Causative Organisms of Urinary Tract Infection and Antibiotic Susceptibility Among Patients Attending in Tertiary Care Hospitals of Bangladesh

Background: Urinary tract infections (UTIs) are considered to be the chronic public health problem due to morbidity and financial cost as urological diseases causes the highest health care cost. UTI is known as one of the most common diseases today. UTI can occur in both men and women, but studies found that the incidence of UTI is more common in women especially among the sexually active women. Material & Methods:This study was a retrospective cross-sectional study which was conducted at the department of Medicine in Tairunnessa Memorial Medical College and Hospital, Gazipur, obstetrics and gynecology in Bikrampur Bhuiya Medical College and Hospital, Munshiganj and Medicine in City Medical College and Hospital, Gazipur. The study was conducted during the period of February 2018- January 2022. The total sample size for this study was 131.Results:Most of the respondents 56(42.7%) were aged from 26-35 years. Majority of them 117(89%) were female whereas only 14(11%) were male. Burning sensation of micturition was found in 115 patients where 46(40%) had burning for 0-3 days, 63(54.8%) for 4-7 days and 6(5.2%) for >7 days. In most cases causative organism was E. Coli in this study. According to sensitivity patterns of E. Coli Amoxiclav was used in 77(59%) cases and followed by Amikacin in 94(72%), Azithromycin in 120(92%), Cefixime in 130(99.2%), Ceftriaxone in 83(63.3%), Cefuroxime in 37(28.2%), Imipenem in 62(47%), Ciprofloxacine 64(49%), and Gentamicin in 38(29%) cases. In assessing the antibiotic resistance pattern of E. coli Ampicillin was used in 55(42%) cases and followed by Amoxycillin in 98(75%), Colchicine in 13(10%), Linezolid in 35(26.2%), Amoxiclav in 54(41.2%), Colistin in 16(12.2%), Imipenem in 69(53%) and Novobiocin in 62(47%) cases.Conclusions:Antibiotics are considered to be the only treatment for UTI. But antibiotic resistance is highly prevalent in bacterial isolates around the world, especially in developing countries.

Evaluation of Pathogens Causing Urinary Tract Infection and Their Sensitivity Pattern

Background: UTI constitute a major public health problem in India accounting 2nd most common infection next to respiratory tract infection. They are responsible for increasing treatment cost and significant morbidity.Aim:-To determine the incidence of UTI, evaluation of pathogens responsible and their antimicrobial susceptibility pattern in the population.Methods:Urine samples were collected from 300 patients attending the OPD Patna medical college, Patna during the period of 18 months (January 2017 to June 2018) Antimicrobial sensitivity testing was done for the bacterial isolates present in the sample by Kirby- Bauer disc diffusion method. Only those samples were taken into consideration which develops count equal to or greater than 1*105CFU/ml as indicated by Kass.Results:Out of 300 samples collected 146 (48.66%)) yielded bacterial growth. Out of 146 culture isolates E.Coli was the most common pathogen followed by klebsiella, CoNS and staphylococcus. Antibiotic sensitivity was performed on all the isolates. It was observed that highest sensitivity was 49.31% to amikacin, gentamycin (45.89%), nitrofurantoin (38.35%) meropenem (27.39%).Conclusions:It was observed that high grade of resistance to ampicillin, cotrimoxazole, ciprofloxacin, cefuroxime, chloramphenicol, cefotaxime, cefazolin, amoxicillin + clavulanic acid and gentamycin is present as a result of misuse or improper use of antibiotic in the community. Hence urine culture is necessary for the diagnostic screening of UTI before the treatment.

Antibiogram of Gram Negative Uropathogens in a Tertiary Care Hospital

Background:In wide range, urinary tract infection (UTI) is a substantial and second most popular bacterial infection affecting individuals of overall ages worldwide. The chronicity of divergent bacterial isolates and their propensity to various antibiotics may contradict widely, peculiarly in hospitalized patients, this makes the survey of vulnerability pattern extremely mandatory for correct selection of antibiotics. Objective: To appraise antimicrobial susceptibility pattern of the Gram negative organisms identified from urine cultures of hospitalized patients. Methodology:Total 500 urine samples from hospitalized patients with significant bacteriuria were surveyed. Using Blood and MacConckey agar, samples were inoculated. Further identification and investigation of organisms was done by standard Microbiological methods. Antimicrobial Susceptibility pattern was interpreted by Modified Kirby- Bauer's disc diffusion method with the group of 15 drugs as per Clinical Laboratories Standard Institute (CLSI) protocols.Results:UTIs were frequent in females 290 (58%). Familiar organism found was Escherichia coli 260 (52%) further accompanied by Klebsiellaspp.120 (24%), Pseudomonas spp.40 (8%), Proteus spp. 38 (7.6%), Citrobacter spp.25(5%) and Acinetobacterspp. 17 (3.4%). Mass of the strains were found sensitive to nitrofurantoin followed by amikacin, piperacillin-tazobactamand cotrimoxazole. Commonly prescribed fluroquinolones were found least effective for treatment of UTI. All the strains were found sensitive to imipenem. Extended spectrum beta lactamase (ESBL) was noted in E.coli and in Klebsiella spp.Conclusion:To break the continuity of non selective use of antibiotics and to intercept further development of bacterial drug resistance, proper knowledge of susceptibility pattern of uropathogens in particular area is very important before prescribing any empirical antibiotic therapy

