Prevalence of antibiotic resistant UTI in immunocompromised patients

Background: Urinary tract infections (UTIs) are amongst the most common bacterial infections, affecting about 150 million individuals per year.Urinary tract infection (UTI) is one of the most common diseases in human societies which occur in women more than men. Women of all ages are more likely to experience such an infection than men, while half of them may be affected by a uropathogen once in their lives, and 25-30% may develop recurrent UTIs not associated with any functional or anatomical abnormality. The aim of this study was to explore the prevalence of antibiotic resistance of urinary tract infections in immunocompromised patients. Material & Methods: This was a retrospective observational study and was conducted in the Department of Medicine of Dhaka Central International Medical College and Hospital, and National Institute of Kidney Diseases & Urology, Dhaka, Bangladesh during the period from June, 2021 to June, 2022. We included 70 immunocompromised patients with UTI. Results: In our study we found 44% patients were aged between 18-30 years old and 83% of our patients were female. Among all respondents, 58 patients were culture positive. We found 38% & 62% and 33% & 67% had history of upper & lower UTI in female and male patients respectively, 29% & 36% and 17% & 25% had urethritis & cystitis in female and male patients respectively. We found culture positive patients with E. coli (41%), Klebsiella spp.(19%), Enterobacter spp.(16%) and 12% with Pseudomonas spp in our study. We found amoxicillin showed resistance to E. coli (58.3%), Staphylococcus (75%), & Klebsiella (36.4%) and amikacin showed resistance mostly to E. coli(50%), Klebsiella (54.5%) & Pseudomonas (42.9%). Conclusion: In our study, we found the most common MDR pathogen among patients with UTI in our institution was E. coli & Staphylococcus. We discovered that being above 40 years old, having DM, CKD and previously received antibiotic medication inappropriately were risk factors for the development of MDR infection. Given the high prevalence of multidrug resistant uropathogens among immunocompromised patients, the growth in Penicillin resistance is alarming. We discovered the significant incidence of MDR bacterial strains, adherence to currently suggested empiric therapy is extremely challenging and is linked with high failure rates.

Perfil de sensibilidade de uropatógenos em gestantes de um hospital de ensino do município de São Paulo / Sensitivity profile of uropathogens in pregnant women at a teaching hospital in the city of São Paulo

Objetivo: O presente estudo tem como objetivo avaliar o perfil de sensibilidade antimicrobiana do patógeno mais comum causador da infecção do trato urinário (ITU) de gestantes que foram internadas em um hospital de ensino do município de São Paulo em determinado período. Métodos: Estudo retrospectivo, transversal, quantitativo, realizado avaliando as uroculturas positivas e o perfil de sensibilidade antimicrobiana dos agentes mais comuns encontrados em ITUs das gestantes de hospital e maternidade-escola do município de São Paulo de janeiro de 2019 até janeiro de 2020. Resultados: A partir da análise de uroculturas positivas e antibiograma de 149 gestantes admitidas com quadro de infecção urinária no referido hospital no intervalo de tempo analisado, constatou-se que 83,89% dos casos apresentaram como patógeno a bactéria Escherichia coli. No âmbito da resistência bacteriana, percebeu-se que o maior índice foi encontrado no que tange a cefalotina (65%), ampicilina (58%) e ampicilina/sulbactam (45%). Ademais, a partir das análises individuais, 20 pacientes, ou seja, aproximadamente 13,42% apresentaram cepas sensíveis a todas as medicações apontadas, e as demais apresentaram resistência a, pelo menos, uma delas. Conclusão: A partir da premissa de eficácia desempenhada pelo protocolo de medicação empírica estabelecido pela instituição no tocante ao tratamento de infecção do trato urinário em gestantes, a cefalotina certamente não deveria compor o rol de drogas ofertadas às pacientes. Isso se dá, pois a sensibilidade apresentada pela Escherichia coli, patógeno que mais comumente está associado aos quadros de ITU do serviço, a essa droga é muito baixa. Já a nitrofurantoína apresentou um satisfatório espectro de cobertura, sendo a resistência à droga inferior a 10%. Com isso, conclui-se que ela deve permanecer como droga inicial para as ITUs das gestantes que chegam a essa instituição.(AU)

