Resistance Of Uropathogens Research Articles

P-1107. Oral Sulopenem/probenecid for Uncomplicated Urinary Tract Infections (uUTI): Results from the REASSURE Trial

Abstract Background Existing oral antibiotics for treatment of uUTI are not reliably effective due to rising antimicrobial resistant uropathogens. Sulopenem is a broad-spectrum IV/oral penem being developed for treatment of multidrug resistant infections. We conducted a pivotal Phase 3 randomized, double-blind, double-dummy, active controlled trial to evaluate the safety and efficacy of sulopenem/probenecid (SUL) vs amoxicillin/clavulanate (AMC) for treatment of uUTI. Methods Adult women with uUTI were randomized to SUL or AMC, both bid for 5 days. The primary objective was to establish noninferiority of SUL to AMC in the mMITT population (patients with ≥105 CFU/mL Enterobacterales in baseline urine culture). The primary endpoint was overall success (combined clinical and microbiologic success) at the Test of Cure (TOC) visit. Using a pre-specified procedure to control for multiplicity, mMITT patients with baseline pathogens susceptible to AMC (mMITTS) were tested for noninferiority/superiority and those with nonsusceptible pathogens (mMITTR) were tested for superiority. Results Of 2222 women randomized, 990 (44.6%) had ≥105 CFU/mL Enterobacterales in baseline urine cultures and were in the mMITT population (Table 1). Of these, 922 had pathogens susceptible to AMC (mMITTS). The sample size in the mMITTR population (N=67) was lower than anticipated and not sufficiently powered to draw any conclusions. Treatment emergent adverse events (TEAE) occurred more frequently in SUL treated patients (all, 18.9% vs 12.3%; related, 14.0% vs 7.7%) with the most frequent TEAEs being diarrhea, nausea and headache. Premature discontinuation from study drug due to TEAEs was low in both treatment groups (≤1%). No serious adverse events were reported in the SUL group, while 5 (0.5%) occurred in the AMC group. Conclusion Sulopenem/probenecid was non-inferior to AMC for the treatment of adult women with uUTI in the mMITT population. In the mMITTS population, SUL demonstrated non-inferiority and based on an ad hoc analysis, demonstrated superiority to AMC. SUL was well tolerated with a safety profile consistent with other β-lactams and has the potential to fill the substantial unmet medical need for an empiric oral antibiotic option for outpatients with uUTI in this era of rising antimicrobial resistance. Disclosures Sailaja Puttagunta, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company) Steven I. Aronin, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company) Jayanti Gupta, PhD, Iterum Therapeutics: Advisor/Consultant Anita F. Das, PhD, Cidara: Advisor/Consultant|Contrafect: Advisor/Consultant|Iterum Therapeutics: Advisor/Consultant|Paratek: Advisor/Consultant|Utility therapeutics: Advisor/Consultant Kalpana Gupta, MD, Iterum Therapeutics: Advisor/Consultant Michael W. Dunne, MD, Iterum Therapeutics: Advisor/Consultant|Iterum Therapeutics: Board Member|Iterum Therapeutics: Stocks/Bonds (Public Company)

P-1092. Re-analysis of Pivmecillinam Randomized Clinical Trial Data According to 2019 US Food and Drug Administration Guidance for the Treatment of Uncomplicated Urinary Tract Infection

