Culture Of Urine Samples Research Articles

Antimicrobial Resistance in Uropathogens Associated with Community Acquired Urinary Tracts Infections in Port Harcourt, Nigeria

Introduction: Antimicrobial resistance (AMR) in uropathogens remain an intractable public health concern due to the associated mortality, morbidity and economic and manpower losses worldwide. This retrospective study was aimed at ascertaining the prevalence of the bacterial uropathogens and the antimicrobial resistance patterns of the dominant strains. Methodology: It involved a review of laboratory records of the over 1426 males (38%) and females (62%) of various s age brackets between January 1, 2021 and December 31, 2022. Results: Out of 1426 urine culture samples 58.5% were negative cultures while 592 (41.5%) yielded bacterial growths. A total of 403 uropathogens comprising 11 species were obtained. Gram negative bacteria constitute 73.9% of the isolates while gram positive bacteria were 26.1% Escherichia coli (54.7%) was the dominant strains, followed by Staphylococcus aureus (10.3%, Enterococcus faecalis (9.5%), Proteus mirabilis (7.7%, Staphylococcus saprophyticus (5.7%, Streptococcus pneumoniae (3.9%), Klebsiella pneumoniae 17 (3.0%), Pseudomonas aeruginosa (2.7%), Enterobacter cloacae (1.1%), Acinetobacter baumannii (0.9%) and Serratia marcescens (0.5%). A cumulative of 50.5% of the strains were resistant to at least on antimicrobial agent. The most resistant uropathogen was Pseudomonas aeruginosa with a resistant profile of 64.1%, followed by Klebsiella pneumoniae (63.7%), Staphylococci (55.7%), Streptococcus pneumoniae (55.2%), Acinetobacter baumannii (51.7%), Proteus mirabilis (51.4%), Escherichia coli (48.0%), Enterobacter cloacae (47.1%), Enterococcus faecalis (46.5%) and Serratia marcescens (43.3%) The least effective antimicrobial agent was nitrofurantoin which resisted by 87.1% strains, the most effective was streptomycin (22.2%). Conclusion: This study will benefit healthcare practitioners in the empirical choice of antibiotics against UTI; however, the high prevalence of AMR necessitates conduct of urine cultures to identify particular uropathogens appropriate antimicrobials in other to curtail increase in AMR among uropathogens.

Investigating the interaction of zno nanoparticles with flagellum and fimbriae in multi-drug resistant uropathogenic bacteria encoding fli and fim genes.

Due to the increasing occurrence of drug resistant urinary tract infections (UTI) among children, there is a need to investigate alternative effective treatment protocols such as nanoparticles. Flagella and fimbriae are primary factors contributing the virulence of urinary tract infecting bacteria. The aim of this study was to assess the antibacterial effects of zinc oxide nanoparticles which have been synthesized using both chemical and green methods on multi-drug resistant (MDR) uropathogenic bacteria encoding fli and fim genes and investigating their binding ability to bacterial appendage proteins. A total of 30 urine culture samples were collected from children under 2 years old diagnosed with urinary tract infection. The isolates underwent antibiotic suseptibility assessment and the isolates demonstrating MDR were subjected to molecular amplification of fimG (fimbrial) and fliD and fliT (flagellal) genes. The confirmation of cellular appendages was achieved through silver nitrate staining. The antibacterial efficacy of the synthetized nanoparticles was assessed using the micro and macrodilution methods. The successful binding of nanoparticles to bacterial appendage proteins was confirmed through mobility shift and membrane filter assays. The dimensions of chemically synthesized ZnO nanoparticles and green nanoparticles were measured at 30nm and 85nm, respectively, with the exhibition of hexagonal geometries. The nanoparticles synthesized through chemical and green methods exhibited minimum inhibitory concentrations (MIC) of 0.0062-0.025g/L and 0.3g/L, respectively. The ability of ZnO nanoparticles to bind bacterial appendage proteins and to combat MDR uropathogenic bacteria are promising for new treatment protocols against UTI in children in future.

