Urinary Tract Infection In Hospital Research Articles

Urinary tract infections with Burkholderia cepacia. A narrative review.

Burkholderia cepacia is an opportunistic Gram-negative bacillus that is found naturally in soil and water and usually causes respiratory infections in patients with cystic pulmonary fibrosis. Few cases of urinary tract infections with B. cepacia have been described in the literature, all of them clinical case presentations or case series. Therefore, we have compiled the data from the literature on this topic in a review to gain a better understanding of the etiopathogenesis, diagnosis and treatment methods of this disease. B. cepacia can lead to multidrug-resistant urinary tract infections in hospitals when surfaces and medical equipment are contaminated. The diagnosis is made after the onset of postoperative febrile syndrome or prolonged hospitalization in the intensive care unit. The evolution can be unfavorable, with the occurrence of sepsis and increased mortality.

Detection of some virulence factors of Pantoea species isolated from urinary tract infections in the Iraqi population

Pantoea is an opportunistic bacterium primarily involved in nosocomial infections, impacting newborns and immunocompromised patients. The study aimed to investigate the virulence factor of Pantoea in urinary tract infections in hospitals in Al-Nasiriyah City, Iraq. The outcome appeared that 22 isolates out of 100 urine samples had been confirmed as Pantoea species by VITEK- 2. RcsA and hrpA genes were detected using conventional Polymerase Chain Reactions (PCR) and specific primers. The distribution of rcsA and hrpA was 40.9% and 59.1% respectively. The Pantoea species were distributed according to age, gender, and ABO blood groups. The percentage was 72.3% for ages 40–70, and females recorded 54.5% more than males. Individuals with the A blood group had a higher percentage (50%) than other blood groups; there were two types of variations (Transversion and Transition) of the16S rRNA gene. It was determined through the sequence alignment, and the symmetry was 90% with the Italian isolate of Pantoea species LL92 (ID: KF202812.1). These variations in the Pantoea local Iraqi isolate were registered in NCBI (ID: OM971851).This bacterial genus recently descended from the species of Enterobacter sp.. The isolation of Pantoea sp.was from UTIs, while previously, in most studies, they were isolated from the surrounding environment.

1293. In vitro Activity of Ceftibuten in Combination with VNRX-5236 against Clinical Isolates of Enterobacterales from Urinary Tract Infections Collected in 2018-2020

BackgroundIncreasing resistance among agents commonly prescribed to treat urinary tract infections indicate that new oral agents are urgently needed. Ceftibuten in combination with VNRX-7145 is under development as an oral treatment for complicated urinary tract infections caused by serine β-lactamase-producing Enterobacterales, including isolates carrying ESBLs and carbapenemases. In vivo, VNRX-7145 (VNRX-5236 etzadroxil) is cleaved into to the active inhibitor, VNRX-5236. This study assessed the in vitro activity of ceftibuten/VNRX-5236 against 592 isolates of Enterobacterales from urinary tract infections (UTIs) from a 2018-2020 global culture collection.MethodsMICs of ceftibuten with VNRX-5236 fixed at 4 µg/mL and comparators were determined following CLSI M07-A11 guidelines against 592 Enterobacterales. Isolates were from community and hospital UTI infections collected from 133 sites in 31 countries in 2018-2020. Resistant phenotypes were based on 2021 CLSI breakpoints.ResultsA substantial percentage of isolates were non-susceptible to extended-spectrum β-lactams, levofloxacin (LVX), trimethoprim-sulfamethoxazole (SXT), and amoxicillin-clavulanate (AMC) (Table). The addition of VNRX-5236 reduced ceftibuten MIC90 values by ≥8-fold to ≥128-fold, depending on the resistant subset. Ceftibuten/VNRX-5236 had potent activity against all Enterobacterales, with MIC50/90 values of 0.06/0.25 µg/mL and 98.3% inhibited at ≤2 µg/mL. Ceftibuten/VNRX-5236 maintained activity against resistant subsets (MIC90 range, 0.5 to 2 µg/mL; 91.5% to 97.1% inhibited at ≤2 µg/mL), including serine carbapenemase-positive isolates (MIC90 0.5 µg/mL; 100% inhibited at ≤1 µg/mL). Ceftibuten/VNRX-5236 in vitro potency was similar to that of newer parenteral and investigational oral therapies.Results Table ConclusionCeftibuten/VNRX-5236 exhibited promising in vitro activity against recent Enterobacterales from UTIs, and may have potential as an oral treatment option for complicated urinary tract infections, including those caused by serine β-lactamase-expressing Enterobacterales (ESBL, KPC, OXA-48/OXA-48-like) for which there are currently few oral treatment options available.Disclosures Meredith Hackel, PhD MPH, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Mark G G. Wise, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor)

