Urinary Tract Infection Pathogens Research Articles

Chemical Profiling and In Vitro Antiurolithiatic Activity of Pleurolobus gangeticus (L.) J. St.- Hil. ex H. Ohashi & K. Ohashi Along with Its Antioxidant and Antibacterial Properties.

Pleurolobus gangeticus (L.) J. St.- Hil. ex H. Ohashi & K. Ohashi (Fabaceae) is an important medicinal plant used to treat various ailments. In this study, we report the antiurolithiatic, antioxidant, and antibacterial potential of chloroform fraction (CF) from P. gangeticus roots. For the chemical profiling, HPTLC, FT-IR, and GC-MS techniques of the CF were carried out, and phytochemical investigation was revealed that stigmasterol (45.06%) is one of the major components present in the fraction. The nucleation and aggregation assays were used to evaluate the in vitro antiurolithiatic activity at various concentration (2-10mg/mL) of the CF. The results showed that the chloroform fraction had dose-dependent effects on Calcium Oxalate (CaOx) crystal formation. In both the assays, the maximum concentration of 10mg/mL has shown better results. This concentration resulted significant increase in CaOx crystal nucleation along with the reduction of crystal size and the inhibition of crystal aggregation. Further, the CF showed stronger antioxidant (DPPH, NO, SOD, TRC) potential with an IC50 values of 415.9327, 391.729, 275.971, and 419.14µg/mL, respectively. The antibacterial evaluation displayed effective results in the Agar well diffusion assay against selective urinary tract infection (UTI) pathogens (Escherichia coli, Klebsiella pneumonia, and Staphylococcus aureus). A maximum zone of inhibition (ZOI) 12.33 ± 1.05mm for K pneumonia and minimum ZOI of 8.46 ± 0.27mm for S. aureus were obtained. Further, the ADME-PK property of the stigmasterol was investigated, and it was found to pass the Lipinski and Ghose rules, supporting the drug-likeliness. This is the first record of the antiurolithiatic potential of P. gangeticus along with antioxidant and antibacterial activities. These findings give an insight into the effective drug development and treatment for kidney stones in future.

Epidemiology of Antibiotic Resistant Pathogens in Pediatric Urinary Tract Infections as a Tool to Develop a Prediction Model for Early Detection of Drug-Specific Resistance.

Antibiotic resistance is an increasing problem, especially in children with urinary tract infections. Rates of drug-specific resistant pathogens were reported, and an easy prediction model to guide the clinical decision-making process for antibiotic treatment was proposed. Data on microbiological isolation from urinoculture, between January 2007–December 2018 at Istituto Gaslini, Italy, in patients aged <19 years were extracted. Logistic regression-based prediction scores were calculated. Discrimination was determined by the area under the receiver operating characteristic curve; calibration was assessed by the Hosmer and Lemeshow test and the Spiegelhalterz test. A total of 9449 bacterial strains were isolated in 6207 patients; 27.2% were <6 months old at the first episode. Enterobacteriales (Escherichia coli and other Enterobacteriales) accounted for 80.4% of all isolates. Amoxicillin-clavulanate (AMC) and cefixime (CFI) Enterobacteriales resistance was 32.8% and 13.7%, respectively, and remained quite stable among the different age groups. On the contrary, resistance to ciprofloxacin (CIP) (overall 9.6%) and cotrimoxazole (SXT) (overall 28%) increased with age. After multivariable analysis, resistance to AMC/CFI could be predicted by the following: sex; age at sampling; department of admission; previous number of bacterial pathogens isolated. Resistance to CIP/SXT could be predicted by the same factors, excluding sex. The models achieved very good calibration but moderate discrimination performance. Specific antibiotic resistance among Enterobacteriales could be predicted using the proposed scoring system to guide empirical antibiotic choice. Further studies are needed to validate this tool.

Rapid Detection of Bacterial Pathogens and Antimicrobial Resistance Genes in Clinical Urine Samples With Urinary Tract Infection by Metagenomic Nanopore Sequencing.

