Urinary Isolates Research Articles

Study on Prevalence and Antimicrobial Sensitivity Pattern of Bacteria Causing Urinary Tract Infection in a Tertiary Care Hospital in Sylhet.

Background: UTI is one of the common bacterial infections occurring hospitals and the community of Bangladesh. Aims and objectives: The aim of this study is to determine the prevalence of UTIs in male and female patients as well as the effect of gender and age on its prevalence. And evaluate sensitivity to common antibiotics. Materials & methods: A cross-sectional observational study was conducted in the Department of Microbiology, Sylhet Women’s Medical College Hospital for a period from May 2021 to October 2021. Urine samples were collected from all suspected UTI patients attending to OPD/ IPD of various departments of Sylhet women’s Medical College Hospital. Isolation and antimicrobial susceptibility were performed using standard microbiological methods. Results: During the study period, a total number of samples sent to the microbiology laboratory from out and in patients of the various departments were 3139 of which 697 (18.0%) of the sample were tested positive and 2442 (82.0%) of the samples were negative. The overall prevalence of UTI for both male and female patients was found to be 18%. In this study, a high prevalence of UTIs showed in females (75%) than in males (25%).The highest susceptible age group of patients to UTI was the age group more than 60 years for both sex (30.3%). Escherichia coli was found the dominant bacteria among the isolated causative pathogens with a rate of (46.1%), the second highest is Klebsiella spp. (31.7%) followed by Staphylococcus saprophyticus 6.3%, Enterococcus faecalis 5.75%, Pseudomonas species 5.5% and Staphylococcus aureus 4.7%. Among them, a good number of isolated pathogens were multidrug resistance. Conclusion: This study reveals a significant prevalence of bacterial isolates in urine with multi drug resistance. Routine bacterial surveillance of causative agents and antibiotic susceptibility to prevent further emergence and spread of resistant bacterial pathogens.

Susceptibility Pattern of E. coli Isolates from Urinary Tract Infections, in Quetta

Globally Urinary tract infections (UTIs) are the serious health problem affecting about 150 million people per year. The most common cause of UTI is Gram negative bacteria that Belong to the family Enterobacteriaceae. Members of these families include Escherichia Coli, Klebsiella, Enterobacter and Proteus. Mid stream urine was collected in a sterile container from suspected case of UTI. The urine was inoculated by 1mm loop, on Mac Conkey agar and EMB agar, incubated at 37c, for 24 hours in aerobic atmosphere. After 24 the colony was examined for colony morphology, gram staining motility test. Biochemical test like Indole, Methyl red, Voges – Proskaur Citrate inoculated in related test media to identify the E. coli strains. Susceptibility pattern was done by disk diffusion method. Total 40 isolates of E. coli were included in this study. Out of them 22 were female and 18 were male patients. The age ranges from 4 less than 14 years 10 patients, 15-29 years, 12 patients from 30 -44 years,7 patients of 45-59 years. 7 more than 60 years age. The Antibiotic susceptibility was Imipenem 96.66%, Nitrofurantoin 96.15%, Amikacin 85%, Meropenem 71.42%, Fosfomycin 66.66%, Ceftazidime 27.27%, Pipemidic Acid 26%, Ceftriaxone 24.24%, Ciprofloxacin 14.81%, Nalidixic Acid 12.5%.E. coli is becoming resistant to routine urinary antibiotics like Nalidixic Acid Pipemidic Acid and Quinolones like ciprofloxacin. Cephalosporins are also loosing sensitivity against E. coli. Imipenem, Nitrofurantoin and Amikacin has good susceptibility against E. coli in urinary isolates

Prevalence and characteristics of multidrug-resistant Escherichia coli sequence type ST131 at two academic centers in Boston and Minneapolis, USA

Escherichia coli sequence type (ST) ST131, with its emergent resistance-associated H30Rx, H30R1, and C1-M27 clonal subsets, accounts for the greatest share of extraintestinal E. coli infections and most extended-spectrum β-lactamase (ESBL)-producing E. coli. We characterized and compared consecutive E. coli urine isolates from two geographically distinct medical centers in Minneapolis, Minnesota (n=172) and Boston, Massachusetts (n=143) for ESBL phenotype, CTX-M-type ESBL genes, phylogenetic groups, selected ST131 subclones, and 40 extraintestinal virulence genes. Whereas the Boston vs. Minneapolis isolates had a similar prevalence of phylogenetic groups (mainly B2: 79% vs 73%), ST131 (34% vs 28%), H30 (28% vs 21%), and H30Rx (6% vs 5%), the emerging C1-M27 subclone occurred uniquely among Boston (6%) isolates. ESBL production was more prevalent among Boston isolates (15% vs 8%) and among ST131 isolates. Identified ESBL genes included blaCTX-M-27 (Boston only) and blaCTX-M-15. Ciprofloxacin resistance was ST131-associated and similarly prevalent across centers. Boston isolates had higher virulence gene scores. Despite numerous similarities to Minneapolis isolates, Boston ST131 isolates demonstrated more prevalent ESBL production, higher virulence gene scores, and, uniquely, the C1-M27 subclone and blaCTX-M-27. Broader surveillance is needed to define the prevalence of ST131's globally successful C1-M27 subclone across the U.S.

