Urinary Pathogens Research Articles

Effect of different DMARD use on the frequency of urinary infection in patients with rheumatoid arthritis

Aims: It is known that the susceptibility to infection in general is increased in Rheumatoid Arthritis (RA) patients, but there is not enough information about whether urinary tract infections in particular differ according to different disease-modifying antirheumatic drugs (DMARDs) groups. The aim of this study was to compare the frequency of urinary infection attacks and pathogens in urine cultures of patients with RA treated with different groups of DMARDs. Methods: In this retrospective study, 76 patients using biologic DMARDs (bDMARDs) and 74 patients using conventional synthetic DMARDs (csDMARDs) among patients followed with a diagnosis of RA for at least 5 years who came for regular follow-ups at our department’s rheumatic diseases outpatient clinic were included. Patients with known immunodeficiency conditions, use of prednisolone (>7.5 mg), chronic renal failure, and renal pathologies were excluded from the study. The evaluation and follow-up records of the included patients between 01.01.2019 and 31.12.2022 were examined. Patients age, sex, medications, comorbidities, urine biochemistry, and urine culture results were recorded. Patients with pyuria detected by urine biochemistry were considered to have a urinary infection. Results: The mean age of patients in the csDMARD group was 61.39±11.41 (37-87) and the mean age of patients in the bDMARD group was 58.68±11.42 (33-89) (p=0.149). The number of urinary infection attacks during the follow-up period was similar in both the groups (p =0.090). The positive culture rate was 23.21% in the bDMARD group and 7.5% in the csDMARD group (p = 0.072). Escherichia coli was detected in 81.8% and Pseudomonas aeruginosa was detected in 18.2% of the positive cultures in the bDMARD group. The pathogen in all positive cultures of the csDMARD group was Escherichia coli. Conclusion: Although urinary infection and positive culture rates were higher in patients receiving bDMARDs, no statistically significant difference was observed between the groups.

A rapid colorimetric sensing methodology for urinary tract bacterial pathogens as a point-of-care approach using natural anthocyanin loaded nanosilver

Various commercial diagnostic kits have been used to detect uropathogens. However, non-intensive, sensitive, and instantaneous detection of bacteria in urine is still at its infancy. Herein, a facile attempt was carried out to detect the most common uropathogens using anthocyanin-loaded silver nanoparticles as the indicator. The significance of the current research was to apply the crucial sensing ability of eggplant peel anthocyanin to detect each pathogen by exhibiting discrete colors, based on pH of the urine sample. The novelty of this study was the ability of a single indicator compound to distinctively differentiate multiple uropathogens, as monocultures or consortia, with accurate chromacity, simultaneously and instantaneously. Anthocyanin (AC) from eggplant (Solanum melongena) peels acted as a pH responsive sensor in the prepared indicator solution. The solution was used to sense three each of Gram-positive and Gram-negative uropathogens, as both monoculture and consortium. AC was loaded onto silver nanoparticles (AgNP) to stabilize the pigment. An evident color change due to the function of AC was considered as the end-point of detection. The optimized conditions for the study were obtained as: 50 μL indicator solution, 105CFU.mL−1 inoculum, and instantaneous sensing time. Deprotonation and protonation of AC due to ammonia and acids, evolved from the microbes, subsequently varied the pH level in the medium. These resulted in the generation of colors as hues of yellow, orange, green and blue and semi-quantitatively represented using average RGB values and delta E analysis obtained after the indicator solution was added to 24 h bacterial growth. In conclusion, the proposed solution can be a potential alternative to the conventional diagnostic tools as a specific, sensitive, rapid, precise and affordable indicator for point-of-care diagnosis of urinary tract infection.

Evaluation of host factors leading to the progression of urinary tract infections to urosepsis: a retrospective analysis from a tertiary care centre in Southern India

Context: Urinary tract infections (UTIs) are one of the recurrently occurring disease caused by bacteria that poses a major public health concern globally. Among the well studied host factors that predispose to urosepsis are the anatomical risk factors of the urinary tract including stones, tumours and interventions involving the urogenital tract such as an indwelling catheter or transrectal prostate biopsy. Aims: To evaluate the host factors leading to the progression of UTI to urosepsis. Settings and design: Clinical and laboratory data available from patient records as per the inclusion criteria were analysed retrospectively by using a detailed proforma. Methods and materials: Patient records were screened using the ICD code provided from the Medical Records department. Data of patients with clinically confirmed UTI were retrieved and included in the study. Statistical analysis used: Patient data was analysed using SPSS software version 20. Categorical and continuous data were summarized as percentages and means ± SD or median (P25, P75) respectively. Univariate analysis was performed using the chi-square test or Fisher's exact test for categorical variables. Results: A total of 94 patient records were included in the study. Demographic data showed that majority (53.19%) of the patients (n = 94) were female individuals. The results of univariate analysis showed that gender, frequent UTI, diabetes mellitus, presence of an indwelling urinary catheter and hospitalization more than 6 months were significantly associated with urosepsis. In addition, results of multivariate analysis identified the independent risk factors for urosepsis associated with urinary tract pathogens. Conclusion: This study showed that there is significant association between risk factors that determine the outcome of UTI and its progression to urosepsis.

