Profile of uropathogens in pregnancy over 5 years from a large tertiary center in South India

Objectives: Urinary tract infections (UTIs) are a common medical problem in both antenatal and postnatal women. Data from India on the demography of these women, microbiology and antimicrobial susceptibility of the causative bacteria, need elucidation. Material and Methods: We performed an observation study that collected data on UTI in antenatal and postnatal women between 2013 and 2017 at our tertiary care center in South India. Antenatally, urine dipstick-positive patients, high-risk, and symptomatic patients submitted urine cultures. Postnatally, all symptomatic patients had urine cultures. This was 20% of all antenatal and postnatal women resulting in 20,203 cultures. Results: Of 20,203 cultures, significant bacteriuria was seen in 9.48% of antenatal and 13.28% of postnatal women. A higher mean age was seen among those with UTI, antenatal 27 (SD 3.5) and postnatal 26.4 (SD 4.7) years versus 23.9 (SD 3.6) with no growth in culture. The mean BMI among antenatal was 28.2 (SD 3.5) and postnatal was 28 (SD 7.4). Most (60%) were primigravida. At delivery, 37% required cesarean sections while 21.2% required instrumental delivery. Recurrent UTI was seen in 25% antenatally and 10% in the postnatal period. Escherichia coli accounted for 66 and 60% of infections among antenatal and postnatal women, respectively. Enterococcus species accounted for 13% in both while Klebsiella species was 4.9 and 7.3%, respectively. Among E. coli, 68.3 and 59.2% of isolates in antenatal and postnatal period were cefpodoxime susceptible. Nearly 75% of ante- and postnatal isolates were susceptible to amoxicillin-clavulanate while 90.2% and 92.5% were susceptible to nitrofurantoin. Enterococci spp. up to 84.4 and 97.1% in ante- and postnatal isolates were susceptible to ampicillin, 64.4 and 77.4% susceptible to high-level gentamicin, and 84 and 95.5% susceptible to nitrofurantoin. Asymptomatic bacteriuria in pregnancy was documented in 2.1% of antenatal outpatients and E. coli was isolated in 74% of these cultures. Conclusion: Importance of microbiological evidence prior to administration of antimicrobials is evidenced by 79% negative cultures in this 5-year cohort. Escherichia coli accounted for 60-66% of significant bacteriuria followed by Enterococcus and Klebsiella species with 30-40% E.coli probable ESBL producers. Nitrofurantoin followed by amoxicillin-clavulanate were found to be the best oral antimicrobial options.

Studies on the Antibacterial Susceptibility of Uropathogens to Senna alata Extracts in Calabar, Cross River State, Nigeria

Background: Senna alata is an underutilized shrub found in many countries and is known for its traditional use in the treatment of dermatophytes and other related diseases. Therefore, this study aimed at evaluating the phytochemical and antibacterial effects of S. alata leaves extracts against bacterial isolates obtained from urinary tract infection patients in Calabar. Methodology: Matured fresh leaves of Senna alata were collected within Calabar, Cross River state, Nigeria, in May 2022 and identified by a botanist in the Department of Botany, University of Calabar. The leaves of S. alata were extracted with water, methanol and ethyl acetate using maceration and soxhlet methods. Phytochemical analysis was conducted to detect the presence of bioactive compounds using standard methods. The crude extracts of S. alata were investigated for antibacterial properties using agar well diffusion method and mechanisms of antibiosis determined using MBC/MIC ratio. Results: In both methods of extraction, methanol yielded more extracts compared to other solvents. Soxhlet methanol extract (SaMeSh) had the highest (12.21%) percentage yield while maceration ethyl acetate extract (SaEaMa) had the least (4.77%) percentage yield. The phytochemicals assayed revealed the presence of saponins, tannins, flavonoids, anthraquinones, terpenoids and steroids. However, terpenoids was not detected in methanol and ethyl acetate extracts. Senna alata extracts demonstrated broad spectrum of activity against the tested isolates at various concentrations with organic solvents exhibiting the highest antibacterial activity. However, the observed activity varied with respect to concentration of extract and types of organisms. The MIC values ranged from 31.25 to 250 mg/mL and MBC values from 62.5 to 500 mg/mL. The MIC index of the crude extracts against the test uropathogens was ?8. Conclusion: This study indicates that S. alata could be a source of novel antimicrobial agent. Further research is required to isolate, characterize and identify bioactive constituents responsible for the observed activity.

Resistencia antimicrobiana de uropatógenos en adultos mayores / Antimicrobial resistance of uropathogens in older adults

Introducción: En la actualidad, la resistencia antimicrobiana ha sido declarada por la Organización Mundial de la Salud como un problema de salud pública. Objetivo: Determinar el perfil de resistencia antimicrobiana de uropatógenos en adultos mayores. Métodos: Estudio descriptivo transversal de 567 urocultivos positivos de adultos mayores atendidos durante el año 2017 en una clínica privada en Lima, Perú. El análisis univariado se realizó por distribución de frecuencias, promedio y desviación estándar. Se estimó la asociación entre la producción de BLEE con respecto a las características epidemiológicas y el tipo de atención mediante Chi cuadrado con un nivel de significación de 0,05. Resultados: La edad promedio de la población fue de 74,1 años (DE:10,7). El 71,8 por ciento de los urocultivos positivos pertenecieron al sexo femenino. Los principales uropatógenos aislados en todos los niveles de atención fueron: E. coli, E. coli BLEE y K. pneumoniae BLEE. La E. coli presentó 69,3 por ciento de resistencia a ampicilina; y la E. coli BLEE tuvo el 100 por ciento de resistencia a ampicilina, ceftriaxona y ceftazidima. El 62 por ciento de microorganismos BLEE se encontraron en la atención ambulatoria. Se evidenció asociación estadísticamente significativa entre los agentes productores de BLEE y el sexo (p=0,004), mas no respecto al tipo de atención (p=0,144) ni subgrupos de edad (p=0,669). Conclusiones: La resistencia antimicrobiana es altamente prevalente en los adultos mayores. El sexo femenino fue el más afectado y el uropatógeno más frecuente la E. coli, este presenta una alta resistencia a ampicilina y mayor sensibilidad a nitrofurantoína. Se determinó un alto porcentaje de agentes productores de BLEE en la atención ambulatoria(AU)

