Urinary Research Articles

Postoperative infections after robotic-assisted radical prostatectomy in a single large institution: Effect of type and duration of prophylactic antibiotic administration.

We evaluated the incidence of and risk factors for postoperative infections after robotic-assisted radical prostatectomy (RARP) according to the type and duration of prophylactic antibiotic administration. A total of 1038 patients underwent RARP at our institution from 2010 to 2021; 1026 patients (201 in the cefazolin [CEZ] group and 825 in the ampicillin/sulbactam [ABPC/SBT] group) were analyzed, and 12 who used other antibiotics were excluded. The primary endpoint was the incidence of urinary tract infection (UTI), surgical site infection (SSI), and remote infection (RI). T-tests, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed. Multivariate logistic regression analysis was performed to evaluate the effect of type and duration of prophylactic antibiotic administration. The incidence of UTI was 2.5% (5/201) in the CEZ group and 3.2% (26/825) in the ABPC/SBT group, with no significant difference between groups (p = 0.622). The rates of SSI and RI were comparable between groups (p = 0.680 and 0.906, respectively). Although the duration of antimicrobial therapy was longer in the ABPC/SBT group (p < 0.001), there was no significant difference in the incidence of UTI/SSI/RI after PSM and IPTW (all p > 0.05). Multivariate logistic regression analysis showed that neither the type of antibiotic nor the duration of administration affected the incidence of UTI/SSI/RI. The risk of postoperative UTI/SSI/RI after RARP did not change with the type and duration of antimicrobial therapy.

Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study

Abstract Background and Aims The bleeding risk of using non-steroidal anti-inflammatory drugs (NSAIDs) in patients treated with oral anticoagulants for venous thromboembolism (VTE) remains unclear. Methods A nationwide cohort study of 51 794 VTE patients initiating oral anticoagulants between 1 January 2012 and 31 December 2022 was conducted. Time-dependent multivariate cause-specific Cox regression was used to compute adjusted hazard ratios between NSAID use and hospital-diagnosed bleeding episodes. Results Event rates for any bleeding per 100 person-years were 3.5 [95% confidence interval (CI), 3.4–3.7] during periods without NSAID use and 6.3 (95% CI, 5.1–7.9) during periods with NSAID use (number needed to harm = 36 patients treated for 1 year). Compared with non-use, the adjusted hazard ratios for any bleeding associated with NSAID use were 2.09 (95% CI, 1.67–2.62) overall, 1.79 (95% CI, 1.36–2.36) for ibuprofen, 3.30 (95% CI, 1.82–5.97) for diclofenac, and 4.10 (95% CI, 2.13–7.91) for naproxen. Compared with non-use, the adjusted hazard ratios associated with NSAID use were 2.24 (95% CI, 1.61–3.11) for gastrointestinal bleeding, 3.22 (95% CI, 1.69–6.14) for intracranial bleeding, 1.36 (95% CI, .67–2.77) for thoracic and respiratory tract bleeding, 1.57 (95% CI, .98–2.51) for urinary tract bleeding, and 2.99 (95% CI, 1.45–6.18) for anaemia caused by bleeding. Results were consistent for anticoagulant and VTE subtypes. Conclusions Patients treated with oral anticoagulants for VTE had a more than two-fold increased bleeding rate when using NSAIDs. This increased bleeding rate was not restricted to the gastrointestinal tract.

Computational approach towards repurposing of FDA approved drug molecules: strategy to combat antibiotic resistance conferred by Pseudomonas aeruginosa

Antimicrobial resistance is recognized as a major worldwide public health dilemma in the current century. Pseudomonas aeruginosa, a Gram-negative opportunistic pathogen, causes nosocomial infections like respiratory tract infections, urinary tract infections, dermatitis, and cystic fibrosis. It manifests antibiotic resistance via intrinsic, acquired, and adaptive pathways, where efflux pumps function in the extrusion of antibiotics from the cell. MexB protein, part of the tripartite efflux pumps MexAB-OprM present in P.aeruginosa, expels the penems and β-lactam antibiotics, thereby enhancing Pseudomonas resistance. The current study was intended to screen around 1602 clinically approved drugs to understand their ability to inhibit the MexB protein. Amongst them, the top 5 drug molecules were selected based on the binding energies for analyzing their physio-chemical and toxicity properties. Lomitapide was found to have the maximum negative binding energy followed by Nilotinib, whereas Nilotinib’s number of hydrogen bonds was higher than that of Lomitapide. ADMET study revealed that all 5 drug molecules had limited solubility. Also, Lomitapide and Venetoclax showed low bioavailability scores, while Nilotinib, Eltrombopag, and Conivaptan demonstrated higher potential for therapeutic levels. A molecular dynamic simulation study of the 5 drugs against MexB was carried out for 200 nanoseconds. The RMSD, RMSF, Hydrogen bond formation, Radius of gyration, SASA, PCA, DCCM, DSSP and MM-PBSA binding energy calculation along with demonstrated high stability of the MexB-Nilotinib complex with lesser distortions. Our study concludes, that Nilotinib is a potential inhibitor and can be developed as a therapeutic agent against MexB protein for controlling P. aeruginosa infections.