Priestia flexa as a Novel Urinary Tract Pathogen in Daloa, Côte d'Ivoire: Insights From Genomic Sequencing.

Bacterial strains coded 21LM367, 21LM07, and 21LM1136 were isolated from the urine of patients with urinary tract infections (UTIs) at the Centre Hospitalier Régional de Daloa in Côte d'Ivoire. Based on average nucleotide identity (ANI) analysis, DNA-DNA digital hybridisation (dDDH), and other comparative genomic methods, strains 21LM07, 21LM367, and 21LM1136 were determined to be Priestia flexa. The size of the assembled complete genomes ranged from 8,624,538 to 4,007,501 bp. The average GC content was 37.76%, 46.33%, and 43.03% for strains 21LM07, 21LM367, and 21LM1136, respectively. The total number of coding regions (CDS) in each genome was 4172, 8497, and 6795, respectively, for strains 21LM07, 21LM367, and 21LM1136. Genomic prediction analysis revealed that a total of 4241, 8583, and 6881 genes were annotated in the 21LM07, 21LM367, and 21LM1136 genomes, respectively. No virulence or resistance genes were predicted in the genomes of strains 21LM07 and 21LM1136. On the other hand, two genes conferring resistance to beta-lactam and tetracyclines as well as nine virulence genes were predicted in the genome of 21LM367. In addition, 438, 350, and 153 mobile genetic elements (MGEs) were predicted in the genomes of strains 21LM367, 21LM1136, and 21LM07, respectively. Strain 21LM07 was characterised by the absence of plasmids in its genome. Two plasmids were predicted in the genomes of isolates 21LM367 and 21LM1136; however, rep7a and IncI2 were predicted to contain the tet(K) resistance gene. No typical multilocus sequences could be characterised in the genomes of the different strains.

Bacteriological Profile and Antibiogram of Urinary Tract Infections at a Tertiary Care Hospital in Kerala, India: A Retrospective Study

Introduction: Urinary Tract Infections (UTIs) are caused by microbial invasion of the urinary tract, extending from the renal cortex of the kidney to the urethral meatus. Over the past years, resistance levels to the traditional drugs used for the treatment of UTIs have been gradually increasing. Therefore, a therapy based on the individual culture report and antibiotic sensitivity test is highly encouraged. Aim: To determine the age-wise and sex-wise prevalence of UTI, as well as to determine the bacteriological profile and antimicrobial sensitivity pattern of isolated uropathogens. Materials and Methods: This retrospective record-based study was conducted in the Department of Microbiology at Travancore Medical College in Kollam, Kerala, India. Samples were collected from patients with clinically suspected UTI attending the Outpatient Department (OPD) and Inpatient Department (IPD) of Travancore Medical College, Kollam, Kerela, India over a period of six months from July 2022 to December 2022. Both male and female patients with clinically suspected UTI were included in the study. The clinical diagnostic criteria included dysuria, frequency, urgency, and fever. Data were retrieved from the culture register maintained in the Microbiology laboratory, LIS (ELLIDER), and the WHONET software system. Urine culture was performed using a semiquantative technique. A growth of >105 Colony Forming Units (CFU)/mL was considered indicative of an active UTI with significant bacteriuria. Organisms were identified using Gram stain, motility testing, and biochemical reactions following standard microbiological techniques. Antimicrobial sensitivity testing was conducted using the Kirby-Bauer Disc diffusion method. The data were entered into a Microsoft Excel worksheet, and the results were analysed using simple descriptive statistics involving percentages and proportions using Statistical Package for Social Sciences (SPSS) software version 16.0. Results: Of the total 2,794 samples, 319 (11.4%) samples yielded significant bacteriuria. Among the positive samples, 204 (64%) were from females and 115 (36%) were from males. UTIs were most commonly seen in the age group of 61-80 years. Escherichia coli (E.coli), with 148 isolates (46.4%), was the predominant organism, followed by Klebsiella pneumoniae with 72 isolates (22.6%). E. coli showed the highest susceptibility to meropenem, with 137 isolates (92.6%), and imipenem, with 136 isolates (91.9%), followed by cefoperazone/sulbactam with 129 isolates (87.2%), and piperacillin/tazobactam with 128 isolates (86.5%). Klebsiella pneumoniae was most susceptible to imipenem, with 42 isolates (60%), followed by meropenem, with 29 isolates (41.4%). Most non fermenters were highly susceptible to carbapenems, cefoperazone/sulbactam, and piperacillin/tazobactam. Among the gram-positive organisms, Enterococcus spp. was the most frequently isolated, showing 100% sensitivity to vancomycin and linezolid. Conclusion: In this study, UTI was found to be more prevalent among elderly females. Gram-negative organisms were the most commonly isolated pathogens in UTI, with E. coli being the most frequent agent. Urinary pathogens exhibited resistance to commonly used antibiotics such as ampicillin, cephalosporins, quinolones, and cotrimoxazole. Based on this study, it can be concluded that the resistance to commonly used antibiotics is very high. Due to the changing trends in the sensitivity patterns of various antibiotics, it is important to understand the antibiogram of common isolates in a specific area or hospital to ensure better empirical treatment.