Identificación de los mecanismos resistencia enzimáticos en uropatógenos de pacientes ambulatorios de un hospital público de San Lorenzo, Paraguay; 2015-2019 / Identification of enzyme resistance mechanisms in pathogens from an outpatient clinic in a public hospital in San Lorenzo, Paraguay; 2015-2019

Introducción: El propósito del estudio es determinar en los urocultivos, la prevalencia de los mecanismos enzimáticos de resistencia encontrados in vitro. Materiales y métodos: Se realizó un estudio retrospectivo, de ambos sexos, mayores de 18 años, que acudieron al Consultorio Externo de Clínica Médica y Urgencias por síntomas de infección urinaria. Se incluyeron todos los urocultivos en los que se aislaron uropatógenos con recuento ≥ 105 UFC/mL. Se excluyeron los urocultivos polimicrobianos, los que no contaban con antibiograma o aquellos con datos clínicos incompletos. Resultados: Se identificaron 1031 urocultivos que cumplieron con los criterios establecidos para la realización del estudio. El 56% correspondió al sexo femenino y el 43% al masculino. La edad media de las mujeres fue de 52± 20 años y el de los hombres fue de 62±16 años. Los uropatógenos más frecuentes fueron Escherichia coli 553 (52% en promedio) seguida de Klebsiella pneumoniae con 148 (14% en promedio). Urocultivos de varones: El principal mecanismo de resistencia de Escherichia coli fueron las BLEE, 55 aislamientos (91%); seguida de las MBL, 3 aislamientos (5%) y KPC, 2 aislamientos (3%). En Klebsiella pneumoniae en 53 aislamientos se puedo observar: BLEE, 31 aislamientos (58%); seguida de las KPC 13 aislamientos (25%) y MBL, 9 aislamientos en (16%). Urocultivos en mujeres: Las enzimas de Escherichia coli fueron 81 aislamientos, de los cuales fueron BLEE, 79 aislamientos (97%); seguido de las KPC, 1 aislamiento (1%) y las MBL, 1 aislamiento (1%). En Klebsiella pneumoniae se pudo observar los siguientes mecanismos enzimáticos en base a 35 aislamientos; BLEE, 19 aislamientos (54%), seguida de las KPC, 12 aislamientos (34%) y por último, MBL, 4 aislamientos (13%). Conclusión: En las IVU de nuestro estudio, Escherichia coli y Klebsiella pneumoniae fueron las principales bacterias que originan resistencia a los antibióticos y la BLEE fue la enzima más frecuentemente identificada en ambos sexos.

Introduction: The objective of this study was to assess frequency of enzymatic resistance mechanisms isolated from community urinary tract infections (UTI) determined in vitro in urine cultures. Objectives: This is a retrospective study, a total of 1031 urine samples were included from patients with urinary tract infection who had consulted at the Outpatient Clinic and Emergencies Services. The following information was recorded, age, sex, urine sample. All urine cultures in which pathogens with a count of ≥ 105 CFU / mL were included. Were excluded polymicrobial urine cultures, those without an antibiogram or those with incomplete clinical data. Results: A total of 1031 urine samples met inclusion criteria, 56% of patients were female and 43% male. The mean age of the women was 52 ± 20 years and in men was 62 ± 16 years. 553 (52%) E. coli and 148 (14%) Klebsiella strains were isolated from community samples. Male urine cultures: The main resistance mechanism of Escherichia coli was ESBLs, 55 isolates (91%); followed by MBL, 3 isolates (5%) and KPC, 2 isolates (3%). In Klebsiella pneumoniae (53 isolates); ESBL, 31 isolates (58%); followed by KPC 13 isolates (25%) and MBL, 9 isolates in (16%). Female urine culture: Escherichia coli enzymes 81 isolates, of which ESBLs were 79 isolates (97%); followed by KPC, 1 isolate (1%) and MBL, 1 isolate (1%). In Klebsiella pneumoniae the following enzymatic mechanisms could be observed based on 35 isolates; ESBL, 19 isolates (54%), followed by KPCs, 12 isolates (34%) and finally, MBL, 4 isolates (13%). Conclusion: The result of our study showed high prevalence of Escherichia coli and Klebsiella pneumoniae causing resistance to antibiotics in culture bacteria from urine samples of patients with UTI, and ESBL was the main ß-lactamase resistance mechanism in Klebsiella and E. coli isolates in both male and female.

