Resistance In Urinary Isolates Research Articles

Antimicrobial Resistance in Urinary Isolates of Escherichia coli with Special Reference to Fluoroquinolone Resistance and ESBL Production.

Antimicrobial Resistance in Urinary Isolates of Escherichia coli with Special Reference to Fluoroquinolone Resistance and ESBL Production.

Coexistence of fluoroquinolone resistance and ESBL production in urinary isolates

Background: Enterobacteriaceae group of organisms are commonly implicated for causing urinary tract infection (UTI). Fluoroquinolones (FQ) are widely used as empirical therapy for UTI. Enterobacteriaceae exhibits high resistance rates to FQs. The plasmid mediated extended spectrum beta lactamase (ESBL) production confers resistance for FQs as well. The aim of the study is to determine the prevalence of fluoroquinolones resistance in urinary isolates and to study the coexistence of FQ resistance and ESBL production in urinary isolates.Methods: Retrospective data of the urine samples received in our microbiology laboratory between December 2018 to May 2019 were reviewed. The organisms were isolated and identified as per standard procedures and the antibiotic susceptibility testing was done following CLSI 2019 guidelines. Ceftazidime (30 µg) and ceftazidime-clavulinic acid (30 µg/10 µg) were used for detection of ESBL production. Levofloxacin (5 µg) and ciprofloxacin (5 µg) were used for detecting FQ resistance.Results: Out of a total of 1403 urine samples received in our laboratory, 240 (17.1%) sample showed growth of Enterobacteriaceae. The different species were E. coli (80.4%), Klebsiella spp (12.2%), Citrobacter spp (4.2%), Enterobacter spp (1.6%) and Proteus mirabilis (1.6%). Amongst these organisms 121(50.4%) were ESBL producers. Co-existence of FQ resistance among the ESBL producers was observed in 106(87.6%) isolates which is higher as compared to that among the ESBL non producers 71(59.7%).Conclusions: Around 50% of the UTI Enterobacteriaceae bacteria are ESBL producers. Fluroquinolone resistance amongst ESBL producing Enterobacteriaceae is very high (87.6%).

Molecular Characterization of Quinolone Resistant Urinary Isolates of Escherichia coli

Molecular Characterization of Quinolone Resistant Urinary Isolates of Escherichia coli

Strategy to reduce E. coli bacteraemia based on cohort data from a London teaching hospital

Background and aimIn 2017, National Health Service Improvement set a 10% reduction target for Escherichia coli bacteraemia by 2018, followed by a 50% reduction in healthcare-associated Gram-negative bacteraemias by 2022....

Data linkage of routinely collected electronic health records to characterise risk factors associated with antibiotic resistance in urinary isolates: an exemplar of NHS Scotland’s Infection Intelligence Platform

ABSTRACT
 ObjectivesUrinary tract infections (UTIs) are amongst the most common infections treated in community and hospital settings. Initial antibiotic treatment of UTI is usually empirical, that is, where the prescriber has no definitive information on the organism or its antibiotic sensitivity.. Overall the prevalence of antimicrobial resistance is increasing, and specifically so for antibiotics commonly used for UTI.
 By linking NHS surveillance data to routinely collected administrative health data this study aims to investigate risk factors for antibiotic resistance in urine samples
 ApproachAll positive urine samples included in the “Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland” dataset in the period from January 2012 to June 2015 (all NHS Health Boards in Scotland submit susceptibility data for up to eleven antibiotics on 400 positive urinary samples per quarter) were analysed. Cases were assigned a resistance status of Sensitive, Resistant or Multi-drug resistant based on the antibiotic susceptibility data recorded.
 Using the NHS Scotland Infection Intelligence Platform all cases were linked to national coverage data: (i) hospital discharge data to create the Charlson score for comorbidity and (ii) patient-level community prescribing data to measure cumulative antibiotic exposure (number of defined daily doses) in the 3 months prior to infection. Risk factors associated with the infection susceptibility to antibiotics were assessed using multivariable multinomial logistic regression.
 Results40,984 positive urine samples were examined. Overall 29.0% were sensitive, 48.1% resistant and 22.9% multi drug resistant. Around a third of the cases (33.9%) had no antibiotic prescribing in the 3 months prior to infection. Age, care home residence and increasing comorbidity were both found to be associated with resistance and multidrug resistance. Cumulative antibiotic exposure had a clear dose-response effect. Those with 1-7DDDs were 1.2 times (95% CI: 1.11-1.29) more likely to have a multidrug resistant infection (compared to a sensitive infection) rising to 7.45 times (95% CI: 95% CI 6.45-8.6) for 29+ DDDs. Similar dose response held for resistant infection but at a lesser scale (1-7DDDs OR=1.36 (95% CI: 1.2-1.5) rising to OR=3.04 (95% CI: 2.38-3.89).
 ConclusionA clear effect of cumulative antibiotic exposure in the community and multidrug resistance in UTI cases has been demonstrated. Such quantification is key to ensuring and supporting robust antimicrobial stewardship policy and will form the evidence base for development of prescribing decision support tools for more patient centred treatment of UTI.