Antibacterial Activities of Secondary Metabolites Derived from Streptomyces sp. VITGV38 (MCC4869) against Selected Uropathogens

Streptomyces sp. VITGV38 (MCC8469) was obtained from the VIT University Microbiology Laboratory where it was isolated from tomato plants. This strain was mass-cultured for 15 days and its extracellular metabolites were extracted in ethyl acetate using a liquid–liquid extraction method. The antibacterial test was performed on the ethyl acetate crude extract against selected urinary tract pathogens, Proteus mirabilis (MTCC-442), Enterococcus faecalis (MTCC-439), Klebsiella pneumoniae (MTCC-109), and Escherichia coli (MTCC-1687), The extract developed a clear inhibition zone that measured between 17–21 mm. The minimum inhibition concentration was observed from a concentration of 25 μg/ml against all selected uropathogens. GC-MS analysis revealed 35 diverse compounds in the ethyl acetate crude extract, which includes 1,2 benzenedicarboxylic acid bis(2methylpropyl) ester, dibutyl phthalate, bis (2-ethylhexyl) phthalate, didodecyl phthalate, octadecanoic acid dodecyl ester, and dodecane. These six compounds are the major antimicrobial compounds present in the ethyl acetate extract. VITGV38 showed greyish aerial mycelium. Scanning electron microscopy revealed elliptical spores with a chain-like smooth orientation.

Use of Common Herbs to Control Microbial Aerosols in Toilet Rooms

Four distinct plant species were used in an investigation into the capacity of plant active volatile essence to eradicate microorganisms in the atmosphere (bioaerosols) in restrooms: Allium sativum (garlic), Allium cepa (onion), Zingiber officinalis (ginger), and Ocimum gratissimum (scent leaf). The study was conducted in the student restrooms for microbiology at Rivers State University Nkpolu Oroworukwu in Port Harcourt. Sedimentation method of aerosol sampling was used to collect the air samples. Artificial culture media were exposed to air at different times, including nutrient agar for total heterotrophic bacteria, Mac Conkey agar for enteric bacteria, sadour and dextrose agar for aerobic fungi, thiosulfate citrate bile salt sucrose agar for vibrio, Cystine lactose electrolyte deficient agar for urinary pathogens, and mannitol salt agar for staphylococcus.
 Samples was taken from the toilet without any mashed plant and served as a control. The THB isolates identified were Bacillus spp, Pseudomonas sp, Staphylococcus sp, Lactobacillus sp, Enterococcus sp, Corynobacterium sp, Escherichia coli, Klebsiella pneumonia. While the fungi isolated were Aspergillus niger, pennicillum sp, Rhizopus sp, Saccharomyces sp, Mucor Sp, Candida sp, Asperillus flavus, Fusarium sp. It can be deduced that these medicinal herbs has the ability in reducing microbial aerosol using ginger, onion, scent leaf, garlic also by combination of the herbs which are Onion & garlic, Onion & garlic, Onion & ginger, Garlic & scent leaf, Garlic & ginger, Scent leaf & ginger, Onion, garlic & scent leaf, Onion, garlic & ginger, Garlic, Scent leaf & ginger, Onion, garlic, scent leaf & ginger. Specifically the microbial aerosols in this investigation including bacteria and fungi were Bacillus species, Pseudomonas species, Staphylococcus species, Lactobacillus species, Enterococcus species, Corynobacterium, Escherichia coli, Klebsiella pneumonia. Aspergillus niger, pennicillum species, Rhizopus species, Saccharomyces species, Mucors species, Candida species, Asperillus flavus, Fusarium species. This work proved that microbial load can be reduced using natural means (plant extract).

