Resistance In Urinary Tract Infections Research Articles

Bacterial Co-Infections and Antibiotic Resistance in Urinary Tract Infection of Covid-19 Patients in Erbil City

The COVID-19 pandemic has raised concerns over secondary infections because it has limited treatment options and empiric antimicrobial treatment poses serious risks of aggravating antimicrobial resistance. Many studies have shown that COVID-19 patients are predisposed to developing secondary infections. The prevalence of urinary tract infections (UTI) was evaluated in 248 patients admitted to different hospitals in Erbil city, Iraq. Results showed 138 (55.65%) patients were positive for bacterial growth, of which 72 isolates of Gram-negative and 66 isolates of Gram-positive bacteria were isolated and identified from the urine of COVID-19 patients depending on the 16S rRNA gene using PCR. The predominant obtained bacteria were Staphylococci species, of which isolates belong to 6 species, and the predominant Gram-negative species was Pseudomonas spp. which belongs to 4 species. Also, their susceptibility to 15 antibiotics was tested and it was found that most of the Gram-negative isolates were highly resistant to ampicillin 66(91.66%), amoxicillin 60(83.33%), cephalexin 52(72.22%) and cefixime 50(69.44%). While the most effective antibiotic was imipenem, and with percentage of 26(36.11%), it also showed variable sensitivity to other antibiotics. For Gram-positive bacteria, the highest resistance was against cefixime 40(60.60%), ampicillin 28(42.42%), and 18(27.27%) for both amoxicillin and ciprofloxacin, while the most effective antibiotic was gentamicin, which showed effectiveness against all the Gram-positive isolates. Another part of the study concerned with detection of the existence of ESBLs genes responsible for antibiotic resistance. The results revealed that all the isolates possessed the 16S rRNA gene, whereas blaTEM and blaCTX-M were found to be the most possessed genes in all the isolates, with a percentage of (88.33%).

Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use

The global health crisis of antibacterial resistance (ABR) poses a particular threat in low-resource settings like East Africa. Interventions for ABR typically target antibiotic use, overlooking the wider set of factors which drive vulnerability and behaviours. In this cross-sectional study, we investigated the joint contribution of behavioural, environmental, socioeconomic, and demographic factors associated with higher risk of multi-drug resistant urinary tract infections (MDR UTIs) in Kenya, Tanzania, and Uganda. We sampled outpatients with UTI symptoms in healthcare facilities and linked their microbiology data with patient, household and community level data. Using bivariate statistics and Bayesian profile regression on a sample of 1610 individuals, we show that individuals with higher risk of MDR UTIs were more likely to have compound and interrelated social and environmental disadvantages: they were on average older, with lower education, had more chronic illness, lived in resource-deprived households, more likely to have contact with animals, and human or animal waste. This suggests that interventions to tackle ABR need to take account of intersectional socio-environmental disadvantage as a priority.

Isolation and molecular characterization of multi-drug resistant uropathogenic Escherichia coli from urine samples: Insights into urinary tract infection management

Urinary tract infections (UTIs) caused by uropathogenic Escherichia coli (UPEC) present a significant global health burden. With UPEC responsible for approximately 90 % of UTIs, understanding its mechanisms of virulence and antibiotic resistance is paramount for effective treatment strategies. This study aimed to investigate the prevalence of multi-drug resistant (MDR) E. coli strains in urinary tract infections and to elucidate the molecular mechanisms underlying their resistance. A total of 150 E. coli isolates were obtained from urinary tract infection specimens collected patients at Doctor’s Diagnostic Centre in Kalyan Nagar, Bangalore over four months November 2022 to February 2023. Isolation and screening of pathogenic E. coli were conducted using Eosin Methylene Blue Agar and Nutrient Agar, followed by identification through gram staining and biochemical characterization tests. Antibiotic susceptibility testing was performed using Mueller-Hinton agar and various antibiotic discs. Phenotypic and molecular identification of extended-spectrum beta-lactamase (ESBL) producers were conducted, along with the screening for specific antibiotic resistance genes using polymerase chain reaction (PCR). Of the 150 E. coli isolates, 57.3 % were found to be multi-drug resistant, with all 35 isolates from hospitalized patients exhibiting MDR characteristics. Phenotypic and molecular analyses revealed the presence of ESBL-producing isolates, with the blaCTX-M, blaTEM, and blaSHV genes detected in PCR assays. Plasmid extraction and PCR assays further identified the presence of plasmid-encoded carbapenemase genes (blaOXA-48, blaNDM-1, blaKPC-2), as well as other antibiotic resistance genes including those conferring resistance to fluoroquinolones. The results underscore the alarming prevalence of MDR E. coli strains in urinary tract infections, particularly in hospitalized patients. Molecular characterization revealed the diverse genetic mechanisms contributing to antibiotic resistance, including the presence of ESBLs and plasmid-encoded resistance genes. These findings emphasize the urgent need for surveillance and infection control measures to mitigate the spread of MDR pathogens and the development of alternative therapeutic strategies to combat antibiotic resistance in UTIs.