Abstract Background Due to increasing prevalence of resistant uropathogens, there is urgent need in the USA for effective new oral antibiotics for treatment of uncomplicated urinary tract infection (uUTI). Pivmecillinam has been used to treat uUTI in Canada and Europe for > 40 years, is recommended as a first-line agent by the Infectious Diseases Society of America, and has high microbiologic activity against most antibiotic-resistant Enterobacterales. We present a re-analysis of clinical trial data, as per 2019 US Food and Drug Administration (FDA) guidance, that supported the recent US approval of pivmecillinam for treatment of uUTI.Table 1.Composite response rates at test-of-cure (micro-ITT population)185 mg of pivmecillinam is equivalent to 200 mg of pivmecillinam hydrochloride.CI, confidence interval; micro-ITT, microbiological intent-to-treat; QID, four times daily; TID, three times daily.1. Ferry SA et al. Scand J Prim Health Care. 2007;25:49–57. 2. Menday AP. Intl J Antimicrob Agents. 2000;13:183–187. 3. Vik I et al. PLoS Med. 2018;15:e1002569. Methods Detailed subject-level clinical data were retrieved from three historic randomized controlled trials (RCTs) including subjects treated with pivmecillinam 185 mg, three times daily for 3–7 days, and re-analyzed in accordance with the 2019 FDA guidance for uUTI. Efficacy endpoints were composite (clinical and microbiologic) response rates, clinical response rates, and microbiologic response rates, analyzed in the microbiological intent-to-treat population (urine culture ≥ 105 colony-forming units/mL; ≤ 2 microorganism species; no baseline pathogen non-susceptible to active comparator).Table 2.Clinical response rates at test-of-cure (micro-ITT population)185 mg of pivmecillinam is equivalent to 200 mg of pivmecillinam hydrochloride.CI, confidence interval; micro-ITT, microbiological intent-to-treat; QID, four times daily; TID, three times daily. 1. Ferry SA et al. Scand J Prim Health Care. 2007;25:49–57. 2. Menday AP. Intl J Antimicrob Agents. 2000;13:183–187. 3. Vik I et al. PLoS Med. 2018;15:e1002569. Results Efficacy in uUTI was demonstrated for the recommended dosage regimen of pivmecillinam in the three studies (total N=369 pivmecillinam, N=385 comparators). Composite response rates for pivmecillinam ranged from 62.0% to 71.7% (Table 1), clinical response rates from 63.5% to 82.7% (Table 2), and microbiologic response rates from 74.3% to 86.9% (Table 3). Efficacy of pivmecillinam was superior to placebo or ibuprofen and similar to cephalexin. Clinical and microbiologic response rates for pivmecillinam and comparators were generally numerically lower in the re-analysis versus original reports, reflecting the more stringent 2019 FDA criteria.Table 3.Microbiologic response rates at test-of-cure (micro-ITT population)185 mg of pivmecillinam is equivalent to 200 mg of pivmecillinam hydrochloride.CI, confidence interval; micro-ITT, microbiological intent-to-treat; QID, four times daily; TID, three times daily. 1. Ferry SA et al. Scand J Prim Health Care. 2007;25:49–57. 2. Menday AP. Intl J Antimicrob Agents. 2000;13:183–187. 3. Vik I et al. PLoS Med. 2018;15:e1002569. Conclusion This re-analysis of RCT data confirmed the efficacy of pivmecillinam in uUTI, and was used to support the recent US approval of oral pivmecillinam, 185 mg three times daily for 3–7 days, for the treatment of female patients aged ≥ 18 years with uUTI caused by susceptible isolates of Escherichia coli, Proteus mirabilis, and Staphylococcus saprophyticus. Disclosures Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|CARB-X: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant Anita F. Das, PhD, Cidara: Advisor/Consultant|Contrafect: Advisor/Consultant|Iterum Therapeutics: Advisor/Consultant|Paratek: Advisor/Consultant|Utility therapeutics: Advisor/Consultant Niels Frimodt-Møller, MD DMSc, Eli Lilly Ltd: Stocks/Bonds (Private Company)|Pfizer Ltd: Stocks/Bonds (Private Company)|Rosco A/S: Advisor/Consultant Kalpana Gupta, MD, GlaxoSmithKline: Advisor/Consultant|IDSA GL on UTI: Uncompensated author|Iterum Therapeutics: Advisor/Consultant|PhenUtest Diagnostics: Advisor/Consultant|Qiagen Inc.,: Advisor/Consultant|UpToDate: Royalties for UTI topics|Utility Therapeutics Ltd: Advisor/Consultant Thomas Lodise, Jr., Pharm.D., PhD, MERCK: Advisor/Consultant Anne Santerre Henriksen, PhD, Utility therapeutics: Advisor/Consultant Morton Alexander, PhD, SNIPR biome: Shareholder|SNIPR biome: Stocks/Bonds (Private Company)|Union therapeutics: Shareholder|Union therapeutics: Stocks/Bonds (Private Company)|Utility therapeutics: Board Member|Utility therapeutics: Ownership Interest Florian Wagenlehner, MD, Astellas: Advisor/Consultant|AstraZeneca: Advisor/Consultant|Bionorica: Advisor/Consultant|DFG (German Research Foundation) funded research group BARICADE (FOR5427/1-466687329): Speaker|GSK: Advisor/Consultant|GSK: Principal investigator in a GSK-sponsored study|Janssen: Advisor/Consultant|Klosterfrau: Advisor/Consultant|MIP Pharma: Advisor/Consultant|OM Pharma: Advisor/Consultant|Spero: Advisor/Consultant|VenatoRX: Advisor/Consultant

A Four-Year Study of Antibiotic Resistance, Prevalence and Biofilm-Forming Ability of Uropathogens Isolated from Community- and Hospital-Acquired Urinary Tract Infections in Southern Italy.

