Urinary Tract Infection In Patients Research Articles

Utility of the modified 5-item frailty index as a predictor of postoperative febrile urinary tract infection in patients who underwent ureteroscopy with laser lithotripsy.

This study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones. Patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups. Seventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8°C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38°C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups. The modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.

Emerging trends in urinary tract infection pathogens: Insights from K. oxytoca and M. morganii in Indian settings

Urinary tract infections (UTIs) are a significant global health concern affecting millions annually. In India, UTIs linked to various bacterial pathogens, particularly and present a formidable challenge. This study aimed to evaluate the occurrence of these bacteria in urine samples obtained from UTI patients in Indian settings. Our investigation identified a notable proportion of UTIs associated with and highlighting the necessity for customized therapeutic approaches. Additionally, we conducted antibiotic susceptibility testing to guide appropriate antibiotic selection. Our findings revealed that 90% of isolates exhibiting additional resistance to Azithromycin (AZK). These results emphasize the importance of judicious antibiotic use and continuous monitoring of antibiotic resistance in UTI-causing pathogens in Indian healthcare settings. This study contributes to UTI management strategies and the development of tailored treatment modalities for the Indian population.

A novel score for early prediction of urinary tract infection risk in patients with acute ischemic stroke: a nomogram-based retrospective cohort study

This study aimed to construct and externally validate a user-friendly nomogram-based scoring model for predicting the risk of urinary tract infections (UTIs) in patients with acute ischemic stroke (AIS). A retrospective real-world cohort study was conducted on 1748 consecutive hospitalized patients with AIS. Out of these patients, a total of 1132 participants were ultimately included in the final analysis, with 817 used for model construction and 315 utilized for external validation. Multivariate regression analysis was applied to develop the model. The discriminative capacity, calibration ability, and clinical effectiveness of the model were evaluated. The overall incidence of UTIs was 8.13% (92/1132), with Escherichia coli being the most prevalent causative pathogen in patients with AIS. After multivariable analysis, advanced age, female gender, National Institute of Health Stroke Scale (NIHSS) score ≥ 5, and use of urinary catheters were identified as independent risk factors for UTIs. A nomogram-based SUNA model was constructed using these four factors (Area under the receiver operating characteristic curve (AUC) = 0.810), which showed good discrimination (AUC = 0.788), calibration, and clinical utility in the external validation cohort. Based on four simple and readily available factors, we derived and externally validated a novel and user-friendly nomogram-based scoring model (SUNA score) to predict the risk of UTIs in patients with AIS. The model has a good predictive value and provides valuable information for timely intervention in patients with AIS to reduce the occurrence of UTIs.

Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program

Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program

Epidemiology and risk factors for staphylococcal urinary tract infections in the Moroccan Casablanca area.

This study aimed to ascertain the prevalence and risk factors for developing staphylococcal urinary tract infections (UTIs) in the Casablanca area of Morocco. In Casablanca, Morocco, a retrospective evaluation of 772 UTIs patients was conducted between January 2020 and December 2022. The research included two groups of patients: those with staphylococcal UTIs and those without. Sex, age, chronic illnesses, antibiotic exposure, urinary catheterization, urological surgery, and UTIs history were the risk variables assessed. We employed a logistic regression model to identify the characteristics that were predictive of staphylococcal UTIs. Eight staphylococcal species were responsible for 16.84% of UTIs in 772 non-repeating individuals. Patients infected with S. saprophyticus (35.38%) were the most common, followed by those infected with S. epidermidis (24.61%), S. aureus (13.85%), and S. hemolyticus (10.78%). Multivariate logistic regression analysis revealed that male sex (95% CI: 0.261-0.563), immunosuppression and immunosuppressive treatments (95% CI: 0.0068-0.64), chronic diseases (95% CI: 0.407-0.965), previous UTIs (95% CI: 0.031-0.228), frequency of urination more than 8 times a day (95% CI:1.04-3.29), frequency of urination once or twice a day (95% CI: 1.05-2.39), and urinary catheterization (95% CI: 0.02-0.22) were the most likely predictors of staphylococcal UTIs. In addition, a larger proportion of patients with staphylococcal UTIs were made aware of the risk factors associated with staphylococcal UTIs (52.31%, χ2 = 4.82, = 0.014). This is the first global study to evaluate the predictive factors for acquiring UTIs caused by staphylococci. Monitoring these factors will enable medical authorities to devise effective strategies for managing UTIs and combating antibiotic resistance.