High Frequency of Multidrug Resistant Urinary Isolates in Pregnant Women in a Tertiary Care Hospital of Nepal

Urinary Tract Infection (UTI) is one of the most common bacterial infections accounting for about 25% of all types of infection in human and approximately 10% of the humans acquire UTI at some time during their lifetime.

Antibiotic Resistance in Urinary Isolates of Escherichia coli.

Objectives:The aim of this study was to examine the presence of antimicrobial resistance / susceptibility strains of Escherichia coli in inpatients and outpatients.Materials and methods:It is a retrospective study carried out at the Department of Microbiology, Parasitology and Virology Faculty of Medicine, University of Sarajevo. In cooperation with the Microbiological laboratory of the Cantonal Hospital Zenica and the Microbiological laboratory of the General Hospital Tesanj, 3863 urine samples were processed in the period from March 1st to March 31st 2016.Results:Our study showed that E. coli had the highest antimicrobial resistance to trimethoprim / sulfamethoxazole (38.61%), followed by amoxicillin / clavulanic acid (19.62%), ciprofloxacin (9.49%), gentamicin (8.86%), cephalexin (8.23%), nitrofurantoin (8.23%), cefuroxime (7.52%), ceftazidime (6.33%), cefuroxime (89.87%), amikacin (4.43%).Conclusions:The isolated strains of E. coli showed the highest resistance to trimethoprim / sulfamethoxazole and amoxicillin / clavulanic acid. The isolated strains of E. coli showed the greatest susceptibility to amikacin and ceftazidime. Gender distribution of positive E. coli isolates showed statistically significant differences in favor of females.

Uncomplicated Urinary Tract Infections and Antibiotic Resistance—Epidemiological and Mechanistic Aspects

Uncomplicated urinary tract infections are typically monobacterial and are predominantly caused by Escherichia coli. Although several effective treatment options are available, the rates of antibiotic resistance in urinary isolates of E. coli have increased during the last decade. Knowledge of the actual local rates of antibiotic resistant pathogens as well as the underlying mechanisms are important factors in addition to the geographical location and the health state of the patient for choosing the most effective antibiotic treatment. Recommended treatment options include trimethoprim alone or in combination with sulfamethoxazol, fluoroquinolones, β-lactams, fosfomycin-trometamol, and nitrofurantoin. Three basic mechanisms of resistance to all antibiotics are known, i.e., target alteration, reduced drug concentration and inactivation of the drug. These mechanisms—alone or in combination—contribute to resistance against the different antibiotic classes. With increasing prevalence, combinations of resistance mechanisms leading to multiple drug resistant (mdr) pathogens are being detected and have been associated with reduced fitness under in vitro situations. However, mdr clones among clinical isolates such as E. coli sequence type 131 (ST131) have successfully adapted in fitness and growth rate and are rapidly spreading as a worldwide predominating clone of extraintestinal pathogenic E. coli.

Antimicrobial resistance in urinary isolates from inpatients and outpatients at a tertiary care hospital in South-Kivu Province (Democratic Republic of Congo).