The aim of this study was to investigate the differences between nosocomial and community microorganisms isolated from patients with UTI by determining their bacterial profile, antibiotic resistance and ability to produce biofilms. A retrospective study, based on bacterial isolates from consecutive urine samples collected between January 2019 and December 2023, was conducted at a university hospital. The main pathogens isolated from both community and hospital samples were the same, but their frequency of isolation differed. Compared with community-associated cases, hospital-associated infections have more isolates of Acinetobacter baumanii complex. In contrast, Proteus mirabilis isolates were more prevalent in community than in hospital infections. In both hospital and community isolates, gram-positive bacteria showed a lower overall antimicrobial resistance (22%) compared to gram-negative bacteria (30%). The data demonstrated that individual strains exhibited disparate degrees of capacity for biofilm formation. Additionally, the data indicate an inverse correlation between biofilm production and antibiotic resistance. Isolates from community patients exhibited lower capacities for biofilm production in comparison to the capacities demonstrated by microorganisms isolated from nosocomial patients (29% and 35%, respectively). Area-specific surveillance studies can provide valuable information on UTI pathogens and antimicrobial resistance patterns, which can be useful in guiding empirical treatment.

A Study on Clinical and Bacteriological Profile of Urinary Tract Infections (UTI) in North Karnataka

Background The infection of urinary tract UTI is quite common with higher incidence in diabetics compared to non-diabetics. Women are most commonly affected compared to men with an incidence rate of 40 to 50. In recent years the etiology and antibiotic resistance of uropathogens have been evolving worldwide.Aim To investigate the impact of uropathogens and evaluate their drug susceptibility patterns in both diabetic and non-diabetic individuals.Methods This was a prospective study which included 100 patients. Mid-stream urine was collected in a sterile dry wide necked and leak proof container and tested using urine-analyzer. Urine culture was done using Kirby Bauer disc diffusion method and sensitivity was done using Mueller Hinton agar using different antibiotics.Results Out of 100 patients 54 were diabetics and 46 were non-diabetics. Most common age group affected was 60-70 years with females being more commonly affected. About 74 patients were symptomatic and 26 were asymptomatic. Fever was the most common symptom 41 followed by burning micturition 39. Cystitis was noted in 15 diabetic patients and 10 non-diabetic patients. About 22 of diabetic patients had Klebsiella pneumoniae infection 16 had Escherichia coli infection while 16 non-diabetics had K pneumoniae infection and 14 had E. coli infection. Both organisms were sensitive to Cephalosporins followed by Carbapenem group of drugs.Conclusion Maintaining good blood sugar control and proper hygiene plays a significant role in controlling infection of urinary tract. Complications of chronic UTI can be prevented by prompt treatment with appropriate antibiotics.

Facile preparation of polyethyleneimine-conjugated silver sulfide nanoparticles as near-infrared-responsive to sterilization of multidrug resistant uropathogens, and cytotoxicity activity.

The online version contains supplementary material available at 10.1007/s13205-024-04168-3.

Prevalence and Antibiotic Susceptibility Pattern Of Uropathogens From Urinary Tract Infection Suspected Patients Visiting Tertiary Care Hospital of Nepal

Antibiotic resistant uropathogens is a significant problem in all patient, leading to high morbidity, poor quality of life and a limited life expectancy thus situation analysis of those pathogens is necessary. Hence, this study aims to detect uropathogens and evaluate their current antibiotic resistant pattern. Mid-stream urine samples were cultured for bacterial isolation and isolates were identified using biochemical tests. Antibiotic susceptibility testing was done using disc diffusion method. The results were analyzed using statistical software. Out of 1784 suspected cases, 182 urine samples showed significant growth. Among uropathogens, Escherichia coli was predominant followed by Klebsiella pneumoniae, Proteus mirabilis Staphylococcus aureus, Pseudomonas aeruginosa, Morganella morganii, and Acinetobacter spp. The antibiotic-resistant pattern was observed highest among K. pneumoniae and E. coli. Also, higher resistance was observed towards Cephalexin (70.3%), followed by Ceftazidime (70.2%) and Nalidixic acid (67.6%) and Cefixime (62.5%). And, a total of 46.7% (n=85) multidrug resistant isolates were detected of which 17 were identified as high risk clones. In conclusion, antimicrobial resistance among urine isolates, particularly E. coli and K. pneumoniae seem to be emerging. Therefore, antimicrobial resistance trend analysis exploring both phenotypic and molecular techniques would be helpful in intervening in antimicrobial resistance development and spread.