Множественная лекарственная устойчивость уропатогенов как фактор риска при оказании медицинской помощи (опыт Центральной Болгарии)

The emergence of resistance to multiple antimicrobial agents in uropathogenic bacteria has become a significant public health problem. These microorganisms are the cause of urinary tract infections, which are among the most frequently treated diseases in the outpatient medical care. A cross-sectional study was conducted among 353 outpatients over 18 years of age with positive urine sample culture. It involved measuring the index of multiple antibiotic resistance of uropathogens causing infections among individuals. The research was conducted in the period January – June 2023 at a private clinical laboratory center located in Stara Zagora, Bulgaria. One third of the isolates of E. coli and more than a half of those of Klebsiella pneumoniae had a measured MAR index greater than 0.2, with confirmatory high rates of resistance to aminopenicillins and cephalosporins. Alarmingly high MARI values were measured in all representatives of Enterococcus faecalis, Enterobacter species and Pseudomonas aeruginosa. These strains were also established to have high levels of resistance (varying from 58.3 to 100 %) to some of antimicrobial medicines most commonly prescribed in the outpatient healthcare. Findings of this study emphasize the importance and seriousness of the existing problem with the increasing prevalence of uropathogenic microorganisms with multiple resistance to oral antibiotics. This creates elevated risks of failure to provide effective treatment for patients.

Multidrug resistance of uropathogens as a risk factor in providing medical care to patients from central Bulgaria

The emergence of resistance to multiple antimicrobial agents in uropathogenic bacteria has become a significant public health problem. These microorganisms are the cause of urinary tract infections, which are among the most frequently treated diseases in the outpatient medical care. A cross-sectional study was conducted among 353 outpatients over 18 years of age with positive urine sample culture. It involved measuring the index of multiple antibiotic resistance of uropathogens causing infections among individuals. The research was conducted in the period January – June 2023 at a private clinical laboratory center located in Stara Zagora, Bulgaria. One third of the isolates of E. coli and more than a half of those of Klebsiella pneumoniae had a measured MAR index greater than 0.2, with confirmatory high rates of resistance to aminopenicillins and cephalosporins. Alarmingly high MARI values were measured in all representatives of Enterococcus faecalis, Enterobacter species and Pseudomonas aeruginosa. These strains were also established to have high levels of resistance (varying from 58.3 to 100 %) to some of antimicrobial medicines most commonly prescribed in the outpatient healthcare. Findings of this study emphasize the importance and seriousness of the existing problem with the increasing prevalence of uropathogenic microorganisms with multiple resistance to oral antibiotics. This creates elevated risks of failure to provide effective treatment for patients.

Antibiotic resistance rates of <i>Klebsiella pneumoniae</i> strains isolated from urine cultures

Aim: Our study aimed to determine the antibiotic resistance rates of K. pneumoniae by retrospectively examining the results of urine culture samples studied in our laboratory. Methods: Urine samples with K. pneumoniae growth, sent to our laboratory from various wards, outpatient clinics, and intensive care units between July 1, 2018 and December 31, 2022 were included in the study and retrospectively examined. Results: The antibiotic to which K. pneumoniae was most resistant was cefixime (53.3%), and the antibiotic to which it was least resistant was imipenem (12.1%). While the lowest resistance rates were observed in the samples of outpatients, the highest resistance rates were observed in the samples of ward patients and to cefixime (81%), amoxicillin clavulanic acid (AMC) (80%), trimethoprim-sulfamethoxazole (TMT/SXT) (74.8%), and ciprofloxacin (72.1%). Ertapenem (48.9%), meropenem (50.2%) and piperacillin-tazobactam (PRP) (57.3%) resistance was found to be higher in intensive care patients. Conclusion: Although fluctuations in resistance rates have been observed over the years, resistance rates have generally been found to be high for antibiotics frequently used in the empirical treatment of urinary tract infections. Re-adjusting treatment according to culture results and keeping resistance rates in mind for empirical treatment will be important for treatment success.