Commensal Urinary Lactobacilli Inhibit Major Uropathogens In Vitro With Heterogeneity at Species and Strain Level.

The human urinary microbiome is thought to affect the development and progression of urinary tract infections (UTI), particularly recurrent UTIs in aging populations of women. To understand the possible interactions of urinary pathogens with commensal bacteria inhabiting the aging bladder, we conducted an initial functional assessment of a representative set of urinary lactobacilli that dominate this niche in postmenopausal women. We created a repository of urinary bladder bacteria isolated via Enhanced Quantitative Urinary Culture (EQUC) from healthy postmenopausal women, as well as those with a culture-proven recurrent UTI (rUTI) diagnosis. This repository contains lactobacilli strains from eight different species. As many other lactobacilli are known to inhibit human pathogens, we hypothesized that some urinary lactobacilli will have similar abilities to inhibit the growth of typical uropathogens and thus, provide a link between the urinary microbiome and the predisposition to the rUTI. Therefore, we screened the urinary lactobacilli in our repository for their ability to inhibit model uropathogens in vitro. We observed that many urinary isolates strongly inhibit model strains of gram-negative Escherichia coli and Klebsiella pneumoniae but demonstrate less inhibition of gram-positive Enterococcus faecalis. The observed inhibition affected model strains of uropathogens as well as clinical and multidrug-resistant isolates of those species. Our preliminary analysis of inhibition modes suggests a combination of pH-dependent and cell-dependent inhibition. Overall, inhibition strongly varies among species and strains of urinary lactobacilli. While the strength of the inhibition is not predictive of health outcomes in this limited repository, there is a high level of species and strain diversity that warrants future detailed investigations.

Outpatient Antibiotic Resistance Patterns of Escherichia coli Urinary Isolates Differ by Specialty Type.

ABSTRACTAntibiotic-resistant E. coli infections represent a major cause of morbidity and mortality and pose a challenge to antibiotic stewardship. We analyzed a large outpatient data set of E. coli urinary isolates to determine whether resistance patterns vary between types of outpatient practices. Using deidentified data from a clinical reference laboratory over 5 years and logistic regression, we examined the association of antibiotic resistance with outpatient practice type, controlling for testing year, patient sex, and patient age. The odds of antibiotic resistance were significantly higher in urology/nephrology practices for ampicillin (odds ratio [OR] 1.36; 95% CI, 1.10 to 1.69), ciprofloxacin (OR 2.29; 95% CI, 1.77 to 2.94), trimethoprim-sulfamethoxazole (OR 1.52; 95% CI, 1.18 to 1.94), and gentamicin (OR 1.72; 95% CI, 1.16 to 2.46). Odds of resistance were also higher for ciprofloxacin in oncology practices (OR 1.54; 95% CI, 1.08 to 2.15) and “all other specialties” (OR 1.33; 95% CI, 1.13 to 1.56). In contrast, specimens from obstetrics and gynecology practices had lower odds of having resistance to ampicillin (OR 0.90; 95% CI, 0.82 to 0.99) and trimethoprim-sulfa (OR 0.83; 95% CI, 0.73 to 0.93) but higher odds of having resistance to nitrofurantoin (OR 1.33; 95% CI, 1.03 to 1.70). Other findings included lower odds of having resistance to trimethoprim-sulfa in pediatric practices (OR 0.78; 95% CI, 0.64 to 0.94) and lower odds of having resistance to gentamicin in isolates from internal medicine practices (OR 0.66; 95% CI, 0.51 to 0.84) (all P < 0.05).IMPORTANCE Patterns of antibiotic resistance in E. coli urinary isolates can vary between outpatient specialties. The use of clinical data to create practice and specialty-specific antibiograms in outpatient settings may improve antibiotic stewardship.