2821. A Comparison of Empirical Therapy with Cefazolin Versus Ceftriaxone for the Treatment of Complicated Urinary Tract Infections in a Tertiary Care VA Medical Center

Abstract Background Limited data exist regarding the utilization of a narrow-spectrum agent such as cefazolin for the treatment of complicated urinary tract infections (cUTIs). The objective of this study was to evaluate cefazolin compared with ceftriaxone for the empirical treatment of cUTIs in an inpatient setting. Methods We conducted a single center, retrospective cohort study of Veteran patients who received ≥24 hours of cefazolin or ceftriaxone for the empirical treatment of cUTIs between November 1, 2019 and September, 30 2022. The primary outcome was clinical success, defined as resolution of signs and symptoms of infection without re-initiation of antibiotics during hospitalization or relapse, at 30 days after cUTI diagnosis. Secondary outcomes included hospital length of stay and Clostridioides difficile infection (CDI) within 30 days of the end of antibiotic therapy. A multivariate logistic regression analysis was also conducted to identify independent factors associated with 30-day clinical success. Results We identified 118 patients (median age, 72 years; 97% men) with cUTI treated with cefazolin (n = 57) or ceftriaxone (n = 61) who met study criteria. Both study groups had similar demographics, although patients treated with ceftriaxone more frequently had subjective fever on admission or nephrolithiasis while cefazolin-treated patients had more urinary catheters or receipt of another antibiotic prior to study drug. Clinical success was achieved in 51 (90%) and 53 (87%) in the cefazolin and ceftriaxone groups, respectively (P = 0.66). Multivariate analysis identified patients with urinary catheters as an independent predictor of decreased clinical success, with an odds ratio at 30 days of 0.21 (95% CI, 0.06-0.75). Patients treated with cefazolin had a significantly longer length of hospital stay (median 0.4 days longer) compared with ceftriaxone-treated patients (P = 0.02). There were no patients in the cefazolin arm and 4 (7%) patients in the ceftriaxone arm who had CDI within 30 days (P = 0.12). Conclusion Cefazolin was similar to ceftriaxone for the treatment of cUTI based on the outcome of clinical success. Local susceptibility patterns to urinary pathogens should guide empiric treatment. Disclosures Christopher R. Frei, PharmD, FCCP, BCPS, AstraZeneca: Grant/Research Support

Bacteriology and clinical outcomes of urine mixed bacterial growth in pregnancy.

The objective was to analyse the risk of significant bacteriuria in repeat urine cultures from pregnant women, following initial mixed bacterial results. This retrospective study examined maternal characteristics and clinical features of women who repeated urine cultures due to previous mixed cultures results. Of 262 women included, 80 (30.5%) had negative cultures and 125 (47.7%) had mixed bacterial growth in their repeat cultures. Positive results (≥104 CFU/ml of a urinary pathogen) were obtained for 57 women (21.8% [95% CI 17.1-27.0]). For 37 (14.1%), the repeat specimen grew 104-105 CFU/ml of microorganisms; whereas for 20 women (7.6% [95% CI 4.9-11.3]), it grew ≥105 CFU/ml. Among women with positive (>104 CFU/ml) compared with those with negative or mixed growth, rates of urinary symptoms were higher (38.6% vs 23.4%, p=0.028), abnormal dipstick results (49.1% vs 21.0%, p<0.001) and hydronephrosis, as demonstrated by renal ultrasound (12.3% vs 2.0, p=0.003). In a multivariate logistic regression analysis, hydronephrosis was associated with the occurrence of a positive repeat culture (aOR = 10.65, 95% CI 2.07-54.90). The sensitivity and specificity for predicting a repeat urine culture with ≥105 CFU/ml were 12.9% and 94.3% respectively, for urinary symptoms; and 19.7% and 97.4% respectively, for abnormal dipstick results. Mixed bacterial growth might represent a true urinary tract infection in a considerable proportion of women who are symptomatic and have an abnormal dipstick urinalysis.

