Antibiotic resistance patterns of pediatric community-acquired urinary infections

Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77 percent. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55 percent and 51 percent). The antibiotic resistance rates for E. coli were: nitrofurantoin (6 percent), nalidixic acid (14 percent), 1st generation cephalosporin (13 percent), 3rd generation cephalosporins (5 percent), aminoglycosides (2 percent), norfloxacin (9 percent) and ciprofloxacin (4 percent). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population.

Resistência antimicrobiana dos uropatógenos em pacientes ambulatoriais, 2000-2004 / Antimicrobial resistance of uropathogens among outpatients, 2000-2004

Foi realizado um estudo retrospectivo, baseado no banco de dados eletrônico de um hospital universitário, com objetivo de investigar a prevalência dos germes causadores e suas suscetibilidades aos antibióticos em adultos (idade >18 anos), com infecção do trato urinário atendidos ambulatorialmente. Foram identificados 957 exames de urocultura positiva no período entre janeiro de 2000 e dezembro de 2004. Escherichia coli, Proteus mirabillis e Klebsiella sp foram três principais bactérias causadoras. Sulfametoxazol-trimetropim apresentou a maior (46,9 por cento) prevalência de resistência bacteriana seguida por cefalotina (46,7 por cento), ácido nalidíxico (27,6 por cento) e nitrofurantoína (22,3 por cento). Durante o período estudado, o ácido nalidíxico apresentou um aumento anual de 5,9 por cento na taxa de resistência bacteriana (p= 0,02). Ciprofloxacina mostrou também a tendência de aumento, com um crescimento anual de 3,3 por cento (p= 0,07). Este estudo demonstrou que os antibióticos amplamente recomendados no tratamento empírico da infecção do trato urinário em adultos apresentaram altas taxas de resistência bacteriana na população estudada.

A retrospective study based on the electronic database of a university hospital was carried out to investigate the prevalence of etiological agents and their susceptibilities to antibiotics, among adult outpatients (> 18 years old) with urinary tract infections. Nine hundred and fifty-seven positive urine cultures were identified between January 2000 and December 2004. Escherichia coli, Proteus mirabilis and Klebsiella sp were the three principal bacterial etiological agents. Trimethoprim-sulfamethoxazole presented the highest prevalence of bacterial resistance (46.9 percent), followed by cefalotin (46.7 percent), nalidixic acid (27.6 percent) and nitrofurantoin (22.3 percent). Over the study period, nalidixic acid presented annual increases of 5.9 percent in the rate of bacterial resistance (p = 0.02). Ciprofloxacin also showed an increasing trend, of 3.3 percent per year (p = 0.07). This study demonstrated that the antibiotics that are widely recommended for empirical treatment of urinary tract infection in adults presented high rates of bacterial resistance among the population studied.

Antibiotic resistance and trend of urinary pathogens in general outpatients from a major urban city

OBJECTIVE: We assessed the antimicrobial resistance patterns of pathogens responsible for urinary tract infections (UTI) in outpatients in São Paulo, Brazil, as well as the Escherichia coli antimicrobial resistance trend. MATERIALS AND METHODS: Outpatients urine cultures were collected from January 2000 to December 2003. Statistical analysis considered positive results for one bacterial species with colony count > 100,000 CFU/mL. Stratification was done on age group and gender. Statistical tests used included chi-square and the chi-square test for trend to evaluate differences between susceptibility rates among age groups and ordering in the E. coli resistance rates per year, respectively. RESULTS: There were 37,261 positive results with Enterobacteriaceae isolated in 32,530 (87.3 percent) and Gram-positive cocci in 2,570 (6.9 percent) cultures. E. coli had the highest prevalence (71.6 percent). Susceptibility tests were performed in 31,716 cultures. E. coli had elevated resistance rates (> 30 percent) to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. Significant differences between age groups and ordering among years were observed. CONCLUSIONS: The use of trimethoprim-sulfamethoxazole is precluded in the population studied due to elevated resistance rates (> 30 percent) among most prevalent pathogens. Significant resistance rate differences among age groups and years were observed, particularly for fluoroquinolones. Fluoroquinolones should be used with caution. Nitrofurantoin should be used as empirical therapy for primary, non-complicated urinary tract infections.