Introduction: At present, the World Health Organization as a public health problem has declared antimicrobial resistance. Objective: To determine the antimicrobial resistance profile of uropathogens in older adults. Methods: Cross-sectional descriptive study of 567 positive urine cultures from older adults treated during 2017 in a private clinic in Lima, Peru. Univariate analysis was performed by frequency distribution, mean and standard deviation. The association between ESBL production with respect to epidemiological characteristics and type of care is estimated using Chi square with a significance level of 0.05. Results: The average age of the population was 74.1 years (SD: 10.7). 71.8percent of the positive urine cultures were from female sex. The main uropathogens isolated at all levels of care were E. coli, E. coli ESBL and K. pneumoniae ESBL. E. coli showed 69.3percent resistance to ampicillin; and E. coli ESBL had 100percent resistance to ampicillin, ceftriaxone, and ceftazidime. 62percent of ESBL microorganisms were found in outpatient care. There was a statistically significant association between ESBL-producing agents and gender (p = 0.004), but not with regard to type of care (p = 0.144) or age subgroups (p = 0.669). Conclusions: Antimicrobial resistance is highly prevalent in older adults. The female sex was the most affected and the most frequent uropathogen was E. coli, highly resistant to ampicillin and greater sensitivity to nitrofurantoin. High percentage of ESBL-producing agents was determined in outpatient care(AU)

A retrospective study on the prevalence of urinary tract infections in a tertiary care hospital in Sangareddy district of South India

Background: Urinary tract infections (UTI) affect the portion of the urinary tract including kidneys, ureters, bladder, and urethra, and are among the commonly acquired nosocomial infections. Diagnosis based on the culture and sensitivity profile of the organism is highly beneficial for appropriate antimicrobial therapy of the individual.Methods: A retrospective study of culture isolates obtained from urine samples from different departments of a tertiary care hospital was performed in the period January 2018 to March 2020 in the district of Sangareddy, Telangana, India.Results: A total 204 samples of 1886 exhibited significant growth of organisms i.e., ≥105 colony-forming units of bacteria per millilitre (CFU mL-1). The most common pathogen isolated was Escherichia coli (47.05%), followed by Klebsiella pneumoniae (15.68%), Staphylococcus aureus (10.78%), Pseudomonas aeruginosa (10.78%), Enterobacter spp. (7.84%) and, Candida albicans (7.84%). The presence of Gram-negative organisms was found to be more than Gram-positive organisms among the samples cultured. Resistance was found to be more towards Amoxicillin (57.14%), followed by oxacillin (34%), cefotaxime (23.62%), clarithromycin (12.08%), erythromycin (12.08%), azithromycin (9.34%), linezolid (3.84%) and vancomycin (2.19%).Conclusions: Increasing levels of antimicrobial resistance by uropathogens emphasize the importance of therapy based on the culture and sensitivity of the organisms. Many uropathogens exhibit multi-drugs resistance. Regular surveillance and monitoring are useful in controlling the increasing resistance.

Prevalence and antibiotic susceptibility pattern of pathogens in children with urinary tract infection in a tertiary care hospital

Background: The changing pattern of antimicrobial susceptibility of bacterial pathogens causing acute UTI is a growing problem. Hence, the knowledge of the local pattern of urinary pathogens and their susceptibility to various antimicrobials is of atmost importance for selection of the appropriate empiric therapy for children with acute UTI.Methods: This retrospective cross-sectional study was conducted in 208 children of 1-18 years age group with suspected UTI infection who were admitted in KIMS hospital, Bangalore from January to December 2018. The data of all samples were collected from medical record.Results: Overall 208 children between 1-18 years with suspected UTI were screened. Out of which 48 were culture positive, with a prevalence of 23%. Culture positive UTI was predominantly found in males in 1-5 years age group as against female predominance in 6-18 years age group. E. coli (45.83%) was the commonest organism isolated in our study, followed by Enterococcus (31.25%), Klebsiella (16.67%), Proteus (4.17%) and Acinetobacter (4.17%).  Antibiotics with highest sensitivity to E-coli are Amikacin (91%) and Gentamicin (77%). Klebsiella is most sensitive to Gentamicin (87.5%) and piperacillin (75%). Enterococcus has highest sensitivity to Vancomycin (67%) and Linezolid (60%).Conclusions: It requires regular monitoring to determine the current status of resistance against antimicrobial agents.  The use of antimicrobials must be restricted in order to decline the resistance and we suggest that empirical antibiotic selection should be based on the knowledge of local pattern of bacterial organisms and their susceptibility to various antimicrobials rather than on universal guidelines.