Urinary tract infections (UTIs) are among the most common acquired bacterial infections in humans. The current gold standard method for identification of uropathogens in clinical laboratories is cultivation. However, culture-based assays have substantial drawbacks, including long turnaround time and limited culturability of many potential pathogens. Nanopore sequencing technology can overcome these limitations and detect pathogens while also providing reliable predictions of drug susceptibility in clinical samples. Here, we optimized a metagenomic nanopore sequencing (mNPS) test for pathogen detection and identification in urine samples of 76 patients with acute uncomplicated UTIs. We first used twenty of these samples to show that library preparation by the PCR Barcoding Kit (PBK) led to the highest agreement of positive results with gold standard clinical culture tests, and enabled antibiotic resistance detection in downstream analyses. We then compared the detection results of mNPS with those of culture-based diagnostics and found that mNPS sensitivity and specificity of detection were 86.7% [95% confidence interval (CI), 73.5–94.1%] and 96.8% (95% CI, 82.4–99.9%), respectively, indicating that the mNPS method is a valid approach for rapid and specific detection of UTI pathogens. The mNPS results also performed well at predicting antibiotic susceptibility phenotypes. These results demonstrate that our workflow can accurately diagnose UTI-causative pathogens and enable successful prediction of drug-resistant phenotypes within 6 h of sample receipt. Rapid mNPS testing is thus a promising clinical diagnostic tool for infectious diseases, based on clinical urine samples from UTI patients, and shows considerable potential for application in other clinical infections.

Using an ATR-FTIR Technique to Detect Pathogens in Patients with Urinary Tract Infections: A Pilot Study.

Urinary tract infections (UTIs) are a leading hospital-acquired infection. Although timely detection of causative pathogens of UTIs is important, rapid and accurate measures assisting UTI diagnosis and bacterial determination are poorly developed. By reading infrared spectra of urine samples, Fourier-transform infrared spectroscopy (FTIR) may help detect urine compounds, but its role in UTI diagnosis remains uncertain. In this pilot study, we proposed a characterization method in attenuated total reflection (ATR)-FTIR spectra to evaluate urine samples and assessed the correlation between ATR-FTIR patterns, UTI diagnosis, and causative pathogens. We enrolled patients with a catheter-associated UTI in a subacute-care unit and non-UTI controls (total n = 18), and used urine culture to confirm the causative pathogens of the UTIs. In the ATR-FTIR analysis, the spectral variation between the UTI group and non-UTI, as well as that between various pathogens, was found in a range of 1800–900 cm−1, referring to the presence of specific constituents of the bacterial cell wall. The results indicated that the relative ratios between different area zones of vibration, as well as multivariate analysis, can be used as a clue to discriminate between UTI and non-UTI, as well as different causative pathogens of UTIs. This warrants a further large-scale study to validate the findings of this pilot research.

Atypical pathogens in urinary tract infections: a systematic review

Urinary tract infection [UTI] accounts for a significant portion of the worldwide infections, whose cause occurs predominantly through Gram-negative bacilli, followed by Gram-positive bacteria and fungi. However, a number of cases by atypical pathogens are increasing. Thus, a systematic review was carried out on UTIs caused by atypical/emerging agents, covering etiological, epidemiological, clinical and therapeutic aspects. The search conducted via PubMed database and 59 articles composed the final sample. The laboratory approaches reported have included uroculture with special media; molecular methods such as PCR, real-time PCR, and nucleic acid sequencing; and MALDI-TOF mass spectrometry. Pathogens found among bacteria, including Gram-negative bacilli, Gram-positive cocci, diphtheroids, Mycoplasmataceae members, actinomycetes, and Gram-variable coccobacilli; yeasts, molds and microsporidia; virus, including BK polyomavirus, HPV, CMV and HSV-2; and a protozoan, Trichomonas vaginalis. The risk factors appear to be associated with patients' intrinsic features, such as advanced age, female gender, chronic diseases, prostatic hyperplasia, immunocompromised, genitourinary tract alteration; or risky situations as long-term urinary catheter usage, urinary tract manipulation, cancer chemotherapy, alcoholism, prolonged use of antibiotics and risky sexual behavior. The difficulty in identifying these agents was also evident, due to their peculiar characteristics or the unavailability of more sophisticated methods in the laboratorial routines, which implicates in the clinical management. Therefore, it is important that the medical and the microbiology teams are aware of the possibility of these agents in order to assess the need for further testing. The importance of antimicrobial susceptibility tests is also emphasized because of these organisms’ different profiles.