A Gyssens Evaluation On Antibiotics Usage On Inpatients With Urinary Tract Infection In Hospital X, Central Jakarta, on January 2017 – June 2019

Urinary tract infections are infections from the bladder to the renal parenchyma, and can affect all ages. Empirical therapy can reduce morbidity, but due to the use of antibiotics that are not appropriate will have an impact on resistance that will cause increase morbidity, mortality, and health costs. In the Southeast Asian region, high use of antibiotics were found almost more than 80% in various provinces in Indonesia. This study aims to assess the appropriatness use of antibiotics in hospitalized patients with UTIs in the District Hospital X in the period January 2017 - June 2019 using gyssens criteria. This is retrospective study. Research data sourced from medical records. Data was collected and assessed with Gyssens flow, then processed using Microsoft Excel. The results found 15 cases (46.88%) with the appropriate use (category 0), 3 cases (9.37%) incorrect interval (category IIB), 1 case (3.33%) incorrect dosage (category IIA ), 10 cases (31.25%) too short given (category IIIB), 3 cases (9.37%) too long given (category IIIA). Empirical therapy inpatients with diagnosis urinary tract infections atvDistrict Hospital X, 46.8% of antibiotics were used appropriately.

Improvement of Adequacy of Empirical Antimicrobial Therapy in Escherichia coli Bacteremia of Urinary Source in Catalonia (VINCat-PROA)

Background: The antibiotic use optimization program (PROA) in Catalonia (Spain) is part of the surveillance program for nosocomial infections in hospitals in Catalonia (VINCat). Despite the existence of guidelines for the treatment of urinary tract infections in hospitals, adherence to them is not guaranteed. Objective: Our objective was to evaluate the adequacy of empirical antimicrobial therapy to local guidelines in bacteremia caused by Escherichia coli of urinary source within the PROA-VINCat program during a 3-year period. The impact of a voluntary survey asking for evaluating local results and implementing correction measures was also analyzed. Methods: Multicentric prospective observational study including all episodes of E. coli bacteremia of urinary source between May 2017 and September 2019, in adult hospitalized patients in 45 Catalan hospitals. Adequacy of the empirical therapy to local guidelines was one of the prospectively recorded items. A survey evaluating local results of 2017–2018 and asking for possible correcting measures was sent to the participating centers at the end of 2018. Percentages of adequacy of empirical antimicrobial therapy in 2017, 2018, and 2019 were compared by means of χ2 test. Results: Overall, 3,804 episodes of bacteremia were recorded: 845 in 2017, 1,861 in 2018 and 1,098 until September 30, 2019. Globally, adequacy of empirical therapy to guidelines increased from 73.7% in 2017 to 78.2% in 2019 (P = .06). Interestingly, in the 24 hospitals that responded to the voluntary survey, the adequacy of empirical therapy increased significantly from 72.9% in 2017 to 79.9% in 2019 (P = .009). In hospitals that did not respond, adequacy remained the same over the years (76.7% in 2017, 75.1% in 2019; P = .90). Correction measures applied were: meeting with the antimicrobial stewardship team to evaluate the results (100%), review of local resistance rates (62%), review of local guidelines (58.3%), improving guidelines dissemination (75%), sessions for improving guidelines adherence (58%), and analysis of adherence to guidelines after education (65%). Conclusions: In the empirical treatment of E. coli bacteremia of urinary source, adequacy to local antimicrobial therapy guidelines improved from 2017 to 2019, but only in hospitals answering a voluntary survey regarding correcting measures for improving adequacy. Adherence to antimicrobial stewardship proposals improves indicators at local and regional level.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.