BackgroundThe rate of antimicrobial resistant isolates among pathogens causing urinary tract infections (UTIs) in Democratic Republic of Congo (DRC) is not known. The aim of the current study was to determine this rate at the Bukavu Provincial General Hospital (province of South-Kivu, DRC).FindingsA total of 643 isolates (both from inpatients and outpatients) collected from September 2012 to August 2013 were identified using biochemical methods, and tested for antimicrobial susceptibility. The isolates were further screened for Extended-Spectrum Beta-Lactamases (ESBL) production. Beta-lactamase AmpC phenotype was investigated in 20 antibiotic-resistant isolates.Escherichia coli (58.5%), Klebsiella spp. (21.9%) and Enterobacter spp. (16.2%) were the most frequent uropathogens encountered. Rare uropathogens included Citrobacter spp., Proteus spp., and Acinetobacter spp. Resistance was significantly more present in inpatients isolates (22.1% of isolates) when compared to outpatients isolates (8.4% of isolates), (p-value <0.001). Antibiotic-resistant isolates displayed resistance to common antimicrobial drugs used for UTIs treatment in South Kivu province, namely: ciprofloxacin, ampicillin and third generation cephalosporins. ESBL-phenotype was present in 92.9% of antibiotic-resistant isolates. Only amikacin, nitrofurantoin and imipenem displayed satisfactory activity against antibiotic resistant isolates.ConclusionsThis study confirms the presence of antibiotic-resistant uropathogens (mainly ESBL-producers isolates) at the Bukavu General Hospital. This study should serve as a wake-up call and help to raise awareness about the threat to public health of antibiotic resistance in this DRC province.

Prevalence of Quinolone Resistance Among Extended-Spectrum β -Lactamase Producing Uropathogenic Klebsiella pneumoniae.

Background:Extended-spectrum β-lactamase (ESBL) production is the major resistance mechanism to β-lactam antibiotics in Enterobacteriaceae. In addition, emergence of plasmid-mediated quinolone resistance (PMQR) in ESBL-producing isolates has become a global threat for treatment of these infections.Objectives:We investigated the association between ESBL production and quinolone resistance in urinary isolates of K. pneumoniae.Patients and Methods:A total of 196 urinary isolates of K. pneumoniae were collected from Imam Hussein Hospital in Tehran during a four year period (2008-2012). Antibiotic susceptibility was determined by disc diffusion and ESBL production was screened using the phenotypic confirmatory test (PCT).Results:All isolates were susceptible to imipenem. Resistance to piperacillin and cefotaxime were 66.3% and 50.5%, respectively. Resistance to ceftazidime, amoxiclave, aztreonam, ceftriaxone, cefepime, nitrofurantoin, gentamicin, ciprofloxacin, nalidixic acid, ofloxacin, norfloxacin, levofloxacin, amikacin and pipracilin/tazobactam were less than 50%. ESBL production was detected in 92 isolates (46.9%) of which, 61.9% were resistant to nalidixic acid and 65.2% to ciprofloxacin. Multidrug-resistance was observed in 96.7% of ESBL producers.Conclusions:Our results showed coexistence of ESBL and quinolone resistance in the majority of the uropathogenic K. pneumoniae test isolates suggesting that care should be taken for the choice of antibiotic therapy.

Emergence of Escherichia coli, Co-Producing NDM-1 and OXA-48 Carbapenemases, in Urinary Isolates, at a Tertiary Care Centre at Central India.

To detect genes encoding carbapenem resistance in urinary isolates of Escherichia coli recovered from hospitalized patients in tertiary care centre in Pune, India. From Jan 2012 to Dec 2012, a total of 300 consecutive non-duplicate (one isolate per patient) clinical isolates of Escherichia coli were recovered from urine cultures of hospitalized patients including hospital acquired infection cases admitted to the medical and surgical intensive care units. Polymerase chain reaction (PCR) assays and sequencing was used to determine the presence of beta-lactamase encoding genes. Conjugation experiments were performed to determine the transferability of beta-lactamase. All the isolates were completely resistant to the second and third generation cephalosporins tested as well as carbapenems. All the isolates showed 100% susceptibility to tigecycline and colistin in vitro. Conjugation experiments demonstrated that blaNDM-1 was transferable via plasmid. All the isolates showed presence of blaNDM-1 and co-association of blaOXA-48 was 25/45(55%) of the isolates. Repetitive element based PCR (REP PCR), Enterobacterial Repetitive Intergenic Consensus (ERIC PCR) and Randomly Amplified Polymorphic DNA (RAPD) revealed a diversity of six clonal types among E.coli isolates. Co-production of NDM-1with OXA-48 in urinary isolates of E. coli was detected for the first time in India. Transmission of plasmid carrying these resistant genes to other members of Enterobacteriaceae will increase incidence of multidrug resistance. Early detection of these genes will help in prevention and adequate infection control by limiting the spread of these organisms.