Effects of Heat-Killed Probiotic Strains on Biofilm Formation, Transcription of Virulence-Associated Genes, and Prevention of UTIs in Mice.

Urinary tract infections (UTIs) pose a substantial healthcare challenge, exacerbated by the biofilm-forming abilities and antibiotic resistance of uropathogens. This study investigated the inhibition of biofilm formation (anti-biofilm) and dispersion of pre-established biofilm properties of 18 heat-killed probiotics and their supernatants against four antibiotic-resistant uropathogens: UPEC, Klebsiella pneumoniae (KP), Methicillin-resistant Escherichia coli (MREC), and Methicillin-resistant Staphylococcus pseudintermedius (MRSP). Supernatants from 14 probiotic strains significantly (P < 0.001) inhibited UPEC biofilm formation, reducing it by 20-80%, and also showed promise in removing existing biofilms by 10-60% (P < 0.001). Eight strains significantly (P < 0.05 to < 0.001) inhibited MREC biofilm formation, with four strains achieving 50-80% dispersion. Seventeen strains of heat-killed probiotics directly inhibited UPEC biofilm formation by 10-60% (P < 0.05 to < 0.001), but were less effective against MREC and MRSP (10-50% reduction; P < 0.05 to < 0.001) and had limited impact on KP (10% reduction; P < 0.05 to < 0.001). Notably, heat-killed probiotic like LGA, LGC, LGD, TP-8, and TP-4 showed the most significant inhibitory and dispersion of biofilm activity. RT-qPCR analysis further revealed these inactivated probiotics downregulated genes associated with pili and biofilm formation (fimA, csgA) and upregulated genes linked to quorum sensing (luxS, qseBC, sdiA). Therefore, these findings suggest that paraprobiotic treatment could inhibit the formation of pili and biofilms and promote biofilm dispersion. In an animal model, mice given paraprobiotic formulations I (16 strains) and II (a specific mixture) for 2weeks showed reduced urinary bacterial load (P < 0.05). Paraprobiotic I notably reduced morbidity from bacteriuria (> 105CFU/ml) by 5 to 30% within the first 5days post-infection compared to placebo. These findings highlight the potential of specific heat-killed probiotics in combating biofilms and preventing UTIs.

Characteristics of Urinary Tract Infections in Patients with Diabetes from Timișoara, Romania: Prevalence, Etiology, and Antimicrobial Resistance of Uropathogens.

Background and Objectives: Diabetic patients are more likely to develop infections compared to the general population, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence of UTIs in a population of patients with diabetes (DM) from Romania, to identify the most common uropathogens and their antimicrobial resistance (AMR) patterns, as well as to determine the correlations between resistance behavior and particularities of patients with UTIs according to DM type. Materials and Methods: The hospital records of 1282 type 1 (T1D) and type 2 DM (T2D) adult inpatients who were ordered urine cultures during hospitalization were reviewed, and all 241 patients who presented a positive urine culture were included in the present study analysis. Results: The prevalence of UTIs in diabetic patients was 18.8% and higher in patients with T2D vs. T1D. Patients with UTIs and T2D had a significantly older age, longer duration of DM, higher waist circumference and body mass index, lower levels of estimated glomerular filtration rate, and more frequent chronic complications of DM than patients with T1D. E. coli was the most frequently isolated uropathogen (56.4%), with a significantly higher incidence for T2D, followed by K. pneumoniae (12.9%) and Enterococcus spp. (9.5%). Although the acquired resistance phenotypes were more frequently isolated in T2D patients (over 90% of the multidrug-resistant and extended-spectrum beta-lactamase-producing isolates, respectively, and 75% of the total carbapenem-resistant organisms), no statistically significant correlation was found regarding the distribution of AMR patterns in the two types of DM. Conclusions: The present study brings new data regarding the prevalence of UTIs in diabetic patients from Western Romania. By identifying the spectrum of uropathogens and their AMR pattern, this paper may contribute to improving UTI management in diabetic patients, thus reducing antibiotic overuse and preventing recurrent UTIs.