Gaps in communication between different staff groups and older adult patients foster unnecessary antibiotic prescribing for urinary tract infections in hospitals: a qualitative translation approach

BackgroundStudies have reported large scale overprescribing of antibiotics for urinary tract infection (UTI) in hospitalised older adults. Older adults often have asymptomatic bacteriuria, and clinicians have been found to diagnose UTIs inappropriately based on vague symptoms and positive urinalysis and microbiology. However, the joined perspectives of different staff groups and older adult patients on UTI diagnosis have not been investigated.MethodsThematic analysis of qualitative interviews with healthcare staff (n = 27) and older adult patients (n = 14) in two UK hospitals.ResultsInterviews featured a recurrent theme of discrepant understandings and gaps in communication or translation between different social groups in three key forms: First, between clinicians and older adult patients about symptom recognition. Second, between nurses and doctors about the use and reliability of point-of-care urinary dipsticks. Third, between nurses, patients, microbiologists and doctors about collection of urine specimens, contamination of the specimens and interpretation of mixed growth laboratory results. The three gaps in communication could all foster inappropriate diagnosis and antibiotic prescribing.ConclusionInterventions to improve diagnosis and prescribing for UTIs in older adults typically focus on educating clinicians. Drawing on the sociological concept of translation and interviews with staff and patients our findings suggest that inappropriate diagnosis and antibiotic prescribing in hospitals can be fuelled by gaps in communication or translation between different staff groups and older adult patients, using different languages and technologies or interpreting them differently. We suggest that interventions in this area may be improved by also addressing discrepant understandings and communication about symptoms, urinary dipsticks and the process of urinalysis.

Reducing catheter-associated urinary tract infections in hospitals: study protocol for a multi-site randomised controlled study

IntroductionDespite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. A number of measures can be taken to reduce the risk of CAUTI...

Study of Resistance to 82 Clinical Cases Enterobacteriaceae to Beta-lactam Antibiotics

<p class="1Body">Knowledge of antimicrobial resistance patterns in <em>E. coli</em>, the predominant pathogen associated with urinary tract infections (UTI) is important as a guide in selecting empirical antimicrobial therapy. To describe the antimicrobial susceptibility of <em>E. coli</em> associated with UTI in a major university hospital in Tehran (Iran), seventy-six clinical isolates of <em>E. coli</em> were studied for susceptibility to Beta-lactam antibiotics by the disc diffusion method and Minimal Inhibitory Concentrations determination. All isolates were resistant to ampicillin, amoxicillin and oxacillin. Resistance to the other tested antibiotics was shown to be 93.4% to cefradine, 76.3% to carbenicillin, 47.3% to cefazoline, 50% to cefalexin and 32.8% to cephalothin while 1.3% expressed resistance to cefoxitime, and 2.6% were resistant to ceftizoxime and ceftriaxone. Substrate hydrolysis by ultra violet spectroscopy showed that 87.4% harbored penicillinases, 9% produced cephlosporinases and 3.6% degraded both substrates. Clavulanic acid inhibited enzyme activity in 82.9%, of which 78.95% was penicillinases (group IIa) and 3.95% was cephalosporinases (group IIb) of the Bush classification system. These results indicate that <em>E. coli</em> can posses a variety of Beta-lactamases that are responsible for Beta-lactam resistance. Members of the family Enterobacteriaceae, particularly Escherichia coli is the most common causes of urinary tract infections in hospitals and societies. Beta-lactam antibiotics, particularly the third and fourth generation of cephalosporins are effective in treating these infections.</p>

Targeted monitoring and analysis of catheter associated urinary tract infection in patients with severe brain injury