Pattern Of Antibiotic Resistance In Urinary Tract Infections: Insights From A Tertiary Care Hospital In Bangladesh

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections, with increasing rates of antibiotic resistance complicating treatment. This study aimed to assess the prevalence and antibiotic resistance patterns of uropathogens in patients with UTIs at a tertiary care hospital in Bangladesh. Methods: A cross-sectional, retrospective study was conducted from June, 2023 to July, 2024 involving 60 UTI patients. Clinical and microbiological data, including urine cultures and antibiotic susceptibility tests, were collected. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using SPSS version 26.0. Results: Escherichia coli was the most frequently isolated pathogen (50.0%), followed by Klebsiella spp. (20.0%). Both pathogens exhibited high resistance to ciprofloxacin (66.7%) and amoxicillin (83.3%) (p < 0.05). Pseudomonas spp. showed 66.7% resistance to ceftriaxone, and Proteus spp. exhibited 75.0% resistance to nitrofurantoin. However, E. coli and Klebsiella spp. demonstrated higher susceptibility to nitrofurantoin and gentamicin, with 50.0% and 66.7% susceptibility, respectively. Conclusion: The findings indicate a high prevalence of antibiotic-resistant uropathogens, particularly E. coli and Klebsiella spp., in the study population. Nitrofurantoin and gentamicin remain effective treatment options. These results highlight the urgent need for updated empirical treatment protocols and regular monitoring of resistance patterns to guide UTI management in Bangladesh.

Investigating the interaction of zno nanoparticles with flagellum and fimbriae in multi-drug resistant uropathogenic bacteria encoding fli and fim genes.

Due to the increasing occurrence of drug resistant urinary tract infections (UTI) among children, there is a need to investigate alternative effective treatment protocols such as nanoparticles. Flagella and fimbriae are primary factors contributing the virulence of urinary tract infecting bacteria. The aim of this study was to assess the antibacterial effects of zinc oxide nanoparticles which have been synthesized using both chemical and green methods on multi-drug resistant (MDR) uropathogenic bacteria encoding fli and fim genes and investigating their binding ability to bacterial appendage proteins. A total of 30 urine culture samples were collected from children under 2 years old diagnosed with urinary tract infection. The isolates underwent antibiotic suseptibility assessment and the isolates demonstrating MDR were subjected to molecular amplification of fimG (fimbrial) and fliD and fliT (flagellal) genes. The confirmation of cellular appendages was achieved through silver nitrate staining. The antibacterial efficacy of the synthetized nanoparticles was assessed using the micro and macrodilution methods. The successful binding of nanoparticles to bacterial appendage proteins was confirmed through mobility shift and membrane filter assays. The dimensions of chemically synthesized ZnO nanoparticles and green nanoparticles were measured at 30nm and 85nm, respectively, with the exhibition of hexagonal geometries. The nanoparticles synthesized through chemical and green methods exhibited minimum inhibitory concentrations (MIC) of 0.0062-0.025g/L and 0.3g/L, respectively. The ability of ZnO nanoparticles to bind bacterial appendage proteins and to combat MDR uropathogenic bacteria are promising for new treatment protocols against UTI in children in future.

