Urinary Research Articles

Endoscopic treatment of obstructive ectopic ureterocele complexed with concomitant urolithiasis

Ectopic ureterocele is a rare anomaly of the upper urinary tract, often accompanied by the growth of secondary stones caused by impaired urinary outflow. The article presents a clinical case, which shows the peculiarities of diagnosis and possibilities of surgery of this condition, including minimally invasive endoscopic interventions. Emphasis is placed on the consideration of different surgical approaches and their effectiveness in improving the quality of life of patients. Comparative analysis of different techniques shows that endoscopic correction, despite some limitations, remains the preferred option due to the low incidence of complications and rapid rehabilitation.

Two multidrug-resistant Proteus mirabilis clones carrying extended spectrum beta-lactamases revealed in a single hospital department by whole genome sequencing

Proteus mirabilis bacteria is a component of normal intestinal microflora of humans and animals, but can also be found in hospital settings causing urinary tract infections and sepsis. The problem of treating such infections is complicated by multidrug-resistant isolates producing extended spectrum beta-lactamases (ESBL), and the number of ESBL-carrying P. mirabilis strains has significantly increased recently.This study presents a detailed analysis of 12 multidrug-resistant P. mirabilis isolates obtained from the wounds of different patients in one surgical department of a multidisciplinary hospital in Moscow, Russia, using the short- and long-read whole genome sequencing. The isolates under investigation divided into two clusters (clones) C1 and C2 based on their genomic profiles and carried antimicrobial resistance (AMR) genes corresponding well with phenotypic profiles, which was the first case of reporting two different P. mirabilis clones obtained simultaneously from the same specimens at one hospital, to the best of our knowledge. Some genes, including ESBL encoding ones, were specific for either C1 or C2 (aac(6′)-Ib10, ant(2″)-Ia, qnrA1, blaVEB-6 and fosA3, blaCTX -M-65, correspondingly). Additionally, the Salmonella genomic islands 1 were found that differed in composition of multiple antibiotic resistance regions between C1 and C2 groups. CRISPR-Cas system type I-E was revealed only in C2 isolates, while the same set of virulence factors was determined for both P. mirabilis clones.Diversity of all genetic factors found in case of simultaneous existence of two clones collected from the same source at one department indicates high pathogenic potential of P. mirabilis and poses a requirement of proper spreading monitoring. The data obtained will facilitate the understanding of AMR transfer and dynamics within clinical P. mirabilis isolates and contribute to epidemiological surveillance of this pathogen.

Effectiveness of Structured Teaching Programme (Stp) On Knowledge Regarding Prevention and Management of Urinary Tract Infection Among Female in Patients Admitted in Ah&Rc B G Nagara

Background: Urinary tract infection occurs among the most prevalent infections in humans is urinary tract infection. When uropathogenic bacteria, typically Escherichia coli, rise from the perineum into the bladder and defeat host innate immunity, simple infections most frequently occur in apparently healthy women Urinary tract infection is one of the commonest infections to affect humans. Purpose: The study assessed the effectiveness of Structured teaching programme on regarding UTI among female patients admitted in Adichunchanagiri Hospital & Research Center B G Nagara. Method: The patient’s level of knowledge was assessed using an 30-item Urinary Tract Infection female Patient Awareness Questionnaire. An STP was administered to 60 patients with UTI Female Patient. Discussion: The pretest mean knowledge score was 42.89% and SD was ±2.45. The posttest mean knowledge score was 77.00% and SD was ±2.14. The paired t-test showed t=2.04, df=29. Conclusion: STP was effective in enhancing the knowledge of UTI Female patients. This implies that when appropriately implemented, the UTI patients will bring the benefits of STP, Which could enhance their overall health condition.

Antimicrobial resistance, virulence gene profiles, and molecular epidemiology of enterococcal isolates from patients with urinary tract infections in Shanghai, China.