PHENOTYPIC DETECTION AND ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF EXTENDED SPECTRUM BETA LACTAMASE PRODUCING Escherichia coli FROM SUSPECTED CASES OF URINARY TRACT INFECTION IN KANO METROPOLIS, NIGERIA

Urinary tract infections (UTIs) caused by antimicrobial-resistant bacteria, especially ESBL-producing Escherichia coli can be life-threatening as therapeutic options available to treat infected patients are limited. Resistance due to ESBL-producing bacteria poses a peculiar challenge in treating infections because of its association with multidrug resistance. The aim of this study was thus to determine the susceptibility pattern and phenotypic detection of ESBL-producing E. coli from UTI patients. Two hundred and forty-six (246) E.coli isolates obtained from patients with suspected urinary tract infections were studied. The identity of the isolates was confirmed using standard biochemical tests. Antibiotic susceptibility testing was carried out using the Kirby-Bauer Disc Diffusion Technique. Screening for ESBL production was done using the Clinical Laboratory Standards Institute breakpoint. Suspected ESBL producers were subjected to confirmation using the Double Disc Synergy Test. Standard Discs of Augmentin (AMC 30µG Oxoid England), Ceftazidime (CAZ 30µG, Oxoid England) and Cefotaxime (CTX 30µG, Oxoid England) were used for the screening and confirmation. Multidrug-resistant E.coli were found to be 65.4%. Screening for ESBL production showed 67.1% suspected ESBLs producing E.coli. The Double Disc Synergy Test showed 22.4% confirmed ESBLs producing E.coli. Antimicrobial sensitivity of the ESBLs producing organisms showed 100% resistance to augmentin, ceftriaxone, ceftazidime, ciprofloxacin and cefotaxime while resistance to gentamicin was 91.1%, chloramphenicol 89.2%, nitrofurantoin 78.4%, and cotrimoxazole 94.6%. A 100% sensitivity to imipenem was also observed. ESBL-producing E.coli are present in Kano metropolis and are resistant to commonly prescribed antibiotics. We, therefore, suggest screening and confirmation for ESBL, to prevent treatment failure.

Whole genome sequencing of uropathogenic E. coli from Ireland reveals diverse resistance mechanisms and strong correlation with phenotypic (EUCAST) susceptibility testing

Urinary tract infections (UTI) caused by uropathogenic Escherichia coli (UPEC) pose a global health concern. Resistance mechanisms, including genetic mutations in antimicrobial target genes, efflux pumps, and drug deactivating enzymes, hinder clinical treatment. These resistance factors often spread through mobile genetic elements. Molecular techniques like whole genome sequencing (WGS), multilocus sequence typing (MLST), and phylotyping help decode bacterial genomes and categorise resistance genes.In this study, we analysed 57 UPEC isolates from different UTI patients following EUCAST guidelines. A selection of 17 representative strains underwent WGS, phylotyping, MLST, and comparative analysis to connect laboratory susceptibility data with predictive genomics based on key resistance genes and chromosomal mutations in antimicrobial targets.Trimethoprim resistance consistently correlated with dfr genes, with six different alleles detected among the isolates. These dfr genes often coexisted with class 1 integrons, with the most common gene cassette combining dfr and aadA. Furthermore, 52.9% of isolates harboured the blaTem-1 gene, rendering resistance to ampicillin and amoxicillin. Ciprofloxacin-resistant strains exhibited mutations in GyrA, GyrB and ParC, plasmid-mediated quinolone resistance genes (qnrb10), and aac(6′)-Ib-cr5. Nitrofurantoin resistance in one isolate stemmed from a four amino acid deletion in NfsB.These findings illustrate the varied strategies employed by UPEC to resist antibiotics and the correlation between clinical susceptibility testing and molecular determinants. As molecular testing gains prominence in clinical applications, understanding key resistance determinants becomes crucial for accurate susceptibility testing and guiding effective antimicrobial therapy.