Prevalence, associated risk factors and antibiotic resistance pattern of bacterial uropathogens among pregnant women in a tertiary care hospital of Bangladesh

Aims@#The study was designed to determine the prevalence of urinary tract infection (UTI) in pregnant women depending on their various clinical and socio-demographic factors, and to assess the antibiotic susceptibility pattern of the responsible uropathogens in a tertiary care hospital of Dhaka, Bangladesh. @*Methodology and results@#A total of 100 midstream urine samples were collected from pregnant women and different clinical and socio-demographic variables viz. age, gestational weeks, living conditions, and level of education associated with UTI were determined. Bacterial isolation was carried out using blood and MacConkey agar and identified according to their phenotypic characteristics. Antibiogram profiling of the isolates was done by disc diffusion method. From 48% of positive UTI samples, the highest bacteriuria was recorded within the age group of 26-30 years (n=19; 59.38%) and in both, 1st and 3rd trimester period (50%). There was no significant association between the studied risk factors and bacteriuria, except for the age of the pregnant women. Most predominantly isolated bacteria was Escherichia coli (n=39; 81.25%), followed by Klebsiella pneumoniae (n=9; 18.75%). In E. coli, the highest resistance was recorded against ceftriaxone (87.18%), followed by cephalexin (84.61%) and ceftazidime (79.49%); whereas K. pneumoniae showed 100% resistance to ceftriaxone and cephalexin. Netilmicin was found as the only effective antibiotic against E. coli showing 100% sensitivity. For K. pneumoniae, azithromycin, imipenem, chloramphenicol, gentamicin, ciprofloxacin, amikacin and nitrofurantoin were found as the most efficacious drugs. @*Conclusion, significance and impact of study@#As the emergence of drug resistance is ever increasing, the study necessitates the continuous surveillance of antibiotic susceptibility of uropathogens to ensure safety and better treatment to the mother and fetus.

Paediatric Uti: Points Of Concern: A Clinicobacteriological Analysis In A Tertiary Care Hospital

Paediatric UTI is a matter of grave concern particularly at less than two years of age due to predisposition to serious future complications and limited treatment options resulting from ever-increasing antibiotic resistance. This study included 392 established cases of paediatric UTI. Gram negative bacteria were isolated in 68.9% cases, predominated by Escherichia coli(34.7%). It was followed by Klebsiella species(27.3%), Enterococcus faecalis(12.2%), Acinetobacter species(7.4%), Pseudomonas aeruginosa(4.3%), and other GNB. Staphylococcus saprophyticus(4.1%) and Staphylococcus aureus(3.1%) were less common. Antibiograms of the isolates showed very low sensitivity to all commonly prescribed antibiotics, namely, ampicillin, amoxyclav, ceftriaxone, cefotaxime, gentamicin, cotrimoxazole, nitrofurantoin, ciprofloxacin and levofloxacin- making them practically irrational to choose. Most of the GNB were susceptible to imipenem, whereas, gram positive cocci were uniformly susceptible to vancomycin and linezolid

A retrospective analysis of antibiogram on urinary isolates in a tertiary care hospital, Trivandrum, India

Background: Antimicrobial resistance among bacterial strains is an emerging problem. Urinary tract infections are one of the most common bacterial infections in humans both in the hospital and the community settings. Gram-negative bacilli are the common pathogens isolated in urine. These uropathogens have developed resistance to commonly prescribed antimicrobial agents. This severely limits the effective empirical treatment options. Objective of this study was to determine the prevalence and antibiotic susceptibility patterns of bacterial uropathogens isolated from patients attending a tertiary care hospital Trivandrum.Methods: Urine samples received for culture in the laboratory between 6 month periods was cultured in MacConkey agar and blood agar plates. The growth from urine cultures was processed for identification and antibiotic susceptibility as per standard methods. The details of urinary pathogens grown from urine samples and their Antibiogram profile were collected from the records.Results: Out of 924 specimens investigated for significant bacteriuria, 226 shows positive cultures. E.coli and Klebsiella were the predominant pathogens isolated. Antibiotics like 3rd generation cephalosporins, fluoroquinolones, and cotrimoxazole are the usual empirical treatment options, these organisms have developed resistance towards the latter which might make the empirical therapy less effective.Conclusions: Gram-negative bacilli were the predominant pathogens isolated and many were resistant to the commonly prescribed antibiotics. Routine surveillance and monitoring studies need to be constantly conducted to update clinicians on the prevalent pathogens for the rational and empirical treatment of bacteriuria. Beta-lactam beta-lactamase inhibitors, aminoglycosides, carbapenem, and nitrofurantoin showed low resistance so they should be considered as empirical treatment options.