Antibiotic Resistance and Inflammatory Response in Urology Infections Caused by E. coli: A Molecular and Clinical Investigation

Background: Urinary tract infections (UTIs) are a common condition resulting from bacterial invasion of the urinary system, which includes the kidneys, ureters, bladder, and urethra. These infections are particularly prevalent among females due to anatomical differences and hormonal factors. UTIs can range from uncomplicated cases, where there are no structural abnormalities, to more severe infections that may ascend to the kidneys, causing pyelonephritis. Methods: This study aimed to isolate and diagnose Escherichia coli (E. coli) bacteria in patients with UTIs, identify specific virulence genes, and assess the bacteria's resistance to various antibiotics. A total of 100 clinical samples were collected from patients with UTIs at the General Hospital of Homadiyah and Ahmed Maher from October 2021 to December 2022. Bacterial identification was performed using biochemical tests and polymerase chain reaction (PCR) techniques, while antibiotic sensitivity was assessed using the Kirby-Bauer disk diffusion method. Additionally, inflammatory markers (TNF-α, IL-6, and IL-8) were measured using ELISA. Results: E. coli was isolated in 56% of the samples, with the highest prevalence in patients aged 31-40 years. The antibiotic sensitivity test revealed varying levels of resistance, with the highest sensitivity observed to third-generation cephalosporins, particularly ceftriaxone (32.2% resistance). PCR analysis identified the presence of several virulence genes, including the Hly gene in 96.6% of isolates and the iha gene in 10% of isolates. Elevated levels of inflammatory markers were observed in patients with UTIs, indicating a strong immune response to bacterial infection. Conclusion: E. coli is a significant pathogen in UTIs, exhibiting considerable antibiotic resistance, particularly to first-generation cephalosporins. The presence of specific virulence genes correlates with the severity of infection. These findings underscore the need for targeted antibiotic therapy and the development of strategies to manage antibiotic resistance in UTIs.

Individual health insurance data of antibiotic delivery in previous months as a tool to predict bacterial resistance of urinary tract infection: A prospective cohort study

ObjectivesWe aimed to quantify the individual risk of antimicrobial resistance among patients with community-acquired Escherichia coli urinary tract infection (UTI) according to their antibiotic exposure over the previous 18 months. Patients and methodsFrench patients were prospectively recruited in two centers in 2015–2017. Resistance of isolates to amoxicillin (AMX), amoxicillin-clavulanate (AMC), third-generation cephalosporins (3GC), trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQ) and fosfomycin (FOS) was analysed according to previous intra-class and inter-class antibiotic exposure documented in health insurance files. ResultsPrevious antibiotic exposure was found in 588 (81.4 %) of the 722 UTI cases analysed (564 patients). Recent exposure (three months before UTI) was associated with stronger intra-class impact on E. coli resistance compared to remote exposure (18 months before UTI) for AMX, AMC, FQ and TMP-SMX, with respective adjusted odds ratios [95 % confidence interval] of 1.63 [1.20–2.21], 1.59 [1.02–2.48], 3.01 [1.90–4.77], and 2.60 [1.75–3.87]. AMX, FQ, and TMP-SMX also showed significant inter-class impact. Resistance to 3GC was not significantly associated with intraclass exposure (adjusted OR: 0.88 [0.41–1.90]). FOS resistance was remarkably low (0.4 %). Duration of the antibiotic-free period required for resistance risk to drop below 10 %, the threshold for empirical use in UTI, was modelled as < 1 month for 3GC, >18 months for AMX and TMP-SMX and uncertain for AMC (5.2 months [2.3 to > 18]) and FQ (17.4 months [7.4 to > 18]). ConclusionsResistance of E. coli causing UTI is partially predicted by previous personal antibiotic delivery.

Patterns of Antibiotic Resistance in Urinary Tract Infections: A Retrospective Observational Study.