Objective To monitor the catheter associated urinary tract infection in patients with severe brain injury and analyze the incidence and risk factors of urinary tract infection in hospital, so as to take preventive measures and reduce the incidence of urinary tract infection. Methods Based on the monitoring program of indwelling urinary catheter in patients with severe brain injury and combining the method of microbial monitoring and retrospective study of patients in hospital, a total of 204 catheterized patients with severe brain injury were selected and analyzed the catheter associated urinary tract infection. Results There were 12 patients with urinary tract infections, and a higher incidence of urinary tract infection in elderly, serious condition, long-term bed ridden patients and longer catheter indwelling time with severe brain injury. The incidence of urinary tract infection in patients with more invasive operations was 3.8‰. Fungus was the most common pathogenic bacteria. Conclusions Following indwelling catheter indications strictly, strengthening the aseptic management of catheter, shortening time of detaining urethral catheterization, and proper using of antibiotics are recommended as effective measures to lower the incidence of catheter associated urinary tract infection in patients with severe brain injury. Key words: Severe brain injury; Indwelling catheter; Targeted monitoring and analysis; Analysis

Spread of Enterococcal Surface Protein in Antibiotic Resistant Entero-coccus faecium and Enterococcus faecalis isolates from Urinary Tract Infections.

Enterococci rank among leading cause of nosocomial bacteremia and urinary tract infection in hospital and community acquired infections. Several traits that may contribute to enhanced virulence have been identified in Enterococci. Extracellular surface protein (Esp) is a virulence factor that contributes in biofilm formation and resistance to environmental stresses. In this study we aimed to determine occurrence of esp in E. faecium and E. faecalis isolates isolated from urinary tract infections and to investigate whether there is any correlation between presence of esp and antibiotic resistance. One hundred and sixty six isolates were collected from patients with UTI and after identification by biochemical and PCR, antibiotic resistances were examined. The presence of esp was investigated by primer-specific PCR. 43.3% of isolates identified as E. faecium and 56.7% as E. faecalis. The esp gene was found in 76.1% of E. faecium isolates and 77.9% of E. faecalis isolate. There were significant correlation between esp positive E. faecium and resistance to Vancomycin (p<0.01), also in E.faecalis we found correlation between esp positive and resistance to Ampicillin, Chloramphenicol and Tetracycline (p<0.01, p<0.01, p<0.01 respectively). Occurrence of esp in our isolates from urinary tract infection was high that indicates importance of this gene in urinary tract infections and shows importance of ability to forming biofilm and hydrophobicity of surface of Enterococci for causing urinary infection by Enterococci. Also, our finding showed significant correlation between resistance to antibiotics and presence of esp in Enterococci.

Emerging and re-emerging infectious diseases: a continuous challenge for Europe

It is estimated that infectious diseases represent roughly 10% of the total burden of disease in the European Union (EU) [1, 2]. This figure, however, might be underestimated because it does not fully take into account the whole spectrum of long-term sequelae caused by infections [3]. The growing problem of antibiotic resistance represents a major health burden for the EU. For example, carbapenems are the major last-line class of antibiotics to treat infections with multidrug-resistant (MDR) Gram-negative bacteria such as Klebsiella pneumoniae (a frequent cause of pneumonia and urinary tract infections in hospitals). 15–50% of K. pneumoniae from bloodstream infections are resistant to carbapenems in the EU [4]. Another example is Staphylococcus aureus , a bacterium that can cause a variety of infections (from minor skin infections to severe pneumonia). Its adaptation has led to an MDR pathogen, methicillin-resistant S. aureus (MRSA). MRSA is associated with severe invasive disease. Initially, MRSA was only a nosocomial pathogen, but in the last 20 yrs it has been identified in the community (community-associated (CA)-MRSA) [5]. The incidence of CA-MRSA pneumonia is estimated at 0.51–0.64 cases per 100,000 population. Since the incidence of community-acquired pneumonia (CAP) is between 100 and 1,000 per 100,000 population [6], the frequency of CA-MRSA pneumonia can be estimated to be between one in 200 and one in 2,000 cases of CAP [5]. CA-MRSA pneumonia is a severe disease with 75–85% of affected patients being admitted to the intensive care unit and 20–60% dying [7]. Antibiotic resistance also represents a major problem from an economic perspective. In 2009, the European Centre for Diseases and Control (ECDC) and the European Medicines Agency estimated that each year 25,000 Europeans die as a direct consequence of an MDR …