Approach to enhance antibiotics efficiency towards uropathogenic bacteria

@#Aims: Urinary tract infection (UTI) is a common infection caused by many virulent bacteria. Multidrug resistance (MDR) by bacteria represents a major therapeutic challenge worldwide. MRD bacteria have different mechanisms to avoid antibiotics; one of them is horizontal gene transfer. Such genes, encoding antimicrobial resistance, are easily transferred from one bacterium to another. Magnesium and calcium chloride (MgCl2 and CaCl2) have an effect on the permeability of bacterial cell membrane. We aimed these chemical materials could increase the antibiotics efficiency on multidrug resistance bacteria. 250 UTI specimens were collected to isolate multidrug resistant bacteria. Depending on antibiotics resistance, we selected three species of virulent bacteria: Escherichia coli, Staphylococcus aureus and Proteus mirabilis. Then, we tested the effect of MgCl2 and CaCl2 on their antibiotics resistance. Methodology and results: The results showed that percentage of E. coli in UTI infection is the highest (45%), while Enterococcus faecalis is the lowest (3%). The effect of MgCl2 and CaCl2 on bacterial antibiotics resistance has been tested using different types of antibiotics. The findings showed that MgCl2 has significant effect to aid antibiotics against bacteria. In particular, nalidixic acid has shown more efficiency against E. coli and S. aureus but not P. mirabilis. Using different concentrations of CaCl2 increased the efficiency of gentamycin, amoxicillin and trimethoprim against S. aureus, while has increased the efficiency of ampicillin and nalidixic acid against E. coli. However, CaCl2 has no effect on the efficiency of antibiotics against P. mirabilis. In addition, MgCl2, and CaCl2 had no toxic effects in both T24 and 5637 urinary bladder cell lines. Finally, plasmids were isolated from these species to detect any antimicrobial resistance gene such as qnr-A. Conclusion, significance and impact of study: MDR distribution in the worldwide was increased, we highly recommend the avoidance of the random antibiotic usages. The salts CaCl2 and/or MgCl2 can be used at specific concentration to enhance the antibiotics permeability and therefore to decrease the antibiotic resistance.

The Role Of Optical Internal Urethrotomy At Present Scenario

BACKGROUND Urethral stricture Is a relatively common urological disorder which every urologist encounters in his regular urological practice. They pose a significant Problem from both clinical and economic point of view. The etiology of stricture urethra has changed over times. Trauma has taken Over Infection as the commonest cause. The trauma can be either External (Trauma) Or Internal ( Instrumentation ). Another Important Cause Is Balanitis Xerotica Obliterans also Known as Lichen Sclerosus. In a Small Group Of Patients, No Particular Cause Can Be Made Out And They are Grouped Under 'Idiopathic. 'The Management Of Stricture has also evolved over the times. Despite the availability of various options for the treatment of stricture urethra, Internal Urethrotomy has remained as a popular option among the urologists in view of its Simplicity, Safety and Shorter Learning Curve. Optical Internal Urethrotomy (Oiu) Is Best Suited For Single, Bulbar Strictures shorter than 2 Cm, with minimal spongiofibrosis and with no past Internal Urethrotomy. Optical Internal Urethrotomy (Oiu) may be contra-indicated In suspected Urethral Malignancy, Coagulation Disorders Or Active Infection. Optical Internal Urethrotomy (Oiu) is not Suited for Long Strictures (>2 Cm), Multiple Strictures, Previous Optical Internal Urethrotomy (Oiu), Strictures Other than bulbar . AIM OFTHE STUDY — The impact of co morbid factor in the outcome of internal urethrotomy — Association of the site ,length of the stricture, with the outcome of internal urethrotomy. — The effect of Pharmacological adjuncts (mitomycin-c) to OIU. — Duration of catheterization after urethrotomy — Role of repeat urethrotomy METHODS This is a prospective observational and analytical study, conducted at the urology department, kilpauk medical college hospital and govt royapettah hospital chennai in the period between february 2016 to march 2017 . Atotal of 60 male patients, with an age ranged from 15 to 60 years presenting with anterior urethral stricture, were included in the study. RESULTS Most common etiological factor is secondary to iatrogenic .Most common site is bulbar urethra.Most common complication is recurrent stricture .Most common age group is 30 to 40 years of age and the most common presenting complaint is strain to void and thin stream of micturation .With OIU alone76.7 % of patients voiding well ,23.3% came with recurrent stricture . With OIU and mitomycin c 90 % of patients voiding well and the recurrence rate is about 10 % .Diabetes with uncontrolled blood sugar ,length and density of the stricture influencing significantly with results and recurrent stricture formation. CONCLUSION Optical internal urethrotomy is a safe,minimally invasive repeatable procedure for anterior urethral stricture with <1.5 cm with less spongiofibrosis. Mitomycin C significantly reduces the recurrence rate of urethral stricture following OIU,as seen in our study , it is Safe and easily available