Urinary tract infections (UTIs) are among the most common bacterial infections, and antibiotic resistance complicates empiric treatment. This study aimed to describe recent resistance patterns among uropathogens in a tertiary-care teaching hospital to optimize empiric UTI management. This retrospective observational study included 280 patients diagnosed with UTIs at the Dr. Patnam Mahender Reddy Institute of Medical Sciences, Hyderabad, over a six-month period from June 2023 to November 2023. Urine culture and antibiotic susceptibility data were collected from electronic medical records. Patient demographics, including age, sex, and comorbid diabetes, were recorded. Causative uropathogens and their resistance rates to commonly prescribed UTI antibiotics were analyzed. Empiric antibiotic treatment patterns and outcomes were talked about. These included clinical cure, recurrence, susceptibility match, and microbiologic eradication. The mean age of patients was 43.5 years, with 196 (70%) being female and 70 (25%) having diabetes. Escherichia coli caused 210 (75%) of UTIs, Klebsiella pneumoniae 42 (15%), Proteus mirabilis 14 (5%), Enterococcus faecalis 8 (3%), and Staphylococcus saprophyticus 6 (2%). E. coli resistance rates were 48% for ampicillin, 25% for ciprofloxacin, 18% for trimethoprim/sulfamethoxazole (TMP/SMX), and 5% for nitrofurantoin. K. pneumoniae resistance rates were 89% for ampicillin, 67% for ciprofloxacin, 44% for TMP/SMX, and 22% for nitrofurantoin. The most frequently prescribed antibiotic was nitrofurantoin (45%), then ciprofloxacin (35%). Clinical cure was achieved in 75% of cases. Recurrent UTIs within four weeks occurred in 25% of cases. Treatment matched urine culture susceptibility in 82% of patients. The rising fluoroquinolone resistance highlights the need for current local data to guide empiric UTI treatment. Nitrofurantoin had low resistance rates and was an effective first-line therapy. Ongoing monitoring of resistance patterns in UTIs is essential to optimize antibiotic selection.

A STUDY ON IN VITRO ACTIVITY OF FOSFOMYCIN AGAINST ENTEROBACTERIACAE UROPATHOGEN ALONG WITH MICROBIOLOGICAL PROFILE AND ANTIBIOGRAM OF UROPATHOGENS

Background:Urinary tract infection (UTI) is one of the most common infection throughout the world that may affect both the lower and the upper urinary tracts. Aims &amp; Objective:The present study was done to determine various organisms causing Urinary tract infections and to analyse antimicrobial sensitivity patterns of those isolates. Materials and Methods:This prospective study was conducted from April 2020 to March 2021at SIMS&amp; RH, Tumkur. All urine samples were received in Microbiology laboratory for routine microbiology investigations were inoculated on Blood agar and MacConkey agar culture media using calibrated wire loop . Urinary isolates with significant bacteriuria were further processed by conventional biochemical tests and antimicrobial susceptibility testing was done as per standard methods. Results: A total of 697 urine samples were processed in that 324 (46.48%) samples were shown as significant growth of bacteria. Most of the cases seen in (67.28%) female and under age group of 21-30(22.22%).The predominantly Gram-negative bacteria (85.18%) were isolated followed by Gram positive bacteria(10.49%) and Candida spp(4.32%). The Gram negative bacteria showed high sensitivity to Ampicillin sulbactum (88.27%) followed by Amikacin (87.24%). All Gram-positive bacteria isolates is showed sensitivity to Vancomycin (100%).We found that 235( 92.88%) Enterobacteriaceace isolates were is susceptible for Fosfomycin. Conclusion:. Antibiotic resistance has become a major clinical problem worldwide and has increased over the years.Hence antibiotic susceptibility testing should be done to diagnose and treat the drug resistant UTI cases. Fosfomycin may be given empirically in patients with uncomplicated urinary tract infection due to Enterobacteriaceace.

Update About The Changes In Bacterial Resistance For Multiple Antibiotic In Patients With Urinary Tract Infection In Kerbala

Urinary tract infections (UTIs) caused by Escherichia coli (E. coli) are common and recurrent, particularly among females. Treatment often involves various antimicrobial agents, but rising resistance poses challenges. We conducted a study in Al-Hussein Medical City, Kerbala, enrolling 520 UTI patients from April 2022 to February 2023. Urine samples were tested for antimicrobial susceptibility. Results showed high resistance to most agents, except meropenem and levofloxacin. Our findings emphasize the urgent need for strategies to combat antimicrobial resistance in UTIs. Highlights: High resistance in UTI treatment observed. Urgent need for antimicrobial resistance strategies. Study reveals E. coli resistance patterns in Kerbala's medical setting. Keywords: Urinary tract infections, Escherichia coli, Antimicrobial resistance, Al-Hussein Medical City, Kerbala

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic.