Community-onset healthcare-related urinary tract infections: Comparison with community and hospital-acquired urinary tract infections

To analyze the characteristics of infection, adequacy of empirical treatment and outcome of patients with community-onset healthcare-associated (HCA) urinary tract infections (UTI) and compare them with hospital (HA) and community-acquired (CA) UTI. Prospective observational cohort study performed at a university 600-bed hospital between July 2009 and February 2010. Patients with UTI requiring hospital admission were included. Epidemiological, clinical and outcome data were recorded. 251 patients were included. Patients with community-onset HCA UTI were older, had more co-morbidities and had received previous antimicrobial treatment more frequently than CA UTI (p = 0.02, p = 0.01 and p < 0.01). ESBL-Escherichia coli and Pseudomonas aeruginosa infections were more frequent in HCA than in CA UTI (p = 0.03 and p < 0.01). Inadequate empirical treatment was not significantly different between community-onset HCA and CA. Factors related to mortality were P. aeruginosa infection (OR 6.51; 95%CI: 1.01-41.73), diabetes mellitus (OR 22.66; 95%CI: 3.61-142.21), solid neoplasia (OR 22.48; 95%CI: 3.38-149.49) and age (OR 1.15; 95%CI 1.03-1.28). Epidemiological, clinical and microbiological features suggest that community-onset HCA UTI is different from CA and similar to HA UTI. However, in our series inadequate empirical antimicrobial therapy and mortality were not significantly higher in community-onset HCA than in CA UTI.

A prospective study of nosocomial urinary tract infection in hip fracture patients

To investigate risk factors and consequences of nosocomial urinary tract infection in hip fracture patients. Nosocomial urinary tract infection is a well-known problem in hip fracture patients. There are several risk factors for nosocomial urinary tract infection described in the literature. Prospective observational study with a descriptive and comparative design. Hip fracture patients were included consecutively between April 2006-March 2007. Excluded were those under 50, having an indwelling urinary catheter, signs of cognitive impairment or additional severe physical problems at the time of admission. To verify nosocomial urinary tract infection, a urine specimen was taken at admission and discharge. Patients with and without nosocomial urinary tract infection were compared. The study included 86 hip fracture patients, of whom 45 (52·3%) contracted nosocomial urinary tract infection in hospital. Earlier reported risk factors for nosocomial urinary tract infection were not confirmed in this study, with one exception: diabetes. All diabetic patients in the study contracted urinary tract infections. Patients receiving cloxacillin as antibiotic prophylaxis for wound infection contracted UTI less often than other patients. There were no statistical differences between groups with regard to urinary tract infection frequency four months after fracture or with regard to mortality after one year. Diabetes was the only previously known risk factor for nosocomial urinary tract infection confirmed among hip fracture patients in this study. Cloxacillin as antibiotic prophylaxis for surgery seemed to offer a certain protection against nosocomial urinary tract infection. Nurses in clinical practice should be aware of the risk of urinary tract infections in hip fracture patients and especially in hip fracture patients with diabetes. Patients given cloxacillin as antibiotic prophylaxis seem less likely to contract nosocomial urinary tract infection.

Silver or Nitrofurazone Impregnation of Urinary Catheters Has a Minimal Effect on Uropathogen Adherence

