Urinary Tract Infection Strains Research Articles

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.

Effects of Bacteriocin Extracted from Lactobacillus plantarum on Treatment-Resistant Escherichia coli Bacteria Isolated from Humans and Livestock

Background: Lactic acid bacteria (LAB) are among the most common probiotics and play a significant role in promoting health within the human intestinal microbiota. Their protective functions in the intestine include producing antimicrobial compounds, regulating the balance of the intestinal microbiome, and more. Objectives: This study aims to investigate the antimicrobial effects of bacteriocin extracted from Lactobacillus plantarum (L. plantarum) on Escherichia coli (E. coli) strains that cause treatment-resistant urinary tract infections (UTIs) in humans and mastitis in livestock. Methods: Twenty E. coli isolates were obtained from patients with UTIs and cows with mastitis. After culturing the samples on Eosin-methylene blue, McConkey agar, and blood agar, the strains were identified using biochemical tests. Bacteriocin produced by L. plantarum ATCC8014 was extracted, and its concentration was measured using the Bradford method. The antimicrobial effect of the bacteriocin was assessed using the broth microdilution method to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Additionally, the bacteriocin's antimicrobial activity was evaluated through three repetitions of disk diffusion and agar well diffusion methods. Results: The findings revealed that the MIC and MBC concentrations for all human and animal strains were 13.38 μg/mL and 26.76 μg/mL, respectively. Notably, two animal samples (No. 3 and No. 10) and one human sample (No. 6) showed lower MIC and MBC concentrations compared to the other samples and the standard E. coli sample. However, all strains were resistant to bacteriocin in the disk diffusion and agar well diffusion methods. Conclusions: The data indicate a high risk of increasing treatment-resistant E. coli strains in UTIs and livestock, which could pose a significant threat to public and animal health. Therefore, it is essential to further investigate the effects of different bacteriocins on these resistant strains, in conjunction with antibiotic therapies.

Characterization of Clonal Groups of Antibiotic-Resistant Biofilm-Forming Staphylococcus aureus Strains Isolated from Patients with Urinary Tract Infections in Isfahan, Iran

Background: Over the past decades, the role of biofilm-forming Staphylococcus aureus strains in urinary tract infections (UTIs) has garnered significant attention. Objectives: This study aimed to determine the epidemiological characteristics and diversity of S. aureus strains isolated from patients with UTIs in Isfahan, Iran, in 2017, with regard to their antimicrobial resistance, biofilm formation, and phylogenetic profiles. Additionally, the study investigated potential relationships among these factors statistically to develop efficient control and treatment approaches. Methods: All patients with symptomatic UTIs who had positive urine cultures for S. aureus during the study period at the laboratory of a referral hospital in Isfahan were included. All isolates were identified using specific primers for the nucA gene. Their biofilm formation capacity was evaluated using a combination of the microtiter plate and Congo-red agar methods. Antibiotic susceptibility testing was performed using the disk diffusion method. The presence of genes involved in biofilm formation and resistance to cefoxitin, aminoglycosides, and fluoroquinolones was detected using polymerase chain reaction (PCR). Staphylococcal cassette chromosome mec (SCCmec) typing, agr typing, and phene plate (PhP) typing were employed to investigate the diversity of collected strains. Results: Results showed that 19%, 57%, and 24% of confirmed S. aureus strains were strong, intermediate, and non-biofilm formers, respectively. The highest rate of resistance was against nalidixic acid (77%), followed by streptomycin (73%). The icaD and icaA genes had the highest frequency among biofilm-producing strains. gyrA (44%) and grlA (35%) were the most frequent genes among fluoroquinolone-resistant strains, while aph(3′)-IIIa was the most prevalent aminoglycoside-modifying enzyme gene. The majority of bacterial strains harbored SCCmec type III and agr type I. PhP typing of strains revealed the presence of 8 common types (CTs) and 14 single types (STs), with CT2 being the dominant type. Conclusions: The present investigation revealed various biofilm production capacities, antimicrobial resistance profiles, and clonal lineages in S. aureus isolated from patients with UTIs. These findings provide further insights into the epidemiology and pathogenicity of S. aureus strains in Iran, thereby improving the quality of surveillance and therapeutic protocols.