The COVID-19 pandemic has led to significant changes in healthcare practices, including increased antibiotic usage. This study aimed to investigate the impact of the pandemic on the prevalence of extended-spectrum β-lactamase (ESBL) production and carbapenem resistance among key bacterial species causing urinary tract infections (UTIs). Conducted at King Fahad Medical City in Riyadh from January 2018 to December 2022, the study analyzed urine samples from 9697 UTI patients. Patients were categorized into 'pre-COVID-19' and 'during COVID-19' groups. Bacterial isolates were identified, and antimicrobial susceptibility testing was performed following guidelines. ESBL production was detected using the Double-Disc Synergy Test. Escherichia coli and Klebsiella pneumoniae were the main pathogens. During the pandemic, ESBL production decreased in E. coli by 1.9% and in K. pneumoniae by 6.0%. Carbapenem resistance also declined, with E. coli displaying a 1.2% reduction and K. pneumoniae and Pseudomonas aeruginosa displaying 10.7% and 7.9% reductions, respectively. Notably, logistic regression analysis revealed that the odds of ESBL presence were 10% lower during the COVID-19 pandemic (OR 0.91; 95% CI 0.83-0.99; p = 0.040), and there was a significant reduction in the odds of carbapenem resistance (OR 0.43; 95% CI 0.37-0.51; p < 0.001). This study reveals a significant decrease in ESBL production and carbapenem resistance among UTI pathogens during the COVID-19 pandemic, hinting at the impact of modified antibiotic and healthcare approaches. It emphasizes the need for persistent antimicrobial resistance surveillance and policy adaptation to address resistance challenges, offering key directions for future public health actions.

Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda.

Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviour, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Using data from 6,388 patients, we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Among those with microbiologically confirmed UTI (n = 1,946), we used logistic regression to assess the relationship between treatment seeking behaviour, AB use, and the likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathway for UTI-like symptoms in this sample involved attending health facilities, rather than other providers like drug sellers. Patients from sites in Tanzania and Uganda, where over 50% of patients had an MDR UTI, were more likely to report treatment failures, and have repeat visits to providers than those from Kenyan sites, where MDR UTI proportions were lower (33%). There was no strong or consistent relationship between individual AB use and likelihood of MDR UTI, after accounting for country context. The results highlight the hurdles East African patients face in accessing effective UTI care. These challenges are exacerbated by high rates of MDR UTI, suggesting a vicious cycle of failed treatment attempts and sustained selection for drug resistance. Whilst individual AB use may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of variations in ABR.

Trends of Antibiotic Resistance among Uropathogens in Medical vs. Non-Medical Departments of Al-Shifa Medical Complex in Gaza Strip: A Retrospective, Cross-Sectional Study

Antibiotic resistance is a growing global crisis, straining healthcare systems and leaving us with limited options to combat drug-resistant bacteria. This retrospective, cross-sectional study examines the prevalence of antibiotic resistance patterns among urinary tract infections (UTIs) in Al-Shifa Hospital’s medical departments in comparison with non-medical departments using data from microbiology laboratory archives over a one-year period. From the examined urine cultures about 25% were obtained from internal medicine departments and double the number was obtained from non-medical departments. The positive rate was around 35% and about two-thirds of the samples were collected from female patients. Among all departments, Enterobacteriaceae spp. were found to be the most frequently isolated uropathogens, accounting for 80% of cases. However, resistance rates varied depending on the specific organism and antibiotic used. For instance, E. coli showed a resistance rate of only 5% against meropenem, while amoxicillin-clavulanic acid exhibited a resistance rate exceeding 95%. Importantly, the study revealed a significant disparity in resistance rates between medical and non-medical departments, specifically concerning third-generation cephalosporins. In internal medicine departments, resistance rates were alarmingly high, with cefotaxime, ceftriaxone, and ceftazidime showing resistance rates of 75%, 75% and 66.5% respectively. In contrast, non-medical departments displayed lower resistance rates, approximately 60%, 60% and 40%, respectively. In summary, this research sheds light on the escalating problem of antibiotic resistance in UTIs and emphasizes the discrepancy in resistance rates between medical and non-medical departments. Urgent efforts are required to address this issue and find effective solutions to prevent the rise of untreatable bacterial infections.