Evaluation of in vitro effect of Fosfomycin on resistant Gram-negative pathogens in urinary tract infection

Evaluation of in vitro effect of Fosfomycin on resistant Gram-negative pathogens in urinary tract infection

Urinary Tract Infection in Parkinson's Disease.

Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson’s disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.

Gold Nanoparticle Smartphone Platform for Diagnosing Urinary Tract Infections.

Current urinary tract infection (UTI) diagnostic methods are slow or provide limited information, resulting in prescribing antibiotic therapy before bacterial pathogen identification. Here, we adapted a gold nanoparticle colorimetric approach and developed a smartphone platform for UTI detection. We show the parallel identification of five major UTI pathogens at clinically relevant concentrations of 105 bacteria/mL using bacteria-specific and universal probes. We validated the diagnostic technology using 115 positive and 19 negative samples from patients with Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae infections. The assay successfully identified the infecting pathogen (specificity: >98% and sensitivity: 51–73%) in 3 h. Our platform is faster than culturing and can wirelessly store and transmit results at the cost of $0.38 per assay.

Elucidating novel antibacterial compounds from the NPASS database against the FimH lectin domain for the treatment of urinary tract infections: an in-silico study

The increase in multidrug-resistant pathogens in urinary tract infections (UTIs) among communities and hospitals threatens our ability to treat these common pathogens. Uropathogenic Escherichia coli (UPEC) strains are the most frequent uropathies linked to the development of UTIs. This work aims to introduce bioactive natural products via virtual screening of small molecules from a public database to prevent biofilm formation by inhibiting FimH, a type 1 fimbriae that plays a crucial role in UPEC pathogenicity. A total of 30926 small molecules from the NPASS database were subjected to screening via molecular docking. Followed by performing in silico ADME studies, seven molecules showed promising docking results ranging from −6.8 to −8.7 kcal/mol. As a result of the docking score findings, 100 ns Molecular dynamics (MD) simulations were performed. Based on MM-PBSA analysis, NPC313334 ligand showed high binding affinity −42 and stability with the binding pocket of FimH protein during molecular dynamic simulations. DFT calculations were also performed on the ligands to calculate the HOMO-LUMO energies of the compounds in order to an idea about their structure and reactivity. This research suggests that NPC313334 may be a possible antibacterial drug candidate that targets FimH to reduce the number of UPEC-related urinary tract infections. Communicated by Ramaswamy H. Sarma

Comparison of a Chromogenic Urine Culture Plate System (UTid+) and Conventional Urine Culture for Canine and Feline Specimens.

In companion animal medicine, urinary tract infection (UTI) is one of the most common indications for antimicrobial therapy. Definitive diagnosis of UTI requires isolation of bacteria with routine urine culture from an animal with concurrent clinical signs. Urine culture is typically performed at reference laboratories where paired susceptibility testing can be performed, but delays in shipment or processing can affect results. This study evaluated the use of a selective chromogenic, point-of-care culture system (UTid+) compared to conventional urine culture. A total of 119 (73 canine and 46 feline) cystocentesis urine samples were evaluated. Conventional urine culture was positive for 28 (23.5%) of the 119 cultures and UTid+ culture was positive for 26 (21.8%). The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 92.3%, 97.8%, 92.3%, 97.8 and 96.6% for UTid+ respectively. Overall, the UTid+ culture system showed an acceptable level of accuracy when compared to conventional urine culture. Agreement of identification results was high (κ = 0.90) with an important exception being Proteus spp. which was only identified in 1/3 positive cultures. UTid+ may be useful in scenarios where a common UTI pathogen is expected and identification within 24 h is ideal; however, conventional urine culture remains the gold standard.