This study highlighted the critical need to understand Enterococcal strains causing UTIs in Shanghai, given their high prevalence. By assessing antimicrobial resistance profiles, virulence gene presence, and molecular epidemiology, the research offered valuable insights into the local epidemiology of Enterococcus faecalis and Enterococcus. faecium. Identifying linezolid-resistant strains, all of which carry the optrA gene, including the first report of ST300 in China and recognizing dominant MLST types, such as ST16 and ST179 for E. faecalis and ST78 for E. faecium, are vital for guiding treatment and addressing the challenges these infections present. The data emphasize the need for ongoing surveillance and customized therapeutic approaches to combat emerging resistance and virulence factors in Enterococcal UTIs.

Assessment of co-resistance to antibiotics recommended for acute pyelonephritis among Escherichia coli clinical strains from community- and nursing home-acquired urinary tract infections.

This study aimed to assess the frequency of co-resistance to antibiotics recommended in acute pyelonephritis among Escherichia coli clinical strains isolated from urinary tract infections (UTIs) acquired in community or nursing homes (NHs), and to identify situations without alternatives to fluoroquinolones (FQs). All antimicrobial susceptibility test (AST) results of E. coli culture-positive urine samples from females living in the community or in NHs, collected through a large network of clinical laboratories in 2020 in France, were included. The percentages of strains resistant to amoxicillin alone or combined with a resistance to one to four alternatives among amoxicillin/clavulanic acid, trimethoprim/sulfamethoxazole, cefixime and FQs were calculated and compared between age categories and settings. Among 291 367 E. coli strains from community-acquired UTIs, 60.3% were susceptible to amoxicillin (<65-year-olds: 61.8% versus ≥65-year-olds: 58.8%; P < 0.001), and 99.1% to oral alternatives to FQs. Co-resistance to amoxicillin and trimethoprim/sulfamethoxazole was higher among females ≥65 years old versus <65 years old (7.1% versus 6.1%; P < 0.01), as well as co-resistance to amoxicillin, amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole (8.6% versus 10%; P < 0.001). Among 11 340 strains from NH UTIs, 51.2% were susceptible to amoxicillin, and 98% to oral alternatives to FQs. Co-resistance to amoxicillin, amoxicillin/clavulanic acid and/or cefixime was higher in isolates from females ≥65 years old living in NHs versus in the community (respectively 11.9% versus 15.3%, P < 0.001; 0.8% versus 2.8%, P < 0.01; 1.7% versus 4.4%, P < 0.01). Based on AST results, prescribing oral alternatives to FQs for females may be possible in ≥99% of E. coli acute pyelonephritis cases in the community, and ≥98% in NHs.

Oral ciprofloxacin biofilm activity in a catheter-associated urinary tract infection model.

Catheter-associated urinary tract infections (CA-UTIs) are a common hospital-acquired infection. We examined ciprofloxacin activity in a novel CA-UTI in vitro model. Three ATCC strains [Escherichia coli (ECO)-25922, Klebsiella pneumoniae (KPN)-700721, Pseudomonas aeruginosa (PAE)-27853] and 45 clinical urinary isolates were assessed. Biofilm mass and planktonic bacterial density were quantified during drug-free incubation (72 h) and following ciprofloxacin exposure (equivalent 750 mg orally q12h, 3 days). ECO produced smaller biofilms (6.3 ± 1.1 log10 cfu/cm2) compared with KPN (7.1 ± 0.7 log10 cfu/cm2) and PAE (7.0 ± 1.2 log10 cfu/cm2), which extended along the entire catheter length. Following ciprofloxacin, all isolates with MIC > 4 mg/L had minimal biofilm disruption or planktonic kill. Ciprofloxacin resistance was most common in PAE isolates (10/16 isolates), compared with ECO (3/16 isolates) and KPN (6/16 isolates). Greater ciprofloxacin exposure (AUC0-24/MIC) was required for a 3 log10 biofilm kill for KPN (5858; R2 = 0.7774) compared with ECO (2117; R2 = 0.7907) and PAE (2485; R2 = 0.8260). Due to persistent growth in the bladder, ECO required greater ciprofloxacin exposure for a 3 log10 planktonic kill (5920; R2 = 0.8440) compared with KPN (2825; R2 = 0.9121) and PAE (1760; R2 = 0.8781). Monte Carlo simulation supported a 95% PTA for both a 3 log10 biofilm and planktonic kill for ECO and KPN isolates with MIC ≤ 0.5 mg/L and PAE isolates with MIC ≤ 1 mg/L. In a novel CA-UTI model, following simulated ciprofloxacin therapy, KPN biofilms were comparatively more difficult to disrupt, ECO planktonic growth frequently persisted in the bladder, and PAE had greater propensity for emergence of ciprofloxacin resistance.