Suscetibilidade antimicrobiana de uropatógenos em pacientes ambulatoriais na cidade de Goiânia, GO / Antimicrobial susceptibility of the uropathogens in out patients in Goiânia City, Goiás State

Em função do aumento de microrganismos multirresistentes causadores de cistite, este estudo teve como objetivo identificar os patógenos causadores de infecção do trato urinário em mulheres, além de traçar o perfil de suscetibilidade antimicrobiana. Foram analisadas 442 amostras de urina, no período compreendido entre junho de 2002 e agosto de 2003. A identificação dos germes isolados foi realizada por provas bioquímicas e enzimáticas e o antibiograma pelo método de difusão em disco. Ocorreram quadros laboratoriais de infecção do trato urinário em 17,6 por cento dos casos. Foi observada a Escherichia coli como o microrganismo prevalente causador de infecção do trato urinário (67,9 por cento). As bactérias Gram-negativas foram resistentes à amoxicilina em 74,6 por cento dos casos analisados, sendo sensíveis em maior índice a ceftazidima e gentamicina. As bactérias Gram-positivas foram resistentes em maior índice à ampicilina (72,7 por cento), sendo sensíveis a trimetoprim/sulfametoxazol, vancomicina e linezolida. Concluiu-se que o estudo da resistência bacteriana é necessário para indicar novas opções terapêuticas.

Some virulence characteristics of uropathogenic Escherichia coli in different patient groups.

BACKGROUND & OBJECTIVE: Uropathogenic Escherichia coli have virulence properties, that are absent in non pathogenic E. coli. The distribution of these markers can vary according to patient populations. Hence, a study was undertaken to describe the presence of virulence factors like Pfimbriae, type 1 fimbriae and haemolysin in E.coli causing urinary infections in three groups of patients. Antibiogram was also recorded to determine differences, if any, between the groups. METHODS: E. coli isolated from three groups of subjects, in counts of >10(5) CFU/ml and in pure growth were tested for mannose resistant haemagglutination (MRHA) to indicate P fimbriae and mannose sensitive haemagglutination (MSHA) to indicate type 1 fimbriae. Haemolysin production and antimicrobial susceptibility patterns were also recorded. RESULTS: Significantly more isolates from antenatal and postnatal women possessed P fimbriae compared to groups with urologic abnormalities (P=0.05). Haemolysin production was also significantly higher (P<0.001) in this group. Greater proportions of isolates from pregnant women were susceptible to commonly used antimicrobials. However, resistance to third generation cephalosporins was present even in these isolates from community infections. INTERPRETATION & CONCLUSION: In patients with urological abnormality, E. coli with lower virulence can cause infections. Isolates from these patients exhibited greater drug resistance. In pregnant women and in community acquired infections, simple antimicrobial drugs like nitrofurantoin might still be useful. However, urgent and stringent policies for antimicrobial use and infection control in hospitals are required in India.

Estudio comparativo prospectivo aleatorio de antibióticos en resección transuretral de próstata / Comparative prospective randomized study of antibiotics in transurethral resection of the prostate