Antimicrobial Resistance and Biofilm Production in Uropathogens from Renal Disease Patients Admitted to Tribhuvan University Teaching Hospital, Nepal

Background. Various antibiotics are prescribed empirically by physicians to cope with infections in renal disease patients. A urinary tract infection (UTI) is often caused by biofilm-forming multidrug-resistant (MDR) uropathogens. This study aimed to analyze the antibiogram of UTI strains from renal disease patients and the biofilm-forming ability of those strains. Methods. 102 patients clinically diagnosed with a UTI and renal disease were recruited into the study from August 2017 to January 2018. Clean-catch midstream urine samples were processed for the isolation and identification of the bacteria following standard methodologies. The antibiogram of the isolates (n = 106) was produced by the Kirby–Bauer disc diffusion method. Detection of biofilm formation was performed in tissue culture plates. Results. The incidence of a UTI in renal disease was 19.1%. Most patients were diagnosed with chronic kidney disease (18.63%), nephrotic syndrome (16.67%), and nephrolithiasis (14.71%). The commonest uropathogens were Escherichia coli (52.8%), Klebsiella pneumoniae (16%), and Enterococcus spp. (15.0%). Ceftriaxone was the most common antibiotic prescribed empirically (37%), whereas nitrofurantoin was the most prescribed antibiotic as adjusted therapy (36.1%). Among the first- and second-line antibiotics, most Gram-negative bacteria were sensitive to amikacin (70.7%), meropenem (70.7%), cefoperazone-sulbactam (70.0%), piperacillin-tazobactam (67.2%), gentamicin (66.7%), and nitrofurantoin (66.7%). Most Gram-positive bacteria were sensitive to doxycycline (90.0%), nitrofurantoin (72.2%), gentamicin (66.7%), and tetracycline (62.5%). All MDR Gram-negative uropathogens were susceptible to colistin sulfate and polymyxin B. Among the 106 isolates, 74.5% produced biofilms and 70.8% were MDR. In 67.0% of cases, including both MDR and biofilm-producing bacteria, the empirical therapy needed adjustment. Conclusions. Aminoglycoside, carbapenem, beta-lactam inhibitor, and nitrofuran group of antibiotics may be the optimal first-line empirical therapies for uropathogens in hospitalized renal disease patients. Regular surveillance of resistance patterns and the study of biofilm formation in uropathogens must be performed to ensure effective management of the patients.

Assessment of Ricinus Communis Ml Crude Extracts Towards Urinary Tract Infection Strains with Their Associated Ailments

Cases of synergic Urinary Tract Infections with its associated ailments has become a menace. Due to its high costs of treatment, unavailability of relevant antibiotics, misdiagnosis and recurrence, most patients within Africa Sub-Sahara regions prefer ethnopharmacological ways of taking boiled and sieved liquid concoction made from mature leaves (ML) of ricinus communis to clear the urinary tract system from these microbes with their associated ailments. Crude extracts of methanol, chloroform, hexane, and Diethylether prepared from ricinus communis dried powered mature leaves were subjected to phytochemical screening, antibacterial, GC/MS and antioxidant assays. Crude methanolic and chloroform extracts prepared from a mixture of coarsely powdered dried twigs and mature leaves were evaluated for cytotoxic activity on cancer cell line (HCT-116 and K-562). Antibacterial assay of the crude extracts reveals recommendable range of values categorized as moderate and high sensitive with respect to the standard measure. Methanol extract exhibited antibacterial activities against all gram-positive and gram-negative bacterial species while diethylether extract showed its potency against the gram-positive staph only among escherichia, klebsiella and pseudomonas species. Chloroform, diethylether and hexane crude extracts proven to be inert against pseudomonas strain. Highest scavenging capacity range obtained is 60.38 ± 0.034 percent while the lowest cytotoxicity range is 20.18 ± 1.37 μg/ml-1revealing the medicinal value and safeness of the plant extract. Phytochemical analysis and GC/MS results revealed the presence of phytoconstituents and museum of bioactive agents with antibacterial, antifungal, antiviral, anti-inflammatory, anticancer, antidiarrheal, antimutagenic and anti-oxidant properties thus ascertaining its efficacy towards the infection with associated ailments.