Bacterial adherence to the urinary catheter is an early step in biofilm formation and the pathogenesis of catheter associated urinary tract infection. We studied in vitro the effect of silver or nitrofurazone impregnation of urinary catheters on uropathogen ability to adhere to urinary catheters. We studied commercially available nitrofurazone-silicone, silicone only, silver-silicone-hydrogel, silicone-hydrogel, silver-latex-hydrogel and latex-hydrogel catheters. Catheters were incubated in sterile broth for 0, 3, 5, 7 and 10 days, respectively, before inoculation and overnight incubation with Escherichia coli or Enterococcus faecalis. Adherence of E. coli and E. faecalis to nitrofurazone catheters was significantly decreased compared to that of silicone-only catheters when catheters were fresh. The anti-adherence effect of nitrofurazone on E. coli decreased with time but was still significant at 5 days. For E. faecalis the effect of nitrofurazone was lost by 3 days of pre-incubation. E. coli adherence was not significantly decreased on silver impregnated catheters compared to that on control catheters of the same base material. Silver was associated with a significant decrease in E. faecalis adherence to latex-hydrogel catheters but not to silicone-hydrogel catheters. The adherence of each species to silicone catheters with hydrogel was significantly lower than that to silicone-only control catheters. Silver impregnation had little effect on bacterial adherence in our model and nitrofurazone impregnation had a significant effect only for the first 5 days. Our results do not support a role for silver urinary catheters to prevent catheter associated urinary tract infection by decreasing bacterial adherence.

Species and Antimicrobial Resistance of Uropathogens Isolated from Patients with Urinary Catheter

A large number of hospitalized patients have an indwelling urinary tract catheter (IUC) placed at some time during their hospital stay and may suffer from catheter-associated urinary tract infections, the leading cause of nosocomial infections. Here we investigated the prevalence of uropathogens associated with catheter-associated urinary tract infections and assessed the resistances of these pathogens to commonly prescribed antibiotics. In total, 2,997 urine samples were examined at a regional hospital in Taipei, Taiwan in 2004: 1,948 (65%) samples from hospitalized patients and 1,049 (35%) samples from outpatients. Patients with IUCs accounted for 1,381 samples (46%). Stratified analyses were used to calculate the age- and gender-adjusted odds ratio (OR) of antimicrobial resistance associated with the use of IUCs. Compared to the urine specimens of the patients without IUCs, those isolated from catheterized patients had a lower prevalence rate of Escherichia (E.) coli (23.4% vs 36.8%) and higher rates of resistant strains including Pseudomonas species (16.4% vs 8.6%) and rare gram-negative bacilli (5.8% vs 4.5%). Additionally, IUCs significantly increased the antimicrobial resistance of E. coli (OR 2.41-3.07), other species of Enterobacteriaceae (OR 1.57-2.38), and rare gram-negative bacilli (OR 2.41-5.21) to nearly all antibiotics tested, such as trimethoprim/sulfamethoxazole. Thus, IUCs increased the prevalence of urinary tract infections caused by some highly resistant pathogens. Moreover, IUCs were associated with the increased risk of concurrent resistance of Enterobacteriaceae. Clinicians are advised to exercise better management of urinary catheter in order to further reduce and control catheter-associated urinary tract infections in hospitals.

Conformité des prescriptions d'antibiotiques dans les infections urinaires de l'adulte en milieu hospitalier

Objective We estimated the adequacy of antibiotic therapy to guidelines for nosocomial and community-acquired urinary tract infections in hospital. Design For 4 weeks, all adult patients hospitalized with positive bacteriuria were included in our retrospective study. Data was collected from urine culture results and from patient medical files. Adequacy to guidelines was analyzed by two infectious disease specialists, focusing on the indication, antibiotic choice, dosage, route of administration, and duration of treatment. Results Overall 202 patients were enrolled in the study (63.9% women). The decision of initiating or not antibiotic therapy was appropriate in 66.8% of cases. Antibiotherapy indication and antibiotic choice were adequate in 94 cases in empiric prescription (50.8%) and in 123 cases (60.9%) after receiving culture antibiogram results. Route of administration was adequate in 94.4% and dosage in 70.8% of prescriptions. This poor compliance with guidelines was mainly due to unnecessary prescriptions in asymptomatic bacteriuria, unnecessary biotherapies and spectrum errors. Conclusions It seems important to remind prescribers of recommendations for urinary tract infections.