Rapid Identification and Drug Sensitivity Test to Urinary Tract Infection Pathogens by DOT-MGA.

AimTo reduce the inspection time for urinary tract pathogens and provide a rapid and effective therapeutic plan for clinical anti-infection treatment, this study developed a rapid identification (ID) and antimicrobial sensitivity test (AST) method by DOT-MGA.MethodsWe grouped midstream urine samples with single bacteria according to the number of bacteria (≤5/5–15/≥ 15) under per oil microscope after Gram staining. Then we adopted differential centrifugation to process the grouped samples to collect precipitate. MALDI-TOF MS was performed using precipitate directly or after short-term culture. If succeed, we resuspended the precipitate into droplets with or without antibiotics at a MALDI target. Four hours later, mass spectrometer (MS) was used to identify the culture on the target and to analyse AST.ResultsSamples (count ≥ 15), which precipitate can be directly identified by MS; otherwise, the precipitate need a short-term cultured for 3–6 h before ID. The consistency of the ID results between conventional culture and the precipitate is 100%. Compared with broth microdilution method, DOT-MGA for predicting AST had a high consistency. EA and CA for IPM, LEV, CAZ, NIT, and FOT were 100%/100%, 98%/90%, 98%/92%, 100%/90%, 98%/94%, respectively. No VME was observed in all tests. Besides, MIC50 for the five antibiotics by DOT-MGA and broth microdilution method were ≤1/≤0.5,>2/2,≤4/≤2,≤32/≤16,≤64/≤32 and MIC90 were ≤1/≤0.5, >2/>4, 16/16, 128/128, 128/64.ConclusionThis study can shorten the ID time (minimum 0.5h) and AST (minimum 4h) of the main pathogens of urinary tract infection to 5–10 hours, which greatly reduce the inspection time and provide substantial help for the rapid diagnosis and treatment of patients with urinary tract infection.

Emergence of Extended-Spectrum β-Lactamase-Producing Pathogens in Community-Acquired Urinary Tract Infections Among Infants at a Pediatric Emergency Department.

Extended-spectrum β-lactamase (ESBL)-producing pathogens are common among adults and are associated with extended and multiple hospitalizations. They cause urinary tract infections (UTIs) among children with known risk factors such as urinary tract abnormalities and antimicrobial prophylaxis. The emergence of UTIs caused by ESBL-producing organisms among infants has not been well characterized. We sought to describe the incidence and current clinical management of infants who were diagnosed with UTIs caused by ESBL-producing organisms at a pediatric emergency department (ED). In addition, we sought to describe risk factors associated with inpatient hospitalization for UTIs caused by ESBL-producing organisms. We retrospectively identified infants who were treated in the ED from 2013 to 2017 and who had positive urinalyses and urine cultures positive for greater than 50,000 colony-forming unit per milliliter of a single ESBL-producing urinary pathogen. We abstracted details of clinical management and known previous risk factors, including prior neonatal intensive care unit hospitalization stay, prior UTI caused by an ESBL-producing organism, and known urologic abnormalities. Forty-five UTIs caused by ESBL-producing organisms occurred in 43 patients (mean age of 5.9 months and 59% female)-ESBL Escherichia coli represented the majority (42/45). The incidence of UTIs caused by ESBL-producing organisms ranged from 0.9% to 4.5% during the 5-year study period. The 13 patients (26%) admitted from the ED were significantly younger than discharged patients (1.9 vs 6.7 months, P = 0.016) and more likely to have had prior neonatal intensive care unit hospitalizations (50% vs 15.6%, P = 0.0456). Of the 33 visits (77%) resulting in initial outpatient management, 5 were followed by readmission for parenteral antibiotic treatment. Of those who were readmitted, 40% (n = 2) were afebrile at the time of admission. The remainder (28/33) completed outpatient oral antibiotic courses guided by susceptibilities. Two patients (4%) had negative repeat urine cultures despite in vitro resistance to initial antibiotic coverage. Extended spectrum β-lactamase-producing organisms are an increasing cause of UTIs in infants presenting at a pediatric ED, and outpatient management may be reasonable for infants older than 2 months.