Antimicrobial and antibiofilm activities of chromone derivatives against uropathogenic Escherichia coli

Uropathogenic Escherichia coli (UPEC) is a urinary tract pathogen responsible for most nosocomial urinary tract infections and can cause severe conditions like acute cystitis of the bladder or pyelonephritis. UPEC harbors a host of virulence factors like curli, hemolysin, siderophore, and motility factors and can form biofilm-like communities and quiescent reservoirs that aid its survival. This study was performed to investigate the antibiofilm, antimicrobial, and antivirulence potentials of three chromone derivatives, namely, 6-bromo 3-formylchromone, 6-chloro 3-formylchromone, and 3-formyl 6-isopropylchromone. These chromones had MICs against UPEC of 20, 20, and 50 µg/ml, respectively, inhibited biofilm formation by 72–96% at 20 µg/ml, and inhibited UPEC-associated virulence factors, that is, hemolysis, motility, curli, siderophore production, indole production, quiescent colony formation, and cell surface hydrophobicity. Gene expression analysis indicated these three derivatives downregulated virulence genes associated with toxins, biofilm production, and stress regulation and suggested they might target two-component UvrY response regulator. 3D-QSAR analysis showed that substitutions at the third and sixth positions of the chromone scaffold favor antimicrobial activity against UPEC. Furthermore, ADME profiles and C. elegans cytotoxicity assays indicated that these chromone derivatives are potent, safe drug candidates.

Application of Precision Medicine Concepts in Ambulatory Antibiotic Management of Acute Pyelonephritis.

Acute pyelonephritis (APN) is a relatively common community-acquired infection, particularly in women. The early appropriate antibiotic treatment of this potentially life-threatening infection is associated with improved outcomes. The international management guidelines for complicated urinary tract infections and APN recommend using oral antibiotics with <10% resistance among urinary pathogens. However, increasing antibiotic resistance rates among Escherichia coli and other Enterobacterales to fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMX), and beta-lactams has left patients without reliable oral antibiotic treatment options for APN. This narrative review proposes using precision medicine concepts to improve empirical antibiotic therapy for APN in ambulatory settings. Whereas resistance rates to a particular antibiotic class may exceed 10% at the population-based level, the predicted antibiotic resistance rates based on patient-specific risk factors fall under 10% in many patients with APN on the individual level. The utilization of clinical tools for the prediction of fluoroquinolones, TMP-SMX, and third-generation cephalosporin resistance improves the ambulatory antibiotic management of APN. It may also reduce the need to switch antibiotic therapy later based on the in vitro antibiotic susceptibility testing results of bacterial isolates in urinary cultures. This approach may mitigate the burden of increasing antibiotic resistance in the community by ensuring that the initial antibiotic prescribed has the highest likelihood of treating APN appropriately.

Antibacterial and Alteration of Drug Resistance Activities of Black Cumin Seed (Nigella Sativa) Extracts against Urinary Pathogens

Antibacterial and Alteration of Drug Resistance Activities of Black Cumin Seed (Nigella Sativa) Extracts against Urinary Pathogens

Comparative Effectiveness Randomized Clinical Trial Using Next-generation Microbial Sequencing to Direct Prophylactic Antibiotic Choice Before Urologic Stone Lithotripsy Using an Interprofessional Model

BackgroundNext-generation sequencing (NGS) methods for microbial profiling have increased sensitivity to detect urinary pathogens. ObjectiveTo determine whether NGS microbial profiling can be used to guide antibiotic prophylaxis and reduce infection compared with the standard of care. Design, setting, and participantsA prospective randomized controlled clinical trial of patients undergoing urologic stone interventions at an academic health center from December 2019 to January 2022 was conducted. Urine was collected at the preoperative visit for standard culture and intervention NGS diagnostics. Evaluable patients were culture negative, met 2-wk follow-up, and did not cancel surgery. Of 240 individuals (control = 121, intervention = 119), 83 control and 74 intervention patients were evaluable. InterventionMicrobial findings (paired quantitative polymerase chain reaction and NGS) were sent to an infectious disease pharmacist to recommend prophylactic antimicrobial regimen. Outcome measurements and statistical analysisThe primary outcome was postoperative urinary infection within the follow-up period (Fisher’s exact test). The primary outcome was analyzed by modified intent-to-treat (mITT) and per-protocol analyses. Secondary endpoints considered included positive culture concordance, antibiotic use, and adverse events. Additional post hoc analyses investigated factors contributing to infection (univariate logistic regression). Results and limitationsThe intervention significantly reduced postsurgical urinary infection risk by 7.1% (–0.73%, 15%) compared with the standard of care in the mITT analysis (1.4% vs 8.4%, p = 0.045) or by 8.5% (0.88%, 16%) compared with the per-protocol analysis (0% vs 8.5%, p = 0.032). NGS-guided treatment altered the distribution of antibiotics used (p = 0.025), and antibiotics poorly matched with NGS findings were associated with increased infection odds (odds ratio [OR] = 5.9, p = 0.046). Women were at greater odds to develop infection (OR = 10, p = 0.03) and possessed differentiated microbial profiles (p < 0.001). ConclusionsUrinary microbial NGS-guided antibiotic prophylaxis before endoscopic urologic stone lithotripsy improves antibiotic selection to reduce healthcare-associated urinary infections; however, treatment efficacy may be limited by the ability to adhere to the recommended protocol. Patient summaryWe investigated whether microbial DNA sequencing could improve the selection of antibiotics before kidney stone surgery in patients not known to have any bacteria in the urine on standard culture. We found that using microbe DNA to guide antibiotic choices decreased postoperative infection rate and may encourage individualized use of available antibiotics.