Biofilm formation and antibiotic resistance in patients with urolithiasis: assessment of phenotypic and genotypic

Aim: Urolithiasis is a common public health problem that significantly impacts the community. The objective of this study was to identify the prevalent pathogens responsible for urinary tract infections in patients with urolithiasis and investigate the biofilm forming ability of these strains phenotypically and molecularly. Materials and Methods: A total of 100 patients who presented to Kirkuk Training and Research Hospital with symptoms of urinary tract infection and were diagnosed with kidney stones were included in our study conducted between May 2021 and November 2022. Clinically significant bacteria from urine samples were identified using routine conventional methods. Biofilm formation of the identified strains was examined by microplate method. Results: The most frequently isolated agents were Escherichia coli (n:36) and Proteus mirabilis (n:17). Biofilm formation was detected in 89% of E. coli strains and 94% of P. mirabilis strains. Conclusion: The results obtained are important in terms of high biofilm formation, especially in E. coli and P. mirabilis strains, and the frequent presence of genes related to this biofilm formation.

Culture-free detection of β-lactamase-Producing bacteria in urinary tract infections using a paper sensor

Developing simple, inexpensive, fast, sensitive, and specific probes for antibiotic-resistant bacteria is crucial for the management of urinary tract infections (UTIs). We here propose a paper-based sensor for the rapid detection of β-lactamase-producing bacteria in the urine samples of UTI patients. By conjugating a strongly electronegative group –N+(CH3)3 with the core structures of cephalosporin and carbapenem antibiotics, two visual probes were achieved to respectively target the extended-spectrum/AmpC β-lactamases (ESBL/AmpC) and carbapenemase, the two most prevalent factors causing antibiotic resistance. By integrating these probes into a portable paper sensor, we confirmed 10 and 8 cases out of 30 clinical urine samples as ESBL/AmpC- and carbapenemase-positive, respectively, demonstrating 100% clinical sensitivity and specificity. This paper sensor can be easily conducted on-site, without resorting to bacterial culture, providing a solution to the challenge of rapid detection of β-lactamase-producing bacteria, particularly in resource-limited settings.

Molecular typing and virulence characteristics of Escherichia coli strains isolated from hospital and community acquired urinary tract infections.

The main causes of hospital- and community-acquired urinary tract infections (UTIs) are a group of Escherichia coli (E. coli) strains with multiple virulence factors known as uropathogenic E. coli. One hundred E. coli isolates from the urine specimens of hospital- and community-acquired UTI patients were characterized based on their virulence factors and genetic relatedness using PCR and RAPD‒PCR, respectively. Among all, the traT (71%), sitA (64%), ompT (54%), malX (49%), ibeA (44%), tsh (39%), hlyD (18%) and cnf1 (12%) genes had the highest to lowest frequencies, respectively. There was no significant difference between the frequency of tested virulence genes in E. coli isolates from inpatients and outpatients. The frequency of the hlyD gene was significantly greater in E. coli isolates from patients hospitalized in gynecology, dermatology and intensive care unit (ICU) wards than in those from other wards. Eight virulence gene patterns were common among the isolates of inpatients in different wards of the same hospital, of which five patterns belonged to the isolates of inpatients in the same ward. More E. coli isolates with similar virulence gene patterns and greater genetic similarity were found in female patients than in male patients. The analysis of the RAPD‒PCR dendrograms revealed more genetic similarities among the E. coli isolates from inpatients than among those from outpatients. Our findings indicate the presence of a wide variety of virulence factors in E. coli isolates and the possibility of spreading the same clones in different wards of the hospital.

Investigating the impact of the genetic variant CXCR1 (rs2234671) in individuals with urinary tract infections.