Microbiological profile and antibiotic resistance of urinary tract infections in Maternity and Children Hospital, Hafr Al Batin, Saudi Arabia within 2022

Objective: This study aimed to characterize the antibiotic sensitivity, microbial resistance, and prevalence of the bacteria responsible for urinary tract infections (UTIs) at Maternity and Children Hospital (MCH), Hafr Al Batin, Saudi Arabia. Methods: Analysis was done on 1273 culture samples that were processed in the microbiology lab between January and December of 2022. Results: In all, 1273 urine culture (UC) samples were gathered. Gram-negative bacteria accounted for 46.9% of the 1273 positive UC, followed by Gram-positive bacteria with 28.8%, fungal pathogens with 13.1%, and Gram-negative non-fermenting bacteria with 11.2%. The most common uropathogenic organism (76.8%) was Pseudomonas aeruginosa, which was followed by Escherichia coli (55.6%), Staphylococcus epidermidis (22.9%), and Klebsiella pneumonia (24.3%). Candida albicans (69.5%) was determined to be the most frequent agent in terms of fungus, followed by C. glabrata (19.2%). The study revealed that the bacterial isolates exhibited effective resistance to antimicrobial drugs such as Amikacin, Cefepime, Ciprofloxacin, Gentamicin, imipenem, Levofloxacin, and Piperacillin/Tazobactam when administered against Gram-negative bacteria. Furthermore, the most effective antibiotics against Gram‑positive was Erythromycin but were sensitive to Vancomycin. Conclusions: One of the most typical infections that affect women is bacterial urinary tract infection. Using antibiotics for a very long time, and their misuse will result in the widespread growth of resistant bacteria.

Prevalence and antimicrobial resistance of uropathogens in Karachi, Pakistan

Urinary tract infections (UTIs) are one of the major healthcare concerns causing an alarmingly high medical and financial burden in both developing and developed countries. There is a significant rise in multidrug-resistant (MDR) uropathogens, both in hospitalized and community settings, which threatens safe and effective therapy of these infections. The increased rates of resistance in UTIs requires the continuous surveillance of uropathogens in the specific area to inform safe and effective therapy. The present, retrospective, cross-sectional, descriptive study was carried out using samples collected between 01/06/2019 and 31/05/2020 in Karachi, Pakistan, during which, n = 1500 urine samples were collected. The samples were processed on Cystine Lactose Electrolyte Deficient (CLED) agar, identification was carried out by using standard biochemical tests and API 20E/20NE strips. Antimicrobial susceptibility testing was performed using standard disk diffusion test protocol, as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Overall, n = 1189 urine samples (79.27%) showed significant bacterial growth. The median age of affected patients was 56 years (range: 1-100) with n = 811 females (68.21%), with patients between 61-80 years (n = 384; 32.29%) as the most numerous age group. Regarding uropathogen distribution, the overwhelming majority were Gram-negative bacteria (n = 986; 82.93%), the most common causative agent being Escherichia coli (n = 648; 54.49%), followed by Klebsiella spp. (n = 206; 17.33%) and Enterococcus spp. (n = 118; 9.92%). Resistance rates were highest for the tested fluoroquinolones (&gt;70% for most species), trimethoprim-sulfamethoxazole, broad-spectrum penicillins, and cephalosporins, while fosfomycin, carbapenems and colistin largely retained their efficacy. The mitigation of UTIs and the emergence of resistance may be impeded by taking appropriate measures for the better management of patients; these interventions include improvements in the treatment recommendations, provision of health education, and continuous antimicrobial surveillance.