Свойства бактерий, вызывающих инфекции мочевыводящих путей у пациентов в медицинских учреждениях Болгарии

Pathogenic microorganisms of urinary tract infections are mainly representatives of different bacterial species with a wide variety of virulence factors and multi-drug resistant strains. In connection with determining the empirical therapy of urinary tract infections, it is necessary to know the prevalence and incidence of uropathogens in the region. Objective. To determine the etiological structure of urinary tract infections among Bulgarian patients in the outpatient healthcare setting and their antimicrobial susceptibility and resistance. Patients and methods. A cross-sectional study was conducted among 763 outpatients. There were applied microbiological procedures – urine sample culture and antimicrobial susceptibility test. The principles of the Disc Diffusion Method were applied in determining the sensitivity of microorganisms to antimicrobial chemotherapeutics. Results. The leading contingent were mostly women (75.6%). Predominant working diagnoses as the reason for microbiological analysis were cystitis or tubulointestinal nephritis. A positive urine culture was reported in a significant part of the respondents (46.26%) referred by specialists from primary and secondary health care. Among the isolated strains, Escherichia coli was identified in more than half of the examined individuals (53.3%), with high rates of sensitivity to most antibiotics used in medical practice. 17% and 12.2% were the representations of Enterococcus faecalis and Klebsiella pneumonia in the sample, in which increasing levels of resistance and respectively disturbingly high ones to some of the widely applied antimicrobial agents were measured. Conclusion. E. coli is the most common gram-negative bacteria causing urinary tract infections in the outpatient medical care. An alarming trend of high levels of resistance was reported in E. faecalis, which was the second most common uropathogen of urinary tract infections in the sample. There was a tendency towards significantly increased rates of resistance in less frequently isolated uropathogens in outpatient medical care. Referring to the obtained results of the study, the authors emphasize the need to grade various antimicrobial resistance bacterial profiles in the outpatient healthcare setting. Key words: urinary tract infections, etiology, antibiotic susceptibility

Microbiological profile and antibiotic resistance of urinary tract infections in Maternity and Children Hospital, Hafr Al Batin, Saudi Arabia within 2022

Objective: This study aimed to characterize the antibiotic sensitivity, microbial resistance, and prevalence of the bacteria responsible for urinary tract infections (UTIs) at Maternity and Children Hospital (MCH), Hafr Al Batin, Saudi Arabia. Methods: Analysis was done on 1273 culture samples that were processed in the microbiology lab between January and December of 2022. Results: In all, 1273 urine culture (UC) samples were gathered. Gram-negative bacteria accounted for 46.9% of the 1273 positive UC, followed by Gram-positive bacteria with 28.8%, fungal pathogens with 13.1%, and Gram-negative non-fermenting bacteria with 11.2%. The most common uropathogenic organism (76.8%) was Pseudomonas aeruginosa, which was followed by Escherichia coli (55.6%), Staphylococcus epidermidis (22.9%), and Klebsiella pneumonia (24.3%). Candida albicans (69.5%) was determined to be the most frequent agent in terms of fungus, followed by C. glabrata (19.2%). The study revealed that the bacterial isolates exhibited effective resistance to antimicrobial drugs such as Amikacin, Cefepime, Ciprofloxacin, Gentamicin, imipenem, Levofloxacin, and Piperacillin/Tazobactam when administered against Gram-negative bacteria. Furthermore, the most effective antibiotics against Gram‑positive was Erythromycin but were sensitive to Vancomycin. Conclusions: One of the most typical infections that affect women is bacterial urinary tract infection. Using antibiotics for a very long time, and their misuse will result in the widespread growth of resistant bacteria.