Focus on the Blind Spot of Stone Disease: Analysis of Lower Urinary Tract Stone Interventions from 2006 to 2020 using German nationwide inpatient data.

Introduction To analyze contemporary treatment trends in bladder stone management in Germany over a 15-year period. Methods We analyzed data from the nationwide German hospital billing database from 2006 to 2020. The significance of changes over time was evaluated via linear regression analysis. Results Total case numbers of therapeutic interventions for lower urinary tract calculi increased from 6,770 in 2006 to 9,037 in 2020 (p<0.001). Transurethral cystolithotripsy (TUCL) was the predominant procedure with increasing case numbers from 5,552 in 2006 to 7,699 in 2020 (p<0.001). Also, the share of TUCL increased by 4 % during the study period. TUCL with laser fragmentation was coded in 82 cases in 2006 and in 1,527 cases in 2020 (p<0.001). Case numbers of percutaneous cystolithotripsy (PCCL) also increased over time from 406 to 430 cases (p=0.005), but the share decreased by 20 %. Inpatient shock wave lithotripsy (SWL) is very rarely performed for bladder calculi with an average of 22 cases per year in all hospitals in Germany. Case numbers of open cystolithotomy (OCL) also increased from 614 cases in 2006 to 692 cases in 2020 (p=0.006), but the share decreased by 15.5 %. On average 164 cases of stone removal from neobladders per year were performed, mainly transurethrally (47 %) or via an open approach (21 %). Case numbers of TUCL combined with transurethral resection of the prostate (TUR-P) declined from 1,712 in 2006 to 1,450 in 2020 (p=0.014). However, this might be attributed to the concomitant rise of laser enucleation of the prostate with steadily increasing case numbers in Germany. Conclusion We present contemporary population-based data on bladder stone treatment in Germany. TUCL is the predominant therapeutic modality with increasing case numbers, but open cystolithotomy is still performed frequently. TUR-P is the procedure that is most often combined with TUCL.

Rapid inference of antibiotic susceptibility phenotype of uropathogens using metagenomic sequencing with neighbor typing.

Urinary tract infections (UTIs) are a common diagnosis in hospitals and are often treated empirically with broad-spectrum antibiotics. These broad-spectrum agents can select for resistance in these bacteria and co-colonizing organisms. The use of narrow-spectrum agents is desirable as an antibiotic stewardship measure; however, it is counterbalanced by the need for adequate therapy. Identification of causative organisms and their antibiotic susceptibility can help direct treatment; however, conventional testing requires days to produce actionable results. Methods to quickly and accurately predict susceptibility phenotypes for pathogens causing UTI could thus improve both patient outcomes and antibiotic stewardship. Here, expanding on previous work showing accurate prediction for certain Gram-positive pathogens, we demonstrate how the use of RASE from metagenomic sequencing can provide informative and rapid phenotype prediction results for common Gram-negative pathogens in UTI, highlighting the future potential of this method to be used in clinical settings to guide empiric antibiotic selection.