Resistance to Mecillinam and Nine Other Antibiotics for Oral Use in Escherichia coli Isolated from Urine Specimens of Primary Care Patients in Germany, 2019/20.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Escherichia coli is by far the leading cause of community-acquired UTIs. Pivmecillinam, the oral prodrug of the penicillin derivative mecillinam (amdinocillin), was re-introduced in Germany in March 2016 for first-line treatment of acute uncomplicated cystitis. This study aimed to evaluate the prevalence of resistance to mecillinam in comparison to nine other antibiotics used for oral treatment in E. coli urine isolates after the re-introduction of pivmecillinam. A total of 460 isolates were collected at 23 laboratories of clinical microbiology between October 2019 and March 2020. Forty-six isolates (10.0%) produced an extended-spectrum β-lactamase (ESBL) of the CTX-M family. Resistance to amoxicillin (43.3%) was most widespread, followed by resistance to trimethoprim-sulfamethoxazole (27.0%), amoxicillin-clavulanic acid (18.0%), cefuroxime (11.3%), and ciprofloxacin (11.1%). Twenty-four E. coli isolates (5.2%) were resistant to mecillinam. The concentrations of mecillinam needed to inhibit 50/90% of the ESBL-producing isolates and the remaining isolates were 1/4 mg/L and 0.5/4 mg/L, respectively. The findings support the recommendation to regard pivmecillinam as a first-line option for the treatment of uncomplicated lower UTIs.

Antimicrobial resistance in urinary pathogens and culture-independent detection of trimethoprim resistance in urine from patients with urinary tract infection

BackgroundAlthough urinary tract infections (UTIs) are extremely common, isolation of causative uropathogens is not always routinely performed, with antibiotics frequently prescribed empirically. This study determined the susceptibility of urinary isolates from two Health and Social Care Trusts (HSCTs) in Northern Ireland to a range of antibiotics commonly used in the treatment of UTIs. Furthermore, we determined if detection of trimethoprim resistance genes (dfrA) could be used as a potential biomarker for rapid detection of phenotypic trimethoprim resistance in urinary pathogens and from urine without culture.MethodsSusceptibility of E. coli and Klebsiella spp. isolates (n = 124) to trimethoprim, amoxicillin, ceftazidime, ciprofloxacin, co-amoxiclav and nitrofurantoin in addition to susceptibility of Proteus mirabilis (n = 61) and Staphylococcus saprophyticus (n = 17) to trimethoprim was determined by ETEST® and interpreted according to EUCAST breakpoints. PCR was used to detect dfrA genes in bacterial isolates (n = 202) and urine samples(n = 94).ResultsResistance to trimethoprim was observed in 37/124 (29.8%) E. coli and Klebsiella spp. isolates with an MIC90 > 32 mg/L. DfrA genes were detected in 29/37 (78.4%) trimethoprim-resistant isolates. Detection of dfrA was highly sensitive (93.6%) and specific (91.4%) in predicting phenotypic trimethoprim resistance among E. coli and Klebsiella spp. isolates. The dfrA genes analysed were detected using a culture-independent PCR method in 16/94 (17%) urine samples. Phenotypic trimethoprim resistance was apparent in isolates cultured from 15/16 (94%) dfrA-positive urine samples. There was a significant association (P < 0.0001) between the presence of dfrA and trimethoprim resistance in urine samples containing Gram-negative bacteria (Sensitivity = 75%; Specificity = 96.9%; PPV = 93.8%; NPV = 86.1%).ConclusionsThis study demonstrates that molecular detection of dfrA genes is a good indicator of trimethoprim resistance without the need for culture and susceptibility testing.

Nitrofurantoin-resistant Escherichia coli in the UK: genetic determinants, diversity, and undetected occurrences

Background Antimicrobial resistance in enteric or urinary E. coli might predispose invasive E. coli infection and bacteraemia. Nitrofurantoin resistance occurs in &lt;6% of UK urinary E. coli isolates, however, 2018 national recommendations to prescribe nitrofurantoin for uncomplicated urinary tract infection (UTI) raised concerns for increased prevalence of nitrofurantoin-resistant E. coliin the future. Therefore, we investigated mechanisms of nitrofurantoin resistance in UK E. coli isolates and assessed their occurrences in a large dataset of E. coli genomes. Methods To elucidate chromosomal and acquired genetic determinants of nitrofurantoin resistance in E. coli, we analysed whole-genome sequences of nine randomly selected nitrofurantoin-resistant UTI E. coli isolates from West London. We then performed targeted analysis of 12,412 E. coli genomes collected from across the UK and predicted nitrofurantoin susceptibility from identified genotypes. Results Using comparative genomics, we found known and novel point mutations or insertion sequences (ISs) in chromosomal genes encoding oxygen-insensitive nitroreductases NfsA and NfsB in the nine isolates. Most of these genetic alterations resulted in gene inactivation. We also identified the same kinds of mutations in NfsA, NfsB, and their associated enzyme RibE in a number of 12,412 E. coli genomes. We also observed homoplasic mutations in all these proteins. By contrast, multidrug efflux pump OqxAB, which confers resistance when horizontally transferred, was only encoded by one genome. Conclusions Chromosomal de novo mutations and ISs are main causes of nitrofurantoin resistance in UK E. coli. Prevalence of nitrofurantoin resistance should be monitored among urine, blood, and enteric isolates as nitrofurantoin exposure increases.