Sociodemographic disparities in antibiotic-resistant outpatient urine cultures in a Boston hospital, 2015–2020: a cross-sectional analysis

BackgroundAntibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients’ risks for acquiring antibiotic-resistant (AR) uropathogens.MethodsWe identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients’ age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients’ sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients’ census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients’ risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.ResultsWe included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients’ odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients’ odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.ConclusionThe social determinants of health may play important and intersecting roles in determining a patient’s risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.

Trends in Antimicrobial Resistance of Uropathogens Isolated from Urinary Tract Infections in a Tertiary Care Hospital in Dhaka, Bangladesh.

Background/Objectives: Urinary tract infection (UTI) is a prevalent microbial infection in medical practise, leading to significant patient morbidity and increased treatment costs, particularly in developing countries. This retrospective study, conducted at a tertiary care hospital in Dhaka, Bangladesh, aims to examine the antimicrobial resistance (AMR) patterns of uropathogens and evaluate whether these patterns are influenced by demographic factors such as gender, age, or patient status. Methods: Standard microbiological techniques were used to identify uropathogens, and AMR patterns were determined using the Kirby-Bauer disc diffusion method. Results: Out of 6549 urine samples, 1001 cultures were positive. The infection was more prevalent in females compared to males. The incidence of UTIs in children aged 0-10 years accounted for 12.59% of the total cases, with this age group also exhibiting the highest rate of polymicrobial infections. Among the bacterial uropathogens, 71.19% of isolates were multidrug resistant (MDR) and 84.27% were resistant to at least one antibiotic. Escherichia coli (n = 544, 73.90% MDR) and Klebsiella species (n = 143, 48.95% MDR) were the most common Gram-negative uropathogens, while Enterococcus species (n = 78, 94.87% MDR) was the predominant Gram-positive isolate in this study. Our results indicate that most uropathogens showed resistance against ceftazidime, followed by cefuroxime, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, and netilmicin. Moderate levels of resistance were observed against ciprofloxacin, levofloxacin, aztreonam, and cefpodoxime. Conclusions: Amikacin was observed to be effective against Gram-negative uropathogens, whereas cefixime was more active against Gram-positive microorganisms, such as Enterococcus species. Moreover, a principal coordinate analysis (PCoA) depicted no significant influence of gender, patient status, or age on AMR patterns. For the continued usefulness of most antibiotics, periodic analysis of the AMR patterns of uropathogens can help assess the rise of MDR bacteria, and therefore guide the selection of appropriate antibiotic treatment strategies.

Antimicrobial Resistance in Uropathogens Associated with Community Acquired Urinary Tracts Infections in Port Harcourt, Nigeria

Introduction: Antimicrobial resistance (AMR) in uropathogens remain an intractable public health concern due to the associated mortality, morbidity and economic and manpower losses worldwide. This retrospective study was aimed at ascertaining the prevalence of the bacterial uropathogens and the antimicrobial resistance patterns of the dominant strains. Methodology: It involved a review of laboratory records of the over 1426 males (38%) and females (62%) of various s age brackets between January 1, 2021 and December 31, 2022. Results: Out of 1426 urine culture samples 58.5% were negative cultures while 592 (41.5%) yielded bacterial growths. A total of 403 uropathogens comprising 11 species were obtained. Gram negative bacteria constitute 73.9% of the isolates while gram positive bacteria were 26.1% Escherichia coli (54.7%) was the dominant strains, followed by Staphylococcus aureus (10.3%, Enterococcus faecalis (9.5%), Proteus mirabilis (7.7%, Staphylococcus saprophyticus (5.7%, Streptococcus pneumoniae (3.9%), Klebsiella pneumoniae 17 (3.0%), Pseudomonas aeruginosa (2.7%), Enterobacter cloacae (1.1%), Acinetobacter baumannii (0.9%) and Serratia marcescens (0.5%). A cumulative of 50.5% of the strains were resistant to at least on antimicrobial agent. The most resistant uropathogen was Pseudomonas aeruginosa with a resistant profile of 64.1%, followed by Klebsiella pneumoniae (63.7%), Staphylococci (55.7%), Streptococcus pneumoniae (55.2%), Acinetobacter baumannii (51.7%), Proteus mirabilis (51.4%), Escherichia coli (48.0%), Enterobacter cloacae (47.1%), Enterococcus faecalis (46.5%) and Serratia marcescens (43.3%) The least effective antimicrobial agent was nitrofurantoin which resisted by 87.1% strains, the most effective was streptomycin (22.2%). Conclusion: This study will benefit healthcare practitioners in the empirical choice of antibiotics against UTI; however, the high prevalence of AMR necessitates conduct of urine cultures to identify particular uropathogens appropriate antimicrobials in other to curtail increase in AMR among uropathogens.