Urinary tract infections (UTIs) are currently posing a worldwide health concern by affecting millions of people. The genetic variant rs2234671 in the CXCR1-interleukin-8 receptor is closely related to a raised UTI risk. In this work, the impact of CXCR1 (rs2234671) on UTI individuals was examined. The demographic features of 30 recurrent UTI patients and 20 controls were thoroughly investigated. Bacterial isolation and identification were performed by the implementation of cultural and biochemical methods. DNA extraction, purification of all samples from both patients and healthy people, and IL-8 rs2234671 (C/G) SNP genotyping using T-ARMS-PCR were performed. The significance of the results was evaluated by carrying out a statistical analysis. The patient's average age was 34.63 ± 11.44 years, and controls averaged 30.30 ± 8.59 years (P= 0.156). No significant gender difference existed (P= 0.804). Escherichia coli (63.3%) was predominant, followed by Proteus mirabilis (26.7%), Enterococcus faecalis (23.3%), Klebsiella pneumoniae (10.0%), and Pseudomonas aeruginosa (20.0%). No significant association was found between bacterial species frequency, age, or sex. From the CXCR1 (rs2234671) frequency comparison, a higher GG genotype incidence in UTI patients than controls was extracted (26.7% vs. 15.0%), though not statistically significant. Risk analysis revealed that GG homozygous and C/G heterozygous genotypes were not UTI risk factors (OR = 2.47 and OR = 1.85, respectively). Moreover, the allele frequencies displayed no significant difference between the patients and controls (G allele: 66.7% vs. 66.7%; C allele: 33.3% vs. 33.3%). Although no significant association between CXCR1 (rs2234671) and UTI was found, the GG genotype may point to the increasing probability of UTI risk. Additional research is required to confirm and expand these conclusions.

High Incidence of Antibiotic Resistance in the Uropathogenic Bacteria Associated with Different Urological Diseases and Metabolic Complications: A Single Center Cross-Sectional Study.

Urological diseases affect all age groups and are associated with different urinary complications. Presence of pathogenic bacteria complicates the urological diseases such as chronic kidney disease (CKD), kidney stone disease (KSD), emphysematous pyelonephritis (EPN), and urological cancers (UCs) coinciding with urinary metabolic complications. The One Health concept for preventing the spread of antibiotic resistant opportunistic pathogens necessitates detailed investigation on the virulence and the antibiotic sensitivity patterns of the pathogens from the urinary tract infections (UTIs). This cross-sectional study was aimed to profile the pathogenic bacteria associated with different urological diseases that included urine samples from the patients from a tertiary care hospital. The study included 258 patients representing CKD (15.1%), KSD (28.7%), EPN (15.5%), UC (12.0%), and UTI patients without any urological diseases (28.7%) with overall 70.5% patients showing positive urine culture. Furthermore, other than UTI in patients without any urological diseases (100%), higher culture positive cases were seen in KSD (64.9%), followed by CKD (61.5%), EPN (52.5%), and UC (48.4%). Escherichia coli was the most predominant bacteria in UTI (35.1%) and EPN (66.7%). In KSD, Pseudomonas aeruginosa (41.7%), Staphylococcus aureus (18.8%), and Proteus mirabilis (14.6%) were more common. S. aureus (86.7%) was the most isolated bacteria from the UC cases. Overall rate of multidrug resistance (MDR) was 77.8%. All (100%) E. coli, K. pneumoniae, P. mirabilis, and S. aureus strains were MDR. Among the strains, strong biofilm formation was observed in 73.6%, and 66.7% strains were urease positive. Biofilm was positively correlated with MDR and urease activity. The abundance and distribution of bacteria differed among the urological diseases suggesting their association with the urine metabolite profile. Colonization of MDR pathogens in patients with urological diseases is a serious concern requiring steps to control the emergence of drug resistance and their further spread into the ecosystem.

Post-discharge surveillance of urinary tract infections in patients following hip and knee arthroplasty: Identifying targets for infection prevention and control

This population-based study aimed to evaluate the incidence of urinary tract infections (UTIs) following hip and knee arthroplasty (HPRO and KPRO) and to identify UTI risk factors among Polish patients. Analysis included data from 83,525 patients, with incidence rates of 0.7% and 0.49% after HPRO and KPRO, respectively. We identified women, individuals over 65 years old, residents of long-term care facilities, patients with chronic circulatory, endocrine, or digestive diseases, and those operated on due to trauma as targets for infection prevention and control.

IJCM_279A: Evaluation of diabetes mellitus as a risk factor for urinary tract infection in women: A case control study