Using machine learning to predict antibiotic resistance to support optimal empiric treatment of urinary tract infections

Background: Antibiotic resistance is pervasive in the Veterans’ Affairs (VA) healthcare system, with rates of fluoroquinolone and trimethoprim–sulfamethoxazole (TMP/SMX) resistance approaching 30% in E. coli urinary isolates. The efficacy of antimicrobial treatment is critically dependent on the susceptibility of the infecting pathogen; however, prescription decisions are often made empirically in practice. We analyzed susceptibility profiles of enteric gram-negative rods (Enterobacterales) from clinical urine cultures collected from ambulatory patients receiving care in VA clinics and emergency departments. Our goals were (1) to develop a predictive model to support choice of empiric antibiotics pending results of susceptibility testing and (2) to examine the relationship between past antibiotic exposures and susceptibility profiles to enhance understanding of antibiotic selective pressure. Methods: We obtained 265,076 positive cultures from 157,422 unique patients from 2015 to 2020. We trained random forest multinomial classifiers to estimate the risk of a positive urine culture isolate being resistant to the multinomial outcome: fluoroquinolone, TMP–SMX, cephalosporin, or any combination of these 3 agents. Data sources evaluated for model generation included demographics, comorbidities, trend and seasonal terms, treatment history for multiple antimicrobial treatments summarized using number of prescriptions in weekly intervals, and sample history summarized by number of resistant and susceptible cultures in weekly intervals. Using 5-fold cross validation, we assess the performance of the clinical prediction using the area under the receiver operating characteristic curve (AUC) for each multinomial outcome. In addition to prediction, we modeled the direct effect of treatment on resistance using multinomial group lasso (MGL). This method allows variable selection in variable groupings, such as all variables related to the fluoroquinolone treatment history, which allowed us to assess the effect of a patient’s complete course of treatment on resistance. Results: In cross-validation analysis, our random forest model was best at predicting outcomes with fluoroquinolone resistant phenotypes compared to non–fluoroquinolone-resistant phenotypes (Table 1). From MGL, we found that having a prescription for fluoroquinolone treatment 4–8 weeks prior to a urinalysis was positively associated with fluoroquinolone resistance and negatively associated with fluoroquinolone susceptible phenotypes (Fig. 1). Conclusions: Our results show that a patient’s sample and treatment history are highly predictive of a future resistance. Fluoroquinolone treatment is especially associated with increased risk of fluoroquinolone single- and multidrug resistances. A history of either fluoroquinolone or trimethoprim-sulfamethoxazole (TMP-SMX) treatment is a stronger indicator of a future resistant phenotype than cephalosporin or penicillin.Funding: NoneDisclosures: None

Virulence-associated genes analysis of carbapenemase-producing Escherichia coli isolates.

Carbapenem-resistant Escherichia coli has emerged as a major public health issue across the world. This study was aimed to determine the virulence content and phylogenetic groups of carbapenemase-producing E. coli isolates in southwest Iran. One hundred and fifty-two non-duplicate E. coli isolates were collected from various clinical samples. Antibiotic susceptibility and minimum inhibitory concentrations (MIC) were determined according to the Clinical and Laboratory Standards Institute (CLSI) guidelines by Kirby-Bauer disc diffusion and agar dilution methods. Phenotypic screening of carbapenemase enzymes was performed by modified Hodge test (MHT). Detection of carbapenemase genes, phylogenetic groups, and virulence-associated genes were also performed by the PCR assay. The highest and lowest resistance rates were observed against mezlocillin (70.4%) and doripenem (13.1%), respectively. Out of 28 isolates that were resistant to carbapenem antibiotics, 12 (7.9%) strains were phenotypically carbapenemase producers. The blaOXA-48 was the predominant carbapenemase gene, detected in 58.3% of isolates, followed by blaIMP (41.7%) and blaNDM (8.3%). None of the isolates harbored blaVIM and blaKPC genes. Among the twelve carbapenemase-producing strains, urinary isolates were mostly classified into B2 (41.7%) and D (25%) phylogenetic groups, while other clinical isolates belonged to B1 (25%) and A (8.3%) groups. The frequency of virulence-associated genes was also investigated in all isolates and ranged from 6.6% for hly to 75% for fimA. The emergence of carbapenemase-producing strains is a growing concern to public health. Therefore, the proper implementation of monitoring programs is crucial for limiting their dissemination.

