Treatment Of Urinary Tract Infections Research Articles

Green Cystoscopy: Does Minimizing the Use of Drapes Increase Infection Rates?

Importance The U.S. health care system has an enormous carbon footprint made worse by the escalating use of single-use supplies. Emerging evidence suggests that smaller surgical fields (“green” draping) may represent a safe alternative to traditional draping. Objectives The aim of the study was to determine if the proportion of cases treated for culture-proven urinary tract infection (UTI) within 2 weeks of operating room cystoscopy after the green draping protocol implementation is noninferior to preprotocol cases. Secondary objectives included risk factors for UTI and waste and cost savings. Study Design A pre-post implementation noninferiority study was performed from 2021 to 2023 in a urogynecology division at an academic medical center. The green draping protocol eliminated the use of top drapes, leg drapes, and gowns; blue towels were permitted per the surgeon’s discretion. All minor cystoscopy cases were included. Results The cohort included 240 patients. Treatment of culture-proven UTI in the green cohort was noninferior to the preprotocol group (9 [7.5%] vs 7 [5.8%], P < 0.05). The odds of a culture-proven UTI were higher with history of recurrent UTI (odds ratio = 7.02), interstitial cystitis/bladder pain syndrome (odds ratio = 4.33), and older age (odds ratio per 5-year increase = 1.21). Approximately $1,403.92 (2023 USD) was saved, and 165 pounds of waste was diverted from the landfill. Conclusions A green draping protocol is noninferior to standard draping with respect to rates of postoperative culture-positive UTIs. Clinicians may use a smaller operating room field to decrease the carbon footprint without compromising quality of care.

Flemish consensus statement on the prevention, diagnosis and treatment of urinary tract infections in older nursing home residents.

Urinary tract infections (UTIs) are one of the most commonly reported infections in Belgian nursing home residents. In older adults, UTI diagnosis and management is complex, often leading to over-diagnosis and irrational antimicrobial use, stressing the need for a guideline approach. A consensus statement on the prevention, diagnosis and treatment of UTIs in older adults residing in nursing homes was developed in a collaborative effort between the Flemish Hospital Outbreak Support Teams, the Flemish Agency for Care and Health, the Association of the Flemish Coordinating and Advising General Practitioners, the Belgian Association of Urology, the Belgian Society for Gerontology and Geriatrics and PhD researchers based on a combination of clinical expertise, (inter)national guidelines and peer-reviewed studies. Optimizing fluid intake, appropriate toilet behaviour and posture, mobilization and local estrogen therapy in women are of proven value in UTI prevention, whereas the use of cranberry and probiotics is not to be advocated. The importance of avoiding bladder catheterization is stressed. In older nursing home residents, the diagnosis of UTIs remains challenging, mostly due to atypical systemic symptoms. A consensus diagnostic algorithm for UTI among residents with and without a urinary catheter was developed, including the presence of suggestive clinical symptoms and a positive urine culture. Urine dipsticks have a high negative but a low positive predictive value. C-reactive protein point-of-care testing is not recommended. Asymptomatic bacteriuria should not be screened for, in order to avoid unnecessary triggers for treatment. In cystitis, nitrofurantoin is the primary choice for treatment, with fosfomycin as an alternative; in prostatitis and uncomplicated pyelonephritis a fluoroquinolone is the advocated empirical antimicrobial.

Prescription of antibiotics for urinary tract infections in outpatient care in Bavaria: An analysis of routine data.