Assessment Of Ricinus Communis Ml Crude Extracts Towards Urinary Tract Infection Strains With Their Associated Ailments

Cases of synergic Urinary Tract Infections with its associated ailments has become a menace. Due to its high costs of treatment, unavailability of relevant antibiotics, misdiagnosis and recurrence, most patients within Africa Sub-Sahara regions prefer ethnopharmacological ways of taking boiled and sieved liquid concoction made from mature leaves (ML) of ricinus communis to clear the urinary tract system from these microbes with their associated ailments. Crude extracts of methanol, chloroform, hexane, and Diethylether prepared from ricinus communis dried powered mature leaves were subjected to phytochemical screening, antibacterial, GC/MS and antioxidant assays. Crude methanolic and chloroform extracts prepared from a mixture of coarsely powdered dried twigs and mature leaves were evaluated for cytotoxic activity on cancer cell line (HCT-116 and K-562). Antibacterial assay of the crude extracts reveals recommendable range of values categorized as moderate and high sensitive with respect to the standard measure. Methanol extract exhibited antibacterial activities against all gram-positive and gram-negative bacterial species while diethylether extract showed its potency against the gram-positive staph only among escherichia, klebsiella and pseudomonas species. Chloroform, diethylether and hexane crude extracts proven to be inert against pseudomonas strain. Highest scavenging capacity range obtained is 60.38 ± 0.034 percent while the lowest cytotoxicity range is 20.18 ± 1.37 μg/ml-1revealing the medicinal value and safeness of the plant extract. Phytochemical analysis and GC/MS results revealed the presence of phytoconstituents and museum of bioactive agents with antibacterial, antifungal, antiviral, anti-inflammatory, anticancer, antidiarrheal, antimutagenic and anti-oxidant properties thus ascertaining its efficacy towards the infection with associated ailments.

Identification of Bacteria Strains Isolated in Urinary Tract Infections and Their Antibiotic Susceptibility at the National Public Health Laboratory, Ouagadougou

Background: Urinary tract infections are still a real public health concern. The aim of this study was to identify the bacteria strains involved in urinary tract infections and to determine their antibiotic resistance profiles. Methods: Two kinds of studies were performed. The retrospective study was carried out for 2 years (from January 2018 to December 2019), and the prospective study was extended over a period of 6 months (from January to June 2020). Isolation and identification of bacteria strains were performed using conventional microbiology techniques. The strains’ resistance profiles were determined by the diffusion method on Mueller-Hinton according to the criteria of EUCAST- 2015. Fourteen (14) antibiotic discs were used depending on the isolated germ. Results: A total of 187 bacterial strains were isolated from 82 men and 105 women. Among the germs identified, 77.54% were Enterobacteriaceae and 13.36% were cocci strains. Non-fermentative gram-negative bacilli accounted for 9.08% of the isolated bacteria. The results showed that the majority of Enterobacteriaceae strains were resistant to beta-lactams: 100% to amoxicillin, 98.75% to amoxicillin + clavulanic acid, 41.76% to ceftriaxone, and 43.14% to ceftazidime. These findings were obtained with fluoroquinolones and aminoglycosides: 50.09% with ciprofloxacin, 54.04% with norfloxacin, and 22.58% with amikacin. 8.75% of the Enterobacteriaceae strains tested were resistant to imipenem. The same trends were observed with non-fer- mentative bacteria. As for the gram-positive bacteria isolated during our study, 13.33% were resistant to vancomycin, 21.05% to gentamicin, 94.12% to penicillin G, 88.89% to ampicillin, 77.78% to cefotaxime, 63.63% to kanamycin, and 52.63% to erythromycin. Conclusion: This study revealed, as in other studies, that Enterobacteriaceae strains remain the most incriminated bacteria strains in urinary tract infections, with a strong resistance to antibiotics. It is important that actions be taken to reduce the incidence of urinary tract infections and mitigate the spread of resistant bacteria.