A-272 Challenges in Designing an Antibiotic Gene Resistance Panel for Clinical Use

Abstract Background We faced 3 major challenges in our journey of designing a custom panel for antibiotic resistance genes (ABR). Challenge 1# Fast, robust, and affordable antimicrobial resistance testing (ABR) In general, qPCR-based methods are efficient, reliable, and fast with high specificity and sensitivity, and with the test results available within 2–3 h. We offer urinary tract infection identification by qPCR and wanted to supplement this test with detection of antibiotic resistance genes. we narrowed our choice of method to be qPCR based, Applied Biosystems™ OpenArray™ technology on the Applied Biosystems™ QuantStudio™ 12K Flex Real-Time PCR System. Challenge2# Genes to be tested. Antibiotic resistance occurs via various mechanism. Based on the literature review, we included the following gene in our custom panel 1. Aminoglycosides: aac(6′)-Ib-cr6, aac(6′)-Ib-cr, aac(6′)-Ib-cr4 2. Tetracycline: tet(M), tet(B) 3. Sulfonamides: sul1, sul2 4. Macrolide-lincosamide-streptogramin B-ketolides-oxazolidinones: erm C, erm A, erm B 5. Quinolone/(fluoroquinolones): qnrS , qnrA, aac(6′)-Ib-cr6, aac(6′)-Ib-cr, aac(6′)-Ib-cr4 6. Glycopeptides: VanA, VanB 7. Beta-lactam Class A: SHV, KPC, CTX-M 8. Beta-lactam Class B: NDM, VIM, IMP 9. Beta-lactam Class C: CMY, DHA, FOX, KPC 10. Beta-lactam Class D: OXA1, OXA-23, OXA- 48, 11. Methicillin resistance: mecA. Results Validation of the ABR panel Accuracy: 50 isolates were ordered from CDC AR isolate bank and were used to test the accuracy. The accuracy was detected to be 98% concordant. Sensitivity: The assay was sensitive to detect all urinary pathogens upto 10^3 CFU/mL. Precision: the inter and intra reproducibility was shown to be 99% concordant Specific: when tested against the CDC controls, the assays were 100% specific Challenge 3# Genotype—Phenotype correlation and prevalence of antibiotic resistance genes in USA. We compared 100 consecutive clinical specimens (urine) for genotype -phenotype co-relation. Data from the current qPCR panel and Microscan instrument was compared. It was observed for the pathogens that were phenotypically resistant to certain antibiotics, the corresponding gene association was not found in (2–50%) of antibiotic groups. This can be explained due to the limited number of genes in each drug class. Resistance to some antibiotics such as nitrofurantoin drug (100% missed) and sulphonamide drug resistance (50% missed) is induced by point mutations, which are not captured in open array genotyping qPCR assay. To overcome this gap between genotype and phenotype correlation and to understand the prevalence of antibiotic resistance genes in USA, we initiated a new project. We aim to test for 300–400 clinical samples which known resistance phenotypes and check for antibiotic resistance gene in a new expanded panel. We were successful in designing the new panel to include 88 genes (vs 30 genes in the old panel). Conclusion The current assay was approved by the CLIA authorities for clinical testing. In general, qPCR-based methods are efficient, reliable, and fast with high specificity and sensitivity, and with the test results available within 2–3 h.

Evaluating the Bacteria Profile and Drug Susceptibility Patterns of Urinary Tract Infectious Pathogens in Pregnant Women in Abakaliki Metropolis, Nigeria