Objective: The present study aims to evaluate the antimicrobial sensitivity profile of the most common pathogen that causes urinary tract infection (ITU) in pregnant women who were admitted to a Teaching Hospital in the city of São Paulo in a specific period. Methods: Retrospective, cross-sectional, quantitative study carried out evaluating positive urine cultures and the antimicrobial sensitivity profile of the most common agents found in ITU of pregnant women at Teaching Maternity hospital in the city of São Paulo from January 2019 to January 2020. Results: From the of positive urine culture and antibiogram of 149 pregnant women admitted with a urinary tract infection in the referred hospital in the analyzed period of time, it was found that 83.89% of the cases presented the bacterium Escherichia coli as a pathogen. In the scope of bacterial resistance, it was noticed that the highest index was found with respect to Cephalothin (65%), ampicillin (58%) and ampicillin/sulbactam (45%). Furthermore, from the individual analyzes, 20 patients, that is, approximately 13.42% had strains sensitive to all the medications indicated, with the others showing resistance to at least one of them. Conclusion: Based on the premise of efficacy performed by the empirical medication protocol established by the institution regarding the treatment of urinary tract infection in pregnant women, Cephalothin should certainly not be included in the list of drugs offered to patients. This happens because the sensitivity presented by Escherichia coli, the most commonly pathogen associated with the UTI pathogen of the service, to this drug is very low. Nitrofurantoin, on the other hand, presented a satisfactory coverage spectrum, with drug resistance below 10%. Thus, it is concluded that this should remain as an initial drug for ITUs of pregnant women who arrive at this institution.(AU)

Prevalence of Urinary Tract Infection and the Antibiotic Sensitivity Pattern of the Most Common Uropathogen from a Tertiary Care Hospital of Jamshedpur

Introduction: Urinary tract infections are one of the mostcommon infections encountered and pose a major threat topublic health. Strict antibiotic policies based upon theknowledge of regional susceptibility pattern, may be of greathelp for the clinicians and also prevent emergence of resistantstrains of pathogens.Aim: The aim of this study was to observe the prevalence andanalyse the antibiotic sensitivity pattern of the most commonlyisolated uropathogen in urinary tract infection.Materials and Methods: In this study a total of 338 urinarysamples of suspected urinary tract infections were collectedfrom the microbiology laboratory of M.G.M. Medical Collegeand Hospital, a tertiary care hospital. The age and sex ofpatients, the organisms isolated and antimicrobial susceptibilityprofile of the most frequently isolated uropathogens wasobserved.Results: Out of 338 samples suspected of UTI 118samples showed positive growth in MacConkey agar.Antibiotic susceptibility test was done by disc diffusion method.The most frequently isolated uropathogen was E.coli ie 51%and the antibiotic susceptibility pattern of E.coli was observed.Resistance to the commonly used drugs was high.Conclusion: Drug resistance has become a global problemthese days so proper surveillance and coordinance with theclinicians is required for the judicious selection of effectiveempirical treatment of UTI.

Clinical profile of pediatric patients with urinary tract infection in a tertiary care centre in Kashmir, India

Background: The urinary tract is a common site of infection in pediatric patients. Author studied the clinical and microbiological profile along with the antibiotic resistance in children with UTI attending centre.Methods: It was a prospective study was conducted in the Department of Pediatrics, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India over a period of one year from August 2017 to August 2018.A total of 250 children aged 1-36 months were included in the study. A proper history and examination were done in each case. A clean catch mid-stream urine sample was obtained from each child. Quantitative microscopy and urine culture were performed. Standard biochemical tests were done to identify the isolates and for determination of antibiotic sensitivity.Results: Out of the 250 children studied , a total of 216 children were diagnosed as UTI by positive urine culture.102 were males and 114 were females. Significant pyuria was detected in 85%patients. Fever with irritability was the most common presenting symptom (71%) followed by vomiting (63%) and abdominal pain (52%).The most common uropathogen detected was E. coli (57%) followed by Klebsiella spp. (20%), proteus (16%), pseudomonas (5%), and candida (2%). Majority of the patients responded to treatment with ceftriaxone followed by cefixime. Antibiotic resistance in vitro was least seen with amikacin (25%) followed by nitrofurantoin (11%). 91.3% of UTI detected was nosocomial. Vesicoureteral reflux was found in 49% of patients while 13% were diagnosed with posterior urethral valve.Conclusions: Urinary tract infection should be considered as one of the most important differential diagnosis in patients with fever attending pediatric OPD. Urine microscopy and culture should be a part of routine diagnostic evaluation in all febrile children. Early treatment of UTI is important to prevent later sequelae including pyelonephritis and renal scarring.