Transient Pseudohypoaldosteronism in an infant: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Transient pseudohypoaldosteronism is strongly linked to urinary tract infections complicating structural urinary tract anomalies. A 3-month-old baby girl with hyponatremia, hyperkalemia and metabolic acidosis associated with urinary tract infection and structural urinary tract anomalies was diagnosed with transient pseudohypoaldosteronism following elevated serum aldosterone and normal 17-hydroxyprogesterone level. Electrolytes normalized with corrections and antibiotic therapy. Clinicians should have a high index of suspicion for transient pseudohypoaldosteronism in an infant presenting with hyponatremia, hyperkalemia and urinary tract infection with or without associated urinary tract anomalies.

Successful Treatment with Choreito for Recurrent Urinary Tract Infection Treated with Modern Medicine / 日本東洋医学雑誌

Urinary tract infection (UTI) is a common disease, and administration of antibiotics should be the first choice for UTI. However, it often recurs, and recurrent UTI is generally treated with antibiotics. Many reports describe the use of choreito for the treatment of lower urinary tract symptoms and ureteral stones, but only a few reports are dedicated to the treatment of recurrent UTI with choreito. An 84-year-old woman had a UTI that recurred 4 times, and every time she was hospitalized. Although we treated her condition with an antibiotic and α 1-blocker for neurogenic bladder, and provided her home-care advice, her UTI recurred 4 times. Thus, we gave her choreito, which successfully treated her recurrent UTI. Before the treatment, she was hospitalized 4 times within 2 months. However, in the recent 7 months after the treatment with choreito, she did not need to be hospitalized. She is currently visiting a hospital once every 2 months. The present case indicates that choreito is beneficial in terms of health economics.

Prevalence and antimicrobial resistance pattern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya

OBJECTIVES@#To investigate the prevalence of urinary tract infection among patients at Messalata Central Hospital, Libya, to identify the causative bacteria, and to explore their resistance pattern to antimicrobials.@*METHODS@#A total number of 1153 urine samples were collected from patients, who attended daily to Messalata Central Hospital, Libya, in a study extended for one year. Antimicrobial susceptibility testing and isolates typing were done using Phoenix BD (BD diagnostic). Resistance was confirmed manually using agar disk diffusion method.@*RESULTS@#Of the 1153 urine samples tested, 160 (13.9%) samples were positive, from which 17 different, solely Gram negative, uropathogens were identified. Escherichia coli were the most prevalent (55.6%) bacteria, followed by Klebsiella pneumoniae subspecies pneumoniae (16.3%), Proteus mirabilis (6.3%), Pseudomonas aeruginosa (5.6%), Enterobacter cloacae and Klebsiella oxytoca (2.5%, each), Citrobacter koseri and Providencia rettgeri (1.9%, each), Acinetobacter baumannii, Enterobacter aerogenes and Proteus vulgaris (1.3%, each), and Aeromonas caviae, Citrobacter freundii, Cronobacter sakazakii, Enterobacter amnigenus biogroup 2, Pseudomonas putida and Serratia marcescens (0.6%, each). The isolated uropathogens showed increased levels of resistance ranged from 10.5% to 64.5%, with an overall resistance of 28.9%. Amikacin was the most effective antimicrobial followed by Imipenem and Meropenem (0%, 0.6% and 2.5% resistance, respectively); while, Cephalothin and Ampicillin were the least (80.6% and 90.0% resistance, respectively) effective.@*CONCLUSIONS@#The obtained results emphasized the emergence of highly resistant bacteria to most of tested antimicrobials and raise the alarm for physicians to change their treatment pattern depending on antimicrobial susceptibility results.