Resistencia y sensibilidad bacteriana en urocultivos en una población de mujeres de ecuador / Bacterial resistance and sensitivity in urine cultures in a women population in ecuador / Resistência e sensibilidade bacteriana em uroculturas numa população de mulheres do equador

Resumen Objetivo: Determinar la prevalencia de uropatógenos, sensibilidad y resistencia antimicrobiana en la infección del tracto urinario que acuden al Hospital Básico Privado "Provida" del 1 de enero de 2014 al 31 de diciembre de 2016. Material y métodos: Se analizaron los resultados de 116 urocultivos de orina en mujeres no gestantes de todas las edades de 2014 a 2016, que fueron atendidas en el Hospital Básico Privado "Provida" de la cuidad de Latacunga, en Ecuador. El análisis de los datos obtenidos se realizó mediante estadística descriptiva. Resultados: De las 116 muestras, se aislaron: Escherichia coli (84,5%), Staphylococcus saprophyticus (8,6%) y Proteus spp. (6,9%). E. coli mostró sensibilidad a ceftriaxona en el 70 %, seguido de fosfomicina y gentamicina con el 62 y el 60%, respectivamente. La sensibilidad hallada para quinolonas fue del 40% y la ampicilina sulbactam alcanzó el 37%. Proteus spp. mostró sensibilidad del 75% para gentamicina y del 50% para quinolonas y cefuroxima. S. saprophyticus tuvo sensibilidad superior al 50% para gentamicina, ampicilina sulbactam, quinolonas y nitrofurantoína. Para E. coli la resistencia más alta registrada fue con ampicilina en el 86,5%, seguido de las quinolonas con una resistencia superior al 50%. La ampicilina asociada a inhibidor de betalactamasas, fosfomicina, cefalosporinas, nitrofurantoína y aminoglucósidos mostró resistencia inferior al 25%. Conclusión: El agente patógeno más prevalente en infecciones del tracto urinario (ITU) es E. coli (84,7%), porcentaje coincidente con lo reportado en la literatura nacional y mundial. Los antimicrobianos para este uropatógeno con mayor resistencia fueron ampicilina (86%), cirprofloxacina (55%) y norfloxacina (53%). Se podría tener en cuenta en el momento de administrar una terapéutica empírica, dato que debería ser corroborado con información de susceptibilidades de acuerdo con el contexto.

Summary Objective: To determine the prevalence of uropathogens, sensitivity and antimicrobial resistance in urinary tract infections that go to the Private Basic Hospital "Provida" from January 1, 2014 to December 31, 2016. Material and methods: The results of 116 urine cultures in non-pregnant women of all ages from 2014 to 2016, which were treated at the Private Basic Hospital "Provida" of the city of Latacunga, in Ecuador, were analyzed. The data obtained was analyzed using descriptive statistics. Results: In the 116 samples, Escherichia coli (84.5%), Staphylococcus saprophyticus (8.6%) and Proteus spp. (6.9%) were isolated. E. coli showed sensitivity to ceftriaxone in 70%, followed by fosfomycin and gentamicin with 62 and 60%, respectively. The sensitivity found for quinolones was 40% and for sulbactam ampicillin reached a 37%. Proteus spp. showed sensitivity of 75% for gentamicin and 50% for quinolones and cefuroxime. S. saprophyticus had a sensitivity greater than 50% for gentamicin, sulbactam ampicillin, quinolones and nitrofurantoin. For E. coli the highest resistance recorded was found on ampicillin in 86.5%, followed by quinolones with a resistance greater than 50%. Ampicillin associated with inhibitor of beta-lactamase, fosfomycin, cephalosporins, nitrofurantoin and aminoglycosides showed a resistance below 25%. Conclusion: The most prevalent pathogen in urinary tract infections (UTI) is E. coli (84.7%), a percentage that matches what has been reported in national and world literature. The antimicrobials for this uropathogen with the highest resistance were ampicillin (86%), ciprofloxacin (55%) and norfloxacin (53%). This should be taken into account when administering an empiric therapy, even though this data should be corroborated with the susceptibility information depending on the context.

Resumo Objetivo: Determinar a prevalência de uropatógenos, sensibilidade e resistência antimicrobiana na infecção do trato urinário que vão ao Hospital Básico Privado "Provida" de 1 de janeiro de 2014 a 31 de dezembro de 2016. Material e métodos: Analisaram-se os resultados de 116 uroculturas de urina em mulheres não gestantes de todas as idades de 2014 a 2016, que foram atendidas no Hospital Básico Privado "Provida" da cidade de Latacunga, no Equador. A análise dos dados obtidos realizou-se mediante estatística descritiva. Resultados: Das 116 amostras, isolaram-se: Escherichia coli (84,5%), Staphylococcus saprophyticus (8,6%) e Proteus spp. (6,9%). E. coli mostrou sensibilidade a ceftriaxona em 70 %, seguido de fosfomicina e gentamicina com 62 e 60%, respectivamente. A sensibilidade encontrada para quinolonas foi de 40% e a ampicilina sulbactam atingiu 37%. Proteus spp. mostrou sensibilidade de 75% para gentamicina e de 50% para quinolonas e cefuroxima. S. saprophyticus teve sensibilidade superior a 50% para gentamicina, ampicilina sulbac-tam, quinolonas e nitrofurantoína. Para E. coli a resistência mais alta registrada foi com ampicilina em 86,5%, seguido das quinolonas com uma resistência superior a 50%. A ampicilina associada a inibidor de betalactamasas, fosfomicina, cefalosporinas, nitrofurantoína e aminoglucósidos mostrou resistência inferior a 25%. Conclusão: O agente patogénico mais prevalente em infecções do trato urinário (ITU) é E. coli (84,7%), porcentagem coincidente com o apresentado na literatura nacional e mundial. Os antimicrobianos para esse uropatógeno com maior resistência foram ampicilina (86%), cirprofloxacina (55%) e norfloxacina (53%). Poderia ser tido em conta no momento de administrar uma terapêutica empírica, dado que deveria ser corroborado com informação de suscetibilidades de acordo com o contexto.