Profiling the plasmid conjugation potential of urinary Escherichia coli.

Escherichia coli is often associated with urinary tract infection (UTI). Antibiotic resistance in E. coli is an ongoing challenge in managing UTI. Extrachromosomal elements – plasmids – are vectors for clinically relevant traits, such as antibiotic resistance, with conjugation being one of the main methods for horizontal propagation of plasmids in bacterial populations. Targeting of conjugation components has been proposed as a strategy to curb the spread of plasmid-borne antibiotic resistance. Understanding the types of conjugative systems present in urinary E. coli isolates is fundamental to assessing the viability of this strategy. In this study, we profile two well-studied conjugation systems (F-type and P-type) in the draft genomes of 65 urinary isolates of E. coli obtained from the bladder urine of adult women with and without UTI-like symptoms. Most of these isolates contained plasmids and we found that conjugation genes were abundant/ubiquitous, diverse and often associated with IncF plasmids. To validate conjugation of these urinary plasmids, the plasmids from two urinary isolates, UMB1223 (predicted to have F-type genes) and UMB1284 (predicted to have P-type genes), were transferred by conjugation into the K-12 E. coli strain MG1655. Overall, the findings of this study support the notion that care should be taken in targeting any individual component of a urinary E. coli isolate’s conjugation system, given the inherent mechanistic redundancy, gene diversity and different types of conjugation systems in this population.

MP02-03 GENETIC ADAPTATIONS OF ENTEROCOCCUS FAECALIS TO FITNESS AND PERSISTENCE IN THE URINARY TRACT

You have accessJournal of UrologyCME1 May 2022MP02-03 GENETIC ADAPTATIONS OF ENTEROCOCCUS FAECALIS TO FITNESS AND PERSISTENCE IN THE URINARY TRACT Belle Sharon, Dennise Palacious Araya, Moutusee Islam, Philippe Zimmern, Kelli Palmer, and Nicole De Nisco Belle SharonBelle Sharon More articles by this author , Dennise Palacious ArayaDennise Palacious Araya More articles by this author , Moutusee IslamMoutusee Islam More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , Kelli PalmerKelli Palmer More articles by this author , and Nicole De NiscoNicole De Nisco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In postmenopausal women, urinary tract infection (UTI) commonly develops into recurrent UTI (rUTI). Enterococcus faecalis, part of the normal flora of the gastrointestinal tract, is frequently associated with UTI. The presence of E. faecalis in the gastrointestinal tract has been proposed as a predisposing factor for UTI. Although E. faecalis is commonly found in urine of both healthy women and those with rUTI, factors E. faecalis utilizes to colonize the urinary tract remain unclear. The goal of this work is to use comparative genomics to identify adaptations that enable E. faecalis persistence in the urinary niche. METHODS: We completed Illumina and Nanopore sequencing of 37 urinary and 15 gut E. faecalis strains. Generated hybrid genome assemblies provided complete chromosome and plasmid sequences. We curated a database of additional 93 E. faecalis reference genomes (34 gut, 13 urine, 46 blood) and performed Pangenome analysis to assess genetic diversity. Bioinformatic analyses of Multilocus Sequence Typing, Plasmid Typing, Antimicrobial Resistance Gene (ARG) predictions, and pan-Genome Wide Association Studies were done to identify genetic factors associated with urinary strains. RESULTS: Pangenome analysis of 146 E. faecalis genomes revealed diversity among urine strains. Gene enrichment analysis identified enrichment of csp, a gene encoding a cold shock protein (CSP) in urine isolates (86%) compared to gut (51%) and blood (72%). Plasmid types were not significantly different among urinary and gut strains. Urinary strains demonstrated stronger similarity to gut strains in terms of mean genome size, plasmid types, and prevalence of ARGs apart from Vancomycin resistance which was absent in all strains. CONCLUSIONS: Urinary isolates are genetically diverse and no strong clonal cluster was associated with urinary E. faecalis. This suggests multiple E. faecalis lineages may colonize the urinary tract in opportune circumstances. Finding that urinary and gut E. faecalis strains are most similar supports the hypothesis that urinary strains arise from gut reservoirs of E. faecalis. Finally, we have identified csp as an intriguing candidate gene that may be involved in adaptation of E. faecalis to the urinary niche. Source of Funding: The Welch Foundation to NJD, NIH grant R01AI116610 and the Cecil H. and Ida Green Chair to KLP © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e10 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Belle Sharon More articles by this author Dennise Palacious Araya More articles by this author Moutusee Islam More articles by this author Philippe Zimmern More articles by this author Kelli Palmer More articles by this author Nicole De Nisco More articles by this author Expand All Advertisement PDF DownloadLoading ...