Assessment of novel biomarkers of renal dysfunction associated with lower urinary tract symptoms in men with benign prostatic hyperplasia

Introduction. The problem of diagnostics and treatment of patients with complex lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) remains highly relevant. Clinical diagnostic methods do not always allow timely prediction of changes in renal, upper and lower urinary tract function with different types of treatment intervention. The search for potential biomarkers allowing minimally invasive assessment of the bladder and renal function condition seems to be a promising direction of scientific research.Objective. To identify potential urine and serum biomarkers allowing to assess renal function in patients with LUTS/BPH.Materials &amp; methods. The study included 69 patients with LUTS/BPH and subsequently divided them into two groups. Group 1 included 48 patients with moderate LUTS who received combination therapy with alpha-1 adrenergic blockers (AABs) and 5-alpha reductase inhibitors (5ARIs). Group 2 included 21 patients with severe LUTS/BPH. Patients of group 2 underwent surgical treatment: transurethral resection of the prostate. In addition to standard research methods (IPSS, voiding diaries, laboratory, urodynamic and radiation techniques), to search for potential biomarkers in serum and urine, concentrations of: insulin-like growth factor binding protein-7 (IGFBP7), B-Cross Laps, Cystatin C, OPN, trefoil factor (TFF3), uromodulin, Clusterin, lactate dehydrogenase (LDH). The follow-up period for patients was 12 months.Results. The study noted that IGFBP7, Cystatin C, TFF3 in the blood serum, as well as LDH, Clusterin in the urine are associated with the severity of LUTS/BPH. Serum biomarker levels were initially higher in patients with severe LUTS compared to patients with moderate LUTS (group 1). The levels of these substrates decreased in patients of all groups during treatment (conservative therapy, surgical interventions for BPH). When assessing urinary biomarkers, the greatest decrease in Clusterin level by the end of follow-up was registered in group 1 patients, the least pronounced in group 2 patients. The initial value of LDH was twice higher in group 2 vs group 1 and progressively decreased after surgical treatment of bladder outlet obstruction.Conclusion. Biomarkers used to assess renal dysfunction in the development of LUTS/BPH are a promising area of scientific research. Panels of new markers will enable to predict renal dysfunction in patients with moderate-to-severe LUTS, which will improve the quality of medical care for this category of patients.

Biomimetic tubular materials: from native tissues to a unifying view of new vascular, tracheal, gastrointestinal, oesophageal, and urinary grafts.

Repairing tubular tissues-the trachea, the esophagus, urinary and gastrointestinal tracts, and the circulatory system-from trauma or severe pathologies that require resection, calls for new, more effective graft materials. Currently, the relatively narrow family of materials available for these applications relies on synthetic polymers that fail to reproduce the biological and physical cues found in native tissues. Mimicking the structure and the composition of native tubular tissues to elaborate functional grafts is expected to outperform the materials currently in use, but remains one of the most challenging goals in the field of biomaterials. Despite their apparent diversity, tubular tissues share extensive compositional and structural features. Here, we assess the current state of the art through a dual layer model, reducing each tissue to an inner epithelial layer and an outer muscular layer. Based on this model, we examine the current strategies developed to mimic each layer and we underline how each fabrication method stands in providing a biomimetic material for future clinical translation. The analysis provided here, addressed to materials chemists, biomaterials engineers and clinical staff alike, sets new guidelines to foster the elaboration of new biomimetic materials for effective tubular tissue repair.

Characteristics and antibiotic resistance patterns of urinary tract isolates in hospitalized and non-hospitalized patients: a cross-sectional study in Khartoum, Sudan