Examining the Frequency of bla CTX-M and bla TEM Genes in Escherichia Coli Isolates with Multiple Drug Resistance Isolated from Patients Hospitalized in Ahvaz University Hospitals

Background and Objectives In the last few decades, Escherichia coli strains producing extended-spectrum beta-lactamases (ESBLs) have increased and are now considered a major problem in hospitalized patients. The aim of this study was to investigate the prevalence of blaCTX-M and blaTEM genes in Escherichia coli with multiple drug resistance. Subjects and Methods This study was conducted from October 2021 to May 2022. The research site included the microbiology laboratories of Golestan, Imam Khomeini, and Shahid Beqai hospitals where isolates suspected of Escherichia coli were isolated from urine culture samples of patients with urinary tract infection. All Escherichia coli samples were identified by conventional biochemical and molecular methods. The antibiotic sensitivity of the isolates was determined by disk diffusion method. Then, in order to finally confirm the presence of blaCTX-M and blaTE genes, PCR method was used. Results Out of the 160 bacterial isolates examined, 138 (86.3%) showed multidrug resistance (MDR). The highest and lowest percentage of resistance was related to Amoxicillin-Clavonic acid (84.1%) and Meropenem (5.8%), respectively. Based on the combined disk method, 96 isolates (69.6%) were positive for Beta-lactamase enzymes (ESBLs). Among the 96 ESBL-positive isolates, 85 (88.5%) and 38 (39.6%) carried blaCTX-M and blaTEM genes, respectively. Conclusion Given the significant prevalence of Escherichia coli strains that are resistant to multiple drugs and carrying ESBLs beta-lactamase genes in hospital, there is a need for effective surveillance measures to prevent the further spread of drug resistance in these isolates.

Hospital-acquired bacterial infections in COVID-19 intensive care unit: A retrospective cross-sectional study

BackgroundThe aim of this study was to determine the incidence of hospital-acquired infections (HAIs) in patients with SARS-CoV-2 coronavirus (COVID-19) infection admitted to the intensive care unit (ICU), and the most common causing pathogenic microorganisms. MethodsThis retrospective study included 535 patients admitted to the COVID-19 ICU of University Clinical Hospital Mostar from July 2020 to December 2021. The results of blood culture, urine culture, and bronchial aspirate samples were analyzed for each patient who met the inclusion criteria. ResultsOf a total of 535, 194 (36.2 %) patients had 313 confirmed HAIs at the COVID-19 ICU. The predominant infection was hospital-acquired pneumonia (HAP) (56.2 %), following bloodstream infections (BSI) (23.6 %) and urinary tract infections (UTI) (20.2 %). The most common isolate was multidrug-resistant (MDR) Acinetobacter baumannii causing 50.5 % of HAPs, 33.6 % of BSIs, and 9.6 % of UTIs. Furthermore, Klebsiella pneumoniae was the cause of 22 % of BSI, 22.9 % of UTI, and 17.5 % of HAP. Enterococcus species were the most common isolates of UTIs (43.4 %). Patients with HAIs stayed on average significantly longer in the ICU in comparison with patients without HAIs (12.1 ± 5.5 vs 6.7 ± 3.1 days, p < 0.001). ConclusionHospital-acquired infections are common complications in critically ill COVID-19 patients with a predominance of respiratory infections and are also associated with a significantly longer stay in the ICU.

Trimethoprim-Sulfamethoxazole and Ciprofloxacin Resistance Rates in Escherichia coli and Klebsiella spp. in Urinary Tract Infections: A 10-Year Evaluation

Objective: Urinary tract infections are the most common bacterial infections among community-acquired infections in all age groups. In this study, we aimed to evaluate the distribution of Escherichia coli and Klebsiella spp. in community-acquired urinary tract infections by years and the resistance rates to trimethoprim-sulfamethoxazole (TMP-SXT) and ciprofloxacin antibiotics, which are used as the first choice in community-acquired urinary tract infections. Methods: All urine culture samples from all age groups admitted to the medical microbiology laboratory from outpatient clinics and emergency services between January 2011 and August 2021 were retrospectively analyzed. Samples with E. coli and Klebsiella spp. detected as causative agents in urine cultures were included in the study. Conventional methods and automated systems were used to identify bacteria and for antibiotic susceptibility tests. Results: E. coli (n=50 430) and Klebsiella spp. (n=7763) isolated from urine cultures between January 2011 and August 2021 were evaluated. The lowest and highest resistance rates for ciprofloxacin and TMP-SXT for E. coli were 25-40% and 35-51%, respectively. Ciprofloxacin and TMP-SXT resistance rates for Klebsiella spp. were the lowest and highest at 17-43% and 31-43%, respectively. Conclusion: Knowing the resistance rates of antibiotics used as the first choice against common agents such as E. coli and Klebsiella spp. in treating community-acquired urinary tract infections may guide the empirical antimicrobial therapy.