A Case of Urinary Tract Infection Caused by the Emerging Uropathogen Actinotignum schaalii

Actinotignum schaalii is an emerging uropathogen; however, routine culture protocols and usual phenotypic methods do not allow for easy detection and identification. Herein, we report the first Korean case of urinary tract infection caused by A. schaalii in a 79-year-old patient with prostate cancer. A gram-positive rod bacterium was isolated from the patient's urine after 2 days of culture and identified as A. schaalii using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and DNA target sequencing.

Biofilm production and its correlation with antibiogram among clinical isolates of uropathogenic Escherichia coli

Background: Urinary tract infection (UTI) is one of the commonest health problem encountered in clinical practice. The biofilms play major role in decreasing the susceptibility to the antimicrobial agents. The present study aimed at isolation and identification of Escherichia coli from cases of urinary tract infection, and to find out production of biofilms by these isolates and to correlate it with antimicrobial resistance.Methods: This study was a cross sectional study. Urine specimen from patients suspected of UTIs were collected and processed by standard operative procedure, antibiotic susceptibility test was done by Kirby Bauer disc diffusion method. Biofilm production in isolates was done by Tissue culture plate (TCP) method, Christensen’s test tube (CTT) method, and Congo red agar (CRA) method.Results: Out of the total of 250 isolates 191 (76%) showed biofilm positive by TCP method, 180 (72%) showed biofilm positive by CTT method, 161 (64%) showed biofilm positive by CRA method. 90% of total extended spectrum beta lactamase (ESBL) producing Escherichia coli were biofilm producers. There is more resistance for each and every antibiotic among biofilm producers in comparision to biofilm non producers.Conclusions: The microbial biofilms may pose a public health problem, as the microorganisms in the biofilms are difficult to be treated with antimicrobial agents.

Perfil de sensibilidad a los antibióticos de las bacterias en infecciones del tracto urinario / Antibiotic sensitivity profile of bacteria in urinary tract infections

ResumenAntecedentes:las infecciones del tracto urinario representan motivo de consulta médica ambulatoria frecuentemente. Los altos y crecientes índices de resistencia antibiótica implican un reto para el médico tratante.Objetivo:obtener información epidemiológica del perfil de sensibilidad de las bacterias aisladas en los urocultivos.Metodología:entre febrero y junio de 2014, se recolectaron 602 resultados de urocultivos en diferentes laboratorios de las ciudades de San Pedro Sula y El Progreso, en Honduras. Las variables analizadas fueron sexo, edad y bacteria, y los antibióticos que presentaban mayor porcentaje de sensibilidad y resistencia en los urocultivos. Se utilizó el método de Kirby Bauer para valorar los perfiles de resistencia y sensibilidad en todos los laboratorios. Se elaboró una lista de 47 antibióticos de todos los laboratorios. Se correlacionaron las variables para describir los perfiles de resistencia y sensibilidad de la lista de antibióticos.Resultados:las bacterias aisladas fueron E. Coli (70,4%), Enterobacter spp (7,8%), Klebsiella spp (6,3%), Citrobacter spp (6,1%), Proteus spp (2,8%), Staphylococcus s spp (2,7%), Pseudomona aeruginosa (1,8%), Streptococcus spp (1,2%), Hafnia alveii (0,3%), Morganella morgagni (0,2%), Serratia marcenscens (0,2%), Neisseria gonorrhoeae (0,2%). De 602 muestras, la sensibilidad general reportada fue: fosfomicina (n=415, 68,9%), amikacina (n=412, 68,4%), nitrofurantoína (n=376, 62,4%), gentamicina (n=364, 60,4%) y ceftriaxona (n=307, 50%). Se reportó una resistência general a trimetoprim sulfametoxazol (n=302, 50,1%), ciprofloxacina (n=230, 38,2%), levofloxacina (n=221, 36,7%), norfloxacina (n=220, 36,5%) y amoxicilina+ácido clavulánico (n=204, 33,8%).Conclusiones:los resultados de este estudio revelan que por su buen perfil de sensibilidad, antibióticos como la fosfomicina y la nitrofurantoína pueden ser una opción terapéutica empírica viable en pacientes con infecciones del tracto urinario bajo no complicadas, previo a utilizar antibióticos de amplio espectro, evitando así el desarrollo de resistencia antibiótica.