Hemolytic activity and biofilm-formation among clinical isolates of group B streptococcus causing acute urinary tract infection and asymptomatic bacteriuria

Streptococcus agalactiae, also known as group B Streptococcus, is an aetiological agent of urinary tract infection (UTI) in adults, including cystitis, pyelonephritis and asymptomatic bacteriuria (ABU). Whereas ABU-causing S. agalactiae (ABSA) have been shown to grow and achieve higher culture denstity in human urine compared to uropathogenic S. agalactiae (UPSA) other phenotypic distinctions between S. agalactiae isolated from different forms of UTI are not known. Here, we define the hemolytic activities and biofilm-formation of a collection of clinical isolates of UPSA, ABSA and recurrent S. agalactiae bacteriuria (rSAB) strains to explore these phenotypes in the context of clinical history of isolates. A total of 61 UPSA, 184 ABSA, and 47 rSAB isolates were analyzed for relative hemolytic activity by spot assay on blood agar, which was validated using a erythrocyte lysis suspension assay. Biofilm formation was determined by microtiter plate assay with Lysogeny and Todd-Hewitt broths supplemented with 1% glucose to induce biofilm formation. We also used multiplex PCR to analyze isolates for the presence of genes encoding adhesive pili, which contribute to biofilm formation. Comparing the hemolytic activities of 292 isolates showed, surprisingly, that ABSA strains were significantly more likely to be highly hemolytic compared to other strains. In contrast, there were no differences between the relative abilities of strains from the different clinical history groups to form biofilms. Taken together, these findings demonstrate a propensity of S. agalactiae causing ABU to be highly hemolytic but no link between clinical history of UTI strains and ability to form biofilm.

|Isolation and characterization of novel bacteriophages as a potential therapeutic option for Escherichia coli urinary tract infections

Urinary tract infections (UTIs) are mainly caused by uropathogenic Escherichia coli (UPEC), whose impact can be exacerbated by multidrug-resistant (MDR) strains. Effective control strategies are, therefore, urgently needed. Among them, phage therapy represents a suitable alternative. Here, we describe the isolation and characterization of novel phages from wastewater samples, as well as their lytic activity against biofilm and adherence of UPEC to HEp-2 cells. The results demonstrated that phage vB_EcoM-phiEc1 (ϕEc1) belongs to Myoviridae family, whereas vB_EcoS-phiEc3 (ϕEc3) and vB_EcoS-phiEc4 (ϕEc4) belong to Siphoviridae family. Phages showed lytic activity against UPEC and gut commensal strains. Phage ϕEc1 lysed UPEC serogroups, whereas phages ϕEc3 and ϕEc4 lysed only UTI strains with higher prevalence toward the O25 serogroup. Moreover, phages ϕEc1 and ϕEc3 decreased both biofilm formation and adherence, whereas ϕEc4 was able to decrease adherence but not biofilm formation. In conclusion, these novel phages showed the ability to decrease biofilm and bacterial adherence, making them promising candidates for effective adjuvant treatment against UTIs caused by MDR UPEC strains.Key pointsPhage with lytic activity against MDR UPEC strains were isolated and characterized under in vitro conditions.A novel method was proposed to evaluate phage activity against bacterial adherence in HEp-2 cell..Phages represent a suitable strategy to control infections caused by MDR bacteria.

Identification and Ranking of Clinical Compounds with Activity Against Log-phase Growing Uropathogenic Escherichia coli.

Uropathogenic Escherichia coli (UPEC) is a major cause of Urinary Tract Infections (UTIs). Due to increasing antibiotic-resistance among UPEC bacteria, new treatment options for UTIs are urgently needed. To identify new agents targeting growing bacteria that may be used for the treatment of antibiotic-resistant UTIs. We screened a clinical compound library consisting of 1,524 compounds using a high throughput 96-well plate assay and ranked the activities of the selected agents according to their MICs against the UPEC strain UTI89. We identified 33 antibiotics which were active against log-phase clinical UPEC strain UTI89. Among the selected antibiotics, there were 12 fluoroquinolone antibiotics (tosufloxacin, levofloxacin, sparfloxacin, clinafloxacin, pazufloxacin, gatifloxacin, enrofloxacin, lomefloxacin, norfloxacin, fleroxacin, flumequine, ciprofloxacin), 15 beta-lactam or cephalosporin antibiotics (cefmenoxime, cefotaxime, ceftizoxime, cefotiam, cefdinir, cefoperazone, cefpiramide, cefamandole, cefixime, ceftibuten, cefmetazole, cephalosporin C, aztreonam, piperacillintazobactam, mezlocillin), 3 tetracycline antibiotics (meclocycline, doxycycline, tetracycline), 2 membrane-acting agents (colistin and clofoctol), and 1 protein synthesis inhibitor (amikacin). Among them, the top 7 hits were colistin, tosufloxacin, levofloxacin, sparfloxacin, clinafloxacin, cefmenoxime and pazufloxacin, where clinafloxacin and pazufloxacin were the newly identified agents active against UPEC strain UTI89. We validated the key results obtained with UTI89 on two other UTI strains CFT073 and KTE181 and found that they all had comparable MICs for fluoroquinolones while CFT073 and KTE181 were more susceptible to cephalosporin antibiotics and tetracycline antibiotics but were less susceptible to colistin than UTI89. Our findings provide possible effective drug candidates for the more effective treatment of antibiotic-resistant UTIs.