Prevalence and Antibiotic Susceptibility Profile of Uropathogenic ESBL-producing Klebsiella pneumoniae in Keffi Metropolis, Nigeria

Urinary tract infection (UTI) remains the most common bacterial infection in humans despite the widespread availability of antibiotics. Exteded spectrum beta-lactamase production is an important mechanism of antibiotic resistance in the Enterobacteriaceae. Antibiotic resistance is a rising dilemma of significant implications on global public health. Few data exist for the prevalence and trends of Klebsiella pneumoniae antibiotic resistance in Keffi metropolis Nigeria. This study was done to determine the prevalence of ESBL-producing K. pneumoniae as well as its antibiotic susceptibility pattern regarding some predisposing factors. Aim: This study was carried out to determine the prevalence and antibiotic susceptibility pattern of uropathogenic K. pneumoniae in Keffi metropolis, Nigeria. Methodology: The current study was a carried out in Keffi, Nasarawa state, Nigeria from July to October 2024. It was a cross-sectional study comprising of 160 early morning urine samples randomly collected from consenting participants in the six selected hospitals. Isolation and identification of K. pneumoniae was done using standard microbiological methods. The antibiotic susceptibility profile of isolates was carried out using the Kirby-Bauer disc diffusion method and interpretation was done following the Clinical and Laboratory Standards Institute protocol. Results obtained in this study were analysed using Smith’s Statistical Package (version 2.8, California, USA) and P value of ≤ 0.05 was considered statistically significant. Results: The result of this study revealed an overall prevalence of 20/160 (12.5%). The highest prevalence of the isolate was seen in females 14(8.75) compared to males 6 (3.75%), while the highest prevance regarding age was recorded among the 15-34 age group 12 (7.5%) while the least was recorded among those greater than 65 years 0 (0%). Furthermore, the highest number of isolate was recorded at FMCK 7 (4.4%) followed jointly by GHK and PHC TK 4 (2.5%) with PHC, KP and PHC AJ 1 (0.63%) beign the least respectively. There was a high level of resistance to ceftazidime 20 (100%), followed jointly by ceftriaxone, cefurexime and treptomycin 19 (95%) and augmentin 18 (90%) but low to amoxicillin 6 (30%) and ofloxacin 6 (30%) respectively. Most of the isolates tested were multidrug resistant and all were extended spectrum beta lactamase (ESBL) producing. Conclusion: The relatively high detection rate of multidrug resistant uropathogenic K. pneumoniae in this study calls for concern. More concerning is the isolation from primary health care centers (PHCs) signifying the importance of universal health coverage and the place of PHCs in antimicrobial stewardship (AMS) programs as one of the strategies to control the spread of antimocrobial resistance.

ANTIBIOTIC RESISTANCE PATTERNS OF COMMON UROPATHOGENS ISOLATED FROM FEMALES AT ZAKHO CITY, KURDISTAN REGION, IRAQ.