Insights into Hospitalized Children with Urinary Tract Infections: Epidemiology and Antimicrobial Resistance Patterns in Israel-A Single Center Study.

Background: The escalating resistance of uropathogens in pediatric febrile urinary tract infection (F-UTI) is a global concern. This study examined changing trends in F-UTI epidemiology and resistance patterns among Israeli pediatric inpatients over a decade. Methods: Demographic, clinical, and laboratory data for children between 3 months and 18 years old with febrile UTI from 2010 to 2021 were retrieved from electronic medical records. Results: A total of 761 cases of F-UTI were identified (702 females, mean age 43 months). Escherichia coli was the most common pathogen (85.9%), followed by Pseudomonas aeruginosa (3.5%) and Klebsiella pneumoniae (3.4%). Compared with the non-complicated UTI group, the complicated UTI group had significantly higher rates of Pseudomonas aeruginosa (5.3% vs. 1.0%, p = 0.002) and Klebsiella pneumoniae (4.6% vs. 1.6%, p = 0.03). Antibiotic resistance analysis revealed significant differences between the groups: resistance to cephalexin was higher in the complicated UTI group (19.3%) compared with the non-complicated UTI group (13.4%, p = 0.03). Notably, relatively low resistance rates were observed for ceftriaxone (4.4%) and gentamicin (6.0%). Over time, a significant decreasing trend in resistance to ampicillin was observed (slope = -0.0193, p = 0.011). No significant trends were found for trimethoprim-sulfamethoxazole, cephalexin, amoxicillin-clavulanic acid, ceftriaxone, and cefuroxime. Conclusions: Significant differences in pathogen distribution and resistance patterns between complicated UTI and non-complicated UTI groups highlight the need for continuous resistance monitoring and adherence to local guidelines. For the treatment of severe community F-UTI, ceftriaxone could be a reasonable option for first-onset F-UTI. Further studies are needed to implement antibiotic stewardship and optimize usage.

Evaluation of antibacterial susceptibility profile in pregnant women with asymptomatic bacteriuria in Kadapa

: The bacterial urinary tract infection in pregnancy may be symptomatic (cystitis, pyelonephritis) or asymptomatic (bacteriuria without symptoms). Empirical antimicrobial therapy may be affected by resistance of uropathogens due to the irrational use of antibiotics. This prevalence of resistance is rising and varies across the globe due to different treatment recommendations which may be determined by taking into account frequently occurring infections, susceptibility patterns, evidence, physician acceptance, antimicrobial stewardship norms, availability of formularies, and antimicrobial prices. So the current research was carried out. : A cross-sectional study was conducted among pregnant women with UTI attending antenatal care (ANC) by excluding pregnant women who had taken antibiotics within the two weeks prior to their ANC follow-up and symptomatic UTI pregnant women. The antibiotic sensitivity of the uropathogens and their identification were evaluated by conventional culture, microbiological techniques and sensitivity tests. The results were analysed by SPSS software for descriptive statistics. : 377 pregnant women with UTI participated in the present study. The results demonstrated that most of the participants who lived in urban areas (64%) were affected. The results also suggest that 42% of participants who had secondary education as the highest level of education, 45% of participants belonged to an upper middle-class family and, 40% of working professionals in the study were affected. Out of 103 isolates, 79 isolates were gram negative &amp; 24 were Gram positive. Out of seventy-nine gram negative isolates, the major contribution was by (36), . (26). Among 24 gram positive isolates, the major contribution was by Coagulase Negative Staphylococci (CONS) (12). The uropathogens were shown diverse antibiotic sensitivity for the study test drugs. : This study concludes that the antibacterial susceptibility and resistance of uropathogens may vary in different geographical areas based on antibiotic usage and circumstances. This study also demonstrated the imperative prerequisite of periodic assessments.

Vaccinium macrocarpon Based Fe-Doped Zno Nanoparticles as an Alternate Against Resistant Uropathogens

Vaccinium macrocarpon Based Fe-Doped Zno Nanoparticles as an Alternate Against Resistant Uropathogens

Investigating Urinary Pathogens and Their Antibiotic Resistance: A Cross-Sectional Urine Culture Study.