Patient’s demographic data were obtained from a well-structured questionnaire administered before sample collection. A total of two hundred (200) early morning mid-stream urine samples were collected from pregnant women attending Mile 4 hospital to determine the prevalence of UTIs among pregnant women. The collected samples were analysis using Standard Microbiology protocol for isolation and identification of uropathogens. Antibiogram studies of uropathogens were determined using the Kirby–Bauer disk diffusion method and the results were analyzed and were compared with the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints. Results of isolation and characterization revealed an overall occurrence rate of 68(34.0%) bacteria consisting of a high distribution of E. coli 27(13.5%) followed by S. aureus 22 (11.0%) and Klebsiella pneumoniae 19 (9.5%). Socio-demographic data of patients revealed that those aged 42-49 years had a high frequency of bacteria 7(70.0%) followed by those aged 34-41 years 50.0%, 18-25 years 31.1% while those aged 26-33 year had the least isolation rate of 26.3%. The occurrence of UTI was highly predominant among patients with no formal level of Education 24(64.9%) than those with formal level of education 17(26.9%). The result of antibiogram studies shows that the isolates exhibited a high percentage of resistance to colistin 100%, azetronam 100% clindamycin 100%, and tetracycline 77.3% but were 92.6%-100% susceptible to cefoxitin, imipenem and amikacin. However, with substantial evidence in this study, cefoxitin, imipenem, and amikacin as drugs of choice could be used for the treatment of UTI, and further studies should be conducted by using highly sensitive and specific techniques such as Polymerase Chain Reaction (PCR), which is the technique used to make numerous copies of a specific segment of the deoxyribonucleic acid quickly and accurately, including genotypic characterization of resistant determinant in bacteria causing UTI among pregnant patients in a larger sample size.

Intravesical injections of autologous platelet-rich plasma for the treatment of refractory interstitial cystitis.

The urothelium acts as a barrier for the urinary bladder that prevents the influx of urinary toxic substances, electrolytes, urea nitrogen, and pathogens into the circulation. Acute or chronic inflammation of the urinary bladder may impair the regenerative function of urothelial cells and thus urothelial cell differentiation. In an inflamed bladder wall, mature apical cells are defective, resulting in impaired barrier function and thus increased urothelial permeability. This is considered to be the potential mechanism of the symptom trigger in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Previous studies have revealed that increased bladder inflammation, impaired urothelial cell maturation, a defective umbrella cell barrier, and defective junction proteins are prominent in IC/BPS bladders. Platelet-rich plasma (PRP) contains many growth factors and cytokines that are essential proteins for modulating inflammation and promoting tissue regeneration and thus wound healing. As such, PRP has been used as a regenerative therapy in many medical fields. Our preliminary studies have demonstrated that multiple intravesical PRP injections could improve symptoms in 70% of IC/BPS patients. Repeated PRP treatments also improve junctional protein, increase cytoskeleton protein expression, and decrease urinary inflammatory proteins. These preliminary results suggest that PRP injections might reduce bladder inflammation and improve urothelial cell regeneration in IC/BPS patients. This article reviews recently published clinical and basic research on the treatment potential of PRP for IC/BPS patients.

Patterns of Drug Resistance and Bacterial Pathogen Distribution in Patients with Urinary Tract Infections in the Jiaxing Region from 2020 to 2022.

Urinary tract infections (UTIs) and the antibiotic resistance of pathogenic bacteria pose severe threats to public health in the current healthcare environment. The purpose of this study was to assess the frequency distribution of bacterial pathogens causing UTIs as well as the characteristics of antibiotic susceptibility and resistance. The retrospective study was conducted on 32,391 samples of midstream urine culture from January 1, 2020, to December 31, 2022, in Jiaxing. Bacteria were cultivated on blood agar and identified using MALDI-TOF, and their susceptibility to different antibiotics was assessed using the Kirby-Bauer disk diffusion method and drug sensitivity reaction cards. The SPSS 22 software was used for data analysis. Bivariate logistic regression was used to analyze the risk factors for multidrug resistance. The total number of positive growth samples was 5378 (16.6%), including 3206 females (59.6%) and 2172 males (40.4%). The four most common urinary pathogens were Escherichia coli (39.2%), Enterococcus faecalis (12.4%), Klebsiella pneumoniae (7.6%), and Enterococcus faecium (7.6%). As far as antibiotic resistance was concerned, Escherichia coli had a greater than 50% resistance rate to ampicillin (76.1%), ciprofloxacin (58.6%), and levofloxacin (51.2%). The multidrug resistance rate was high (41.8%). Low levels of resistance were seen to ertapenem (0.1%), imipenem (0.7%), meropenem (0.7%), piperacillin/tazobactam (0.7%), and nitrofurantoin (1.8%). Klebsiella pneumoniae was highly sensitive to ertapenem (100%). The resistance rates to nitrofurantoin, ceftriaxone, and ciprofloxacin were 37.4%, 37.1%, and 35.1%, respectively. Up to 41% of Escherichia coli strains and 26% of Klebsiella pneumoniae strains produced extended-spectrum lactamases (ESBL). Two species of enterococci were highly sensitive to tigecycline and linezolid (100%), and a small number of norvancomycin-resistant strains (0.2%/two strains) were found. Escherichia coli and Enterococcus faecium were the most common urinary pathogens in this study. The isolated pathogens showed different sensitivity patterns. Antibiotics should be selected reasonably according to the sensitivity mode of pathogenic bacteria to effectively treat and prevent urinary tract infections.