Investigation of antibiotic resistance determinants and virulence factors of uropathogenic Escherichia coli.

Multidrug-resistant (MDR) uropathogenic Escherichia coli (UPEC) are prevalent throughout the world resulting in a major public health burden. In this research, we isolated and identified 28 MDR UPEC from one university hospital in China, investigated MDR and pathogenic mechanisms by PCR, including 55 antibiotic resistance determinants (ARDs) genes, 13 genetic markers of mobile genetic elements (MGEs) and 6 virulence factors (VFs) genes. In these isolates, we identified 23 ARDs genes and 6 genetic markers of MGEs that played a key role in MDR phenotypes. In addition, we found 2 VFs genes, hofQ and ompT, which could be associated with pathogenicity and invasiveness of these strains in urinary tract infections (UTIs).

Replication of Crohn's Disease Mucosal E. coli Isolates inside Macrophages Correlates with Resistance to Superoxide and Is Dependent on Macrophage NF-kappa B Activation.

Mucosa-associated Escherichia coli are increased in Crohn’s disease (CD) and colorectal cancer (CRC). CD isolates replicate within macrophages but the specificity of this effect for CD and its mechanism are unclear. Gentamicin exclusion assay was used to assess E. coli replication within J774.A1 murine macrophages. E. coli growth was assessed following acid, low-nutrient, nitrosative, oxidative and superoxide stress, mimicking the phagolysosome. Twelve of 16 CD E. coli isolates replicated >2-fold within J774.A1 macrophages; likewise for isolates from 6/7 urinary tract infection (UTI), 8/9 from healthy subjects, compared with 2/6 ulcerative colitis, 2/7 colorectal cancer and 0/3 laboratory strains. CD mucosal E. coli were tolerant of acidic, low-nutrient, nitrosative and oxidative stress. Replication within macrophages correlated strongly with tolerance to superoxide stress (rho = 0.44, p = 0.0009). Exemplar CD E. coli HM605 and LF82 were unable to survive within Nfκb1-/- murine bone marrow-derived macrophages. In keeping with this, pre-incubation of macrophages with hydrocortisone (0.6 µM for 24 h) caused 70.49 ± 12.11% inhibition of intra-macrophage replication. Thus, CD mucosal E. coli commonly replicate inside macrophages, but so do some UTI and healthy subject strains. Replication correlates with resistance to superoxide and is highly dependent on macrophage NF-κB signalling. This may therefore be a good therapeutic target.

Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China

BackgroundTo evaluate the susceptibility rates of aerobic and facultative Gram-negative bacterial isolates from Chinese intra-abdominal infections (IAI) and urinary tract infections (UTI) focusing on carbapenems and comparing their effectiveness between 2014 and 2015.MethodsA total of 2318 strains in 2015 (1483 from IAI and 835 from UTI) and 2374 strains in 2014 (1438 from IAI and 936 from UTI) were included in the analysis. Antimicrobial susceptibilities were determined at a central laboratory using CLSI broth microdilution and interpretive standards. Hospital acquired (HA) IAI and UTI were defined as isolates sampled > 48 h and community acquired (CA) as isolates sampled < 48 h after admission.ResultsThe main species derived from IAI and UTI in 2015 were Escherichia coli (50.86%) and Klebsiella pneumoniae (19.20%). Susceptibilities of Escherichia coli IAI and UTI strains to imipenem (IPM) and ertapenem (ETP) were > 90% in 2014 and 2015, while the susceptibilities to IPM and ETP of Klebsiella pneumoniae IAI strains were > 80% in 2014 but dropped to ≤80% in 2015 for UTI strains. Susceptibilities of IAI Enterobacteriaceae strains to IPM and ETP in 2015 were lowest in the colon and abscesses, and Enterobacteriaceae susceptibilities of UTI and IAI isolates to IPM and ETP were lowest in medical, pediatric and surgery intensive care units (ICUs) in 2015.ConclusionsIPM and ETP were effective in vitro against Enterobacteriaceae isolated from IAIs and UTIs in 2014 and 2015, but susceptibility to carbapenems in UTIs markedly decreased in 2015.