Detection of E. Coli Bacteria in Urinary Tract Infection in Emergency Department at Alimmam Al-Sadiq Hospital: Hilla \ Iraq

Background: Urinary tract infection (UTIS) is a common microbial infection in community and in all age groups. are alarming worldwide. Therefore, this study aims to detection antibiotics resistance of Escherichia coli (E. coli) bacteria responsible for UTIS Methods: Retrospective chart review for patients admitted to emergency department and diagnosed with UTIS at Al-immam Al-SAdiq Hospital between February to April 2021 was performed. Antimicrobial susceptibility to ampicillin, augmentin (amoxicillin/clavulanate), cefazolin, co-trimoxazole (sulfamethoxazole/trimethoprim), ciprofloxacin, and nitrofurantoin, and cefpodoxime was determined for 101 E. coli urinary isolates. Results: Escherichia coli was the most bacteria causing UTIS representing 93.55, 60.24, and 45.83% of all bacteria isolated from urine culture of pediatric, adult, and elderly, respectively. High rates of resistance to ampicillin (82.76, 58, and 63.64%) and co-trimoxazole (51.72, 42, and 59.09%), among E. coli isolated from pediatric, adult and elderly respectively. Nitrofurantoin was the most active agent, followed by ciprofloxacin, augmentin and cefazolin. 22.77% of E. coli isolates exhibited multiple drug resistance (MDR). Among 66 and 49 isolates resistant to ampicillin and co-trimoxazole, respectively, 34.84 and 42.85% were MDR. In contrast, all isolates resistant to augmentin and nitrofurantoin were MRD, while 72.7 and 82.4% of isolates resistant to ciprofloxacin and cefazolin were MDR. Conclusions: High resistance was observed to ampicillin and co-trimoxazole which commonly used as empirical treatments for UTIS, limiting their clinical use. This necessitates continuous surveillance for resistance pattern of uropathogens against antibiotics. Keywords: Antibiotics sensitivity , E. coli bacteria , UTIS.

Increased rates of extended-spectrum beta-lactamase isolates in patients hospitalized with culture-positive urinary Enterobacterales in the United States: 2011 – 2020

Antimicrobial resistance in Enterobacterales has made empiric therapy for hospitalized patients with urinary tract infections (UTIs) more challenging. We analyzed the antibiotic susceptibility of nonduplicate Enterobacterales isolates from urine cultures tested at US hospitals in the BD Insights Research Database (2011–2020). Multivariable generalized estimating equation models were used to assess resistance trends over time. A total of 322 US hospitals provided data on 876,507 urinary Enterobacterales isolates (62.4% Escherichia coli). Enterobacterales antibiotic resistance rates were 64.6%, 29.3%, 27.6%, and 26.3% for beta-lactams, fluoroquinolones, nitrofurantoin, and trimethoprim/sulfamethoxazole, respectively, and 12.4% had an extended-spectrum beta-lactamase (ESBL) phenotype. In multivariable models, rates of ESBL isolates and isolates resistant to ≥3 drug classes increased significantly between 2011 and 2020, while other categories of resistance generally decreased. We conclude that antimicrobial resistance is common in urinary Enterobacterales isolates. Management of UTIs should be guided by urine culture data and may benefit from new therapies.

Antibiogram of Urinary Tract Infections and Sepsis among Infants in Neonatal Intensive Care Unit.

Neonatal infections including sepsis and urinary tract infections are considered among the leading causes of mortality in neonatal intensive care units (NICU). Thus, use of empiric antibiotics is very important in infected neonates and the success of this practice is mainly reliant on the availability of an up-to-date antibiogram for currently used antibiotic drugs. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of bacteria isolated from blood or/and urine cultures belonging to patients at the NICU. A total of 54 urine samples were collected in the period between January 2015 and December 2019. Data of infants with positive urine and blood bacterial isolates were gathered retrospectively. The most commonly isolated bacteria from urine observed were K. pneumoniae (44%) and E. coli (39%), while Acinetobacter baumannii (33%) and K. pneumoniae (22%) predominated in neonatal blood samples. The majority of uropathogens and blood isolates exhibited low resistance to imipenem and tigecycline, respectively. These antibiotics would be recommended for future use as empirical treatment in neonates with urinary tract infections and/or sepsis. This investigation highlights the importance of surveillance studies to manage and ensure the effectiveness of treatment plan for critically ill infants.