BackgroundUrinary tract infections (UTIs) are widespread worldwide impacting society, economics, and healthcare systems. The rise of antibiotic resistance in both hospital and community settings has further complicated UTI management. This study aims to assess the epidemiologic distribution and microbiologic classification of UTI-causing microorganisms, as well as their resistance patterns.MethodsThis cross-sectional descriptive study was conducted at the National Public Health Laboratories in Khartoum, Sudan. Urine samples were collected from three hospitals from September to December 2021, and 65 bacterial isolates were recovered from patients with clinical symptoms of UTI. Bacterial identification and antimicrobial susceptibility testing were performed using standard bacteriological methods and Kirby-Bauer’s disc diffusion method. Genotyping for Extended Spectrum Beta-Lactamase (EsβL) production was conducted using multiplex PCR.ResultsOf the 65 bacterial isolates, 27 (41.5%) were community-acquired UTI patients (C-UTIs), and 38 (58.5%) were hospital acquired UTI patients (H-UTIs). Males were more commonly affected by H-UTIs (68.4%), while females represented the majority among C-UTIs (85.2%). Gram-negative bacteria were predominant in urinary isolates (81.54%), with Escherichia coli being the most common organism (49.1%). Gram-positive organisms accounted for 18.46% of isolates, with Enterococcus spp. being the most prevalent. In-vitro susceptibility analysis revealed that meropenem was the most effective antibiotic in Gram-negative isolates (77.4%), while nitrofurantoin was the most effective in Gram-positive isolates (91.67%). EsβL production was detected in 11/23 (47.8%) of the tested isolates with Escherichia coli being the most common ESβL producer.ConclusionThis study highlights the pattern of antibiotic-resistant bacteria in UTIs and their significance. Continuous monitoring, development of local antibiograms, and implementation of surveillance programs are essential for guiding empirical antibiotic use and managing UTIs effectively, especially in resource-limited settings like Sudan.

Do We Need to Re-Focus on Functional Female Urethral Disorders in Lower Urinary Tract Dysfunction? ICI-RS 2024.

Insights into the role of the urethra in maintaining continence and in normal voiding have been provided with advances in imaging techniques. Also, functional urethral testing is used to understand which treatments are optimal for women with functional bladder outlet obstruction (BOO), but which testing is better for which treatment? This review aims to describe our current understanding of female urethral function and dysfunction and to provide future research directions for treating functional female urethral disorders. This is a consensus report of the proceedings of a research proposal discussed at the annual International Consultation on Incontinence-Research Society (ICI-RS), 6th-8th June 2024 (Bristol, UK): "Do we need to re-focus on functional female urethral disorders in lower urinary tract dysfunction? ICI-RS 2024". Regarding female urethral nomenclature, it was agreed that the same terminology should be used in the orientation of the female urethra as in the male. Also, functional MRI and computer modeling could aid further understanding of urethral function in women with voiding dysfunction and OAB symptoms. As for functional urethral assessment, options include video-urodynamics with leak point pressure (LPP) testing, urethral pressure profilometry (UPP), and striated urethral sphincter electromyography (EMG). Future testing may include the use of modalities (borrowed from cardiologic assessment of vascular structures such as resistive measures obtained with ultrasound) for the purpose of assessing urethral closure. UPP testing has limitations in measurement and reproducibility in assessing urethral pressure. Urethral sphincter EMG is difficult to perform and reproduce. LPP also has limitations related to testing and to patient effort, in addition to being influenced by factors such as bladder volume and compliance. When performing urethral surgery, it is imperative to dissect in tissue planes that preserve urethral function. Regarding therapeutic modalities for the treatment of functional female urethral dysfunction, conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, and extracorporeal magnetic stimulation. Furthermore, there was a robust discussion on the use of cognitive-behavioral therapy to address psychological comorbidities, thereby improving female LUTD. The evidence supporting long-term pharmacologic treatment of female urethral LUTD remains scarce. As for invasive management options, the evidence supporting the use of botulinum toxin in female LUTD is limited. Finally, the very existence of BNO and the validity of its diagnosis was discussed. Furthermore, bladder neck incision as a treatment of BNO was debated, and the indications for this procedure include a therapeutic decision balancing benefit to complications. Improving the treatment of female functional storage and voiding disorders depends on optimal urethral function assessment. Functional MRI to better understand urethral function, expanding the use of UPP testing, LPP testing, and emerging modalities while maintaining urethral function during female urethral surgery, and addressing psychological comorbidities whilst pursuing both conservative and invasive options (for refractory symptoms) are all important considerations in treating functional female urethral disorders.