Caracterización y perfil de susceptibilidad de uropatógenos asociados a la presencia de bacteriuria asintomática en gestantes del Departamento del Atlántico, Colombia, 2014-2015. Estudio de corte transversal / Characterization and susceptibility profile of uropathogens associated with the presence of asymptomatic bacteriuria in pregnant women in the department of Atlántico, Colombia 2014-2015. Cross-sectional study

RESUMEN Objetivo: La bacteriuria asintomática con manejo inadecuado en el embarazo, se asocia con pielonefritis que puede llevar a complicaciones maternas y fetales. El objetivo de este estudio fue caracterizar los uropatógenos y su perfil de susceptibilidad, asociados a la presencia de bacteriuria asintomática en una muestra de mujeres gestantes. Materiales y métodos: Estudio descriptivo de corte transversal, en gestantes atendidas en el programa de control prenatal en una institución de primer nivel en el departamento del Atlántico, Colombia. Se realizó un muestreo por conveniencia a partir del universo de pacientes atendidas en el programa. Se hizo el diagnóstico de bacteriuria asintomática por la presencia de recuentos ≥ 105 colonias / mL de un solo germen. Para la identificación y determinación del perfil de susceptibilidad de las bacterias aisladas se utilizó el sistema automatizado Phoenix® BD. Se describe la prevalencia de bacteriuria asintomática, y la frecuencia y susceptibilidad por tipo de germen. Resultados: Ingresaron 226 gestantes. La frecuencia de bacteriuria asintomática fue del 10,6 %. El uropatógeno más frecuentemente aislado fue la Escherichia coli en un 25 % de los casos, seguida por Enterococcus faecalis en un 20,8 %. La resistencia a la ampicilina fue del 33,3 y 20 % respectivamente; el resto de enterobacterias identificadas presenta una resistencia natural a dicho antibiótico. La resistencia de E. coli para el sulfametoxazol fue del 66,6%, y de la E. coli y el E. faecalis a la nitrofurantoína fue del 16,6 y 20% respectivamente. Conclusiones: Se encuentra resistencia importante en el nivel de atención de los gérmenes más frecuentemente aislados en gestantes con bacteriuria asintomática a la ampicilina y el trimetoprim. La nitrofurantoína sigue siendo una buena opción para el tratamiento en la primera mitad del embarazo.

ABSTRACT Objective: Asymptomatic bacteriuria, when inadequately managed during pregnancy, is associated with pyelonephritis, which may give rise to maternal and foetal complications. The objective of this study was to characterize uropathogens associated with the presence of asymptomatic bacteriuria and their susceptibility profile in a sample of pregnant women. Materials and methods: Descriptive, cross-sectional study in pregnant women coming to antenatal care at a Level I center in the Department of Atlantico, Colombia. A convenience sampling was made from the universe of patients seen in the programme. Asymptomatic bacteriuria was diagnosed on the basis of the finding of counts ≥ 105 colonies /mL of a single germ, unaccompanied by symptoms. An automated Phoenix® BD system was used for the identification and determination of the susceptibility profile of the bacterial isolates. The prevalence of asymptomatic bacteriuria, and the frequency and susceptibility by germ type are described. Results: Overall, 226 pregnant women were included. The frequency of asymptomatic bacteriuria was 10.6 %. The uropathogen most frequently isolated was Escherichia coli in 25 % of cases, followed by Enterococcus faecalis in 20.8 %. Ampicillin resistance was 33.3 % and 20 %, respectively; the rest of the enterobacteria identified show natural resistance to this antibiotic. For trimetoprim sulfametoxazol resistence was 66 %. Regarding Nitrofurantoin resistance was 1.6 % and 20 % for E. coli and E. faecalis, respectively. Conclusions: There is significant resistance of the most frequently isolated germs in pregnant women with asymptomatic bacteriuria to ampicillin, trimetoprim sulfametoxazol Nitrofurantoin continues to be a good treatment option during the first half of the pregnancy.

Prevalencia de uropatógenos y sensibilidad antimicrobiana en lactantes menores de 2 años provenientes de la comunidad con diagnóstico de infección de vías urinarias / Prevalence of uropathogens and antimicrobial susceptibility in infants younger than 2 years of age from the community with a diagnosis of urinary tract infection

RESUMEN Introducción: la infección urinaria (IU) es una patología frecuente en los niños. La prevalencia de los uropatógenos varía de acuerdo a las regiones geográficas e incluso entre los diferentes centros asistenciales. El conocimiento de dicha prevalencia y de la sensibilidad a los antimicrobianos ayuda a la elección de la antibioticoterapia empírica inicial, permitiendo de esa manera, el control del cuadro agudo y evitando la resistencia bacteriana. Objetivo determinar la sensibilidad de los uropatógenos a los antimicrobianos obtenidos de urocultivos de niños menores de 24 meses con diagnóstico de IU provenientes de la comunidad. Material y métodos: estudio observacional, descriptivo, retrospectivo, de corte transverso. Se analizaron los expedientes clínicos y resultados de urocultivos de lactantes menores de 24 meses internados en el Departamento de Pediatría del Hospital Nacional en el período comprendido entre enero de 2012 a diciembre de 2014 , con diagnóstico de IU. Resultados: los uropatógenos más frecuentemente obtenidos fueron: Escherichia coli (67,6%) seguido de Klebsiella pneumoniae (18,3%), Enterobacter cloacae (8,4%), Pseudomonas aeruginosa (2,8%) y otros en 2,9%. La sensibilidad de la E. coli a la ciprofloxacina, las cefalosporinas y aminoglucósidos fue alta. El 14,6% de Escherichia coli fue productora de betalactamasa de espectro extendido (BLEE). El 100% de las cepas de Klebsiella pneumoniae fuer sensible a amikacina, ciprofloxacina y acidonalidíxico. Conclusiones: el germen más frecuentemente encontrado fue E. coli, seguido de la Klebsiella pneumoniae. El tratamiento de elección recomendado es la combinación de cefalospinas de primera generación asociado a aminoglucósidos, ya que con este esquema se cubrirá más del 95% de los uropatógenos causantes de infección de vías urinarias de la comunidad. Los gérmenes productores de infección urinaria atípica, deberán ser investigados.