Prevalence and antimicrobial resistance pattern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya

Objectives To investigate the prevalence of urinary tract infection among patients at Messalata Central Hospital, Libya, to identify the causative bacteria, and to explore their resistance pattern to antimicrobials. Methods A total number of 1 153 urine samples were collected from patients, who attended daily to Messalata Central Hospital, Libya, in a study extended for one year. Antimicrobial susceptibility testing and isolates typing were done using Phoenix BD (BD diagnostic). Resistance was confirmed manually using agar disk diffusion method. Results Of the 1 153 urine samples tested, 160 (13.9%) samples were positive, from which 17 different, solely Gram negative, uropathogens were identified. Escherichia coli were the most prevalent (55.6%) bacteria, followed by Klebsiella pneumoniae subspecies pneumoniae (16.3%), Proteus mirabilis (6.3%), Pseudomonas aeruginosa (5.6%), Enterobacter cloacae and Klebsiella oxytoca (2.5%, each), Citrobacter koseri and Providencia rettgeri (1.9%, each), Acinetobacter baumannii, Enterobacter aerogenes and Proteus vulgaris (1.3%, each), and Aeromonas caviae, Citrobacter freundii, Cronobacter sakazakii, Enterobacter amnigenus biogroup 2, Pseudomonas putida and Serratia marcescens (0.6%, each). The isolated uropathogens showed increased levels of resistance ranged from 10.5% to 64.5%, with an overall resistance of 28.9%. Amikacin was the most effective antimicrobial followed by Imipenem and Meropenem (0%, 0.6% and 2.5% resistance, respectively); while, Cephalothin and Ampicillin were the least (80.6% and 90.0% resistance, respectively) effective. Conclusions The obtained results emphasized the emergence of highly resistant bacteria to most of tested antimicrobials and raise the alarm for physicians to change their treatment pattern depending on antimicrobial susceptibility results.

Cesarean Section and Urinary Tract Infection Correlation with Bronchiolitis in Lebanese Hospitalized Children between One Month and Two Years Old.

Background: Bronchiolitis of infancy is a clinically diagnosed respiratory condition presenting with breathing difficulties, cough, poor feeding, and irritability and, in the very young, apnea. Objective: To determine the effect of cesarean section and UTI on bronchiolitis in children aged 2 months to 2 years. Design: Retrospective population-based data linkage cohort study of 202 cases in Rafic Hariri University Hospital (RHUH) and Makassed University Hospital (MUH). Methods: We reviewed retrospectively and studied prospectively the charts of the bronchiolitis hospitalized children between one month and two years in RHUH and MUH between 2011 and 2012 and continued prospectively until 2013. We studied: age, date of admission, type of delivery, gestational age, presence of UTI, screening and investigations done, related congenital diseases. The UTI is considered only when urine culture is positive. The type of delivery also mentioned. Results: Our study showed that 48% of bronchiolitis patients were born by cesarean section delivery compared with spontaneous vaginal delivery, these children had increased risk of admissions for bronchiolitis with (OR 2.71; CI 95%) and 10.16% of all patients had UTI. Conclusion: Physicians and expectant parents need to be made aware of this additional risk of elective cesarean sections and associated infant morbidity to aid in deciding the most appropriate mode of delivery. In infants and children with bronchiolitis continue to have a clinically important rate of UTIs.

Uropathogenic Analysis and Commonly Used Drug Sensitivity Patterns of the Pathogens in Dhaka City, Bangladesh.

Aims: Human urinary tract infections (UTI) are very common in Bangladesh. The objectives of the current study are to identify the uropathogenic agents infecting males and females of different age groups, and commonly used drugs sensitivity profiles. Study Design: A total of 980 urine samples from both sex and different age groups, were collected for the study. Chemical analyses of the samples were done by Dipstick method. Cultural, microscopic and biochemical analyses were done to identify the isolates. Finally antibiotic sensitivity was tested against conventionally used antibiotics. Place and Duration of Study: All the samples were collected from patients of both indoor patient department (IPD) and outdoor patient department (OPD) in the Laboratory Medicine Department, United Hospital, Dhaka, Bangladesh between January 2012 and May 2012 following published procedures. Results: Only 29.6% of the urine samples yielded positive culture. UTI showed more prevalence among female than male. Female belonging to the age group of 41-50 years were detected as high risk groups for UTI. Most common Gram negative isolates were Escherichia coli, Klebsiella sp., Candida sp., Pseudomonas sp., Proteus sp., and Acinetobacter baumannii. Gram positive bacteria comprised Enterococcus sp. and non-hemolytic Streptococci. Like most of the previous reports, E. coli was predominant, which is also corroborated in this study. However, the sensitivity pattern of the organisms differed from the previous studies. Conclusion: The isolates were found resistant to most common oral antibiotics used, such as cotrimoxazole, nitrofurantoin, and nalidixic acid. This finding, however, need further work to validate reliability.

Profile of urinary tract infections in paediatric patients.