Актуальна динаміка видової структури етіологічних збудників інфекції сечової системи в дітей та антибактеріальної чутливості цих патогенів

Understanding the structure of etiopathogenes of urinary tract infections (UTIs) in children, the state of antibacterial resistance (ABR) is an important component of the empirical choice of antibiotics in treatment. Purpose - to study the species structure of UTIs pathogens in children, the prevalence of ABR the rate of its formation at the present stage. Materials and methods. The study involved 2754 hospital and outpatient children aged 0 to 18 years with UTIs in the active phase of the disease for the period 2009-2019. The contingent of subjects was divided into 3 groups: patients for 2009, 2014 and 2019 years of follow-up. Results. Escherichia coli was recognized as the leading uropathogen in all observation groups: in the 1st group (2009) its share was 47% (158/337), in the 2nd (2014) - 64% (210/328), in 3rd (2019) - 66.5% (252/379). The high dynamics of ABR prevalence of Escherichia coli was recognized: an increase of 11% in 2019 compared to 2014; by 18.8% compared to 2009. Thus, in 2019, every second child had resistance (57.6%±1.6 (1586/2754)) and every third - polyresistance (27.4%±3), 04 (755/2754)). We found an increase in the relative risk of ABR in 2019 1.6 times compared to 2014 and 3 times compared to 2009. The mathematical forecast of the prevalence of resistant strains of Escherichia coli for 15 years approached 100% (y=9.5x6+41=98%) at R² = 0.9918. For 10 years the indicator corresponded to 88.5%, for 5 years - 79%. The prognostic increase in ABR relative risk of 2.9-3.7 times in the next 5-10 years has been established. Conclusions. The obtained data are of great practical importance for general practitioners and specialists, as they indicate a high rate of formation of resistant strains of Escherichia coli and other pathogens among children with UTIs, which complicates the empirical choice of antibacterial therapy. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Informed consent of the children's parents was obtained for the research. The authors declare no conflict of interest. Key words: urinary tract infection, children, etiological pathogens, antibacterial resistance.

A0111 - Report on microbial and resistance patterns of the causative pathogens of nosocomially-acquired urinary tract infections: Preliminary data analysis of the GPIU-Studies 2015-2020

A0111 - Report on microbial and resistance patterns of the causative pathogens of nosocomially-acquired urinary tract infections: Preliminary data analysis of the GPIU-Studies 2015-2020

Antioxidant and Antimicrobial Capacities of Two Medicinal Plants Used against Urinary Infections in Burkina Faso

Objective: This study aimed to evaluate the antioxidant and antimicrobial capacities of extracts from Euphorbia hirta L. and Terminalia avicennioides GUILL & PERR. Methodology: The crude hydro-acetonic and aqueous extracts as well their fractionations were prepared. The total phenolic, flavonoids and tannins contents were assessed using the Folin-Ciocalteu, aluminum chloride and vanillin acid methods, respectively. The antioxidant and antibacterial activities were investigated using standard methods. Results: Euphorbia hirta showed significant contents of total phenolic and flavonoids in n-Butanol (145.14 ± 1.37 GAE/100mg extracts) and ethyl acetate (23.56 ± 0.68 mg QE/ 100mg extracts) fractions. Total tannins were high in hydro-acétonique extract (11.18 ± 0.31 mg TAE/100mg extracts) and aqueous fraction (11.12 ± 0.28 mg TAE/100mg extracts) of Terminalia avicennioides stem barks. Extracts and fractions of both plants demonstrated a strongly antioxidant capacity through the free radicals scavenging and the ferric ions reducing. Concerning antimicrobial screening the extracts of Terminalia avicennioides were effective against 16 causative pathogens of urinary tract infections. Bactericidal effect against Staphylococcus aureus ATCC 29213, Staphylococcus aureus and 2 methicillin-resistant Staphylococcus haemolyticus strains was found with aqueous fraction of Terminalia avicennioides leaves. This fraction also highlighted a synergetic effect with some antibiotics used against these bacterial strains. Conclusion: Terminalia avicennioides leaves could be recommended as an herbal drug formulation for the urinary infections management.