Patients with urinary tract infection (UTI) in German outpatient care are usually treated by general practitioners (GPs), as well as by other specialties. To prevent antibiotic resistances and side effects, German guidelines recommend fosfomycin, nitrofurantoin, pivmecillinam and nitroxoline as first-line treatments, and advice against broad-spectrum antibiotics such as fluoroquinolones and cephalosporins. However, data from the European Centre for Disease Prevention and Control indicates a significant proportion of second-line antibiotics in German outpatient care. Our aim was to analyze whether antibiotic prescription has changed over time in accordance with guidelines. In addition, we aimed to investigate whether specialties prescribe different antibiotics for UTIs and whether prescription varies according to patient age and sex. For patients receiving more than one antibiotic, we wanted to determine whether subsequent prescriptions show a change in substances and specialties involved. This retrospective study involved routine data (2013 to 2019) provided by the Bavarian Association of Statutory Health Insurance Physicians. Data on diagnoses and prescriptions were transmitted from outpatient care physicians on a quarterly basis. UTI patients ≥12 years were included. We analyzed 1.7 million UTI prescription cases. In females, shares of fluoroquinolones decreased sharply over time, while shares of first-line substances fosfomycin and pivmecillinam increased. Gynecologists showed the highest shares of first-line substances compared to GPs and urologists. Fluoroquinolone shares decreased in all three specialty groups. In females, older patients showed lower shares of first-line substances than younger patients. If a second or third antibiotic was prescribed, fosfomycin shares decreased, while shares of nitrofurantoin, nitroxoline and cephalosporins increased. Our findings show a trend towards a more guideline-adherent prescribing in the treatment of UTI, with a significant increase of shares of fosfomycin and pivmecillinam, especially in women, and a sharp decrease of shares of fluoroquinolones.

69 Urinary tract infections in preterm infants: Review in two Canadian tertiary centers

Abstract Background Urinary tract infections (UTI) in premature infants are commonly seen in the neonatal intensive care unit (NICU). The reported prevalence of UTI in this population ranges from 1.9-12.2% due to the lack of standardized criteria for UTI among infants less than two months of age. Enterococcus and Enterobacteriaceae are well known to cause UTI and their resistance pattern has been reported to be rising in the neonatal nosocomial infections worldwide. Objectives To describe the epidemiology, microbiology, and antimicrobial treatment for UTI in premature infants based on different diagnostic criteria. Design/Methods This retrospective study (2019-2022) included infants born at <33 weeks of gestational age (GA) with positive urine cultures and ≥5 days of antimicrobials treatment. We collected data from two tertiary level NICUs in Canada, including demographics, microbial susceptibility patterns, urinalysis and imaging results, and antibiotic treatment. Results We identified 43 infants managed as UTI based on physicians’ discretions. The median GA at birth was 26-27 weeks, while the median onset of first UTI ranged 39-80 days, with male predominance [Table 2]. Mixed growth of organisms constituted 21-42% of cases of UTI [Table 1]. Among UTI cases with only single growth organism, we found 53.5% and 18.6% cases fulfilled UTI diagnostic criteria based on the concentration of colony forming units (CFU) of >104/mL or >107/L and >105/mL or >108/L, respectively [Table 1]. Of these cases, 67.4% of infants had urinalysis sent with the culture, and the higher the concentration of CFU, the more likely the samples showed positive nitrites on urinalysis, with 100% correlation among those with CFU >105/mL or >108/L. [Table 1] The most common pathogens were Enterococcus species, E.Coli, Klebsiella species, Citrobacter species and Enterobacter cloacae complex [Table 2]. Among gram negative bacilli (E. Coli and Klebsiella species), greater than 42-80% were resistant to 3rd generation cephalosporins (3GC). We did not identify any vancomycin-resistant Enterococcus strains. Median duration of antimicrobial treatment ranged from 8-13 days, depending on the diagnostic criteria applied. At least 10% of infants with UTI showed abnormalities on kidney ultrasound [Table 2]. Conclusion There exists a large variation in UTI prevalence according to different diagnostic criteria. Abnormal urinalysis with presence of nitrites were frequently associated with UTI of high CFU count. High resistance to 3GC among gram negative bacilli was concerning and carried an impact on the appropriate empirical treatment choice.