Background & objectives: this cross-sectional study was conducted at a tertiary care centre in Puducherry, south India, with the aim of finding the profile of the paediatric urinary tract infection (UTI), bacterial pathogens involved, and also to observe vesicoureteric reflux (VUR) and renal scarring in these patients. Methods: A total of 524 paediatric patients ≤13 yr, suspected to have UTI, were included in the study. Urine samples were collected, processed for uropathogen isolation and antibiotic susceptibility test was performed as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Thirty two culture proven children with UTI underwent micturating cysto-urethrography (MCU) and dimercaptosuccinic acid (DMSA) scanning was done for 69 children. Results: of the 524 children, 186 (35.4%) had culture proven UTI with 105 (56.4%) being infants, 50 (27.4%) between 1-5 yr, 30 (16.12%) between 5-13 yr and 129 (69.35%) males. Posterior urethral valve (PUV) was noted in three, hydronephrosis in one, VUR in 18 and renal scarring in 33. VUR as well as renal scarring were more in males >1 yr of age. A significant association (P=0.0054) was noted with a combined sensitivity and specificity of these investigations being 83 and 90 per cent, respectively of the MCU and DMSA scans for detecting VUR. Escherichia coli was the most common pathogen isolated, sensitive to nitrofurantoin, followed by cefoperazone-sulbactam, aminoglycosides and meropenem. Interpretation & conclusions: Our results indicate that UTI varies with age and gender and extensive evaluation is required in boys under one year of age with UTI. This study also highlights the better efficacy of aminoglycosides, cefoperazone-sulbactam and nitrofurantoin in vitro compared with meropenem in gram-negative uropathogens.

Phylogenetic grouping and pathotypic comparison of urine and fecal Escherichia coli isolates from children with urinary tract infection

The aim of this study was to investigate the phylogenetic background and to assess hlyD (involved in the secretion of haemolysin A) and intll (encoding a class 1 integrase) in Escherichia coli isolates derived from urinary and fecal specimens. A total of 200 E. coli isolates was collected from patients presenting with urinary tract infection (UTI) during September 2009 to September 2010 and screened for hlyD and intll genes by polymerase chain reaction (PCR). Phylogenetic analysis showed that E. coli is composed of four main phylogenetic groups (A, B1, B2 and D) and that uropathogenic E. coli (UPEC) isolates mainly belong to groups B2 (54%) and D (34%) whereas group A (44%) and D (26%) are predominant among commensal E. coli isolates. In this study, hlyD was present in 26% of UPEC and 2% of commensal E. coli isolates. However, hemolytic activity was detected for 42% of UPEC and 6% of commensal E. coli isolates (p < 0.05). intll gene was more frequently expressed in UPEC (24%) in comparison with commensal E. coli isolates (12%). Resistance to aztreonam, co-trimoxazole and cefpodoxime were frequently found among UPEC isolates whereas commensal E. coli isolates were commonly resistant to co-trimoxazole, nalidixic acid and cefotaxime. Concluding, a considerable difference between UPEC and commensal E. coli isolates was observed regarding their phylogenetic groups, presence of class 1 integron and hlyD gene, hemolysin activity and resistance pattern. The detection of class 1 integrons and hlyD gene was higher among UPEC compared with commensal E. coli isolates. These findings may contribute for a better understanding of the factors involved in the pathogenesis of UPEC.

Evaluation of asymptomatic bacteriuria in antenatal women at C. U. Shah Medical College & Hospital, Surendranagar, Gujarat.

Background: Asymptomatic bacteriuria (ASB) refers to the presence of a bacterial isolate in urine culture in an asymptomatic person. Pregnant women with ASB are more likely to develop acute pyelonephritis in later pregnancy, postpartum urinary tract infection, hypertensive disease of pregnancy, anaemia, chronic renal failure, prematurity, low birth weight babies and prenatal death if untreated. The incidence of these can be reduced by treating ASB during pregnancy. Aims & Objective: To study the incidence of asymptomatic Bacteriuria in pregnancy. Material and Methods: Approximate 20 ml of clean catch midstream urine samples were obtained from 100 pregnant women attending the Obstetric Outpatient Department. Samples were processed as per standard guidelines. Results: Microscopic analysis of urine showed pus cells in 5 (45.45%) and Gram's stain smear showed bacteria in 9 (81.81%). Urine culture showed ASB in 11 (11%) pregnant women. Escherichia coli were found in 6 (54.55%), Klebsiella pneumoniae 3 (27.27%), Enterococcus sp. in 1 (9.09%) and Staphylococcus aureus in 1 (9.09%). Antibiotic sensitivity testing showed that all isolates were sensitive to all the antibiotics. Conclusion: Incidence of asymptomatic bacteriuria was 11% in 100 pregnant women. Microscopic analysis of all 11 urine culture positive samples showed pus cells in 5 (45.45%) and Gram's stain smear showed bacteria in 9 (81.81%). The most common bacterial isolate was Escherichia coli (54.54%), followed by Klebsiella pneumoniae (27.27%), Staphylococcus aureus (9.09%) and Enterococcus sp. (9.09%). Urine culture is necessary for screening pregnant women.

Urolithiasis prevalence and related factors in a rural area of Manipur.