Fecal microbiome composition in neonates with or without urinary tract infection.

Most infants with febrile urinary tract infection (UTI) do not have an underlying anatomical risk factor. Thus, other non-anatomical risk factors should be considered. Since the most common pathogens arise from the fecal microbiota, our aim was to investigate whether the gut microbiota composition differs between febrile infants younger than 2months with or without UTI. In this prospective, case-control, pilot study, we performed 16S ribosomal ribonucleic acid amplicon sequencing to characterize gut microbiota of febrile neonates with and without UTI admitted to the pediatric ward at Shamir Medical Center between February 2019 and May 2021. The study cohort included 42 febrile neonates: 17 with and 25 without febrile UTI. We found a significant difference in beta diversity (i.e. between-sample/study group similarity indices) between the UTI and non-UTI group (p = 0.016). There were also distinct differences in the relative abundance of the 20 most prevalent genera. Furthermore, several genera were significantly enriched in the UTI group, with others dominating the non-UTI group. Streptococci were underrepresented in the UTI group. There was no difference in alpha diversity (i.e. within-sample diversity/richness) between groups. Febrile neonates with UTI have a different fecal microbiota composition (beta-diversity), but not alpha diversity, in comparison to febrile neonates without UTI. A larger study is warranted to confirm these findings and their potential applications.

Peripheral Mechanisms Underlying Bacillus Calmette–Guerin-Induced Lower Urinary Tract Symptoms (LUTS)

Peripheral Mechanisms Underlying Bacillus Calmette–Guerin-Induced Lower Urinary Tract Symptoms (LUTS)

Understanding the demographic and socioeconomic determinants of morbidity in Eastern Uganda: a retrospective analysis of the Iganga-Mayuge health and demographic surveillance data

IntroductionUnderstanding the determinants of disease burden is imperative in enhancing population health outcomes. This study uses data from the Iganga-Mayuge Health and Demographic Surveillance Site, to understand demographic and socioeconomic...

Preventive effect of cranberries with high dose of proanthocyanidins on urinary tract infections: a meta-analysis and systematic review

Preventive effect of cranberries with high dose of proanthocyanidins on urinary tract infections: a meta-analysis and systematic review

Rapid antibiotic susceptibility testing for urinary tract infections in secondary care in England: a cost-effectiveness analysis

ObjectivesTo perform a model-based cost-effectiveness evaluation of a rapid antimicrobial susceptibility test.DesignA Markov model of a cohort of hospital inpatients with urinary tract infection (with inpatient numbers based on national...

Patterns of Antimicrobial Resistance in Urinary Tract Infection Pathogens: Analysis in a Provincial Hospital in Zimbabwe

Introduction. Urinary tract infections (UTIs) are among the most common infections globally. Rising multidrug-resistant uropathogens in Zimbabwe underscore the need to review their susceptibility profiles. This study examines antimicrobial susceptibility trends of uropathogens in patients from Victoria Chitepo Provincial Hospital. Methods: This retrospective study included 385 randomly selected UTI-positive patients from 2023. Midstream, clean-catch urine samples were processed using standard microbiological techniques, and statistical analysis was conducted. Results: More females (56.4%) than males (43.6%) had UTIs, with age groups 0–9 and 20–29 years most affected (16.6% each). The predominant uropathogens were E. coli (27.2%), K. pneumoniae (18.4%), Staphylococcus spp. (17.4%), and Enterobacter spp. (12.2%). E. coli was most susceptible to ceftriaxone (93%) and most resistant to doxycycline; K. pneumoniae was most susceptible to chloramphenicol (70.4%). Conclusion: E. coli was the most common uropathogen. Most uropathogens showed susceptibility to ceftriaxone, gentamicin, and chloramphenicol. However, Staphylococcus spp. displayed resistance to norfloxacin, ciprofloxacin, nalidixic acid, and doxycycline. The high resistance rates highlight the need for antimicrobial stewardship and confirmatory testing before prescribing.