Surveillance of urine cultures and evaluation gram negative uropathogens;five year data from Erbil

Objective: Urinary tract infections (UTIs) are most common infectious disease and a public health problem that imposes a large economic burden. Determining the distribution and resistance profiles of uropathogens in a region is important for planning empirical treatments, preventing antimicrobial drug resistance and establishing rational antibiotic use policies. The aim of this study is to gather surveillance data of urine cultures and determine the prevalence of uropathogens in urine samples of patients referred to outpatient clinics in Erbil region and to evaluate the antimicrobial susceptibility of the gram negative uropathogens.&#x0D; &#x0D; Methods: All urine cultures result of patients referred to Erbil hospitals in the last 5 years (2015-2020) are retrospectively examined in this study. Microorganisms are identified by standard bacterial methods and their susceptibilities are assessed by VITEK 2 (bioMérieux, Marcy l’Etoile, France) automated system.&#x0D; &#x0D; Results: The results of urine culture of 3380 suspected UTI cases are examined and out of 3097 positive cultures observed, a total of 1961 (63.3%) isolates are gram-negative and 1136 (36.7%) are gram-positive pathogens.&#x0D; &#x0D; Conclusion: The most common urinary pathogen determined in this study is Escherichia coli. The highest resistances of gram-negative urinary pathogens are against the ampicillin, trimethoprim/sulfamethoxazole and ceftriaxone. It is thought that the data obtained from this study will be useful in the planning of empirical treatment of urinary tract infections and in the development of rational antibiotic use policies.

Bacterial Etiology of Urinary Tract Infection and Antibiogram Profile in Children Attending Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia.

Bacterial urinary tract infections are important public health problems in children. This study was conducted to identify the bacterial agents of urinary tract infections and antibiogram patterns in children. A hospital-based cross-sectional study including 220 children was carried out between November 15, 2021, and March 10, 2022. Simple random sampling was used to enroll participants. The sociodemographic and clinically pertinent information was gathered using a semi-structured questionnaire. Every participant in the study who was ≤15 years old gave clean-catch midstream urine. Urine samples were inoculated onto a cystine lactose electrolyte-deficient agar using a calibrated inoculating loop with a 0.001 ml capacity and then incubated aerobically for 24 hours at 37°C. Subculturing for significant bacteriuria was done on MacConkey and blood agar. Gram staining, biochemical assays, and colony characteristics were used for bacterial identification. The disc diffusion method developed by Kirby and Bauer was used for antimicrobial susceptibility testing. SPSS software version 25 was used for data entry and analysis. To find the risk factors, bivariate and multivariate logistic regression analyses were performed. An association was deemed statistically significant if the p value at the 95 percent confidence interval was less than 0.05. In this study, the majority (50.5%) of the study participants were males. The mean age of the study participants was 6 ± 0.91 years. It was found that 31.8% of children had urinary tract infections. The most prevalent urinary pathogens among the isolates were E. coli (27.1%) and S. aureus (18.6%). Approximately 56% of the participants were infected with multidrug-resistant pathogens. Additionally, compared to children who have never had a urinary tract infection, children with a history of infection had 1.04 (95 percent confidence interval (CI): 0.39, 2.75) times higher risk of infection. This study has shown an alarming increase in the prevalence of pediatric urinary tract infections which warrants further investigation into multidrug-resistant bacterial infection.

Clinical relevance of expanded quantitative urine culture in health and disease.

"Expanded quantitative urine culture (EQUC)" is an enhanced culture protocol for the detection of viable microbes in urine specimens. Using a large volume of urine and different sets of cultural conditions, EQUC is able to uncover a wide range of bacteria and fungi (yeasts) that were otherwise undetected by the standard urinary culture. In addition to common urinary pathogens, EQUC has been shown to detect emerging and new pathogens, and commensal microbiota. Although the usefulness of EQUC protocol in clinical set up has not yet been fully established, recent studies have demonstrated that EQUC can provide valuable information regarding symptom resolution, treatment responses and diagnosis of major urinary disorders including urinary tract infections, urinary incontinence and other lower urinary tract symptoms. EQUC may also help in evaluating the utility of beneficial microbiota as biotherapeutics. This narrative minireview describes the current research findings regarding the clinical utility of EQUC in characterizing the role of urinary microbiome and uropathogens in health and disease. The literature which are written in English, available on "PubMed" and contain any of the terms- "expanded quantitative urine culture", "enhanced quantitative urine culture" and "EQUC" in the abstracts were used as the source articles to prepare this minireview.