Background: Urolithiasis is the third most common urological disease. The prevalence is on the rise due to various changes in the socio-demographic and other etiological factors in the north-eastern states of India in general and Manipur in particular. Aims & Objective: The study was conducted to determine the prevalence of urinary stones and to assess the association between urolithiasis and selected variables of interest. Material and Methods: The study was conducted during September 2008 to August 2010 among wetland dwellers of Loktak Lake in Thanga, a rural area of Manipur. A representative sample of subjects, which included men and women 15 years of age and above were included in the study. Sample size was calculated based on a prevalence rate of 5.41% with an allowable error of 1.5 at 95% confidence level. Calculated sample size was 875. A pre-tested interview schedule was used for data collection. Results: A total of 875 individuals were studied. The prevalence rate of urolithiasis was 196(22.40%) and was more commonly present in the age group of 25-44 years. Urolithiasis was observed to be significantly more common among those individuals who are more educated, engaged in heavy work, with history of urinary tract infection (UTI), with history of stressful events in recent years, among those who consumed only 2-4 glasses of water per day and with family history of stones. Conclusion: Prevalence of urolithiasis was observed to be 196(22.4%). Information regarding the risk factors which have been identified in the present study can be utilized in formulating future health plans for preventive services.

Prevalence and antimicrobial susceptibility pattern of Escherichia coli in hospital acquired and community acquired patients related to urinary tract infection in India.

There is a dearth of information regarding to prevalence and antimicrobial susceptibility pattern of E. coli, a most common cause of nosocomial infections, in community and hospital acquired urinary tract infections. The antibiotic resistant pattern against E. coli varies when isolated from different sources. This study was carried out with an objective to isolate E. coli from male and female patients infected with hospital and community acquired UTI. The isolates were subjected to five different antibiotic categories comprising 18 antibiotics. On the basis of antibiotic resistance profiling MAR index was calculated. Prevalence of UTI was found 69.17% which was high in hospital (56.63%) than community settings (43.37%). Females were found more susceptible to UTI than males in both settings. Prevalence of E. coli was found 61.45% among all isolates. Carbepenems showed highest sensitivity against E. coli isolated from UTI patients. The highest MAR indices were 0.8 (3.57%) and 0.7 (8.69%) of E. coli isolated in hospital and community settings. The present study suggests that females are highly susceptible to UTI in both community and hospital settings as well as the occurrence of E. coli were also found high in female patients. E. coli showed resistance against commonly prescribed antibiotics.

Antibacterial resistance and trend of urinary tract pathogens to commonly used antibiotics in Kashmir Valley / Resistencia antibacteriana y tendencia de los patógenos de las vías urinarias frente a los antibióticos comúnmente usados en el Valle de Cachemira

OBJECTIVE: Increase in resistance pattern of urinary tract pathogens to conventional antimicrobial agents used for urinary tract infections (UTIs) is gaining the attention of many microbiologists worldwide in respect to treatment of UTIs. The aim of the present study was to obtain data on resistance patterns of pathogens responsible for UTIs to currently used antimicrobial agents in Sher-I-Kashmir Institute of Medical Sciences (tertiary healthcare hospital). METHOD: A total of 2842 samples were collected from both outpatient and inpatient departments. The majority of samples in this study were midstream urine specimens, others included catheterized urine samples. Standard parameters were followed for isolation and identification of clinical isolates and further antimicrobial susceptibility test was done by Kirby Bauer disk diffusion method. RESULTS: Out of 2842 samples, 1980 (67%) were culture positive. Escherichia coli (E coli) was the most prevalent isolate (OP 63%, IP 45.5%) followed by Klebsiella pneumonia (K pneumonia) as the second commonest UTI-causing agent (OP 15.9%, IP 21.7%). High percentage of isolates showed resistance to sulfa drugs such as cotrimoxazole. First generation cephalosporins were ineffective, while aminoglycosides and third generation cephalosporins were effective against E coli, K pneumoniae, Pseudomonas aeruginosa (P aeruginosa), Enterococcus faecalis and Staphyococcus aureus (Staph aureus). Furthermore, this study noticed that glycopeptide drugs such as vancomycin are highly effective against E faecalis and Staph aureus UTIs. CONCLUSION: This study reveals the increased trend in resistance pattern of uropathogens in the valley region. These data may aid health professionals in choosing the appropriate treatment for patients with UTI in the region and hopefully will prevent the misuse of antibiotics.