Urinary tract infections (UTIs) are among the most prevalent infectious diseases. Females are more affected than males. The primary culprit is Escherichia coli. Multiple research investigations have documented widespread antimicrobial resistance in uropathogens, sparking global concerns, especially regarding the rise of multidrug resistance (MDR). This cross-sectional study was conducted from December 2023 to March 2024. A non-probability purposive sampling technique was employed to select participants, and informed consent was obtained from them. Data were extracted from the culture and sensitivity reports of these patients. The collected data were meticulously entered into IBM SPSS Statistics for Windows, Version 21 (IBM Corp.,Armonk, NY). The findings were then presented using a blend of percentages and numerical figures, offering a clear and concise representation of the data. Our study of 313 participants showed a higher prevalence of UTIs in females (219, 70%) compared to males (94, 30%). E. coli and Citrobacter were the predominant pathogens, with E. coli and Citrobacter more common in females, while Enterobacter and Staphylococcus were more prevalent in males. Antibiogram analysis revealed sensitivities to specific drugs like nitrofurantoin and meropenem, while resistance was observed against others, including polymyxin B and ampicillin. These findings stress the need for tailored UTI treatment approaches. In conclusion, our research highlights a concerning trend of escalating antibiotic resistance among Pakistani patients with UTIs. Tobramycin B, ticarcillin-clavulanic acid, ampicillin, and clotrimazole exhibited the highest resistance rates, while imipenem, meropenem, nitrofurantoin, sulfonamides, and tigecycline demonstrated notable sensitivity. These findings emphasize the urgent need for the exploration of alternative treatment options to combat rising resistance levels effectively.

Diagnostic ultrasonography and antimicrobial resistance of different pathogens associated with canine and feline lower urinary tract disorders

There is a significant issue concerning the dissemination of antimicrobial-resistant bacteria within companion animals. Urinary tract infections (UTIs) are a common problem in veterinary medicine for which empirical antibiotics are utilized. This study aimed to investigate the antimicrobial resistance of different uropathogens associated with UTIs in canine and feline cases. A total of 146 dogs and 162 cats suffered from lower urinary tract disorders were subjected to ultrasonographic and microbiological examination. Cystitis, urinary sediment, and cystic calculi are the most common ultrasonographic abnormalities associated with bacterial UTIs. Bacterial UTIs were obtained in 36.98 % and 25.92 % of cases in dogs and cats, respectively. A low rate of mixed infection was detected in canine cases (3.7 %). E. coli was the most prevalent pathogen isolated from 46.4 % and 66.7 % of canine and feline isolates, respectively followed by Proteus spp. in canine isolates (16.1 %) and Klebsiella spp. in feline isolates (14.3 %). Staphylococcus spp. was isolated from canine cases only with the detection of methicillin-resistant Staphylococcus pseudintermedius (MRSP) strains at 3.6 %. The majority of the isolated strains were resistant to various antibiotic classes, particularly β-lactams. All gram-negative bacteria were susceptible to amikacin, whereas gram-positive strains exhibited 100 % sensitivity to nitrofurantoin and linezolid. Different bacterial species displayed low resistance to carbapenems and fluoroquinolones. Multi-drug resistance was reported in canine and feline strains at 64.3 % and 54.8 %, respectively. These findings prove the crucial necessity to restrict antibiotic consumption depending on urine culture and antibiotic sensitivity tests.

The Antimicrobial Effect of Cornus mas L. and Sorbus aucuparia L. Fruit Extracts against Resistant Uropathogens in Correlation with the Prevalence of Urinary Tract Infections in Companion Animals.