AbstractBackground:Urinary Tract Infections represent a frequent reason of ambulatory medical consult.The high and increasing percentages of antibiotic resistance represent a challenge for the physician treating them.Aim:To obtain epidemiological information of the sensibility profile from bacteria isolated in urine cultures.Methods:Between February and June of 2014, 602 urine culture samples were collected from different laboratories in the cities of San Pedro Sula and El Progreso, Honduras. The variables analyzed were sex, age and bacteria, antibiotics with higher sensibility and with higher resistance in urine culture. The Kirby Bauer method was used to determine the sensitivity and resistance profiles of each urine culture. A total of 47 antibiotics were used in all the laboratories. The variables were correlated to describe the resistance and sensibility profiles of the list of antibiotics.Results:The bacteria isolated were E. Coli (70.4%), Enterobacter spp (7.8%), Klebsiella spp (6.3%), Citrobacter spp (6.1%), Proteus spp (2.8%), Staphylococcus s spp (2.7%), Pseudomona aeruginosa (1.8%), Streptococcus spp (1.2%), Hafnia alveii (0.3%), Morganella morgagni (0.2%), Serratia marcenscens (0.2%), Neisseria gonorrhoeae (0.2%). From 602 samples, the general sensitivity reported was: fosfomycin (n=415, 68.9%), amikacin (n=412, 68.4%), nitrofurantoin (n=376, 62.4%), gentamicin (n=364, 60.4%) y ceftriaxone (n=307, 50%). The resistance for all the samples reported was as follows trimetoprim sulfametoxazole (n=302, 50.2%), ciprofloxacin (n=230, 38.2%), levofloxacin (n=221, 36.7%), norfloxacin (n=220, 36.5%) y amoxicilin+clavulanic acid (n=204, 33.9%).Conclusions:The results in this research reveal that due to their good sensitivity profile, antibiotics like fosfomycin and nitrufurantoin can be a viable empiric therapy in patients with low urinary, or not complicated tract infection before using wide spectrum antibiotics, always personalizing according to the clinical state of the patient and trying to avoid the development of antibiotic resistance.

Comparison of four different methods for detection of biofilm formation by uropathogens.

Context: Urinary tract infection (UTI) is one of the most common infectious diseases encountered in clinical practice. Emerging resistance of the uropathogens to the antimicrobial agents due to biofilm formation is a matter of concern while treating symptomatic UTI. However, studies comparing different methods for detection of biofilm by uropathogens are scarce. Aims: To compare four different methods for detection of biofilm formation by uropathogens. Settings and Design: Prospective observational study conducted in a tertiary care hospital. Materials and Methods: Totally 300 isolates from urinary samples were analyzed for biofilm formation by four methods, that is, tissue culture plate (TCP) method, tube method (TM), Congo Red Agar (CRA) method and modified CRA (MCRA) method. Statistical Analysis: Chi‑square test was applied when two or more set of variables were compared. P < 0.05 considered as statistically significant. Considering TCP to be a gold standard method for our study we calculated other statistical parameters. Results: The rate of biofilm detection was 45.6%, 39.3% and 11% each by TCP, TM, CRA and MCRA methods, respectively. The difference between TCP and only CRA/MCRA was significant, but not that between TCP and TM. There was no difference in the rate of biofilm detection between CRA and MCRA in other isolates, but MCRA is superior to CRA for detection of the staphylococcal biofilm formation. Conclusions: TCP method is the ideal method for detection of bacterial biofilm formation by uropathogens. MCRA method is superior only to CRA for detection of staphylococcal biofilm formation.

Lower Urinary Tract Infections among Patients Diagnosed of Benign Prostate Hyperplasia in Federal Medical Centre, Bida, North Central, Nigeria.