First Record of Dissemination of BLBLI-Resistant Enterobacter cloacae from Public Hospitals in Baghdad, Iraq

Background: Enterobacter cloacae are most frequently isolated from human clinical specimens. Objective: This cross-sectional study aimed to investigate the dissemination of E. cloacae clinical isolates resistant to β-lactam-β-lactamase inhibitor (BLBLI) combinations from different clinical specimens of hospitalized patients. Methods: E. cloacae isolates were recovered from different clinical samples of hospitalized patients in three main hospitals in Baghdad city. E. cloacae isolates were identified based on their morphology and biochemical tests, and the identification was confirmed using Vitek-2 system. The antibiotic susceptibility testing of E. cloacae isolates to a variety of antibiotics was achieved using disc diffusion test (DDT) and Vitek-2 system. Results: Results found that among 335 culture-positive samples, 30 isolates (8.9%) belonged to E. cloacae. A high rate of isolation was observed in urine isolates (46.6%), followed by wounds (burns) isolates (26.6%). Out of 30 E. cloacae strains isolated during this study, 18 (60%) showed reduced susceptibility to BLBLI combinations. TEM genes (TEM-1 and TEM-2) were successfully amplified from 7/18 isolates (38.8%) and high rate of BLBLI genes was detected (CTX-M, bla-SHV, SHV-2, and OXA-1). However, no BLBLI genes of bla-AmpC, bla- OXA-2, and bla- OXA-10 were found in E. cloacae isolates when tested using specific primers for bla-AmpC and bla-OXA genes. Conclusion: From this study, we can conclude that the production of inhibitor-resistant β-lactamases by E. cloacae isolates could be increasingly common in nosocomial pathogens other than E. coli or K. pneumoniae in public hospitals in Baghdad, Iraq.

Occurrence of Extended-spectrum Beta-lactamases and the Antibiogram Pattern of Escherichia coli Isolates from Pus and Urine Samples

Escherichia coli (E. coli) is a significant species and a common dweller in the guts of humans and animals causing urinary tract infections, wound infection, otitis media, bloodstream infections, and other complications in humans. Worldwide resistance to antimicrobials is a serious public health problem. β-lactamases production by E. coli is responsible for resistance to frequently used beta-lactam antibiotics. 1) To determine antibiotic susceptibility pattern of Escherichia coli isolated from pus and urine samples 2) To determine ESBL producing Escherichia coli and its antibiotic susceptibility pattern. Retrospective study of E. coli isolates from urine and pus samples was performed by collecting data from bacteriology registers. Gender, age details of patients, number of E. coli isolates, and their antimicrobial susceptibility profiles were collected from the records. Out of 747 samples 102 E. coli were isolated and among them 60 (59%) were ESBL producers. Male preponderance was seen i.e. 59 (57.84%) and majority 68 (66.66%) were isolated from the age group of &lt;18 years. E. coli showed maximum sensitivity to imipenem 88 (86.27%), followed by piperacillin-tazobactam 84 (82.35%), aminoglycoside group 76 (74.5%) and maximum resistance was seen to penicillin groups 92 (90.19%), followed by cephalosporins 71 (69.6%). Urinary isolates showed maximum sensitivity to nitrofurantoin (93.67%). ESBL producers showed resistance to ciprofloxacin 47 (78%). This study helps in the periodic formulation of regional antimicrobial policies and also giving continuous information to the clinicians with respect to the sensitivity pattern along with ESBL production which can help to avert further drug resistance.

Assessment of Antibacterial Efficacy of Callistemon viminalis (Sol. ex Gaertn.) G. Don against Some Isolates Obtained from Urinary Tract Infections.