Upper Urinary Tract Stereotactic Body Radiotherapy Using a 1.5 Tesla Magnetic Resonance Imaging-Guided Linear Accelerator: Workflow and Physics Considerations

Background/Objectives: Advancements in radiotherapy technology now enable the delivery of ablative doses to targets in the upper urinary tract, including primary renal cell carcinoma (RCC) or upper tract urothelial carcinomas (UTUC), and secondary involvement by other histologies. Magnetic resonance imaging-guided linear accelerators (MR-Linacs) have shown promise to further improve the precision and adaptability of stereotactic body radiotherapy (SBRT). Methods: This single-institution retrospective study analyzed 34 patients (31 with upper urinary tract non-metastatic primaries [RCC or UTUC] and 3 with metastases of non-genitourinary histology) who received SBRT from August 2020 through September 2024 using a 1.5 Tesla MR-Linac system. Treatment plans were adjusted by using [online settings] for “adapt-to-position” (ATP) and “adapt-to-shape” (ATS) strategies for anatomic changes that developed during treatment; compression belts were used for motion management. Results: The median duration of treatment was 56 min overall and was significantly shorter using the adapt-to-position (ATP) (median 54 min, range 38–97 min) in comparison with adapt-to-shape (ATS) option (median 80, range 53–235 min). Most patients (77%) experienced self-resolving grade 1–2 acute radiation-induced toxicity; none had grade ≥ 3. Three participants (9%) experienced late grade 1–2 toxicity, potentially attributable to SBRT, with one (3%) experiencing grade 3. Conclusions: We conclude that MR-Linac-based SBRT, supported by online plan adaptation, is a feasible, safe, and highly precise treatment modality for the definitive management of select upper urinary tract lesions.

Purified α-Amylase from Bacillus cereus exhibits antibiofilm and antiquorum sensing activities against uropathogenic Escherichia coli, Downregulating fimH, and papC virulence genes: implications for urinary tract infections

Background and aimPathogenic Escherichia coli is a known harmful microorganism that takes advantage of favorable conditions to cause various infections in healthcare settings, such as bloodstream infections related to catheters, as well as infections in the urinary and respiratory tracts. E. coli utilizes biofilm development as a means to enhance its virulence and pathogenicity. This work aims to investigate the antibiofilm activity of α-amylase enzyme against uropathogenic E. coli (UPEC) and its effect on biofilm-regulatory genes.MethodologyIn this study, we evaluated the antibiofilm activity of α-amylase enzyme by spectrophotometric microtiter plate analysis and confocal laser scanning microscopy. Also, the antibacterial activity of the test enzyme was evaluated by measuring the MIC and MBC levels against UPEC. The quorum-quenching activity of α-amylase enzyme was assessed using a qRT-PCR to evaluate the impact on biofilm-regulatory genes.ResultsBased on our results, purified α-amylase showed MIC and MBC levels ranged between 128 and 512 µg /ml against UPEC isolates using broth microdilution assay. Crystal violet assay revealed MBIC of 128 µg/ml and MBEC of 256 µg/ml for the purified α-amylase. When the biofilm was analyzed by confocal laser scanning microscope, our results showed inhibition of biofilm thickness (56%) and live/dead cell percentages (43/55%). Furthermore, analysis of the effect on the expression of biofilm-encoding genes showed downregulation of both fimH and papC genes by 57 and 25%, respectively, upon treatment of UPEC with ½ of the MIC (64 µg/ml).ConclusionsThe results demonstrate that our purified α-amylase from B. cereus exhibits promising antibiofilm activities against UPEC at both phenotypic as well as genotypic levels. These findings suggest that this enzyme may serve as a natural effective tool for removing bacterial biofilms, potentially offering new therapeutic avenues for treating infections caused by UPEC.