Suppression of virulence factors of uropathogenic Escherichia coli by Trans-resveratrol and design of nanoemulgel

BackgroundDevelopment of multidrug resistance in Uropathogenic Escherichia coli (UPEC) makes treatment of Urinary Tract Infections (UTIs) a major challenge. This study was conducted to investigate the effect of trans-resveratrol (t-RSV) at a subinhibitory concentration (sub-MIC-t-RSV) on phenotypic and genotypic expression of virulence factors of clinical isolates of UPEC and develop a nanoformulation of t-RSV. Fifty-five clinical UPEC strains were investigated for the presence of virulence factors by phenotypic methods and PCR detection of virulence genes. The effect of sub-MIC-t-RSV was studied on the phenotypic and genotypic expression of virulence factors. t-RSV-loaded nanoemulgel formulation was prepared and characterized.ResultsOut of the 55 tested isolates, 50.9% were biofilm producers, 23.6% showed both mannose-sensitive and mannose-resistant hemagglutination, 21.8% were serum-resistant, 18.2% were hemolysin producers, while 36.4% showed cytotoxic effect on HEp-2 cells. A total of 25.5% of the isolates harbor one or more of hly-A, cnf-1 and papC genes, while 54.5% were positive for one or more of fimH, iss and BssS genes. A concentration of 100 µg/mL of t-RSV effectively downregulates the phenotypic and genotypic expression of the virulence factors in positive isolates. A stable t-RSV-nanaoemulgel with droplet size of 180.3 nm and Zetapotential of -46.9 mV was obtained.ConclusionThe study proves the effective role of t-RSV as an antivirulence agent against clinical UPEC isolates in vitro and develops a stable t-RSV-nanoemulgel formulation to be assessed in vivo. The promising antibacterial and antivirulence properties of t-RSV place this natural compound to be a better alternative in the treatment of persistent UTIs.

Homoeopathic Management of Chronic Urinary Tract Infection (UTI) in Males—Two Evidence-Based Case Reports

AbstractUrinary tract infections (UTI) are uncommon in men, with an incidence of 5 to 8 per 10,000 per year among those aged between 21 and 50 years, in contrast to women, where the incidence is 30 times higher. UTI in men can lead to severe and painful symptoms, often requiring surgical interventions. Considering the limitations and complications of conventional medical or surgical procedures, homeopathy may offer a viable solution for such conditions. Two cases of chronic UTIs in men are presented here, in which constitutional homeopathic medicines were prescribed with positive results. In the first case, the patient experienced frequent urination, urgency, straining before urination, and a drop-wise urine flow. A retrograde urethrogram X-ray diagnosed the condition as a stricture urethra. In the second case, the patient had been suffering from repeated UTIs with painful urination for two years and was diagnosed with cystitis and epididymo-orchitis. After detailed case assessments, both patients were prescribed constitutional homeopathic remedies. Sulphur was prescribed in the first case, and Arsenic in the second case, both in 50 millesimal potencies, providing relief within a short period. However, in both cases, Thuja was prescribed as complementary medicine, which cleared all UTI symptoms, leading to a negative urine culture result. Homeopathy proved effective in providing relief in two cases of chronic UTI. It's important to note that the conclusions drawn from these two cases may not be sufficient to reach a definitive conclusion. Therefore, clinical trials are suggested to establish the efficacy of constitutional medicine in the treatment of chronic UTIs in men.

Pragmatic randomised trial assessing the impact of peer comparison and therapeutic recommendations, including repetition, on antibiotic prescribing patterns of family physicians across British Columbia for uncomplicated lower urinary tract infections

ObjectiveTo evaluate the impact of a personalised audit and feedback prescribing report (AF) and brief educational summary (ES) on empiric treatment of uncomplicated lower urinary tract infections (UTIs) by family...

Bladder irrigation with tap water to reduce antibiotic use for urinary tract infections in catheter users.

