical schemes of antibacterial therapy.&#x0D; AIM: The aim of this study was to determine the spectrum of uropathogens and the activity of antibacterial drugs against pathogens of community-acquired urinary tract infections in pregnant women with type 1 diabetes mellitus or without diabetes mellitus.&#x0D; MATERIALS AND METHODS: We analyzed 91 strains obtained from pregnant women with or without type 1 diabetes mellitus. The sensitivity of microorganisms to all antibacterial drugs was evaluated by the disk diffusion method.&#x0D; RESULTS: In the group of pregnant women with type 1 diabetes mellitus in the etiological structure of uropathogens, enterobacteria accounted for 84.8%, Escherichia coli (71.7%) and Klebsiella spp. (13.0%) being the most common. In the group of pregnant women without diabetes mellitus in the structure of uropathogens, enterobacteria accounted for 75.6%, while E. coli was the causative agent of urinary tract infections in 62.2% of women and Klebsiella spp. in 11.1%. Gram-positive uropathogens were isolated much less frequently. In the group of pregnant women with type 1 diabetes mellitus, piperacillin/tazobactam, carbapenems, nitrofurantoin, and amikacin (100%), as well as fosfomycin and gentamicin (97%), had the maximum antibacterial activity against E. coli. The sensitivity of E. coli to various cephalosporins varied in the range of 84.990.9%. In the group of pregnant women without diabetes mellitus and with urinary tract infections, the highest E. coli sensitivity rates were observed for piperacillin/tazobactam, carbapenems, fosfomycin, nitrofurantoin, gentamicin, and amikacin (100%). E. coli sensitivity to second and third generation cephalosporins varied in the range of 75.082.1%, and it was 96.4% to cefepime. Ampicillin and amoxicillin/clavulanate demonstrated the least activity against E. coli in the two study groups. The rate of extended spectrum beta-lactamase production by uropathogenic enterobacteria in pregnant women with type 1 diabetes mellitus was 15.8% of the strains, and in pregnant women without diabetes mellitus, it was 18.1%.&#x0D; CONCLUSIONS: There were no significant differences in the activity of antibacterial drugs against the pathogens of community-acquired urinary tract infections in pregnant women with or without diabetes mellitus.