ABSTRACT Introduction Urinary tract infection (UTI) is a common pathology in children. The prevalence of uropathogens varies according to geographic regions and even between different care centers. Knowledge of this prevalence and antimicrobial susceptibility helps to choose the initial empirical antibiotic therapy, thus allowing the control of the acute condition and avoiding bacterial resistance. Objective to determine the sensitivity of uropathogens to antimicrobials obtained from urine cultures of children younger than 24 months with diagnosis of UTI from the community. Material and methods: observational, descriptive, retrospective, cross-sectional study. We analyzed the clinical records and results of urine cultures of infants under 24 months admitted to the Department of Pediatrics of the National Hospital in the period between January 2012 and December 2014, diagnosed as UI. Results: the most frequent uropathogen was Escherichia coli (67.6%) followed by Klebsiella pneumoniae (18.3%), Enterobacter cloacae (8.4%), Pseudomonas aeruginosa (2.8%) and others in 2, 9%. The sensitivity of E. coli to ciprofloxacin, cephalosporins and aminoglycosides was high. 14.6% of Escherichia coli was a producers of extended spectrum betalactamase (ESBL). 100% of Klebsiella pneumoniae strains was a sensitive to amikacin, ciprofloxacin and acidonaldehyde. Conclusions: the more frequent germ found was E. coli, followed by Klebsiella pneumoniae. The recommended treatment of choice is the combination of first-generation cephalosporins associated with aminoglycosides, as this scheme will cover more than 95% of the uropathogens that cause urinary tract infection in the community. Germs producing atypical urinary infection should be investigated.

Emergence of CTX-M-15 producing E. coli O25b-ST131 clone in a tertiary care hospital of Bangladesh

Background: Extended-spectrum β-lactamase (ESBL) producing uropathogens has become prevalent worldwide. E. coli O25b-ST131 clone, associated with blaCTX-M-15, has been reported from many parts of the world and is frequently associated with multidrug resistance. Thus far, there are no reports about this clone in Bangladesh. The objective of this study was to investigate ESBL producing uropathogens and to survey the prevalence of E. coli O25b-ST131 clone among ESBL positive E. coli isolates. Methods: From symptomatic urinary tract infection cases, a total of 800 urine samples were collected. Bacterial identification and antimicrobial susceptibility testing was performed using established methods. Screening of ESBL producers was done using the disk diffusion method. Screening positive isolates were phenotypically confirmed by double disk synergy (DDS) test. Genes encoding ESBLs (blaCTX-M-15, blaOXA-1) were identified both by PCR and DNA sequencing. Phenotypic positive ESBL producers were also studied by PCR for existence of class 1 integron. Subsequently, O25b-ST131 clone was identified by allele specific PCR. Results: Of 138 gram-negative uropathogens, 45 (32.6%) were positive for ESBLs. ESBL producers showed high frequency of antimicrobial resistance except imipenem. Among 45 ESBL producers, 36 (80%) produced blaCTX-M-15, 18 (40%) produced blaOXA-1. Fifteen (33.3%) strains simultaneously produced both blaOXA-1 and blaCTX-M-15. Class 1 integron was present in 30 (66.7%) isolates. Of the 31 blaCTX-M-15 positive E. coli, 22 (71%) were positive for E. coli O25b-ST131 clone and all (100%) belonged to B2 phylogenetic group. Conclusion: Rising antimicrobial resistance among uropathogens, and especially the emergence of blaCTX-M-15 positive E. coli O25b-ST131 clone in Bangladesh has provided urgency to the development of novel preventive and therapeutic strategies.

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.

occurrence of blaNDM-1 & absence of blaKPC genes encoding carbapenem resistance in uropathogens from a tertiary care centre from north India.

Background & objectives: Carbapenem resistance mediated by carbapenemases is increasingly being reported worldwide. This study was conducted to know the occurrence of important carbapenem resistance encoding genes in gram-negative bacilli (GNB) causing complicated urinary tract infection (CUTI), and to look at the genetic diversity of these isolates. Methods: The study was carried out on 166 consecutive carbapenem resistant uropathogens (CRU) isolated from cases with CUTI during 2008 and 2012. Carbapenemase production was characterized phenotypically and polymerase chain reaction was used to detect blaVIM, blaIMP, blaKPC, and blaNDM-1. BOX- PCR was done on 80 randomly selected isolates for molecular typing. Results: The blaVIM gene was present in 34 (43.6%), blaIMP in five (6.4%) and none of the isolates from 2008 had blaNDM-1 or blaKPC genes. Among the isolates from 2012, blaNDM-1 gene was present in 47 (53.4%), blaVIM in 19 (24.4%), blaIMP in one (1.1%) and none had blaKPC. There were nine isolates during the two years which had multiple genes encoding carbapenemases; while 66 did not have any of the genes tested. Of the 80 isolates subjected to BOX-PCR, 58 could be used for analysis and showed, presence of multiple clusters of carbapenem resistant isolates and absence of a single dominant clone. Interpretation & conclusions: The blaNDM-1 gene was absent in our isolates obtained during 2008 but was present amongst Enterobacteriaceae isolated in 2012. The blaKPC gene was also not found. Nine isolates obtained during the two years had multiple genes encoding carbapenemases confirming the previous reports of emergence of GNB containing genes encoding multiple carbapenemases. Typing using BOX-PCR indicated that this emergence was not because of clonal expansion of a single strain, and multiple strains were circulating at a single point of time.