Urinary tract infections (UTIs) are a widespread condition in pets, with many antibiotics being prescribed, contributing to the rise in antimicrobial resistance, which is a worldwide threat. This study's main objective was to analyze the in vitro antimicrobial activity of Cornus mas and Sorbus aucuparia fruit hydro-ethanolic extracts towards bacteria identified in the urine of companion animals experiencing UTIs. Urine samples were collected from dogs and cats (n = 83; 47 negative, 36 positive); several bacterial strains were identified (n = 49) belonging to the Escherichia, Enterococcus, Staphylococcus, Proteus, Klebsiella, Enterobacter, Pseudomonas, Acinetobacter, Leclercia, and Kocuria genera. Bacterial susceptibility was tested using the disk diffusion method, with the majority being resistant to several beta-lactams, quinolones, trimethoprim/sulfamethoxazole, and nitrofurantoin. Subsequently, 13 resistant isolates were selected to evaluate the fruits extracts' antimicrobial potential using the agar well diffusion and broth microdilution methods. Cornus mas exhibited the greatest activity against Gram-negatives (primarily Pseudomonas luteola), while Sorbus aucuparia showed maximum effects towards Gram-positives (particularly Enterococcus faecalis). The MIC was 0.01 μg/μL for both extracts; the MBC was 0.08 μg/μL for Cornus mas and 0.05 μg/μL for Sorbus aucuparia. However, Cornus mas showed a stronger bactericidal effect. This is the first study to investigate these fruit extracts in UTI isolates of companion animals, and these extracts might be used as substitutes or adjuvants for antibiotics, thus contributing to a reduction in antimicrobial resistance.

Trend of Antimicrobial Resistance of Gram-Negative Uropathogens Post Kidney Transplantation.

Trend of Antimicrobial Resistance of Gram-Negative Uropathogens Post Kidney Transplantation.

Identification of a copper-responsive small molecule inhibitor of uropathogenic Escherichia coli.

Urinary tract infections (UTIs) are a major global health problem and are caused predominantly by uropathogenic Escherichia coli (UPEC). UTIs are a leading cause of prescription antimicrobial use. Incessant increase in antimicrobial resistance in UPEC and other uropathogens poses a serious threat to the current treatment practices. Copper is an effector of nutritional immunity that impedes the growth of pathogens during infection. We hypothesized that copper would augment the toxicity of select small molecules against bacterial pathogens. We conducted a small molecule screening campaign with a library of 51,098 molecules to detect hits that inhibit a UPEC ΔtolC mutant in a copper-dependent manner. A molecule, denoted as E. coli inhibitor or ECIN, was identified as a copper-responsive inhibitor of wild-type UPEC strains. Our gene expression and metal content analysis results demonstrate that ECIN works in concert with copper to exacerbate Cu toxicity in UPEC. ECIN has a broad spectrum of activity against pathogens of medical and veterinary significance including Acinetobacter baumannii, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus. Subinhibitory levels of ECIN eliminate UPEC biofilm formation. Transcriptome analysis of UPEC treated with ECIN reveals induction of multiple stress response systems. Furthermore, we demonstrate that L-cysteine rescues the growth of UPEC exposed to ECIN. In summary, we report the identification and characterization of a novel copper-responsive small molecule inhibitor of UPEC.IMPORTANCEUrinary tract infection (UTI) is a ubiquitous infectious condition affecting millions of people annually. Uropathogenic Escherichia coli (UPEC) is the predominant etiological agent of UTI. However, UTIs are becoming increasingly difficult to resolve with antimicrobials due to increased antimicrobial resistance in UPEC and other uropathogens. Here, we report the identification and characterization of a novel copper-responsive small molecule inhibitor of UPEC. In addition to E. coli, this small molecule also inhibits pathogens of medical and veterinary significance including Acinetobacter baumannii, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus.

Multidrug resistance of uropathogens as a risk factor in providing medical care to patients from central Bulgaria

The emergence of resistance to multiple antimicrobial agents in uropathogenic bacteria has become a significant public health problem. These microorganisms are the cause of urinary tract infections, which are among the most frequently treated diseases in the outpatient medical care. A cross-sectional study was conducted among 353 outpatients over 18 years of age with positive urine sample culture. It involved measuring the index of multiple antibiotic resistance of uropathogens causing infections among individuals. The research was conducted in the period January – June 2023 at a private clinical laboratory center located in Stara Zagora, Bulgaria. One third of the isolates of E. coli and more than a half of those of Klebsiella pneumoniae had a measured MAR index greater than 0.2, with confirmatory high rates of resistance to aminopenicillins and cephalosporins. Alarmingly high MARI values were measured in all representatives of Enterococcus faecalis, Enterobacter species and Pseudomonas aeruginosa. These strains were also established to have high levels of resistance (varying from 58.3 to 100 %) to some of antimicrobial medicines most commonly prescribed in the outpatient healthcare. Findings of this study emphasize the importance and seriousness of the existing problem with the increasing prevalence of uropathogenic microorganisms with multiple resistance to oral antibiotics. This creates elevated risks of failure to provide effective treatment for patients.