Objective: This study was aimed to identify the aetiology of bacteria associated with Benign Prostate Hyperplasia (BPH) and to determine the antimicrobial susceptibility pattern of the isolated organisms in the community. Study Design: Data were obtained from Medical Microbiology Department register from February 2009 through December 2013, and was exempted from ethical approval. Urine samples were collected from a total of 536 patients with indwelling urinary catheter on hospital admissions that were clinically diagnosed of BPH. Subjects were between the ages of 41 and 100 years. Data was coded, computed and analyzed using SPSS version 16.0 and p values ≤0.05 was considered to be statistically significant. Results: Our research showed that the incidence of urinary tract infections in this study population was (62.5%), and statistically not significant (p- value = 0.296, mean age=5.13, mode=4.00 and S.D ±2.03). Escherichia coli 247(67.7%) was the most prevalent uropathogen followed by Staphylococcus aureus 34(9.3%), Pseudomonas species 29(7.9%), Klebsiella species 10(2.7%), Proteus species 10(2.7%), Candida albicans 4(1.1%) and Staphylococcus albus 1(0.3%) being the least isolates. The highest uropathogen was susceptible to Nitrofurantoin (61.9%) followed by Levofloxacin (44.1%) and least susceptible to Gentamycin (12.1%), Nalidixic acid (12.1%), Augmentin (7.7%) and Ampicillin (0.4%). Conclusion: Our research showed high incidence rate of 62.5% of UTIs among patients with indwelling urinary catheter and diagnosed of benign prostate hyperplasia in our community. This is of serious concern to all stake holders in health industry.

New Insights for Febrile Urinary Tract Infection (Acute Pyelonephritis) in Children

Although asymptomatic bacteriuria, cystitis, and acute pyelonephritis (APN) have been categorized as urinary tract infections (UTIs), the immunopathogenesis of each disease is different. APN shows an age predilection; the majority of children (over 70-80%) with APN are under 1-2 years of age, with a male predominance. After 1-2 years of age, female predominance has been reported. This finding suggests that the immature immune state of infancy may be associated with the pathogenesis of APN. Escherichia coli is the most common etiologic agent; other uropathogens associated with UTIs originate from the host and comprise normal flora that are continuously altered by environmental factors. Therefore, uropathogens may have characteristics different from those of extraneous bacterial pathogens. Although antibiotic-resistant uropathogens, including extended-spectrum beta-lactamase-producing strains, are increasing in Korea and worldwide, treatment failure is rare in immune-competent children. The immunopathogenesis of APN remains unknown. Intact bacteria may not be the causative substances in renal cell injury; rather, smaller substances produced during bacterial replication may be responsible for renal cell injury and scarring. Moreover, substances from host cells such as proinflammatory cytokines may be involved in renal cell injury. A dimercaptosuccinic acid scan is used to detect the site of bacterial replication in the renal parenchyma, and may be influenced by the size of the focus and the stage of APN. Traditional aggressive studies used to identify vesicoureteral reflux after the first episode of APN have been modified because of rare cases of chronic kidney disease in patients with recurrent UTI.

Pattern of antibiotic sensitivity of bacteria causing urinary tract infection in a private Medical College Hospital in Dhaka.

Background: Urinary tract infections (UTI), being the most common infections diagnosed in community and hospital, are to be treated scrupulously considering the type of infecting organism and its antibiotic sensitivity and resistance pattern. Aims and objectives: The aim of the present study was to observe the antibiotic sensitivity pattern of isolated uropathogens from urine samples of patients attending at Shahabuddin Medical College & Hospital, Dhaka, during the period of July 2008 to June 2009. Result: A total of 555 urine samples were studied; of which 84 (15.13%) were culture positive. Among 84 culture positive cases, 84 isolates were identified. Among the isolates, E.coli was the most predominant 61 (62.88%) followed by Enterococci 11 (11.34%), proteus 4 (4.13%) and Pseudomonas 3 (3.09%). Whereas Staphylococcus saprophyticus and Klebsiella showed frequency rate of 2 (2.06%) for each. However Gram positive cocci showed lowest frequency rate of 1 (1.03%). All of the isolates were sensitive to Netilmicin. The majority of isolates were sensitive to Imipenam (92.3%) followed by Amikacin (91.1%), Meropenam (83.3 %), Tetracycline (70%). Sensitivity & resistance rate were same (50%) in Vancomycin & Cefodoxime. Where complete (100%) resistance was shown to Ampicillin, Azithromycin and Cefoxitin. However all isolates were poorly sensitive to cotrimoxazole (35.7%), ciprofloxacin (43%) and nitrofurantoin (44.8%). Conclusion: So, routine urine culture and susceptibility before therapy should be encouraged and periodic evaluation of predominant organisms and their antimicrobial susceptibility pattern should be studied for appropriate selection of antibiotic for effective management of UTI cases.