To evaluate the safety and effectiveness of bladder irrigation (BI) with tap water to reduce antibiotic use for the treatment of urinary tract infections (UTIs) in patients with recurrent UTI symptoms and to assess the treatment satisfaction of BI. This prospective, observational study included patients with an indwelling catheter or performing clean intermittent catheterisation (CIC) who had recurrent UTI symptoms between July 2022 and March 2024. BI with tap water was used for the treatment of UTIs without systemic symptoms (e.g., fever, flank pain or delirium). Patients started daily irrigation at the onset of UTI symptoms and used a tapering schedule. The number of antibiotic treatments for UTIs, UTI incidence rate ratio (IRR), UTI-related hospitalisations, treatment satisfaction and quality of life (QoL) were compared between a 3-month period before and after BI with tap water. A total of 60 patients were included with a median (interquartile range) age of 64.5 (50.4-72.6) years, 66.7% were male, and 83.3% were performing CIC. Antibiotic use was decreased on average by 38.1% (IRR = 0.62; P = 0.016) and catheter-associated UTIs by 37.9% (IRR = 0.62; P = 0.005). No increase was observed in the incidence of UTIs with systemic symptoms or UTI-related hospitalisations. In addition, no differences were observed in the health-related QoL. The majority of patients were positive about the subjective effectiveness (81%), ease of use (86%) and overall satisfaction (85%) of BI with tap water. These findings emphasise the potential of BI with tap water as a promising and patient-friendly alternative for the treatment of UTIs in patients with urinary catheters. BI with tap water significantly reduces antibiotic use and UTI incidence in patients with recurrent UTIs and is a safe and patient-friendly alternative that can be easily implemented in the management of UTIs.

Primary vesicoureteral reflux.

Primary vesicoureteral reflux (VUR) is one of the most common urological abnormalities in infants and children. The association of VUR, urinary tract infection (UTI) and renal parenchymal damage is well established. The most serious complications of VUR-associated reflux nephropathy are hypertension and proteinuria with chronic kidney disease. Over the past two decades, our understanding of the natural history of VUR has improved, which has helped to identify patients at increased risk of both VUR and VUR-associated renal injury. The main goals in the treatment of paediatric patients with VUR are the prevention of recurrent UTIs and minimizing the risk of renal scarring and long-term renal impairment. Currently, there are four options for managing primary VUR in infants and children: surveillance or intermittent treatment of UTIs with management of bladder and bowel dysfunction; continuous antibiotic prophylaxis; endoscopic subureteral injection of tissue-augmenting substances; and ureteral reimplantation via open, laparoscopic or robotic-assisted surgery. Current debates regarding key aspects of management include when to perform diagnostic imaging and how to best identify the paediatric patients that will benefit from continuous antibiotic prophylaxis or surgical intervention, including endoscopic injection therapy and minimally invasive ureteral reimplantation. Evolving technologies, such as artificial intelligence, have the potential to assist clinicians in the decision-making process and in the individualization of diagnostic imaging and treatment of infants and children with VUR in the future.

Chromogenic versus Conventional: A Comparative Analysis for Uropathogen Detection in Paediatrics at a Tertiary Centre

Abstract Background: Urinary tract infections (UTIs) are a common bacterial infection in children, often presenting with non-specific symptoms such as undiagnosed fever and gastrointestinal issues. Early detection and treatment are essential to reduce morbidity and mortality. Aims: This study aimed to compare conventional culture media with chromogenic culture methods for detecting uropathogens and to identify the causative pathogens in pediatric patients at a tertiary care hospital. Patients and Methods: The study was conducted over 18 months in the department of microbiology at a tertiary care hospital, involving 400 pediatric patients who met the inclusion and exclusion criteria. Urine samples were collected and promptly processed, then inoculated on various media, including blood agar, MacConkey agar, cysteine lactose electrolyte deficient agar, and UTI chromogenic agar. Bacterial isolates were identified using standard bacteriological techniques, and their antimicrobial susceptibility was determined using the Kirby–Bauer disk diffusion method. Results: Escherichia coli was the most prevalent Gram-negative organism detected on both conventional and UTI chromogenic agar. UTI chromogenic agar showed greater efficiency in isolating and presumptively identifying uropathogens. E. coli isolates demonstrated high susceptibility to key antimicrobial agents. Enterococcus spp. were completely sensitive to vancomycin and linezolid, while nitrofurantoin was effective in 57.14% of cases. Conclusion: UTI chromogenic agar is an effective alternative to conventional media, offering advantages in isolating and presumptively identifying uropathogens. Its enhanced sensitivity, particularly for Gram-positive cocci like Enterococcus spp. in mixed cultures, provides valuable support to clinicians for early UTI diagnosis and treatment decisions.