Escherichia coli dominance and antimicrobial resistance in urinary tract infections among diabetic patients: Insights from Birnin Kebbi Metropolis, Nigeria

Background: The global rise in antibiotic-resistant urinary tract infections (UTIs) is a growing concern, particularly among diabetic patients. This study examines the antibiotic resistance patterns of bacterial uropathogens in diabetic patients at Sir Yahaya Memorial Hospital in Birnin Kebbi.&#x0D; Methods: A purposive sampling approach was used to collect 51 mid-stream urine samples in sterile containers. Cultural and biochemical methods were employed for the isolation and identification of uropathogenic bacteria. Antibiotic sensitivity testing was performed using the disc diffusion method, with results interpreted according to the Clinical Laboratory Standards Institute (CLSI) guidelines.&#x0D; Results: UTIs were prevalent in 23.5% (12/51) of the samples. Escherichia coli was the most prevalent uropathogen, accounting for 41.3% (7/17) of cases, followed by Klebsiella pneumoniae at 23.5% (4/17). Staphylococcus aureus and Proteus mirabilis each contributed to 17.6% (3/17) of cases. Notably, E. coli and K. pneumoniae exhibited 100% resistance to chloramphenicol and sparfloxacin, respectively.&#x0D; Conclusion: These findings underscore the need for further molecular research to characterize these uropathogens and identify the genes contributing to antibiotic resistance.

Pre- and Post-COVID-19 Appraisal of Antimicrobial Susceptibility for Urinary Tract Infections at an Outpatient Setting of a Tertiary Care Hospital in Delhi.

This study was conducted to understand the effect of the COVID-19 pandemic on urine culture and sensitivity results in an outpatient setting. There are plenty of data from inpatient and ICU settings but there is a paucity of data in outpatient or community settings. Thus, this study primarily targeted change in antibiotic resistance of urinary tract infection (UTI) agents in the pre- and post-COVID-19 period. In the study, urine samples received in the Department of Laboratory Medicine (microbiology laboratory) with a preliminary diagnosis of UTI between April 2019 and March 2021 were analyzed. Urine cultures and antibiotic susceptibility tests of the patients included in the study were examined in two periods (pre-pandemic and post-pandemic). A total of 22,372 urine samples were received in the pre-pandemic period (April 2019 to March 2020) and 4885 samples in the post-pandemic period (April 2020 to March 2021). The positivity rate obtained from urine cultures sent post-COVID-19 pandemic (16%) was significantly higher than those sent before the COVID-19 pandemic (8%). According to cultures and antibiogram results, resistance to ampicillin, amikacin, ceftazidime (p < 0.05), co-trimoxazole, levofloxacin, gentamicin (p < 0.05), nitrofurantoin, fosfomycin, and tetracycline decreased compared with the pre-COVID-19 period. In this study, we found that the frequency of significant bacteriuria increased significantly in the post-pandemic period. However, resistance to antibiotics decreased significantly in the post-COVID-19 period compared to the pre-COVID-19 period. There was no significant change in the etiology of UTI during the two time periods.

Fluoroquinolone resistance in urinary tract infections: Epidemiology, mechanisms of action and management strategies.

Fluoroquinolone resistance is an issue of concern amongst physicians worldwide. In urology, fluoroquinolones are often used in the treatment of acute pyelonephritis and prostatitis, as well as infections caused by multidrug-resistant pathogens. We aim to highlight the importance of antimicrobial stewardship and the need for ongoing biomedical research to discover novel agents in our losing battle against resistant pathogens. In this review, we survey the literature and summarise fluoroquinolone resistance as it pertains to pyelonephritis and prostatitis, as well as alternative treatment strategies and prevention of multidrug resistance. The rise of fluoroquinolone resistance in bacteria has reduced the available treatment options, often necessitating hospital admission for intravenous antibiotics, which places an additional burden on both patients and the healthcare system. Many countries such as Australia have attempted to limit fluoroquinolone resistance by imposing strict prescribing criteria, though these efforts have not been entirely successful. Solutions to overcome resistance include prevention, combination therapy and the development of novel antimicrobial agents. Prevention of the proliferation of resistant organisms by antimicrobial stewardship is paramount, and urologists are obliged to be aware of responsible prescribing practices such as referring to local guidelines when prescribing. By reserving fluoroquinolones for infections in which they are truly indicated and by prescribing based on both patient and local environmental factors, we can preserve this effective resource for future use.