Proanthocyanidins-Will they effectively restrain conspicuous bacterial strains devolving on urinary tract infection?

Struvite or infection stones are one of the major clinical burdens among urinary tract infection, which occur due to the interaction between microbes and urine mineral components. Numerous urinary tract infection (UTI) causing microbes regulate through biofilm formation for survival from host defense, it is often found difficult in its eradication with simple anti-microbial agents and also the chance of recurrence and resistance development is significantly high. Cranberry consumption and maintenance of urinary tract health have been supported by clinical, epidemiological, and mechanistic studies. It predominantly contains proanthocyanidins that belong to the class of polyphenols with repeating catechin and epicatechin monomeric units. Numerous studies have correlated proanthocyanidin consumption and prevention of bacterial adhesion to uroepithelial cells. Quorum sensing (QS) is the prime mechanism that drives bacteria to coordinate biofilm development and virulence expression. Reports have shown that proanthocyanidins are effective in disrupting cell-cell communication by quenching signal molecules. Overall, this review assesses the merits of proanthocyanidins and its effective oppression on adherence, motility, QS, and biofilm formation of major UTI strains such as Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis by comparing and evaluating results from many significant findings.

Urinary Tract Infection among Pregnant Women at Pumwani Maternity Hospital, Nairobi, Kenya: Bacterial Etiologic Agents, Antimicrobial Susceptibility Profiles and Associated Risk Factors

Urinary Tract Infections (UTIs) during pregnancy are among the most common infections worldwide and can lead to poor perinatal and maternal outcomes. This study determined the prevalence of UTIs during pregnancy, associated risk factors and antimicrobial susceptibility profiles of associated bacterial pathogens. A cross-sectional study was conducted among 210 pregnant women attending antenatal clinic at Pumwani Maternity hospital. Their social-demographic profiles were obtained using a structured questionnaire. Cultures were done from midstream urine and antimicrobial susceptibility testing determined using the disc diffusion test. The overall prevalence of UTI was 15.7% regardless of the women’s age, parity and stage of gestation. Prevalence of asymptomatic and symptomatic bacteriuria was 4.3% and 11.4% respectively. Material of undergarment and frequency of changing the undergarments were found to contribute significantly to the acquisition of UTI (P < 0.05). E. coli was the most predominant UTI organism at (44.5%) followed by K. pneumoniae (21.2%) and S. aureus (15.1%). Almost a half (over 49%) of all Gram-negative organisms showed resistance prevalence against third generation cephalosporins, fluoroquinolones, Sulfamethoxazole-Trimethoprim, Cefoxitin, Nitrofurantoin and Amoxicillin-clavulanic acid. Gram-positive strains were susceptible to Amoxicillin-clavulanic acid, Nitrofurantoin, Linezolid and Ofloxacin. The prevalence of multi-drug resistance (MDR) in all study isolates was 96%. Our data suggest a serious resistance trend among UTI strains and more should be done to slow down this trend. Pregnant women should be screened by urine culture and treatment be guided by the antimicrobial susceptibility data.

Adaptation in a Fibronectin Binding Autolysin of Staphylococcus saprophyticus.