Evaluating the pattern of antibiotic resistance of urinary tract infection (UTI)-causing bacteria in the urine culture samples of patients in the infectious ward of Imam Khomeini Hospital, Kermanshah, in Iran from 2016–2018

BackgroundIncreasing resistance of bacteria to antimicrobial agents is a significant problem worldwide. This study aimed to assess the pattern of antibiotic resistance among bacteria that cause urinary tract infections (UTIs) in patients admitted to the infectious ward of Imam Khomeini Hospital in Kermanshah between 2016 and 2018, based on urine culture samples.MethodsThe present study was a cross-sectional and descriptive study. The study’s statistical population included all patients referred to the infectious disease ward of Imam Khomeini Hospital due to urinary tract infections during the project period. Urine samples were collected in sterile containers, and by using a calibrated loop, the urine sample was cultured on EMB and blood agar media under sterile conditions. Microbial sensitivity was performed by standard disk diffusion method, and the results were analyzed using SPSS-V 16 software.ResultsThe antibiotic resistance assays showed that the highest resistance included nalidixic acid (73.5%), ciprofloxacin (72.1%), cotrimoxazole (70.6%), and ceftazidime (61.8%), cefixime (57.4%), ceftriaxone (48.5%), gentamicin (32.4%), cephalothin (16.6%), nitrofurantoin (10.3%), norfloxacin (5.9%), cefotaxime (4.4%), imipenem (2.9%), cefepime (2.9%), ampicillin (2.9%), ceftizoxime (1.5%), vancomycin (1.5%), cefazolin (1.5%), and chloramphenicol (1.5%), respectively. In addition, investigating the antibiotic resistance of UTI-causing bacteria according to the gender and age of the patients in the present study showed no significant statistical difference (P > 0.05).ConclusionThe bacteria causing urinary infections in the study area mainly belonged to the E. coli and Klebsiella families. Considering the determination of antibiotic sensitivity patterns in common organisms in the studied area, its report to doctors can be considered in experimental treatments.

Antibiotic Sensitivity on Isolates from Diabetic And Non-Diabetic Population Based In Pattoki Punjab

Objectives: To isolate and characterizing microorganisms from diabetic and non-diabetic patients and assessing the antimicrobial activity of isolate extracts from Citrus sinensis and Psidium guajava. Methodology: Experimental study of one year and six month duration from May 2016 to May 2018 conducted in Microbiology Laboratory University of Lahore, Pakistan. Convenient sampling was done by collecting the urine sample at random from 250 persons in the Pattoki community. All the urine samples from diabetic and non-diabetics were cultured separately and after biochemical confirmation of microorganisms, the disc diffusion method was used for carrying out an antimicrobial activity.Results: A total of 105 samples, were found to have positive urine cultures. Among these positive urine culture samples, 75 were diabetic and 30 were non-diabetics. The bacterial isolate most commonly found among diabetics was E.coli followed by the presence of Staphylococcus aureus, Klebsiella pneumoniae,Pseudomonas aeruginosa, Proteus vulgaris respectively. Minimal Inhibitory Concentration (MIC) of different parts of plant extracts against isolated bacteria from diabetics showed that the highest sensitivity was shown against peel, leaves and seed extracts of Citrus sinensis and Psidium guajava while the least sensitivity was shown against the stem and root extracts of these plants. Moreover, antibiotic sensitivity tests of isolated microbes showed that the highest resistance is found against Augmentin and Tetracycline while the most sensitive drug for isolates was found to be Chloramphenicol.Conclusion: From the results, it is concluded that leave extract of Psidium guajava and peel extracts of Citrus sinensis showed effective results against bacterial pathogens and could serve as a good alternate source of antibacterial agents

Systematic review–how do we identify urinary tract infections today?