Skip The Dip For Urinary Tract Infection in over 65s. A National Initiative To Reduce Antibiotic Prescribing In Older Persons

Abstract Background Urinary tract infection (UTI) is the most common reason for antibiotic use in older persons in residential care. Dipstick urinalysis for UTI is an ingrained practice. Inappropriate use of dipstick urinalysis can lead to inappropriate antibiotic prescribing, contributing to adverse effects and antimicrobial resistance. The ‘Skip the Dip for UTI in over 65s’ quality improvement initiative (QI) aims to raise awareness of best practice for diagnosis and management of suspected UTI to reduce unnecessary antibiotic use. It supports implementation of national guidance stating dipstick urinalysis is not recommended for assessment of evidence of UTI in people 65 years and over. Methods Focus groups with nursing staff in older persons residential care facilities (OPRCFs) identified barriers and facilitators for implementing national guidance on dipstick urinalysis for UTI. Supporting resources developed included a resident leaflet on UTI, staff handbook and webinar recording, hosted on www.antibioticprescribing.ie. Antimicrobial pharmacists delivered workshops on improving assessment of suspected UTI in the HSE OPRCFs from September 2023 to March 2024. Monthly monitoring of antibiotic use for UTI was established in all 119 HSE OPRCFs. Surveys to establish dipstick urinalysis practice in the OPRCFs were administered in March 2023 and March 2024. Results A baseline survey in 2020/21 indicated 98% HSE OPRCFs (133/135) performed dipstick urinalysis for residents with symptoms of UTI, reducing to 53% (57/107) in March 2023, and 24% (25/103) in March 2024 following this QI. Prevalence of antibiotics for treatment of UTI in the HSE OPRCFs decreased by 38%, from a baseline of 2.6% (114/4,446 residents) in 2020/21, to 1.6% (66/4,222 residents) in March 2024. Conclusion The ‘Skip the Dip for UTI in over 65s’ QI has resulted in a change in practice, with the majority of HSE OPRCFs now reporting dipstick urinalysis is not performed for UTI assessment, with a considerable reduction in antibiotics prescribed for UTIs.

Exploring Stigma Communication About Urinary Tract Infections in the United States

ABSTRACT Urinary tract infections (UTIs) have steadily increased in prevalence and severity among women in the United States and can lead to serious complications if left untreated. Yet, women are often reluctant to discuss such infections due to potential stigmatization. Indeed, UTI treatment and prevention often involves communication with intimate partners and physicians, and this communication can require stigma management. Further, stigma communication can influence women’s experiences with UTI symptoms and treatment. The theory of stigma management communication is well-suited to explore how stigma-related communication unfolds about the experience, diagnosis, and treatment of UTIs. The current study uses in-depth interviews conducted in 2022 to learn about experiences with stigma communication surrounding UTIs. Findings reveal that participants perceived UTIs as stigmatized due to associations between UTIs and female gender, sexual behavior, genital health, and hygiene. Participants described using stigma management strategies to accept, ignore, avoid, reduce responsibility for, and challenge stigmas related to UTIs. This analysis has implications for theorizing choice in stigma management research and for provider-patient interactions surrounding UTIs.

Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management.

Urinary tract infections (UTIs) are the second most common infectious disease, predominantly impacting women with 150 million individuals affected globally. It increases the socio-economic burden of society and is mainly caused by Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter spp., and Staphylococcus spp. The severity of the infection correlates with the host factors varying from acute to chronic infections. Even with a high incidence rate, the diagnosis is mainly based on the symptoms, dipstick analysis, and culture analysis, which are time-consuming, labour-intensive, and lacking sensitivity and specificity. During this period, medical professionals prescribe empirical antibiotics, which may increase the antimicrobial resistance rate. Timely and precise UTI diagnosis is essential for addressing antibiotic resistance and improving overall quality of life. In response to these challenges, new techniques are emerging. The review provides a comprehensive overview of the global burden of UTIs, associated risk factors, implicated organisms, traditional and innovative diagnostic methods, and approaches to UTI treatment and prevention.