Background: Urinary tract infection (UTI) is an infection in any part of the urinary system, including kidneys, ureters, bladder, and urethra. Uropathogenic bacterial-antibiotic resistance has become a severe challenge among UTI-causative agents. Objective: This work attempted to screen the activity of a wide range of antibiotics routinely used for UTI-derived infection management to assess the impact of antibiotics on some common UTI pathogens isolated from females. Method: This retrospective study was performed at Zakho Emergency Hospital, Kurdistan region of Iraq, from January 2016 to December 2019. Conventional bacteriological tests were used to identify the most common isolated uropathogens in females. The antibiotic sensitivity test was performed according to the Clinical and Laboratory Standards Institute (CLSI). The bacterial-antibiotics assay was determined using the disk diffusion (Kirby-Bauer) method, which depended on the microbiology laboratory records. Results: Out of 1730 urine samples, 1040 (60.4%) were found to be pathogens-positive samples. The most common uropathogens isolated were Staphylococcus spp 44% (n=460), Escherichia coli strains 25.35% (n=265), Klebsiella spp 15.78% (n=65), and Streptococcus spp 14.83 (n=155). Regarding the microbial-antibiotic resistance, ≤ 25% of the UTI investigated cases, except Streptococcus spp, meropenem, imipenem, and amikacin, showed a remarkable effect against all addressed pathogens. Vancomycin was the first choice against gram-positive bacteria in addition to rifampicin and doxycycline for Streptococcus spp. Gentamycin was found to be the most effective antimicrobial against Klebsiella spp. Concerning bacterial-antibiotic resistance ≥75% and excluding Streptococcus spp, amoxicillin, ampicillin/cloxacillin, erythromycin, clindamycin, cloxacillin, and metronidazole were completely non-functional against all bacteria. Azithromycin, norfloxacin, oxacillin, cefixime, nalidixic acid, and ceftazidime showed relatively weak activity against gram-positive bacteria in addition to cephalexin, ceftriaxone, and cloxacillin for Streptococcus spp. Ampicillin, augmentin, penicillin, and cephalexin were comparatively non-functional against gram-negative pathogens in addition to vancomycin, rifampicin, cephalothin, oxacillin, and trimethoprim for Klebsiella spp. All remaining antibiotics produced an activity ranging between ≥25% to ≤75% of examined cases. The results of this work may help clinicians to accurate their antibiotic-bacterial infection empirical treatment. Conclusion: All subjected bacteria exhibited a strong resistance to a broad spectrum of antibiotics. Therefore, except for imipenem, meropenem, or amikacin, an antibiotic sensitivity test should be conducted prior to prescribing any antibiotic.

Pediatric urinary tract infections: The latest trends and treatment breakthroughs from Fattouma Bourguiba Hospital

Pediatric urinary tract infections: The latest trends and treatment breakthroughs from Fattouma Bourguiba Hospital

Examination of fecal electrolyte on pediatric patient with intestinal stoma

Intestinal stomas are increasingly performed in pediatric patients to manage various gastrointestinal conditions, such as congenital malformation of intestinal, necrotizing enterocolitis and intestinal obstruction, which are frequently occured in developing countries with Low-Middle Income Country (LMIC). However, the presence of a stoma has possibility of morbidity such as can significantly affect the body’s fluid and electrolyte balance, particularly in infant and under five years old children. This risk is increased due to the immature renal system in pediatric patients, increased loss of fluids and electrolytes through stoma output, especially small intestinal stoma. In addition to being a challenge in the management of infants and children with stomas and intestinal resections, electrolyte imbalances are one of the factors contributing to morbidity and mortality in these group. Early detection of abnormalities can guide timely interventions such as fluid replacement therapy and dietary modifications, prevent complications like dehydration, metabolic acidosis or electrolyte disturbances. Measuring fecal electrolyte provide valuable insights into the patient’s hydration status and potential electrolyte imbalances. Since the fecal sample measuring is the simplest, harmless and noninvasive than the other electrolyte tests, so it can be considered for pediatric patients.

Lower urinary tract symptoms in men after surgery for benign prostatic hyperplasia

BACKGROUND: The development of medical technologies has resulted into a significant increase in the number of patients undergoing minimally invasive surgeries for benign prostatic hyperplasia. However, 29.9–41% of patients after surgical treatment are not satisfied with the surgical treatment results. AIM: To assess the rate and nature of lower urinary tract symptoms in men after surgical treatment of benign prostatic hyperplasia with various surgical techniques. MATERIALS AND METHODS: A telephone survey was carried out among 6117 men aged 59.57 ± 11.11 years (48–83 years), who underwent surgical treatment for benign prostatic hyperplasia with various surgical techniques and 5960 of these patients were surveyed using the IPSS questionnaire in the period 2012–2022. Moreover, to assess urination, patients kept their voiding diaries for 72 hours, a questionnaire to evaluate the symptoms of overactive bladder; ultrasound of the bladder, prostate and upper urinary tract, uroflowmetry, and, if indicated, a urodynamic study were performed. RESULTS: The study showed that 2413 (40.5%) patients were “absolutely satisfied” with the surgical treatment results, 829 (13.9%) patients were “partially satisfied” and noted improved urination, although its quality was assessed as unsatisfactory, and 2718 (45.6%) operated men were “absolutely dissatisfied”. Lower urinary tract symptoms persisted in 2655 (47.9%) men which underwent surgery, and in 3.3% of cases (87 patients) their severity increased in the postoperative period. CONCLUSIONS: The high rate of dissatisfaction with the surgical treatment results of patients with benign prostatic hyperplasia is caused by the persistence of irritative symptoms in the postoperative period and does not depend on the surgery performed. The origin of symptoms in most patients is not associated with benign prostatic hyperplasia, and the surgery indications are overestimated.