Background: Diabetes mellitus (DM) disrupts insulin production and function leads to hyperglycaemia and subsequently exacerbating the risk of complications. Studies highlight hyperglycaemia’s impact on neutrophil function, predisposing diabetic patients to severe infections like pneumonia, urinary tract infections (UTIs), and skin issues. Objectives: To quantify DM’s contribution to UTI development, and to assess the risk of contracting UTI conferred by diabetes mellitus in otherwise healthy women and to characterize the UTI in the cases. Methodology: The case control study was conducted among 200 participants (100 cases with UTI and 100 controls without UTI) from 3 hospitals affiliated to Kasturba Medical College, Mangalore. The data were collected using a structured proforma. Chi – square test and students ‘t’ test was used for comparison of the results across the groups. Results: Patients with urinary tract infections (UTI) showed a higher prevalence of diabetes mellitus (DM) (27.66%) compared to controls (7.45%). The UTI patients were 4.75 times more likely to have DM. Diabetic UTI cases exhibited elevated glycated haemoglobin (HbA1C) and random blood sugar levels than controls. Complicated UTIs were more prevalent in diabetic (77%) than non-diabetic (60%) UTI cases, with E. coli being the most common infecting organism. Conclusion: The uncontrolled diabetes mellitus confers an increased risk of developing UTI and the risk of developing UTI caused by organisms which are not known to cause infections in people with normal immunity (like Candida species). Additionally, diabetics show a higher proportion of complicated UTI cases as compared to non-diabetics.

A Clarification of the Concept of Clean Intermittent Catheterization Adherence Using the Evolutionary Method

Background and purpose:Clean intermittent catheterization (CIC) nonadherence may lead to renal compromise, incontinence, and frequent urinary tract infections in patients with spinal cord injury and spinal dysraphism. Adherence to CIC lacks definition in the nursing literature despite implications for research and clinical practice, including patient education. The aim of this concept analysis was to analyze how CIC adherence is conceptualized and synthesize a definition for nursing.Method:Rodgers’ evolutionary concept analysis method was used to analyze the concept of CIC adherence in patients and caregivers. We searched databases to identify studies describing CIC adherence and identified common attributes, antecedents, and consequences. A definition was synthesized, and an exemplar was developed to illustrate the concept in practice.Results:Sixteen sources were analyzed. The attributes of CIC adherence were initiation, execution, including prescribed process and prescribed frequency, and persistence. Antecedents included the presence of neurogenic bladder, acceptance, and engagement. Consequences included improved health outcomes and quality of life.Implications for practice:Adherence to CIC lacks definition in the nursing literature despite implications for research and clinical practice. A unified definition of CIC adherence will facilitate nurses’ efforts to plan effective care, anticipate support barriers and opportunities, and develop strategies for improving CIC adherence.

Antibiotic Duration and UTI Outcomes in Recurrent UTI Patients.

Little evidence is available to inform management of acute urinary tract infections (UTIs) in women with recurrent urinary tract infection (rUTI). This study aimed to compare the proportion of acute UTIs with persistence/relapse or recurrence based on duration of treatment antibiotics (acute UTI guideline-consistent versus extended). A retrospective noninferiority study of women with rUTI was performed at an academic tertiary referral center from January 2016 to December 2020. Exposure was UTI treatment with acute UTI guideline-consistent versus extended antibiotics. Outcomes were persistent/relapsed UTI (subsequent culture with the same pathogen requiring additional antibiotics within 4 weeks), recurrent UTI (culture with different pathogen), or resolution. Sample size was calculated under the null hypothesis that the proportion of acute UTIs with persistence/relapse or recurrence after acute UTI guideline-consistent antibiotics would be within a 10% noninferiority margin of extended duration (α = 0.05, β = 0.20, 2-sided tests, P < 0.05 significant). We included 219 patients with 553 acute UTIs. The mean ± SD number of UTIs per patient was 2.53 ± 1.88, the mean ± SD age was 68.60 ± 16.29 years, and the mean ± SD body mass index was 29.73 ± 7 (calculated as weight in kilograms divided by height in meters squared). There were no differences in prior surgical procedures postvoid residual volume, pelvic floor disorders, or preventive treatments between groups. Two-hundred sixty UTIs (260 of 553 [47%]) were treated with acute UTI guideline-consistent antibiotics. Overall, 86 of 553 UTIs (15.6%) persisted/relapsed, and 29 of 553 (5.2%) recurred. The difference in the proportions of UTIs with persistence/relapse or recurrence excluded the noninferiority margin (4.4%; 95% confidence interval, -0.04 to 6.80%). In total, 115 of 553 UTIs (20.8%) had persistence/relapse or recurrence. In this cohort of patients with rUTI experiencing acute UTIs, acute UTI guideline-consistent duration of antibiotics was noninferior.