Frequency of extended spectrum β-lactamase producing urinary isolates of Gram-negative bacilli among patients seen in a multispecialty hospital in Vellore district, India.

Extended‑spectrum beta‑lactamase (ESBL) producing strains of Coliform bacilli are on the rise and present a major threat especially in India. We assessed the frequency of ESBL producers among urinary isolates from patients presenting urinary tract infections. ESBL screening was done using Double Disk Synergy Test (DDST) and confirmed using E‑test and Polymerase Chain Reaction (PCR). With E‑test, 92.2% were positive for ESBL. In PCR, 100% strains were positive for any of the three gene targets tested. CTX‑M was positive in majority of the strains followed by TEM and SHV. Two (3.22%) strains were positive for all the three genes; 21% strains were positive for both TEM and CTX‑M genes. There was no statistically significant difference in the findings of E‑test and PCR testing in the determination of ESBL producers (Fisher exact test P = 0.15). The strength of agreement between them was ‘fair’ (k = 0.252). Continuous monitoring of ESBL producers among Indian strains is important to rationalize the antibiotic policy to be followed.

Utility of Chromogenic Disc Using Replication System versus Conventional Method for Detection of Uropathogens.

Aims: To evaluate utility of replication system using chromogenic disc for detection of uropathogens and to compare the result with conventional method for the same. Design: A total of 625 urine samples were processed from suspected cases of urinary tract infection, admitted in a rural medical college of Maharashtra. Methodology: The culture isolates of uropathogens were identified by both conventional method and by chromogenic disc using replica system. Results: Out of 625 urine specimens, 419 (67.04%) were Culture positive. There was growth of Escherichia coli 197(99.49%), Enterococcus faecalis 88 (21%), Klebsiella pneumoniae 63 (15.03%) and Pseudomonas aeruginosa 10.73%. There was mixed growth of organisms 15(3.57%) in urine specimens. All uropathogens isolates were identified correctly by conventional as well as chromogenic disc using replica system, except one. One of the Escherichia coli isolate was identified by conventional methods but with replica system it showed colourless colonies instead of purple colonies. Conclusion: Replica system is a rapid, cost effective and easy method for detection of uropathogens with satisfactory result. It can be adopted in clinical microbiology laboratory for presumptive diagnosis of uropathogens.

Susceptibilidad antimicrobiana de microorganismos causantes de infección de vías urinarias bajas en un hospital pediátrico / Antimicrobial susceptibility of uropathogens from uncomplicated urinary tract infection in a pediatric hospital

Introducción: La infección del tracto urinario en los niños es reconocida como una causa de morbilidad y de condiciones médicas crónicas, por lo que resulta indispensable conocer con claridad la patogénesis de esta enfermedad. Sin embargo, la resistencia creciente complica su tratamiento ya que aumenta la morbilidad, los costos, la estancia hospitalaria y el uso de fármacos de mayor espectro antimicrobiano. El propósito de este estudio fue determinar la susceptibilidad antimicrobiana de los uropatógenos aislados en niños. Métodos: Se incluyeron en el estudio 457 niños que asistieron a la consulta externa y a urgencias del Hospital Infantil de México Federico Gómez, con síntomas de infección del tracto urinario baja no complicada. La orina fue tomada a la mitad del chorro o por cateterismo, y se realizó la identificación y la susceptibilidad antimicrobiana. Resultados: Los patógenos aislados con mayor frecuencia fueron: Escherichia coli (E. coli) (312, 68.3%), Enterococcus spp. (42, 11%), Klebsiella pneumoniae (K. pneumoniae) (40, 8.7%), Pseudomonas aeruginosa (P. aeruginosa) (34, 7.5%), Proteus mirabilis (P. mirabilis) (21, 4.5%), Enterobacter cloacae (8, 1.7%). La resistencia para trimetoprima/sulfametoxazol fue del 73.7, 62.2, 100, 52, 50%,respectivamente, para E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis y Enterobacter spp., del 92.5% para Enterococcus faecalis (E. faecalis) y del 49.9% para Enterococcus faecium (E. faecium). Para ampicilina fue del 86.3, 45, 100, 47.9 y 66.6% para las mismas bacterias, respectivamente. Para ciprofloxacina del 33.8, 9, 18.8, 0 y 0%; para nitrofurantoína del 4.4, 13, 97.7, 70, 0% para enterobacterias, del 0% para E. faecalis y del 16.7% para E. faecium. Conclusiones: Los antimicrobianos frecuentemente prescritos para el tratamiento empírico de la infección del tracto urinario no complicada demuestran resistencia importante o baja susceptibilidad cuando se les probó frente a las cepas aisladas.