Multi Drug Resistant Pathogens Causing Urinary Tract Infections in Children at Kathmandu Model Hospital

Introduction: Antibiotic resistance of urinary tract pathogens has increased globally. Updated knowledge of the antibiotic resistance patterns of uropathogens in the health institutes is important for the selection of an appropriate empirical antimicrobial therapy. The aim of this study was to evaluate the multi drug resistant urinary isolates in the children from 1 to15 years and evaluate the options for empiric antibiotic therapy. Materials and Methods: The study was conducted from December 2011 to May 2012 in the Bacteriology laboratory, Kathmandu Model Hospital. Urine samples received in the laboratory were processed for routine, culture and its sensitivity. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute (CLSI) recommended Kirby-Bauer Disc Diffusion method. Results: Of the total 372 urine samples received in the laboratory, 60 (16.13%) showed significant growth; of which 55.0 % (33/60) were MDR isolates. Escherichia coli were the predominant isolate from urine sample. Out of 49 Escherichia coli isolates, 27 (45.0%) were Multi drug resistant. Enterococcus faecalis (N=3) was the most predominant Gram positive isolate and 66.67 % (2/3) of this organism were multi drug resistant. Among the first line drugs used against gram negative isolates, nitrofurantoin was the most effective drug followed by quinolones, while among the second line drugs; meropenem was the most effective drug followed by chloramphenicol and amikacin, whereas; nitrofurantoin (100%) was the most effective drug for Gram positive isolates followed by norfloxacin and cefotaxime. Conclusion: High percentages of multi drug resistant uropathogens were revealed in children. Nitrofurantoin was found to be the most effective drug for gram positive, gram negative and multi drug resistant isolates. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6771 J. Nepal Paediatr. SocVol.32(3) 2012 233-238

Antibiotic Susceptibility and Arsenic Tolerance of Urinary Bacteria Isolated from Arsenic-Exposed People in Nepal

Community-based information on antibiotic susceptibility of urinary bacteria is useful in clinical practice, including empiric therapy. Owing to evidence of coselection of metal and antibiotic resistance, there is growing concern on testing of such selective pressure in clinical as well as environmental bacterial isolates. We examined arsenic tolerance and antibiotic resistance in urinary isolates and their possible coselection among arsenic-exposed subjects. Urinary arsenic levels were assessed by atomic absorption spectrophotometer. Antibiotic resistance and arsenic tolerance of urinary bacteria were observed by modified Kirby-Bauer and minimum inhibitory concentration methods, respectively. The percentage of one, two, and multidrug-resistant urinary isolates were 30.4%, 37%, and 30.4%, respectively. Isolates showed variable tolerance to arsenic species. Gram-negative isolates were more tolerant to arsenic species than Gram positive. Although statistically insignificant, arsenic tolerance tended to increase from total susceptible to two-drug resistance. However, multiple drug resistance was not induced by the urinary arsenic (p>0.05). We observed moderately positive correlation between urinary arsenic level to arsenic tolerance of isolates (p<0.05). Although tolerance significantly correlated to urinary arsenic level, coselection/coresistance of arsenic to the antibiotic resistance in urinary isolates is inconclusive and remains to be further elucidated.

CTX-M-15-producing urinary Escherichia coli O25b-ST131-phylogroup B2 has acquired resistance to fosfomycin