Standard urine culture is still considered a gold standard in the identification of Urinary Tract Infections (UTIs), but is time-consuming and in approximately 20% of patients with UTI symptoms produces false-negative results. Medical and scientific communities are in search of a faster, more accurate, yet affordable method with high clinical utility. As a supplement to standard culture in routine practice Urine Flow Cytometer (UFC) screening method is used, in order to detect negative urine culture samples. This allows for shortening issuing time for sterile urine culture reports and the cost of the analysis itself. In addition, urine dipstick tests and microscopic examinations of urine sediment can also be performed in biochemical laboratories but are usually preceded by urine culture. Nowadays, advanced methods such as proteomics and genomics are used to identify pathogens causing UTIs but are still used mainly for scientific purposes and rarely in clinical practice. From genomic methods PCR, 16S rRNA gene sequencing, and metagenome sequencing are being researched. PCR is great for targeted diagnostics, 16S RNA gene amplification can determine bacterial genera and their abundance, but is not good for in-depth species analysis, while metagenomics is the most comprehensive and unbiased method. The proteomics field also offers several methods for microbial identification, with MS as the leading one. Clinical applications of MS platforms usually imply MALDI-TOF MS analyzers which produce a characteristic spectrum called peptide mass fingerprint or more present for scientific purposes LC-MS/MS-based peptide sequencing.

Detection of Extended Spectrum Beta-Lactamase (ESBLs) among Urinary Tract Patients in Khartoum State, Sudan

Background: Many different organisms can cause urinary tract infections, but Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus are the most prevalent ones. 60% of all antibiotics used to treat infectious diseases around the world are beta-lactam antibiotics, one of the main classes used to fight gram-negative and gram-positive bacteria. Objective: The purpose of this study is to detect and isolate Extended-Spectrum Beta-Lactamases (ESBLs), which are responsible for urinary tract infections, as well as check for any potential medication resistance. Materials and Methods: The gram stain technique and biochemical assays were used to identify 100 urine samples from Khartoum state hospitals based on their cultural characteristics and morphological appearance. Using the disk diffusion method, the isolates were tested for antimicrobial susceptibility to third-generation cephalosporins (Cefotaxime, Ceftazidime, and Ceftriaxone). The Combination Disk Technique (clavulanic acid+third-generation cephalosporins) was used to inoculate the bacterial isolates to demonstrate their capacity to create ESBL. In comparison to non-ESBL producers, the ESBL producers were assessed. Results: E. coli, Klebsiella, S. aureus, Proteus, and Pseudomonas were among the microorganisms isolated from UTI patients. 61% of the participants in this study were female, whereas 39% were male. E. coli has an increased frequency among isolated bacteria, as it presented in 46% of urine cultures, followed by pseudomonas and Klebsiella, each with a 22% frequency. Growth of the majority of the bacteria was found among females more frequently than males, and it also seems to be among older age patients than younger. Amoxyl alone and in combination with Clavulanic Acid (AAMC) was the most medicine that bacteria were resistant to (76%), but Ceftriaxone (CTR) has higher sensitivity (45%) and resistance (50%). The growth of the bacteria in the media of antibiotics was sorted into sensitive, intermediate, and resistant. Conclusions: Tested antibiotic resistance was higher for AAMC than for CTR, which is typically taken without performing urine sample culture and sensitivity testing, which over time leads to increased resistance.

Evaluation of the Sysmex UF-4000i urine analyzer as a screening test to rule out urinary tract infection and reduce urine cultures.