Background: Urinary tract infection in children is well recognized as a cause of acute morbidity and chronic medical conditions. As a result, appropriate use of antimicrobial agents, however, increases antibiotic resistance and complicates its treatment due to increased patient morbidity, costs, rates of hospitalization, and use of broader-spectrum antibiotics. The goal of this study was to determine antibiotic susceptibility to commonly used agents for urinary tract infection against recent urinary isolates. Methods: A total of 457 consecutive children attending the emergency room at the Hospital Infantil de México Federico Gómez with symptoms of uncomplicated lower urinary tract infection were eligible for inclusion. Patients who had had symptoms for ≥ 7 days and those who had had previous episodes of urinary tract infection, received antibiotics or other complicated factors were excluded. Midstream and catheter urine specimens were collected. All isolates were identified and the in vitro activities of antimicrobials were determined. Results: The most frequently isolated urinary pathogens were as follows: Escherichia coli (E. coli) (312, 68.3%), Enterococcus spp. (42, 11%), Klebsiella pneumoniae (K. pneumoniae) (40, 8.7%), Pseudomonas aeruginosa (P. aeruginosa) (34, 7.5%), Proteus mirabilis (P. mirabilis) (21, 4.5%), Enterobacter cloacae (8, 1.7%). The resistance to trimetoprim/sulfametoxazol (%) was 73.7, 62.2, 100, 52, and 50, respectively, for E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis and Enterobacter spp., 92.5 for Enterococcus faecalis (E. faecalis) and 49.9 for Enterococcus faecium (E. faecium). Ampicillin was 86.3, 45, 100, 47.9, and 66.6% for the same strains, ciprofloxacin 33.8, 9, 18.8, 0, 0%, nitrofurantoin 4.4, 13, 97.7, 70, 0%; to E. faecalis 0% and 16.7% to E. faecium. Conclusions: Frequently prescribed empirical agents for uncomplicated urinary tract infection demonstrate lowered in vitro susceptibilities when tested against recent clinical isolates.

Prevalence of extended spectrum beta-lactamase producing uropathogens and their antibiotic resistance profile in patients visiting a tertiary care hospital in central India: Implications on empiric therapy.

Context: Antimicrobial resistance showed by different uropathogens is one of the barricades that might hinder a successful treatment. Detection of extended spectrum beta-lactamase (ESBL) production among uropathogens is an important marker of endemicity. Aims: The present prospective study was done to identify the trends of uropathogens, to find the prevalence of ESBL isolates and to study the antibiotic resistance profile of the ESBL and non-ESBL uropathogenic isolates. Materials and Methods: This study was conducted in the Department of Microbiology of a teaching tertiary care hospital from July 2013 to September 2013. All the uropathogenic isolates were identified up to species level by conventional methods. The prevalence of potential ESBL producers was explored. Antibiotic resistance test of the urinary isolates was done by disc-diffusion method and the results were interpreted according to Clinical Laboratory Standards Institute-2013 guidelines. Results: A total of 670 urine samples from male and female patients visiting the outpatient department (OPD) and inpatient department (IPD) of our hospital were collected. A significantly higher number of IPD and OPD males (55.1% and 55.5%) were found to be culture positive. Escherichia coli (55.3%) was the most frequently isolated uropathogen followed by Klebsiella pneumoniae (23%). However, strains of Escherichia coli (41.6%) were the highest ESBL producing isolates followed by Pseudomonas aeruginosa (36.1%). ESBL producing isolates were found to be multidrug-resistant when compared to non-ESBL producers. However, excessive drug-resistance among non-ESBL producing isolates can’t be ignored. Conclusion: Our study confirms a global trend toward increased resistance to beta-lactam antibiotics. We emphasize on the formulation of antibiotic policy for a particular geographical area.

Plasmid Profile of Uropathogens among Children.

Aims: The study was carried out in order to determine the plasmid profile, antibiotic susceptibility pattern and the type of antimicrobial resistance (whether it is chromosomal or plasmid mediated) among producers of extended spectrum beta-lactamases of uropathogens in children. Study Design: A cross-sectional study of three hundred children in a hospital. Place and Duration of Study: Department of Pediatrics (Pediatrics Ward) and Department of Medical Microbiology and Parasitology, Nnamdi Azikiwe University Teaching Hospital, Nigeria between January 2009 to September 2010. Methodology: Clean-catch urine samples were collected from 300 children aged 1 month to 16 years with suspected community acquired urinary tract infection. Isolated bacteria were identified using standard microbiological techniques. Antimicrobial susceptibility test was carried out by disc diffusion method. Extended Spectrum Beta- Lactamase (ESBL) was determined among the Gram-negative bacteria using double disc synergy test (DDST). The plasmid DNA of the bacterial isolates was extracted using alkalysis method and electrophoresed on 0.8% agarose gel stained with 2μl ethidium bromide (EtBr). Result: The result of the study showed that Staphylococcus aureus had the highest prevalence among gram positive bacteria. Escherichia coli had the highest prevalence among gram negative bacteria. Staphylococcus aureus showed cross resistance towards some of the antimicrobial agents. Escherichia coli and Pseudomonas showed multiple drug resistance. All the uropathogens isolated were 100% susceptible to imipenem. The study highlights among the ESBL-producers, plasmids of higher molecular weight of 30Kb. Conclusion: It is therefore suggested that appropriate antimicrobial agent be administered to reduce the risk of multi-drug resistance and avert the ineffectiveness of antimicrobial agents.