Urine microbiota and bladder cancer

Urine analysis data obtained using modern microbiological methods and 16S rRNA gene sequencing technology indicate that the urinary system has its own microbial ecosystem. Individual microbiota members can play a key role in the development of cancer. Certain bacterial taxa have been revealed in bladder urothelial carcinoma cells that can affect carcinogenesis, treatment response, and the development of relapses through various mechanisms. The studies are conducted to use not only vaccine strains, but also probiotic strains and oncolytic bacteria for the treatment and prevention of relapses.

Nucleotide and Amino Acid Analyses of Unique Infectious Bronchitis Virus (IBV) Variants from Canadian Poultry Flocks with Drop in Egg Production.

Infectious bronchitis (IB) is a highly infectious avian disease caused by the infectious bronchitis virus (IBV). The disease causes lesions mainly in the respiratory, reproductive, and renal systems and has a significant economic impact on the poultry industry worldwide. We discovered two unique IBV isolates (T-62: PP737794.1 and CL-61: PP783617.1) circulating in Canada and molecularly characterized them. The phylogenetic analysis revealed that the IBV isolates belong to genotype I and fall between lineages 25 and 7. Further analysis of the T-62 IBV isolate indicated that it is a potential recombinant of the Iowa state isolate (IA1162/2020-MW) and that the CL-61 strain of the IBV is also a recombinant IBV with the Connecticut (Conn) vaccine strain as its major parent. The S1 glycoprotein of the CL-61 and T-62 strains of the IBV had 85.7% and 73.2% amino acid (aa) identities respectively compared to the Conn vaccine strain. There were 67 and 129 aa substitutions among the S1 glycoprotein of the CL-61 and T-62 strains of the IBV compared to the Conn vaccine, respectively. Importantly, two and nineteen of these aa variations were in hypervariable regions 1 (HVR1) and HVR3. Finally, the two IBV isolates possessed a higher affinity for the sialic acid ligand compared to the DMV/1639 and Mass/SES IBV strains. Genetic recombination in the IBV results in the continual emergence of new variants, posing challenges for the poultry industry. As indicated by our analyses, live attenuated vaccine strains play a role in the genetic recombination of the IBV, resulting in the emergence of variants.

Molecular detection and the frequency of a pore-forming toxin in Enterococcus faecalis isolated from urinary tract infections

Molecular detection and the frequency of a pore-forming toxin in Enterococcus faecalis isolated from urinary tract infections

Combined laparoscopic nephroureterectomy with transurethral approach to the ureter in renal tuberculosis treatment

BACKGROUND: Tuberculosis of the genitourinary system is a common cause of organ removal surgeries. Despite the improvement of medical technologies, kidney and urinary tract surgeries for urogenital tuberculosis are traditionally performed using the open method. AIM: To assess the findings of laparoscopic and open combined nephroureterectomy with transurethral resection of the distal ureter in patients with renal tuberculosis. MATERIALS AND METHODS: The findings of 61 nephroureterectomies with transurethral resection of the distal ureter performed for destructive renal tuberculosis were analyzed. Open nephroureterectomy was performed in 31 patients, and laparoscopic approach was used in 30 patients. Patients in both groups were comparable by gender and age. RESULTS: The surgery duration, volume of intraoperative blood loss, rate and severity of postoperative complications were lower in patients who had laparoscopic interventions. When examined 1 month after surgery, patients in both groups showed the improvement of clinical parameters. The following changes were reported: a significant decrease in the nighttime urination rate, a decrease in IPSS scores, and an increase in the functional bladder capacity without significant differences depending on the surgical approach. After the surgery, a significant improvement in the quality of patients’ life was observed. In patients who had laparoscopic surgery, improvements were detected in all the SF-36 questionnaire domains. However, in patients after open surgery with a positive effect on most of assessed parameters no significant improvement of parameters in section “General Physical Health” was found. CONCLUSIONS: Irrespective of the selected approach, combined nephroureterectomy with transurethral resection of the distal ureter is an effective method of surgical treatment of patients with destructive renal tuberculosis. Moreover, the laparoscopic technique has shown a number of significant advantages over open surgery.