Urinary tract infection (UTI) diagnosis by urine culture is time- and labor- consuming. In the Ibn Rochd microbiology laboratory, up to 70% of urine culture samples yield no growth or insignificant growth. To evaluate the new generation of Sysmex UF-4000i fluorescence flow cytometry analyzer with a blue semiconducting laser as a method to rule out negative urine samples for UTI, in comparison of urine culture. Flow cytometry and microbiological analysis were performed on 502 urine samples included in the study. We used ROC analysis to determine cutoff points at which optimal sensitivity and specificity are achieved for clinical use. Our results showed that bacteria count at a cut-off of 100/μL, and/or the leucocytes count ≥45/μL are the optimal indicator for positive culture results. At these cut off, bacteria sensitivity (SE), specificity (SP), Positive predictive value (PPV) and negative predictive value (NPV) were 97,3%, 95%, 87,8% and 98,8% respectively. For leucocytes, SE, SP, PPV and NPV were 99,1%, 95,8%, 88,6% and 99,7% respectively. The bacterial and leucocytes counts generated by UF-4000i analysis may be useful in our context as a rapid screening to exclude UTI by reducing about 70% of urines cultures and then workload. Nevertheless, further validation is needed for different patient groups especially with urological disease or immunocompromised patients.

Enterococcus Species Isolated from Urine Cultures and Antibiotic Resistance Rates

While enterococci are found as flora elements in many parts of the body, they have recently emerged as different infectious agents such as urinary tract infections, bacteremia, and meningitis. Increasing antibiotic resistance also poses additional challenges in treatment. In this study, it was aimed to determine the species identification and antibiotic resistance rates of enterococci isolated from the urinary tract. Enterococcus strains isolated from urine culture samples sent to the routine microbiology laboratory from various clinics of our hospital between 01.01.2020 and 31.12.2021 with the preliminary diagnosis of urinary tract infection were included in this study. Samples were cultivated on sheep blood agar and eosin methylene blue agar, and species determination and antibiogram evaluation were carried out in accordance with the recommendations of EUCAST (European Committee on Antimicrobial Susceptibility Testing-2020-2021) using conventional methods and automated identification device (VITEK 2 Compact-BioMerieux-France). All enterococci isolates (n=349) were susceptible to vancomycin, teicoplanin, tigecycline and linezolid. Of Enterococcus faecalis isolates (n=238), 32.8% were resistant to ciprofloxacin, 23.7% to high-level gentamicin, 33.2% to imipenem, 2.5% to nitrofurantoin, and 26.9% to streptomycin. Of the Enterococcus faecium isolates (n=111), 84.7% were resistant to ciprofloxacin, 58.6% to high-level gentamicin, 91% to imipenem, 31.5% to nitrofurantoin, and 83.8% to streptomycin. In conclusion, it is important to determine the resistance patterns of enterococcus strains, which are most frequently isolated as the causative agent of urinary tract infection, and also cause other clinical presentations such as wound infection or bacteremia, and to establish appropriate treatment protocols and to determine new antibiotic resistances.

Detection of urogenital pathogens in sterile pyuria samples by polymerase chain reaction

BackgroundPatients with sterile pyuria may be infected with sexually transmitted diseases or have renal tuberculosis. This study investigated the possibility of detecting sexually transmitted diseases and Mycobacterialtuberculosis in sterile pyuria samples with polymerase chain reaction.MethodsForty-four day-3 negative urine culture samples were investigated for the presence of sexually transmitted diseases and Mycobacterialtuberculosis.ResultsAmong the 44 samples, 61.4% were positive by polymerase chain reaction (PCR) for bacterial DNA (either sexually transmitted diseases or Mycobacteria). Among the 27 positive samples, 37% were positive for Ureaplasmaurealyticum, 26% were positive for Chlamydiatrachomatis, 14.8% were positive for Neisseriagonorrhoeae, 11.1% were positive for Mycoplasmagenitalium, 7.4% were positive for Mycoplasmahominis, and only one sample (3.7%) was positive for Mycobacterialtuberculosis. No significant associations were found between PCR-positive urine samples and patient characteristics.ConclusionsIt was concluded that Ureaplasmaurealyticum was predominant in sterile pyuria followed by Chlamydiatrachomatis. There were no significant associations between PCR-positive samples and sex, symptomatic patients, or antibiotic use. PCR is an instant diagnostic tool for sexually transmitted diseases in sterile pyuria; hence, it is advised to be performed on negative culture samples as a routine laboratory screening test whenever possible.