Game-Changing Antibiotic Solutions for Chronic UTIs in Women

Urinary tract infections (UTIs) are prevalent in primary healthcare settings, with persistent recurrences posing significant challenges. These recurrences necessitate extended antibiotic use, adversely affecting patients' quality of life, mental health, and physical activity. The evolving defense mechanisms of bacteria against the host immune system and antibiotics complicate treatment. This article examines the pathomechanisms of recurrent UTIs, focusing on bacterial defense factors. Understanding these mechanisms is essential for developing innovative treatments, particularly non-antibiotic methods, to reduce antibiotic use and its associated side effects, thereby improving patients' overall well-being. The review synthesizes current knowledge on the pathomechanisms, diagnostics, and treatments for recurrent UTIs, emphasizing the impact on patients' mental and physical health. It highlights innovative, non-antibiotic treatment approaches.

Optimizing Antibiotic Treatment for Urinary Tract Infections Secondary to Escherichia coli in Elderly Diabetic Patients: Considering Age and Blood Glucose Control

Introduction: This study aimed to examine the susceptibility profile of Escherichia coli in urinary tract infections (UTIs) among elderly diabetic patients to support judicious and evidence-based antibiotic use. Methods: From January 2021 to December 2022, urine culture results were analyzed to determine the distribution of pathogens, especially E. coli, and their drug susceptibility. Results: E. coli infection was the most prevalent infection in elderly diabetic patients with UTIs, accounting for 32.6% of cases. Moreover, this bacterium’s multiple resistance rate (38.3%) was significantly higher than other bacteria’s multiple resistance rate (χ2 = 81.644, p < 0.05). Compared to older diabetic patients with optimal glucose control (HbA1c ≤7.0%), patients with poor glycemic control (HbA1c >7.0%) had lower resistance rates to lactams, and urine pH values were higher (p < 0.05). Conclusion: The most common cause of UTIs is E. coli, with advanced age and diabetes being the main risk factors. To optimize UTI treatment safety and efficacy, antibiotics should be administered based on the patient’s age and blood glucose control.

Urinary tract infections: pathogenesis, host susceptibility and emerging therapeutics.

Urinary tract infections (UTIs), which include any infection of the urethra, bladder or kidneys, account for an estimated 400 million infections and billions of dollars in health-care spending per year. The most common bacterium implicated in UTI is uropathogenic Escherichia coli, but diverse pathogens including Klebsiella, Enterococcus, Pseudomonas, Staphylococcus and even yeast such as Candida species can also cause UTIs. UTIs occur in both women and men and in both healthy and immunocompromised patients. However, certain patient factors predispose to disease: for example, female sex, history of prior UTI, or the presence of a urinary catheter or other urinary tract abnormality. The current clinical paradigm for the treatment of UTIs involves the use of antibiotics. Unfortunately, the efficacy of this approach is dwindling as the prevalence of antimicrobial resistance rises among UTI isolates, and the immense quantity of antibiotics prescribed annually for these infections contributes to the emergence of resistant pathogens. Therefore, there is an urgent need for new antibiotics and non-antibiotic treatment and prevention strategies. In this Review, we discuss how recent studies of bacterial pathogenesis, recurrence, persistence, host-pathogen interactions and host susceptibility factors have elucidated new and promising targets for the treatment and prevention of UTIs.

Awareness Regarding the Disease and Its Prevention amongst Women with Recurrent Urinary Tract Infection: A Cohort Study