Surgical treatment of hypospadias with lichen sclerosus: Long‐term outcomes from a single center

AbstractBackgroundHypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.ObjectivesTo report surgical strategies and outcomes for primary and redo hypospadias patients with LS.Materials and methodsWe conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.ResultsFor primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).ConclusionsFor primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively.

Glomus tumors in the urinary tract: a rare case and literature review

Background: The Glomus tumor is a rare mesenchymal tumor that predominantly affects the subcutaneous skin of the distal extremities. Solid organs are rarely affected, and the urinary tract has been the reason for isolated reports. This paper reviews the occurrence of glomus tumors in the entire urinary tract. Case Report: We report a case of a 56-year-old female, asymptomatic, with a 5.5 cm renal glomus tumor, and review the literature about the urinary tract involvement by this rare neoplasia. Conclusion: Glomus tumor mostly behaves as a benign lesion that rarely affects solid organs, being the kidney, the most affected organ in the urinary tract. It should be considered in the differential diagnosis of another renal cell tumor, especially those that are eosinophilic.

Higher dietary insulin index is directly associated with the odd of kidney stones.

Kidney stones or Nephrolithiasis are the most common health condition associated with the urinary system. Dietary factors stand as important factors in the occurrence and development of kidney stones. This study aimed to examine the potential link between dietary insulin index (DII) and dietary insulin load (DIL) with prevalence of kidney stones. This cross-sectional study was conducted among adults aged 30 to 75 years in the Shahedieh district of Yazd, Iran, over the period of 2015-2016. DII and DIL were calculated using a validated semi-quantitative food-frequency questionnaire and mathematical formula. Diagnosis of kidney stones is made on the basis of information obtained from self-reported questionnaire (Yes/ No). To explore the association between DII and DIL with the odds of kidney stones, logistic regression was employed in crude and adjusted models. A total of 4,829 participants were included in this study. Individuals in the last quartile of DIL had 214% higher odds of kidney stones in the crude model (OR: 2.14, 95% CI: 1.62-2.83; P-trend < 0.001); this association was remained significant after adjustments for confounding variables (OR: 1.44, 95% CI: 1.04-1.97; P-trend: 0.019). There was a direct significant relationship between DII and odds of kidney stones among third and forth quartiles of DII (OR: 1.52, 95% CI: 1.16-1.98, P-trend = 0.002); but this association disappeared for adjusted models. Higher DII and DIL were associated with an increased odd of renal stones. Large longitudinal study is required to clarify these associations.

The Long-Term Functional and Oncologic Outcomes of Kidney-Sparing Surgery in Upper Tract Urothelial Carcinoma.

This study investigated the utilization of kidney-sparing surgery (KSS) as an alternative option to radical nephroureterectomy (RNU) in managing upper urinary tract urothelial carcinoma (UTUC) patients. Our study aimed to compare the functional outcomes and oncological outcomes between KSS and RNU. We retrospectively analyzed 252 patients with UTUC without clinical node positivity or metastasis who had been treated with either RNU or KSS. We collected information on each patient, including clinicopathological factors, renal function variations, and oncological outcomes. Hemodialysis-free survival (HDFS), stage 4 chronic kidney disease (CKD4) progression-free survival (PFS), recurrence-free survival (RFS), and overall survival (OS) were assessed using inverse probability of treatment weighting (IPTW)-weighted Kaplan-Meier analysis. The hazard ratio for oncological and functional outcomes of KSS was analyzed using the Cox proportional hazards model. The OS at 8 years was 77.06% (RNU) and 70.59% (KSS) and did not significantly differ between the two groups (p=0.691), although the KSS group experienced a higher recurrence rate. Functional outcomes indicated no significant difference in postoperative renal function at 1year; however, KSS was associated with better preservation of renal function (23.44% vs. 28.23%), albeit not statistically significant (p=0.055). Kaplan-Meier analysis revealed no significant disparities in CKD4 PFS between the KSS and RNU groups involved in the study (p=0.089), although the KSS group displayed poorer HDFS than the RNU group (p=0.001). KSS had no compromising survival outcomes when compared with RNU, not only in low-risk patients but also in high-risk patients with a normal contralateral kidney. The efficacy of renal function preservation was presented in this study, however the results were below our expectations.