OBJETIVO: El aumento del patrón de resistencia de los patógenos de las vías urinarias frente a los agentes antimicrobianos convencionales usados para las infecciones de las vías urinarias (IVU) está ganando la atención de muchos microbiólogos a nivel mundial, en relación con el tratamiento de las IVU. El objetivo del presente estudio fue obtener datos sobre los patrones de resistencia de los patógenos responsables de las IVU en el Instituto de Ciencias Médicas Sher-I-Cachemira (hospital de atención terciaria a la salud) frente a los agentes antimicrobianos de uso común. MÉTODO: Se recogieron un total de 2842 muestras provenientes de los departamentos de pacientes externos e internos. La mayoría de las muestras en este estudio fueron especimenes de orina de mitad de micción; otros incluyeron muestras de orina cateterizada. Se siguieron los parámetros estándar para el aislamiento y la identificación de los aislados clínicos, y posteriormente se realizó la prueba de susceptibilidad antimicrobiana mediante el método Kirby-Bauer de difusión por disco. RESULTADOS: De 2842 muestras, 1980 (67%) fueron cultivos positivos. Escherichia coli (E coli) fue el aislado más frecuente (OP 63%, IP 45.5%) seguido por Klebsiella pneumonia (K pneumonia) como el segundo agente más común causante de IVU (OP 15.9%, IP 21.7%). Un alto porcentaje de aislados mostró resistencia a los medicamentos de sulfa, por ejemplo el cotrimoxazole. Las cefalosporinas de primera fueron ineficaces, mientras que los aminoglucósidos y las cefalosporinas de tercera generación fueron efectivas frente a E coli, K pneumoniae, Pseudomonas aeruginosa (P aeruginosa), Enterococcus faecalis y Staphyococcus aureus (Staph aureus). Además, en este estudio se observó que los medicamentos glicopéptidos, tales como la vancomicina, son altamente efectivos frente a las IVU por E faecalis y Staph aureus. CONCLUSIÓN: Este estudio revela un aumento en la tendencia del patrón de resistencia de los uropatógenos en la región del Valle. Estos datos pueden ayudar a los profesionales de la salud a escoger el tratamiento apropiado para los pacientes con IVU en la región, y es de esperar que asimismo ayuden a prevenir el uso inadecuado de antibióticos.

Prevalence of uropathogens in various age groups & their resistance pattern in a Tertiary Care Hospital in Central India.

Background: The prevalence of multidrug resistance among uropathogens in rapidly increasing. Analysis of the prevalence in various age groups and the common antimicrobial co-resistance pattern of uropathogens isolated from patients in a tertiary care hospital would have important implication for patient care. Methods: A total of 1383 urine samples received during year 2010 were processed. Urine microscopy & culture was done using standard microbiological techniques. Organisms were identified by standard microbiological techniques. Antimicrobial susceptibility testing was done as per CLSI guidelines.Results: A total of 426 uropathogens were isolated. E coli were seen in 65.96 % (most common) followed by Klebsiella spp. 12.44%. Enterococcus was the commonest Gram positive isolate (5.86%). Urinary tract infection (UTI) was seen in 59.86% females as compared to 40.14% males. Average antimicrobial resistance for E.coli 75.74%, Klebsiella spp. 47.45%, Proteus 65.54%, Pseudomonas 75.89%, Enterococci 66.54%, Staphylococcus aureus 39.28%, Staphylococcus saprophyticus 47.79%.

Aceptabilidad del tratamiento empírico de la infección urinaria aguda en el niño / Acceptability of the «empirical» treatment of acute urinary infection in children

Las guías propuestas por grupos internacionales enfatizan en la importancia del diagnóstico de la infección del tracto urinario en la atención primaria de salud, para poder iniciar un tratamiento precoz con antibióticos en los casos de mayor riesgo. El médico de atención primaria en ocasiones realiza su trabajo lejos de los laboratorios de microbiología y no puede realizar el urocultivo con la rapidez necesaria para un tratamiento adecuado. Este médico necesita disponer de pruebas diagnósticas rápidas que le ayuden a tomar la decisión médica más adecuada, aunque ninguna combinación de ellas puede sustituir al urocultivo. En esta propuesta se analizan las situaciones en las que el médico debe esperar el resultado del estudio bacteriológico y en las que puede iniciar un tratamiento empírico después de tomar la muestra para el urocultivo, si este puede realizarse. En los casos excepcionales de imposibilidad de realizar el estudio bacteriológico, el médico tiene que actuar utilizando los llamados métodos de diagnóstico rápido

The guidances proposed for international groups emphasize the significance of diagnosis of the urinary tract infection in primary health care to start an early antibiotics treatment in cases of a major risk. The primary care physician sometimes works far from the microbiology laboratories and can not to carry out a fast uroculture for an appropriate treatment. This physician needs to have available fast diagnostic tests helping him to make a more suitable medical decision, although any combination of them may to replace the uroculture. In present proposal are analyzed those situations where the physician must to await for bacteriological study results to start the empirical treatment after the sample take for uroculture if it may to be carry out. In exceptional cases of impossibility to conduct the bacteriological study, the physician must to act using the so called fast diagnosis methods