Abstract Introduction: Urinary tract infection (UTI) is regarded as the most common bacterial infection in the community. This disease is more common in females and those in the perimenopausal age group are particularly vulnerable. One of the dreaded complications of UTI is its recurrence. Although the use of antibiotics is the primary modality of treatment of UTI, recurrence can be prevented by adopting behavioural and lifestyle changes and other non-antibacterial measures. Awareness regarding this amongst the patients is of paramount importance. Aims and Objectives: This study was undertaken to assess the knowledge regarding UTI and its preventive measures in a cohort of women with primary UTI attending various Urological clinics in an urban population. Methodology: One hundred and eighty patients with proven UTIs having no comorbid diseases and structural/functional abnormalities in the urinary system were included in the study. A structured questionnaire was prepared to assess the knowledge of patients regarding the basics of UTI and lifestyle modifications, including non-antibacterial measures that could potentially prevent the recurrence of UTI in them. The total scores obtained by patients were categorised into those with inadequate knowledge, moderate knowledge and adequate knowledge. The percentage of patients in each category was calculated. Results: While assessing the overall knowledge using the scale, it was observed that 80% of the patients had inadequate knowledge, while 16.67% had moderate knowledge. Only 3.34% had overall adequate knowledge on the questionnaire. The mean percentage of patients having adequate knowledge on the three subsets of questionnaire given was 18.0%, 8.45% and 7.45%, respectively. The overall mean percentage of adequate knowledge level was only 8.97%. Conclusions: Poor awareness on UTI and its preventive measures could be an important factor in averting recurrent UTI (RUTI) in the community women, particularly belonging to the perimenopausal age group. Since there is a strong correlation between knowledge and practice, educating these women with UTI regarding preventive measures could significantly reduce the incidence of RUTI.

Effect of hydro-ethanolic extract of Abelmoschus moschatus against multidrug resistant uropathogenic Escherichia coli biofilm—An insight into antibiofilm therapeutics

Uropathogenic Escherichia coli (UPEC) associated with urinary tract infection (UTI) frequently develops biofilms, assisting UPEC persistence and resulting in antimicrobial resistance. Thus, biofilm inhibition is important in UTI treatment. This study investigated the antibiofilm efficacy of the hydro-ethanolic extract of Abelmoschus moschatus (AMHE), a traditional Indian medicinal plant, against multidrug-resistant (MDR) UPEC in vitro. Nine clinical MDR-UPEC and E. coli (ATCC25922) were screened for biofilm production by safranine staining. Water:ethanol (3:7) was used to prepare AMHE. Phytocomponents in AMHE were identified by ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-ESI-MS). Minimal inhibitory concentration (MIC) and minimal biofilm inhibitory concentration (MIC-b) of AMHE were determined by spectrophotometry. Growth curve and time-kill kinetics were performed using standard protocols. Metabolic activity and biofilm biomass were determined by MTT assay and confocal laser scanning microscopy. GraphPad Prism v8.0.2 was used for statistical analysis. An array of phytoconstituents in AMHE, including sesquiterpenes, polyphenols, fatty acids, and phytosterols, were identified. All E. coli isolates at 24 and 48 h of static growth exhibited significant biofilm production (p ≤ 0.0001) with cumulative AMHE MIC; 0.8–3.2 mg/ml and MIC-b; 1.6–6.4 mg/ml, respectively. The highest significant (p ≤ 0.0001) reduction in biofilm biomass and metabolic activity at respective 0.5 MIC of AMHE was observed in 3 selected strains without any effect on planktonic growth compared to untreated controls, which suggested its antibiofilm efficacy. Additionally, presence of farnesol, farnesyl acetate, ambrettolide along with other phytoconstituents in AHME might be responsible for the potential antibiofilm attributes. Therefore, future investigations on AMHE might pave the way towards developing effective antibiofilm therapeutics against UPEC biofilm.

Urinary tract infection among people living with human immunodeficiency virus attending selected hospitals in Addis Ababa and Adama, central Ethiopia.