Application of photodynamic inactivation against pathogens of urinary tract infections

Photodynamic inactivation (PDI) is an alternative to antibiotic therapy method for biocidal action against microorganisms, which can be used for lithotripsy and sanitation of the bladder cavities. Objective. Selection of parameters and application PDI against uropathogenic microorganisms. Materials and Methods. In this study we used bacterial strains isolated from urine samples of patients. Differentiation media and biochemical plates were used for identification of microorganisms. The sensitivity of uropathogenic microorganisms to PDI was studied on pure cultures and in native urine. The photosensitizer “Photoditazine” (50 µg/ml) was used in the work, as well as Triton X-100 (5 % vol.) was applying to increase the permeability of the cell wall of gram-negative microorganisms. The samples were irradiated by a medical laser device “Latus-K” with a wavelength of 662 nm. To assess the effectiveness of PDI, the values of the logarithmic decrease of colony-forming unit (CFU) of the microorganisms were calculated. Statistical analysis was made by Statistica 10.0 and Mann-Whitney criterion. Results. 50 strains of uropathogens belonging to 18 species were isolated from 36 samples of native urine. Among them, the most common were S. aureus, E. coli, P. aeruginosa, K. pneumoniae. The value of logarithmic decrease in CFU for gram-positive bacteria ranged from 5 to 6, which corresponds to inactivation 99.999-99.9999% of bacterial cells in a sample. For gram-negative strains, this value was slightly lower and ranged from 4 to 5.5, which, nevertheless, corresponds to inactivation 99.99-99.999% of CFU bacteria. The addition of Triton X-100 increase the efficiency from 46% to 99.99% for E. coli, from 99% to 99.99% for P. mirabilis, from 16% to 94% for K. pneumoniae and from 97% to 99.999% for P. aeruginosa. It should be noted that the PDI was affect microorganisms both in isolated pure cultures and in native urine. Conclusions. Photodynamic inactivation may be considered as an alternative to antibiotic therapy method of biocidal action against uropathogenic microorganisms.

Prevalence of Bacteriuria in Pregnant Women Visiting Provincial Hospital, Janakpurdham, Nepal

INTRODUCTION: Considering the importance of urinary tract infection (UTI) in pregnant women which is responsible for several complications, its diagnosis and treatment are essential to maintain the health of mother and baby.The purpose of the present study was to evaluate the isolation and identification of Escherichia coli from the UTI suspected pregnant women visiting at provincial Hospital Janakpur.&#x0D; MATERIALS AND METHODS: A total of 200 mid-stream urine samples were collected from UTI suspected pregnant women of 18 to 45 years visiting antenetal OPD in Provincial Hospital Janakpur in between February 2021 to April 2021. The collected urine samples were processed in the microbiology department of the Model Multiple College, Janakpur. Standard Microbiological procedures were followed.&#x0D; RESULTS: The Escherichia coli were predominant identified as 17 (35.41%). Patients aged between 25-30 years were mostly infected 35 (72.9%). The majority of bacteria isolated were more sensitive to Cephalexin and nitrofurantoin.&#x0D; CONCLUSIONS: Escherichia coli is one of the most important pathogen for UTI in pregnant women. The majority of bacteria isolated in the present study were more sensitive to Cephalexin and nitrofurantoin.