Human-pathogenic bacteria are found in a variety of niches, including free-living, zoonotic, and microbiome environments. Identifying bacterial adaptations that enable invasive disease is an important means of gaining insight into the molecular basis of pathogenesis and understanding pathogen emergence. Staphylococcus saprophyticus, a leading cause of urinary tract infections, can be found in the environment, food, animals, and the human microbiome. We identified a selective sweep in the gene encoding the Aas adhesin, a key virulence factor that binds host fibronectin. We hypothesize that the mutation under selection (aas_2206A>C) facilitates colonization of the urinary tract, an environment where bacteria are subject to strong shearing forces. The mutation appears to have enabled emergence and expansion of a human-pathogenic lineage of S.saprophyticus. These results demonstrate the power of evolutionary genomic approaches in discovering the genetic basis of virulence and emphasize the pleiotropy and adaptability of bacteria occupying diverse niches. IMPORTANCEStaphylococcus saprophyticus is an important cause of urinary tract infections (UTI) in women; such UTI are common, can be severe, and are associated with significant impacts to public health. In addition to being a cause of human UTI, S.saprophyticus can be found in the environment, in food, and associated with animals. After discovering that UTI strains of S.saprophyticus are for the most part closely related to each other, we sought to determine whether these strains are specially adapted to cause disease in humans. We found evidence suggesting that a mutation in the gene aas is advantageous in the context of human infection. We hypothesize that the mutation allows S.saprophyticus to survive better in the human urinary tract. These results show how bacteria found in the environment can evolve to cause disease.

Urinary Tract Infection &amp;lt;i&amp;gt;Escherichia coli&amp;lt;/i&amp;gt; Is Related to the Environmental &amp;lt;i&amp;gt;Escherichia coli&amp;lt;/i&amp;gt; in Their DNA Barcoding and Antibiotic Resistance Patterns in Grenada

Urinary Tract Infections (UTIs) are among one of the most common infections in women, with uropathogenic E. coli (UPEC) being involved in 80% of cases. In addition, E. coli exhibits an increasing resistance to broad spectrum antimicrobial agents as well as the subsequent generations of these drugs. The genetic diversity and antibiotic resistance patterns of both clinical and environmental E. coli isolates were studied to predict the potential of transmission of organisms and genes for antibiotic resistance from three different major eco-habitats including the gut of iguanas’ fresh and marine waters and the human urinary tract. (GTG)5 and BOX-PCR extragenic DNA fingerprinting allowed for the tracking of the relatedness of four different ecotype groups. Both DNA fingerprinting methods targeted non-protein coding or exogenous palindromic DNA and demonstrated shared origin and intraspecies level of genomic diversity within the population of the studied bacteria. DNA fingerprinting based on BOX-PCR was less discriminating than the (GTG)5-PCR, and produced five major clades. BOX-PCR analysis indicated that 44% of the UTI E. coli isolates was comprised within a single clade, therefore it correlated better with ecotype distribution. The (GTG)5 PCR based co-clustering analysis showed that the clinical isolates appeared to have a closer relationship to iguana E. coli isolates than to the fresh and marine water isolates. However, in accordance with the BOX PCR co-clustering analysis, the clinical isolates were most similar to the marine water isolates, followed by the freshwater and iguana E. coli isolates. Seventy two percent of antibiotic resistance patterns were shared by the UTI strains with E. coli isolated from freshwater, followed by iguana.

Antimicrobial Susceptibilities and Clinical Characterization of Pseudomonas aeruginosa Isolates from Urinary Tract Infections

Introduction:Pseudomonas aeruginosa is a uropathogen that is mainly involved in nosocomial infection. The aim of this study was to analyze the antimicrobial susceptibilities and clinical characterization of P. aeruginosa isolates from urinary tract infections (UTIs). Materials and Methods: The study collected all P. aeruginosa UTI strains from a hospital in Chongqing, China, from January 1st, 2010 to December 31st, 2011. The antibiotic susceptibilities of the P. aeruginosa isolates were analyzed using the agar dilution method and the genotypes were assessed using random amplification of polymorphic DNA-PCR (RAPD-PCR). The clinical characteristics of the patients with UTIs were collected from the hospital information systems, and significance was analyzed using the proportion test. Results: A total of 2,778 episodes of culture-proven UTIs were used in the study. There were 198 infections (7.1%) caused by P. aeruginosa. P. aeruginosa strains were highly resistant to most drugs tested. The RAPD-PCR data revealed that the 198 P. aeruginosa infections had 82 different genotypes. Antibacterial use, previous UTI, urinary tract catheter and urinary tract operation were found to be risk factors for the development of UTIs. Conclusions:P. aeruginosa is the second most common UTI pathogen in our hospital. We should closely monitor patients with risk factors for P. aeruginosa infection.