Urinary tract infections (UTIs) and antibacterial resistance (ABR) are important public health problems, but they are not well-studied among people living with human immunodeficiency virus (PLHIV) globally, especially in low-income countries. Therefore, it is important to regularly measure the extent of UTIs and ABR in the most susceptible populations. This study aimed to investigate the prevalence of UTIs, associated factors, bacterial causal agents, and their antibiotic susceptibility profile among PLHIV in central Ethiopia. A hospital-based cross-sectional study was conducted to recruit 688 PLHIV by a simple random sampling method. Background information was gathered through interviews, while clinical information was gathered from recent information sheets of patient charts using organized, pretested, and validated study tools. Midstream urine was collected aseptically and transported to the Microbiology Laboratory of Aklilu Lemma Institute of Pathobiology within 4 h of collection, maintaining its cold chain. Standard conventional microbial culture methods and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry were used to identify the bacterial isolates at the species level. Kirby Bauer's disk diffusion method was used to determine the antibiotic susceptibility profile of the bacterial isolates based on the interpretation guidelines of the Clinical Laboratory Standard Institute. Logistic regression models were used to examine factors associated with the occurrence of UTIs among PLHIV attending selected hospitals in Addis Ababa, and Adama. Out of 688 PLHIVs involved in the current study, 144 (20.9%) were positive for UTIs, whereas the majority were asymptomatic for UTIs. In the multivariable logistic regression analysis, only HIV RNA ≥ 200 copies/ml [AOR = 12.24 (95% CI, 3.24, 46.20), p < 0.01] and being symptomatic for UTIs during the study period [AOR = 11.57 (95% CI, 5.83, 22.97), p < 0.01] were associated with the occurrence of UTIs. The dominant bacterial species isolated were Escherichia coli (E. coli; n = 65; 43%), followed by Enterococcus faecalis (E. faecalis; n = 16; 10.6%) and Klebsiella pneumoniae (K. pneumoniae; n = 11; 7.3%). Over half of the E. coli isolates were resistant to antibiotics such as gentamicin (GM; n = 44; 67.7%), amikacin (AN; n = 46; 70.8%), nalidixic acid (NA; n = 42; 64.6%), ciprofloxacin (CIP; n = 40; 61.5%), and azithromycin (AZM; n = 45; 69.2%). All of the K. pneumoniae isolates (n = 11; 100%), (n = 6; 54.5%), and (n = 7; 63.6%) were resistant to [amoxicillin as well as amoxicillin + clavulanic acid], ceftriaxone, and sulfamethoxazole + trimethoprim, respectively. All the Staphylococcus aureus (S. aureus) isolates were resistant to cefoxitin, which implies methicillin-resistant S. aureus (MRSA). The high prevalence of UTIs and antibiotic resistance revealed in the current study needs public health interventions such as educating the population about preventive measures and the importance of early treatment of UTIs. Our findings also highlight the need to provide UTI screening services for PLHIV, and healthcare providers should adopt antibiotic stewardship programs to promote and ensure their appropriate and judicious use.

Evaluation of the efficacy of a live Escherichia coli biotherapeutic product (asymptomatic bacteriuria E. coli 212).

Recurrent bacterial cystitis, often referred to as recurrent urinary tract infection (UTI), can be difficult to manage and alternative treatments are needed. Intravesicular administration of asymptomatic bacteriuria (ASB) E. coli 212 will not be inferior to antimicrobial treatment for the management of recurrent UTI in dogs. Thirty-four dogs with >1 UTI in the 12 months before presentation. All dogs were deemed normal otherwise based on absence of abnormalities on physical examination, CBC, serum biochemical panel, and abdominal ultrasonography. Dogs were randomized to 1 of 2 treatment groups: Group 1 antimicrobials for 7 days or group 2 intravesicular administration of ASB E. coli 212. Owners were provided a voiding questionnaire regarding their dogs' clinical signs, which was completed daily for 14 days to assess clinical cure. Dogs were examined on days 7 and 14 to assess clinical cure, and urine specimens were submitted for urinalysis and bacterial culture. Clinical cure rates for ASB E. coli 212-treated dogs were not inferior to 7 days of antimicrobial treatment with a 12% margin of difference to determine non-inferiority. No significant difference was found between the treatment groups on days 7 and 14 in the proportion of dogs achieving ≥50% or ≥75% reduction in their clinical score compared with baseline. These data suggest that intravesicular administration of ASB E. coli 212 is not inferior to antimicrobials for the treatment of recurrent UTI in dogs. This biotherapeutic agent could help alleviate the need for antimicrobials for some dogs with recurrent UTI, improving antimicrobial stewardship.