1057. Tebipenem In vitro Activity Against a Collection of Pathogens Responsible for Urinary Tract Infections in the US

1057. Tebipenem <i>In vitro</i> Activity Against a Collection of Pathogens Responsible for Urinary Tract Infections in the US

Evaluation of Antibacterial Potential of Ethanol Fruit Peel Extract of Mangifera indica against Isolated UTI Pathogens

Effective use of antimicrobial agents for treatment/management of infectious diseases is decreasing due to emergency of multi-drug and cross resistant strains of pathogenic microbes. Medicinal plants are now increasingly used alone or as an adjunct in the management of infectious diseases as a result of their claimed efficacy and safety. This research focused on evaluating the antimicrobial potential of ethanol fruit peel extract of Mangifera indica against isolated Urinary tract infection (UTI) pathogens. Urinary tract infection (UTI) bacterial strains (staphylococcus aureus, escherichia coli and pseudomonas aeruginosa) were isolated from midstream urine of infected students using standard procedures after which the isolated Urinary tract infection pathogens were subjected to antimicrobial susceptibility test by agar-well diffusion method (Cup plate method) and the mean diameter of growth inhibition zones (n=3) of the extract at different concentrations were compared against the controls (sterile water and ciprofloxacin). Ethanol fruit peel extract of Mangifera indica significantly and dose dependently inhibit the growth of all the isolated Urinary tract infection pathogens with E.coli exhibiting the highest inhibition zone ranging from 16.83 to 28.23 mm, this was followed by pseudomonas aeruginosa with inhibition zone of 24.33 mm and staphylococcus aureus least susceptible with 22.63 diameter of zone inhibition. Ethanol fruit peel extract of Mangifera indica demonstrated a dose dependent antimicrobial activity with more pronounced effect exhibited by E. coli suggesting that the extract is more effective against gram negative bacteria despite their permeability barrier, thus suggesting Mangifera indica fruit peel as a potential candidate for the management of bacterial infections especially those caused by gram negative organisms.

First Detection of Klebsiella pneumoniae Isolate Co-Harboring Fosfomycin Resistance Gene fosA3 and blactx-m Among Gram Negative Urine Isolates in a Turkish Hospital.

The most common gram-negative pathogens in urinary tract infections are Escherichia coli and Klebsiella pneumoniae. Therapy that is often empirical relies on local antibiotic resistance data, hence monitorization of antimicrobial resistance periodically in each hospital is a requirement. In this study, antibiotic susceptibility profiles of consecutive urinary isolates (E. coli [n = 235] and K. pneumoniae [n = 56]) of adult patients collected between February 2018 and February 2019 from inpatients in Hacettepe University Hospital were assessed. Isolates resistant to fosfomycin (minimum inhibitory concentration >32 mg/L) were further investigated for the presence of fosA, fosA3, and fosC2. Fosfomycin susceptibility was determined by agar dilution method. Broth microdilution method was performed for amikacin, gentamicin, ceftazidime, ceftriaxone, meropenem, ciprofloxacin, tigecycline, trimethoprim/sulfamethoxazole (TMP/SMX), colistin, and piperacillin/tazobactam (PIP/TAZ). PCR method was employed to investigate fosA, fosA3, fosC2, and blaCTX-M. Existence of fosA3 gene was confirmed by sequencing. Resistance rates to amikacin, gentamicin, ceftazidime, ceftriaxone, meropenem, ciprofloxacin, tigecycline, TMP/SMX, colistin, and PIP/TAZ were 2.7%, 18.5%, 25.4%, 33.0%, 3.4%, 45.4%, 2.4%, 43.6%, 6.2%, and 23.7%, respectively. Sixteen isolates (5.5%) were resistant to fosfomycin. Resistance was most frequently observed in K. pneumoniae (n = 9). fosA3 gene was detected in one fosfomycin-resistant K. pneumoniae isolate. This isolate also carried blaCTX-M. fosC2 and fosA genes could not be detected in any of the isolates. In this study, we report for the first time the existence of fosA3 in Turkey and its association with the blaCTX-M gene. As a result of increasing blaCTX-M producing Enterobacterales isolates globally, increase in fosfomycin resistance may be expected in near future.