Microbial etiology and antibiotic resistance in urinary tract infections in children; view from an area where antibiotics are overused.

The aim of our study is to determine the uropathogenic causing urinary tract infections (UTIs) and their incidences, assess their antibiotic resistance, and determine an appropriate empirical antibiotic treatment strategy. We retrospectively analyzed the culture and antibiogram results of urine cultures of 49,706 patients aged 1 day to 18 years who applied to Diyarbakır Children's Hospital between March 2018 and October 2022. A total of 4,064 cases meeting the study criteria were recorded. Girls comprised 76.7% of the study population. While reproduction in urine culture was more common in boys in the 0-1 age group, there was a decrease in the number of boys with increasing age, and the most common culture growth was seen in girls in the 5-10 age group (p<0.001). Escherichia coli (E. coli) infections were more common in girls, while non-E. coli infections were more common in boys (p<0.001). Gram-negative bacterial growth in urine cultures was the most common growth type. In descending order, E. coli was grown in 68.1% of all cultures, Klebsiella spp in 12.6%, and Proteus spp in 3.9%. Less commonly, Pseudomonas spp (2.8%), Enterobacter spp (1.5%), and fungi (1.1%) were grown. Antibiotic resistance/sensitivity tests revealed resistance patterns most commonly against ampicillin (73.2%), amoxicillin-clavulanate (57.9%), cefuroxime axetil (46.7%), cefixime (51%), and ceftriaxone (40.5%), and less commonly against meropenem (1.7%), amikacin (2.4%), and nitrofurantoin (9.8%). Escherichia coli showed resistance most commonly against ampicillin (69.8%), amoxicillin-clavulanate (59.7%), and cefixime (51.3%), while non-E.coli bacteria showed resistance most commonly against ampicillin (84.6%), amoxicillin (52.0%), and cefixime (50%). Resistance against nitrofurantoin was lower in E. coli infections than non-E. coli infections, although the difference did not reach statistical significance (3.7% and 27%, respectively; p=0.149). In contrast, resistance against trimethoprim-sulfamethoxazole was more common in E. coli infections than non-E. coli infections, although the difference was not statistically significant (42% and 29.7%, respectively; p=0.093). Our study revealed that resistance has developed at very high rates against many oral and parenteral antibiotics that we use in the treatment of UTIs. If our rate of antibiotic use continues to increase this way, it is predicted that UTIs will, unfortunately, become untreatable with oral antibiotics. This upsetting point reached by our country, which is the state that uses antibiotics the most in Europe, exemplifies the importance of rational antibiotic use for the whole world.

Antimicrobial stewardship program in urinary tract infections due to multiresistant strains in the emergency department

Urinary tract infections (UTI) are a frequent reason for attendance at emergency department (ED). The present study evaluates the impact of a multidisciplinary program for the optimization of antibiotic therapy in patients with UTI caused by multi-drug resistant bacteria treated from the hospital ED. Descriptive study of the implementation of a program in which emergency, microbiology and pharmacy departments participated. Antibiotic treatment of the patients who consulted the ED with positive urine cultures caused by multidrug-resistant bacteria was reviewed upon discharge. In those patients with inappropriate treatment, doctors and/or pharmacists of the next level of healthcare or patients in the case of home discharge were contacted. The impact of the program was evaluated based on new visits to the ED at 30 days after discharge, compared with the results obtained from the usual practice three months prior the intervention. During the first year, 2,474 urine cultures of patients with UTI were reviewed, 533 (21.7%) were caused by multidrug-resistant bacteria. Empirical treatment was inappropriate in 287 (53.4%), making treatment modifications in 243 of them. 73 (19.3%) patients returned to the ED 30 days after discharge, being lower than the results obtained in the three months prior intervention (27.9%; p=0.031), without significant differences in new visits associated with UTI. The implementation of a multidisciplinary program focused on multidrug resistant UTI at discharge form ED correct antibiotic therapy in a large number of patients, being a potentially tool to reduce the number of new ED visits.