This study aimed to examine the antibacterial effects of constituents obtained from Callistemon viminalis leaves. This goal was achieved by using three organic solvents, namely Ethanol, Ethyl acetate, and Hexane to prevent the growth of the causative urinary tract infections isolates, such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, and Proteus sp. in Iraq. The C. viminalis fresh leaves collected from different regions of Hillah City, during March 2020, were classified according to the taxonomic features of Iraqi Flora. Extractions were completed by a method of digestion and then the stock solution of 200 mg/mL was prepared in 10% of Dimethylsulfoxide. A Millipore filter (0.22 µm) was used for the sterilization of all the extracts used in this study. Agar well diffusion method was utilized to test the antibacterial effects of the constituents separated from the dried leaves of C. viminalis against the urinary tract infection bacteria at three concentrations of 50, 100, and 200 mg/mL for each extracted constitute by the three different solvents. Dimethylsulfoxide 10% and the meropenem were utilized as the negative and positive controls. Constituents separated by ethanol solvent at 200 mg/mL exhibited significant supremacy (P≤0.05) over the meropenem against Proteus sp. isolate, and exhibited the same significant difference (P≤0.05), compared to the meropenem drug against E. coli. Constituents extracted by Ethyl acetate organic solvent at a concentration of 200 mg/mL exhibited a similarly significant effect (P≤0.05), compared to the meropenem against Proteus sp. isolate. However, the hexane extract was the least effective among the other solvents utilized in this study. The results of the current study revealed that constituents in the leaves of C. viminalis could be considered a valuable herbal remedy for controlling urinary tract infections pathogenic bacteria.

Outpatient antibiogram and predictors of ciprofloxacin and trimethoprim-sulfamethoxazole resistant urinary tract infections.

Context: Rising antibiotic resistance has transcended hospital boundaries and impacted individuals with community acquired urinary tract infections (UTI). Scant data on antibiotic resistance in outpatient settings exists and most studies in the United States (U.S.) have identified predictors of resistance in acute-care settings. Objective: Determine the antibiogram among Escherichia coli isolates and factors associated with ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) resistant gram-negative urinary isolates. Study Design: Retrospective cohort study. Setting: Two primary care, safety-net clinics in Houston, TX between 11/2018 and 3/2020. Population studied: Patients aged 18 and older presenting with provider suspected uncomplicated or complicated UTI. Outcome measures: Resistance and predictors of resistance to UTI-relevant antibiotics. Results: Among 1265 cultures collected, 372 (28.4%) were positive. We detected E. coli (50.3%) and Group B Streptococcus (18.6%) most frequently. Our patient population consisted mostly of Hispanic (75.7%) females (92.5%) born outside the U.S. (67.3%) with a mean age of 47. Among patients with E. coli isolated (n=189), antibiotic resistance was highest to ampicillin (63%), TMP-SMX (44%), ciprofloxacin (31%), and cefazolin (30%); no or low resistance against amikacin (0%), fosfomycin (0%), and nitrofurantoin (2.7%) was detected. Approximately 12% of E. coli isolates were extended-spectrum beta-lactamase positive. Having a prior UTI caused by a TMP-SMX resistant gram-negative organism and being born outside the U.S increased the odds of TMP-SMX resistance by 3.71 (95% confidence interval: 1.6-9.2) and 3.08 (95% CI: 1.6-6.3), respectively. Having a complicated UTI (odds ratio (OR): 3.58; 95% CI: 1.1-12.1), prior fluoroquinolone use (OR: 6.81; 95% CI: 1.7-34.1) and a prior UTI with ciprofloxacin resistance (OR: 7.84; 95% CI: 3.2-20.7) increased the odds of having a ciprofloxacin resistance. Conclusion: The Infectious Disease Society of America cautions against prescribing an antibiotic if regional resistance exceeds 20%. We constructed an antibiogram and found resistance surpassed this threshold for TMP-SMX and ciprofloxacin and identified factors associated with resistance to these agents. Assessing these characteristics during clinical decision making may improve antibiotic-organism susceptibility concordance in primary care.

Risk Factors for Trimethoprim and Sulfamethoxazole-Resistant Escherichia Coli in ED Patients with Urinary Tract Infections

BackgroundWhile trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs). MethodsThis multicenter, retrospective study included adult patients who were discharged from 12 emergency departments (EDs) with a urine culture positive for E. coli between January 1, 2019 and December 31, 2019. Logistic regression was used to assess the relationship between potential risk factors and TMP-SMX resistance. The overall institutional antimicrobial resistance rates for E. coli were compared to the rates seen in the study population of ED urinary isolates. ResultsAmong 427 patients included from a randomized sample of 500 with a urine culture positive for E. coli, 107 (25.1%) were resistant to TMP-SMX. Three predictors of TMP-SMX resistance were identified: recurrent UTI (OR 2.27 [95% CI 1.27–3.99]), genitourinary abnormalities (OR 2.31 [95% CI 1.17–4.49]), and TMP-SMX use within 90 days (OR 8.77 [95% CI 3.19–28.12]). When the antibiotic susceptibilities for this ED cohort were compared to the institutional antibiogram, the TMP-SMX resistance rate was found to be higher in the ED population (25.1% vs 20%). ConclusionsTMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.