Antibiotic Resistance and ESBL-Presence of Community- Acquired Escherichia Coli Strains [Afsin Devlet Hastanesinde, Idrar Orneklerinden Izole Edilen Toplum Kaynakli Escherichia Coli Suslarinin Antimikrobiyal Direnc Durumu ve GSBL Varligi

Escherichia coli is the most common microorganisms isolated from community-acquired urinary tract infections (UTIs). Furthermore increasing frequency of extended spectrum β-lactamase (ESBL) positive E. coli strains in community-acquired UTIs has led to increasing rates of resistance to antibiotics that used in empirical treatment. The aim of this study was to determine the antimicrobial resistance patterns and epidemiological characteristics of community-acquired E.coli strains in our geographical region. The 3887 (2146 women and 1741 men) urine culture samples examined between September 2011 - September 2013 which were sent to microbiology laboratory from outpatient clinics of our hospital with a preliminary diagnosis of UTIs. 697 (18%) of urine culture samples were find positive; 423 (61%) were female, 274 (39%) were male. By using conventional methods, 352(51%) of the isolated strains were identified as E.coli. Antimicrobial susceptibilities of E.coli strains determined by Clinical Laboratory Standards Institute criteria. Extended spectrum β-lactamase was investigated by double-disk synergy test. The 352 isolated strains of E.coli belong to 47% of urology, 28% of internal medicine and 25% of pediatric patients urine cultures. The highest resistance ratio was observed against to ampicillin according to 68% treatments. There was no resistance found against imipenem and amikacin and 2% of resistance determined to fosfomycin trometamol. The 53 (15%) of isolated strains had extended spectrum β-lactamase. Determination of the antimicrobial resistance rates and selection of the empirical treatment according to these results will prevent the ESBL production and development of resistance to antimicrobials in our region. Also, we hope this study will help to determine the differences between similar geographical regional studies and comparing the results.

The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention--authors' response

Sir, We thank Balakrishnan and Smith for their interest in our paper and congratulate them for the results they have achieved with their approach to antimicrobial prophylaxis for transrectal ultrasound-guided needle biopsy. A risk-based stratification to decide on the choice of prophylaxis is a commendable approach. However, as with other risk-based strategies, it is possible that some patients may slip through the net for a variety of reasons; for instance, when the risk factors are unknown or have not been elicited by the urologist. Furthermore, if radiologists do the biopsies, as in our hospital, they would need to be informed of the suitable prophylaxis for each patient. It is for these practical reasons that we have not adopted a risk-based strategy in our hospital. Given the very low incidence of post-biopsy infections reported by Balakrishnan and Smith, we think it would be necessary to followup a larger cohort of patients to state confidently that the risk-based approach using temocillin prophylaxis is consistently effective. It would also be informative for them to compare their current rate of infections with the background rate before they started their riskbased strategy. Similarly, it would be useful to know the prevalence of ciprofloxacin resistance and extended-spectrum b-lactamases (ESBLs) in their local community. Finally, it would be useful to know the proportion of patients undergoing biopsy that needed temocillin prophylaxis based on this risk-based strategy. We have had good results by adding amikacin to ciprofloxacin prophylaxis since 2007. In a review of our practice in 2012 we continued to have a low rate of infection using this combination. Amikacin has the advantage of a long post-antibiotic effect, conferring an added benefit. Moreover, a high concentration of amikacin is found in prostatic tissue after one dose. Additionally, we believe it is unlikely that a single dose of amikacin will critically alter the intestinal flora or promote resistance. It is worth noting that we have had Pseudomonas spp. bacteraemia among our prostate biopsy patients in the past. Amikacin would clearly be more useful in such settings. In our local population in north-west London, 1% of Escherichia coli strains in urinary tract infections are resistant to amikacin compared with 7% resistant to temocillin, and 1% of ESBL strains are amikacin resistant whereas 4% are resistant to temocillin (G. Gopal Rao, unpublished laboratory data). Clearly, the field of antimicrobial prophylaxis for prostate biopsy is an evolving one and new strategies to make the procedure safer are needed and would be welcomed.