Chromobacterium violaceum Related Urinary Tract Infection: A Case Report

Chromobacterium violaceum (C. violaceum) is a motile, gram-negative bacilli found in water and moist soil. Infections due to C. violaceum are uncommon but have a significant mortality rate (upto 80%) due to their tendency for haematogenous dissemination resulting in sepsis. The organism has been reported to cause skin and soft tissue infections, diarrhoea, bacteremia, and visceral abscess; Urinary Tract Infection (UTI) is rarely seen. Here, a 41-year-old male diabetic who presented with fever, altered sensorium and burning micturition caused by C.violaceum is presented. Initial investigations revealed an increased Random Blood Sugar (RBS) level, high anion gap metabolic acidosis with normal renal and liver function (except for hypoalbuminemia). Diabetic ketoacidosis, probable meningitis and urosepsis were considered as differential diagnosis. On culture of urine sample, C. violaceum was isolated which was susceptible to all the antibiotics tested except amikacin. Blood culture was reported as sterile. Patient was successfully treated with susceptible antibiotic (ciprofloxacin) and repeat culture of urine was also sterile. Early diagnosis and adequate treatment is necessary to reduce the risk of progression to fatal infection.

Determination of antibiotic resistance of E. coli isolated from urine culture samples

The high use of antibiotics causes the increasing trend of microbial resistance, followed by the limitation of treatment options, the complexity of the treatment, and the increase in the cost of the healthcare system. In this study, we examined antibiotic resistance of E. coli isolated from urine culture samples in Shahid Sadoughi Hospital, Yazd. This cross-sectional study was conducted on urine cultures related to patients hospitalized in different wards of Shahid Sadoughi Hospital in Yazd in 2021. Antibiotic resistance to E. coli isolates was investigated in 395 cultures, and the data was analyzed using SPSS software (version 26). The highest antibiotic resistance of E. coli was to ampicillin. Resistance to gentamicin was the highest in the surgery ward and the lowest resistance was observed in the women's ward. Also, the resistance to cefepime was the highest in the surgery ward and the lowest resistance rate was related to the emergency ward. The results of the present study showed the high antibiotic resistance of Ecoli isolates in hospitalized patients with urinary tract infection, especially in the population of men and elderly people.

Analysis of the Distribution and Drug Resistance of Pathogens in Patients with Urinary Tract Infection in the Eastern Chongming Area of Shanghai from 2018 to 2020.

The aim of this study was to clarify the distribution and drug resistance of pathogens causing urinary tract infection (UTI) and to provide a scientific reference for the rational application of antibiotics. The results of bacterial identification and drug sensitivity analysis of midstream urine samples in our hospital from January 2018 to December 2020 were retrospectively analyzed. The data were analyzed using WHONET 5.6 and SPSS 26.0 (IBM) software. In all, 1786 pathogens were isolated from 13,141 midstream urine culture samples. Of these, 1093 (61.2%) were gram-negative bacteria, mainly Escherichia coli [29.1%] and Klebsiella pneumoniae [14.3%]; 543 (30.4%) were gram-positive bacteria, mainly Enterococcus faecium [16.7%] and Enterococcus faecalis [8.4%]; and 150 (8.4%) were fungal isolates, with the most common being Candida albicans (3.7%). The resistance rates of E. coli to piperacillin/tazobactam (3.4% vs 10.0%, p<0.05), ampicillin/sulbactam (43.0% vs 53.8%, p<0.05), and ciprofloxacin (58.0% vs 72.9%, p<0.05) increased significantly. K. pneumoniae was highly sensitive to ertapenem (100%). Two Enterococcus spp were highly sensitive to tigecycline (100%), and a small number of norvancomycin-resistant strains were found. The drug resistance rate of E. faecium to quinupristin was 6.7%. The drug resistance rates of E. faecalis to furantoin and ampicillin were 4.0% and 4.7%, respectively. The pathogens that cause UTIs in patients are diverse, with the most common being E. coli. The isolated pathogens exhibited different resistance patterns. Antibiotics should be rationally selected based on the resistance patterns of the pathogens.