Evaluation of Vit. D3 and Zn levels in patients with urinary tract infections

Background: Vitamin D, known for its immunoregulatory effects and antimicrobial properties, plays a crucial role in regulating inflammation and chemokine production. Zinc is influential for a healthy immune system and human health, influencing cell differentiation, proliferation, and apoptosis, which impact organism growth. Objective: Determine the serum zinc and vitamin D3 levels in UTI patients and controls to detect the role of vit. D3 and Zn in UTIs, and their levels in recurrent and non-recurrent infections. Materials and Methods: Samples of 60 urinary tract infection patients, distributed between 30 females and 30 males, were collected from Imam Hassan Al-Mujtaba Hospital for the period from December 2022 to April 2023. After collecting venous blood samples from patients and the controls, the serum was separated to measure the concentrations of vitamin D3 and zinc. The concentration of vitamin D3 was measured using the Cobas system, while the concentration of zinc was measured using a Mindray device. Results: UTI patients have lower serum zinc levels than the controls group, with the patient group having 83.0 mg/dL compared to the control group. Vitamin D3 was also low in the patients group compared to controls (10.50, 12.58 respectively). Conclusion: Vitamin D3 and zinc levels can influence UTI development, with patients having lower serum vit. D3 and zinc than the controls group, indicating a potential risk of UTI.

Analysis of epidemiological characteristics and risk factors of catheter-associated urinary tract infections in patients with perineal and/or hip burns

Objective: To explore the epidemiological characteristics and risk factors of catheter-associated urinary tract infections in patients with perineal and/or hip burns. Methods: This study was a retrospective case series study. From January 2018 to December 2022, 260 patients with perineal and/or hip burns and urinary catheters indwelling who met the inclusion criteria were admitted to the Department of Burns and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 192 males and 68 females, aged 20-93 years. The total incidence of catheter-associated urinary tract infections in patients with perineal and/or hip burns, the detection of pathogenic bacteria, and the resistance of major Gram-negative and Gram-positive bacteria to commonly used antimicrobial drugs in clinic were recorded. According to whether catheter-associated urinary tract infection occurred or not, the patients were divided into infection group (43 cases) and non-infection group (217 cases). The basic conditions including gender, age, total burn area, depth of perineal burn, depth of hip burn, and burn site on admission, complications of diabetes mellitus, inhalation injury, and hypoproteinaemia, invasive operations including tracheotomy and non-perineal/hip debridement/skin transplantation surgery, duration of catheter retention, number of urethral catheterization, and bladder irrigation of patients between the two groups were compared, and the independent risk factors influencing the occurrence of catheter-associated urinary tract infections in patients with perineal and/or hip burns were screened. Results: The total incidence of catheter-associated urinary tract infections in patients with perineal and/or hip burns in this study was 16.5% (43/260). The pathogens detected were predominantly Gram-negative, followed by fungi; the main Gram-negative bacterium was Klebsiella pneumoniae, and the main Gram-positive bacterium was Enterococcus faecalis. The resistance rates of Klebsiella pneumoniae to amoxicillin/clavulanic acid, amitraz, amikacin, ciprofloxacin, ceftriaxone, and levofloxacin were higher than 70.0%, the resistance rates of Klebsiella pneumoniae to cefoxitin, cefoperazone/sulbactam, cefepime, meropenem, imipenem, and piperacillin/tazobactam ranged from 56.3% to 68.8%, and the resistance rates of Klebsiella pneumoniae to ceftazidime and tigecycline were lower than 50.0%. The resistance rates of Enterococcus faecalis to ciprofloxacin and penicillin were both 85.7%, the resistance rates of Enterococcus faecalis to erythromycin, clindamycin, moxifloxacin, and tetracycline ranged from 14.3% to 57.1%, and the resistance rates of Enterococcus faecalis to linezolid, tigecycline, and vancomycin were all 0. The differences were statistically significant between the two groups in terms of gender, status of complication of hypoproteinaemia, depth of perineal burn, status of non-perineal/hip debridement/skin transplantation surgery, status of bladder irrigation, number of urethral catheterization, and duration of catheter retention of patients (with χ2 values of 7.80, 4.85, 10.68, 9.11, and 16.48, respectively, and Z values of -4.88 and -5.42, respectively, P<0.05). There were no statistically significant differences in the age, total burn area, complications of diabetes mellitus and inhalation injury, burn site, depth of hip burns, and status of tracheotomy of patients between the two groups (P>0.05). Multifactorial logistic regression analysis showed that gender, deep partial-thickness perineal burns, non-perineal/hip debridement/skin transplantation surgery, bladder irrigation, and duration of catheter retention were the independent risk factors for catheter-associated urinary tract infections in patients with perineal and/or hip burns (with odds ratios of 2.86, 2.63, 2.79, 2.34, and 1.04, respectively, with 95% confidence intervals of 1.21-6.73, 1.03-6.71, 1.03-7.59, 1.05-5.22, and 1.02-1.06, respectively, P<0.05). Conclusions: The incidence of catheter-associated urinary tract infections is high in patients with perineal and/or hip burns, with Klebsiella pneumoniae as the predominant pathogenic bacteria having a high resistance rate to commonly used antimicrobial drugs in clinic. Gender, deep partial-thickness perineal burns, non-perineal/hip debridement/skin transplantation surgery, bladder irrigation, and duration of catheter retention are the independent risk factors for catheter-associated urinary tract infections in patients with perineal and/or hip burns.