To describe trends in fosfomycin resistance in urinary isolates of Escherichia coli producing extended-spectrum beta-lactamases (ESBLs) in relation to fosfomycin consumption and to characterize representative fosfomycin-resistant isolates. In 2007-08, an unexpected increase in fosfomycin resistance in ESBL-producing urinary E. coli was observed. Laboratory records were reviewed and a prospective surveillance study was initiated on all urinary tract infections caused by ESBL-producing, fosfomycin-resistant E. coli. bla(ESBL) types, phylogroups, genetic environment and afa/dra operon were determined by PCR and sequencing. Molecular epidemiology was analysed by PFGE and multilocus sequence typing. To elucidate possible mechanisms of fosfomycin resistance, uhpT, glpT, uhpA, ptsI, cyaA and murA genes were analysed. Fosfomycin consumption was determined as recommended by WHO. From 2004 to 2008, fosfomycin consumption increased by 50%, while fosfomycin resistance in ESBL producers increased from 2.2% to 21.7%. Of 26 isolates studied, 24 produced CTX-M-15 and belonged to the O25b-ST131-phylogroup B2 clonal strain. PFGE revealed two clusters. Cluster I included 18 isolates, 16 of them indistinguishable from strains producing CTX-M-15 previously described in Madrid. The five isolates of Cluster II had the IS26 linked to bla(CTX-M-15) and the afa/dra operon. In Cluster I isolates, no mutations in glpT, uhpT, uhpA, ptsI, cyaA and murA were detected. Cluster II isolates showed a 15 bp deletion (A(169)-C(183)) in uhpA. Fosfomycin resistance in urinary E. coli has increased due to the acquisition of this resistance by a previously circulating CTX-M-15-producing E. coli O25b-ST131-phylogroup B2 strain. This happened during a period when the use of fosfomycin increased by 50%.

Antibiotic Resistance in Urinary Isolates of Escherichia coli from College Women with Urinary Tract Infections

Of 176 urine isolates from female students positive for Escherichia coli, 29.6% were trimethoprim-sulfamethoxazole resistant and none were nitrofurantoin resistant. Among students with a history of urinary tract infection (UTI) (n = 119), resistance to ciprofloxacin was 11.8%, compared to 1.8% among those without prior UTI. Nitrofurantoin should be considered for empirical therapy of lower tract UTI.

Community-Acquired Antibiotic Resistance in Urinary Isolates from Adult Women in Canada

There are currently limited data regarding the prevalence of antimicrobial-resistant organisms causing community-acquired urinary tract infections among adult women in Canada. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line empirical antibiotic treatment, unless resistance of Escherichia coli to TMP-SMX exceeds 20%. To assess current levels of TMP-SMX-resistant E coli in community-acquired cases of urinary tract infection in adult women. Assessment of urine culture reports obtained from 21 laboratories across Canada, submitted by family physicians for women aged 16 years and older. In 2199 adult women with a positive urine culture, 1079 (49.1%) of pathogens isolated were resistant to at least one antibiotic and 660 (30.0%) were multidrug-resistant (resistant to two or more antibiotics). TMP-SMX resistance was seen in 245 of 1613 (15.2%) E coli isolates (95% CI 13.5 to 17.0). This proportion was higher in women 50 years of age and older (155 of 863 isolates [18.0%]; P=0.001), in British Columbia (70 of 342 isolates [20.5%]) and in Ontario (62 of 370 isolates [16.8%]) when compared with eastern provinces (65 of 572 isolates [11.4%]; P=0.001). Fluoroquinolone-resistant E coli occurred in 107 of 1557 (6.9%) isolates (95% CI 5.7 to 8.2), with the highest level found in British Columbia (54 of 341 isolates [15.8%]; P=0.001). TMP-SMX continues to be appropriate as first-line empirical treatment of acute cystitis in adult women in Canada, as resistance remains below 20%. However, TMP-SMX resistance is higher in older women and in some provinces. The level of fluoroquinolone-resistant E coli is highest in British Columbia.

Studies on the emergence of resistance to lomefloxacin in vitro

The emergence of resistance to lomefloxacin, norfloxacin and ciprofloxacin was investigated in nalidixic acid sensitive and resistant urinary isolates by continuous turbidimetry. A decline in susceptibility was observed after a single exposure to each of the drugs, and further increments of resistance occurred during three sequential passages. Variants resistant to one quinolone were cross-resistant to the others. The level of resistance selected by norfloxacin in three of the five test strains was greater than that observed with lomefloxacin or ciprofloxacin. In experiments in a model of the treatment of bacterial cystitis, concentrations of lomefloxacin well within those readily achievable in urine suppressed growth of nalidixic acid sensitive and resistant strains for more than 20 h without causing any decline in susceptibility of surviving bacteria.

Reappraisal of the significance of multiply resistant urinary isolates of Proteus rettgeri.

Reappraisal of the significance of multiply resistant urinary isolates of Proteus rettgeri.