Effect of an Add-On Multi-Strain Probiotic Formulation in the Prevention of Recurrent Urinary Tract Infections: A Double-Blind Randomized Placebo-Controlled Trial

Urinary tract infections (UTIs) present a significant health challenge for women globally, particularly due to high recurrence rates. This randomized, double-blinded, placebo-controlled study conducted at AIIMS Bhubaneswar, India, evaluated the effectiveness of a multi-strain lactobacilli probiotic formulation as an adjunct to standard antibiotic therapy in preventing recurrent UTIs. Fifty-one adult women (18–50 years) with recurrent UTIs received either the probiotic or a placebo for 24 weeks. The primary outcome was UTI recurrence, while secondary outcomes included the number of UTI episodes and changes in urinary nerve growth factor (NGF) and serum macrophage colony-stimulating factor (M-CSF) levels. The results showed a significant reduction in UTI recurrence in the probiotic group, with 75% remaining recurrence-free, compared to 33% in the placebo group (p = 0.007). The relative risk for recurrence absence was 2.67 (95% CI: 1.19–5.99). Although the mean number of UTI episodes decreased in the probiotic group, the difference was not statistically significant (p = 0.379). The urinary NGF and serum M-CSF levels significantly decreased from baseline in both groups, but there were no significant differences between them. This study suggests probiotics may be a valuable adjunct therapy for preventing recurrent UTIs.

Antibacterial Mechanisms and Clinical Impact of Sitafloxacin.

Sitafloxacin is a 4th generation fluoroquinolone antibiotic with broad activity against a wide range of Gram-negative and Gram-positive bacteria. It is approved in Japan and used to treat pneumonia and urinary tract infections (UTIs) as well as other upper and lower respiratory infections, genitourinary infections, oral infections and otitis media. Compared to other fluoroquinolones, sitafloxacin displays a low minimal inhibitory concentration (MIC) for many bacterial species but also activity against anaerobes, intracellular bacteria, and persisters. Furthermore, it has also shown strong activity against biofilms of P. aeruginosa and S. aureus in vitro, which was recently validated in vivo with murine models of S. aureus implant-associated bone infection. Although limited in scale at present, the published literature supports the further evaluation of sitafloxacin in implant-related infections and other biofilm-related infections. The aim of this review is to summarize the chemical-positioning-based mechanisms, activity, resistance profile, and future clinical potential of sitafloxacin.

Clinical Profile Of Urinary Tract Infection In Neonates With Suspected Sepsis: Efficacy Of Dipstick Testing As A Diagnostic Tool

Clinical Profile Of Urinary Tract Infection In Neonates With Suspected Sepsis: Efficacy Of Dipstick Testing As A Diagnostic Tool

Investigation of Antibiotics Susceptibility and Resistance Pattern of ESBL and CRE Producing Escherichia coli and Klebsiella pneumonia Isolates from Northern Region of Saudi Arabia

The presence of ESBLs and CRE in E. coli and Klebsiella pneumoniae poses a significant challenge in healthcare and community settings. These enzymes can confer resistance to multiple antibiotics, limiting treatment options for infections caused by these strains. This resistance complicates infection management, leading to prolonged illness, increased healthcare costs, and higher mortality. This cross-sectional study, conducted from 2021 to 2022 at three hospitals in the northern border region of Saudi Arabia, involved collecting 541 samples from various wards and units. Samples were inoculated on blood-agar and MacConkey’s media, incubated overnight at 37°C, and analyzed for growth. Antibiotic susceptibility was tested using the “MicroScan WalkAway-96 SI-automated system. A total of 541 positive cases were collected from three major cities in the northern border territory of Saudi Arabia. Observations show that E. coli (18.66%, n = 101) was the most prominent pathogen, compared to Klebsiella pneumoniae (9.9%, n = 54). Females were more prone to ESBL-producing E. coli infections, with 67% having a urinary tract infection, whereas male patients were more predisposed to respiratory K. pneumoniae infections (54% compared to females at 46%). Out of 155 samples, 49.01% were ESBL-producing E. coli, and 20.38% were ESBL+CRE. Furthermore, 15.68% of K. pneumoniae were ESBL producers. E. coli showed resistance to 92% of ampicillin, 90% of oxacillin, 79% of ceftazidime, 76% of cefepime, 57% of aztreonam, and 53% of cephalothin, while amikacin (85%), imipenem, and meropenem were effective. Klebsiella pneumoniae showed 74% resistance to ampicillin, 67% to ceftazidime, 63% to co-trimoxazole, 57% to amoxicillin-clavulanate, and 42% to aztreonam. The sensitive antibiotics were imipenem (46%), aztreonam (42%), and amikacin (44%). The results are both intriguing and alarming. It is crucial to address the spread of ESBL and CRE-producing organisms.