Prevalencia de β-lactamasa CTX-M-15 en grupos filogenéticos de Escherichia coli uropatógena aisladas en pacientes de la comunidad en Mérida, Venezuela / Prevalence of β-lactamase CTX-M-15 in phylogenetic groups of uropathogenic Escherichia coli isolated from patients in the community of Merida, Venezuela

En este estudio se determinó la prevalencia de b-lactamasas de espectro extenso (BLEEs) en grupos filogenéticos de E. coli uropatógena (ECUP) aislados en pacientes de la comunidad. Durante Enero 2009 a Julio 2010, se coleccionaron 21 cepas de ECUP, con susceptibilidad disminuida a las cefalosporinas de amplio espectro, provenientes de pacientes que asistieron al Laboratorio de Salud Pública del estado Mérida, Venezuela con diagnóstico de infección del tracto urinario (ITU). La caracterización genotípica determinó que todas las cepas ECUP albergaban genes blaBLEEs. En el 76,2% de las cepas se observó la presencia de un único gen productor de BLEE, representado por blaCTX-M-15, mientras que el 23,8% estuvo conformado por ECUP con diversas combinaciones de genes bla (blaCTX-M-15 + blaTEM-1, blaCTX-M-15 + blaSHV y blaSHV + blaTEM-1). El 61,9% de los aislados se ubicó en el filogrupo A y el resto de las cepas en el grupo B2 (38,1%). No se evidenció la diseminación de una clona de ECUP particular, solo 7 cepas demostraron pertenecer a un grupo clonal con un índice de similitud de más de 85%. De acuerdo a nuestro conocimiento, esta es la primera descripción de blaCTX-M-15 en ECUP causantes de ITU en pacientes de la comunidad, lo que evidencia que Venezuela también forma parte de la llamada pandemia CTX-M-15. Los hallazgos obtenidos en este estudio y las implicaciones clínicas y epidemiológicas que de ello derivan, conllevan a la necesidad de controlar y vigilar la diseminación de ECUP productora de CTX-M-15 no sólo en el ámbito regional sino también nacional.

In this study we determined the prevalence of extended-spectrum b-lactamases (ESBLs) in phylogenetic groups of uropathogenic E. coli (UPEC) isolated from patients in the community. Twenty one UPEC strains with reduced susceptibility to broad-spectrum cephalosporins were collected between January 2009 and July 2010, from patients with urinary tract infection who attended the Public Health Laboratory in Mérida, Venezuela. Genotypic characterization determined that all UPEC strains harbored blaBLEEs genes: 76.2% of the strains showed the presence of a single ESBL-producer gene, represented by blaCTX-M-15, whereas 23.8% of UPEC showed various combinations of bla genes (blaCTX-M-15 + blaTEM-1, blaCTX-M-15 + blaSHV and blaSHV + blaTEM-1). In this study, 61.9% of the isolates were placed in phylogroup A and the remaining strains were assigned to group B2 (38.1%). There was no evidence of spread of a particular UPEC clone; only seven strains belonged to a clonal group with an index of similarity greater than 85%. To our knowledge, this is the first description of blaCTX-M-15 in UPEC from patients with community-acquired urinary tract infections, which shows that Venezuela is also part of the so-called CTX-M-15 pandemic. The findings in this study, as well as its clinical and epidemiological implications, lead to the need for monitoring and controlling the spread of CTX-M-15 producing UPECs, not only regionally, but also nationwide.