Relation of poverty with treatment-seeking behavior and antibiotic misuse among UTI patients in Pakistan.

The current study aimed to assess the relation between multi-dimension poverty, treatment-seeking behavior, and antibiotic misuse among urinary tract infection (UTI) patients. A cross-sectional approach was utilized to recruit patients who had a history of UTI in the previous month from two provinces of Pakistan. The treatment-seeking behavior and antibiotic misuse data were collected on a self-developed questionnaire, whereas the poverty data were collected on a modified multi-dimension poverty index (MPI). Descriptive statistics were applied to summarize the data. The logistic regression analysis was carried out to assess the association of multi-dimension poverty with patient treatment-seeking behavior and antibiotic misuse. A total of 461 participants who had UTI symptoms in the previous month were recruited. Most of the participants in the severely deprived stage treated the UTI (p < 0.001); however, there was a high proportion of the participants who consulted with friends and family for UTI treatment (p < 0.001). The patients with deprivation status (deprived and severely deprived) were less associated with formal consultation. The poorer subgroups were less likely to practice antibiotic course completion. The current study highlighted that poverty plays an important role in antibiotic misuse. Poorer subgroups were associated with informal consultations and the incompletion of the antibiotic course. Further studies are needed to explore the potential role of poverty in treatment-seeking behavior and antibiotic misuse.

Genotypic Detection of Carbapenems Resistance Genes in Acinetobacter baumannii Isolated from Urinary Tract Infection Patients

Acinetobacter baumannii is a Gram-negative bacterium characterized by its short, round, rod-shaped morphology. It is an opportunistic pathogen that poses a significant threat, particularly to immunocompromised patients, often those with hospital stays lasting less than 90 days. Between June 2022 and July 2023, 214 urine samples were collected from individuals suspected of having urinary tract infections (UTIs). These samples were subjected to antibiotic resistance testing, focusing on detecting specific genes related to carbapenem resistance, namely blaNDM, blaKPC, and blaVIM.The study's results revealed a notable trend in antibiotic resistance among the bacterial isolates. Ceftazidime, cefotaxime, and ceftriaxone, commonly used antibiotics for UTIs, showed a high resistance rate among the tested isolates. This resistance highlights the challenges healthcare professionals face when treating UTIs caused by Acinetobacter baumannii. On the other hand, the isolates displayed a comparatively lower resistance rate to imipenem and meropenem, two necessary carbapenem antibiotics. This lower resistance to carbapenems is encouraging as these drugs are often considered the last line of defense against multidrug-resistant bacterial infections. The presence of carbapenem resistance genes, such as blaNDM, blaKPC, and blaVIM, in the Acinetobacter baumannii isolates is of particular concern. These genes confer resistance to carbapenem antibiotics, crucial for treating severe infections caused by multidrug-resistant bacteria. In conclusion, the study aims to study the growth of antibiotic resistance in Acinetobacter baumannii, especially in urinary tract infections in immunocompromised patients with more extended hospital stays. It also highlights the need for Surveys and periodic examinations to detect the spread of bacteria and their resistance. Keywords: Carbapenems, UTI, genes, blaNDM, blaKPC, and blaVIM.