Characteristics of pathogens causing urinary tract infections in hospitals in North America: results from the SENTRY Antimicrobial Surveillance Program, 1997

Urinary tract infection (UTI) is common and involves pathogens with changing susceptibility patterns. The SENTRY Antimicrobial Surveillance Program evaluates international pathogen incidence patterns to detect and manage the emergence of resistant strains. We describe the antimicrobial resistance patterns among 1617 pathogens recovered from UTIs during the third-quarter of 1997 in North America (United States and Canada), as part of this worldwide program. The isolates were tested against more than 50 antimicrobial agents (20 reported) by reference broth microdilution methods, and selected isolates were characterized by pulsed-field gel electrophoresis (PFGE) and automated ribotyping. The five most frequently isolated species were Escherichia coli (48.6%), Enterococcus spp. (13.7%), Klebsiella spp. (12.0%), Pseudomonas aeruginosa (6.2%), and Enterobacter spp. or Proteus mirabilis (3.8% each). For each nation, imipenem and cefepime produced the widest spectrum of coverage among the β-lactams and amikacin was best among the aminoglycosides. For Gram-negative species, high resistance among β-lactam antimicrobial agents was noted especially for various penicillins against E. coli (37.9% to 42.8%) and for the cephalosporins tested against enterococci (99.4% and 100%). Approximately 7.0% of enterococci in the USA were vancomycin-resistant (88% with Van A). P. aeruginosa provided the most consistent levels of resistance, but the following agents were most active against these organisms: amikacin (96.6 to 97.4% susceptible), tobramycin (89.5 to 100.0%), piperacillin/tazobactam (89.5 to 100.0%), piperacillin (89.5 to 96.6%), imipenem (89.7 to 92.1%), cefepime (77.6 to 89.7%), and ceftazidime (82.9 to 86.2%). E. coli (2.2 to 2.7%), K. pneumoniae (6.2 to 6.4%), and a single Enterobacter cloacae strain produced extended-spectrum β-lactamases; and five other Enterobacter spp. were likely to have expressed chromosomally mediated ( Amp C) stably derepressed cephalosporinases with associated resistance to ceftazidime (16.7 to 21.2% resistance). These data demonstrated that several UTI isolates in SENTRY hospitals have high levels of resistance to various classes of antimicrobial agents with little evidence of clonal dissemination.

Probable association between urinary tract infections (UTI) and common diseases of infancy and childhood: a hospital-based study of UTI in Durban, South Africa.

In a retrospective study of UTI among 54 pediatric patients in a tertiary hospital, a striking finding was that UTI seldom existed as a single condition. In 86 per cent of cases, UTI was part of other common diseases: gastroenteritis (in 35 per cent of UTI patients), protein energy malnutrition (in 43 per cent) and acute respiratory infection (24 per cent). Presenting symptoms were similar in children with or without UTI. Other features included infrequency of urinary tract signs (13 per cent), resistance of infecting organisms to first line antibiotics and urinary tract structural abnormalities in only two patients of 36 investigated by ultrasonograms; both the latter patients had easily diagnosable underlying diseases (TB spine, posterior urethral valves). These findings require confirmation by prospective studies as they may have implications for management of UTI in hospitals in developing countries.

Epidemiology of Enterococcus faecalis urinary tract infection in a teaching hospital in London, United Kingdom.

Enterococcus faecalis is a frequent cause of urinary tract infection in hospitalized patients. Recent reports have suggested that the organism may frequently be acquired by cross-infection from other patients. In this study, we used total DNA restriction patterns to type 135 urine isolates of E. faecalis from four sets of patients. Isolates were placed into types (all bands identical) and into groups (most bands identical). Most isolates were discriminated by the typing method, and the results suggested that direct cross-infection occurred rarely if at all. However, two groups of clonally related isolates occurred frequently in the urine specimens and also in feces from hospital-associated patients and were often associated with antibiotic resistance. Isolates from these two groups were found less frequently in feces from people not associated with the hospital.

Enterococcal urinary tract infections in a teaching hospital.

A six year retrospective survey of enterococcal urinary tract infections in hospital inpatients is reported. During the study period there was an increase in the proportion of significant cultures that yielded enterococci. These organisms were more frequently isolated from catheter specimens than midstream specimens of urine and from surgical than from medical wards.