Antibiotic resistance patterns of uropathogens in 141 children hospitalized with complicated urinary tract infection / 中国医师进修杂志

Objective To investigate the distribution and antibiotic resistance patterns of uropathogens in children with complicated urinary tract infection to guide the empirical antimicrobial treatment.Methods Retrospective analysis of isolated bacteria from 141 children hospitalized with complicated urinary tract infection was performed from January 2011 to January 2013.Results Gram-negative bacillus were the main pathogens [56.6％(81/143)],and Escherichia coli was the leading cause (41.3％,59/143).Gram-positive bacillus accounted for 38.5％ (55/143),including Enterococcus faecium (17.5％,25/143) and Enterococcus faecalis (14.7％,21/143).Fungi caused 4.9％ (7/143) of the infections.The resistance of Escherichia coli to amoxicillin was the highest [92.0％ (23/25)] and resistance to imipenem (4.3％,2/47),amikacin (6.8％,4/59) and nitrofurantoin (6.8％,4/59) was lower.It was observed resistance of Enterococcus faecium to linezolid,quinupristin,vancomycin and nitrofurantoin was significantly lower than other common antibiotics.The resistance of Enterococcus faecalis to quinupristin,tetracycline,erythromycin,rifampicin was significantly higher than other common antibiotics.Concluusions Escherichia coli,Enterococcus faecium and Enterococcus faecalis are the common uropathogens.These pathogens have a high antibiotic resistance to many common antibiotics.The selection of empirical treatment of children with complicated urinary tract infection should be adjusted by antimicrobial susceptibility test.

Detection of Uropathogens by Using Chromogenic Media (Hicrome UTI agar), CLED agar and other Conventional Media.

This study was undertaken to find media better than routinely used media in isolation of uropathogens.Three hundred urine samples having pus cells >_ 5/ HPF were enrolled for the study. Comparison of isolation and identification of uropathogens among HiCrome UTI Agar media, 5% Sheep Blood agar & MacConkey agar and CLED agar media were done. Among them 95(31.67%) samples showed single growth, 6 (2%) showed mixed growth and 199 (66.67%) showed no growth. Rate of presumptive identification of organisms in primary culture plate were high in HiCrome UTI agar media. For Escherichia coli, it was 94.20% whereas in CLED agar it was 79.71% and by Blood agar and MacConkey agar media in combination it was 82.61%. All the Enterococcus spp. were identified in HiCrome UTI agar media, 33.33% in CLED agar media but none in Blood agar and MacConkey agar media. Among the mixed growth, 100% organisms were identified on HiCrome UTI Agar media due to distinct colour produced by the different organisms, whereas in one (16.67%) sample (mixed Esch.coli and Pseudomonas spp.) organisms were identified on other three media.

Adhesion, Hemagglutination, Hemolysin Production and Serum Resistance of Uropathogenic Escherichia coli / 대한비뇨기과학회지

The species Escherichia coli is a large and heterogeneous group of organisms which is the most common etiologic agent of urinary tract infections. There are some evidences that certain properties are found more commonly in strains from the patients with urinary tract infections than in those from normal feces and in enteropathogenic strains. Twenty eight strains of E. coli from acute pyelonephritis patients and twenty eight strains from a cute cystitis patients were examined for the abilities of adhesion to normal uroepitheliaI cells, hemagglutination, hemolysin production and resistance to the bactericidal effect of normal rabbit serum. For comparison, 20 strains from normal feces and 20 enteropathogenic strains were tested for these properties. The results were as follows; l. The strains from the patients with urinary tract infections adhered in significantly larger numbers to the epithelial cells than those from normal feces and enteropathogenic strains (p<0.0l). 2. The strains from the patients with urinary tract infections induced hemagglutination of human erythrocytes no more frequently than those from normal feces. 3. The strains from acute pyelonephritis patients more commonly produced hemolysin than those from normal feces and enteropathogenic strains. 4. The resistance to the bactericidal effect of normal rabbit serum was higher in the strains from the patients with urinary tract infections than in those from normal feces and enteropathogenic stains. 5. There was no significant mutual relationships among the properties of uroepithelial adhesion, hemaglutination, hemolysin production and serum resistance. From the results the abilities of adhesion to human uroepitheliaI cells, hemolysin production and resistance to the bactericidal effect of normal rabbit serum are supposed to be common properties of uropathogenic Escherichia coli and essential factors in the pathogenesis of urinary tract infections.