Comparar las complicaciones infecciosas con el uso de 2 esquemas antibióticos en resección transuretral de próstata (RTU-P) de pacientes con bajo riesgo, de modo de reducir el uso de antibióticos en este tipo de pacientes. Secundariamente, intentar ponderar la influencia de los antecedentes clínicos, hallazgos y complicaciones intraoperatorias y evolución postoperatoria en el desarrollo de dichas complicaciones. Se diseñó un estudio comparativo, prospectivo, aleatorio, abierto de 95 pacientes con orina estéril, no usuarios de sonda uretrovesical, sometidos a RTU-P en el plazo de 1 año. El grupo 1 recibió una modificación del esquema antibiótico mayormente utilizado hasta la fecha, consistente en cefazolina 1 gr IV preoperatorio y cada 8 h durante el primer día (3 dosis), seguido de ciprofloxacino 250 mg VO, cada 12 h, hasta el retiro de la sonda uretrovesical (dosis terapéutica). El grupo 2 recibió cefazolina 1 g IV preoperatorio y a las 8 h postoperatorias (2 dosis), seguido de nitrofurantoína, 100 mg VO en la noche, hasta el retiro de la sonda uretrovesical (dosis profiláctica). Se excluyeron 5 pacientes del análisis después de la distribución aleatoria (5,3'porciento) y no hubo pérdidas en el seguimiento. Se analizan 90 pacientes, 45 en cada grupo, los cuales fueron comparables en sus características clínicas, parámetros quirúrgicos, parámetros postoperatorios y complicaciones. Se presentó fiebre (temperatura axilar igual o mayor a 37,5 °C) en el 2 porciento del grupo 1 y en el 11 porciento del grupo 2 (p=0,091). Se presentó bacteriuria postoperatoria (recuento > 100.000 UFC por mL) precoz o tardía en el 2 porciento del grupo 1 y en el 13 porciento del grupo 2 (p=0,049). Esto, posiblemente, se debió al espectro de acción y dosis de los antimicrobianos utilizados. La fiebre estuvo relacionada estadísticamente con la infección urinaria postoperatoria.

Antibiotic sensitivity and resistance profile of the micro-organisms responsible for urinary tract infection observed in Kashmir, India.

Urinary tract infection happens to be common and is generally treated empirically by general practitioners, for which they need to be aware of the locally prevalent strains and their sensitivity pattern. Since over the last few decades the resistance pattern of urinary isolates has been showing dramatic changes all over the world, it was felt useful to study the existing microbiological pattern of the urinary tract infections in Kashmir valley and to assess the sensitivity profile of the isolated organisms to the generally used antibiotics for empirical therapy in primary health care settings. The retrospective analysis of 324 such samples which were found positive for pathological bacteria by the microbiology laboratory of Government Medical College, Srinagar, Kashmir revealed that 90.12% of the isolates were E. coli followed by klebsiella (7.72%) and staphylococcus (1.24%). Significantly 43.57% of the E. coli exhibited resistance to the commonly used antibiotics, and the most effective in-vitro agents were found to be amikacin followed by gentamicin among the injectables and ciprofloxacin among the orally administered ones. Other useful oral antibiotics were nitrofurantoin, chloramphenicol and nalidixic acid. The organisms showed resistance to currently preferred urinary antibiotics and chemotherapeutic agents like co-trimoxazole, norfloxacin, pefloxacin and cephalexin. Conclusion was that among the orally administered antibiotics ciprofloxacin remains the choice while other quinolones or derivatives have turned ineffective and among the injectables gentamicin is still effective.

Efeitos renais do trimetoprim e sulfametoxazol / Renal effects of trimethoprim and sulfamethoxazole

Os efeitos renais de sulfametoxazol (30 mg/kg) e trimetoprim (6 mg/kg) foram avaliados no cäo. Uma simples dose endovenosa produziu aumento do volume urinário e das excreçöes urinárias de sódio e cloreto, enquanto que a taxa de filtraçäo glomerular, as excreçöes urinárias de potássio e fosfato näo se alteraram. Quando o trimetoprim foi administrado em outro grupo de 6 animais foram observados similares aumentos da diurese e da excreçäo urinária de sódio, sem alteraçäo na filtraçäo glomerular e na excreçäo de potássio. A administraçäo de sulfametoxazol em 6 cäes näo produziu quaiquer efeitos, Estes dados sugerem que o trimetoprim diminui as reabsorçöes tubulares de água e sódio, provavelmente no túbulo coletor, à semelhança do local de açäo do diurético amiloride.

Effect of cotrimoxazole (Bactrim) on cholesterol metabolism.

Male albino rats when treated with antimicrobial cotrimoxazole (trimethoprim+sulphamethaoxazole) showed an elevation of plasma high density lipoprotein (HDL) cholesterol and lecithin cholesterol acyl transferase activity (LCAT). Very low density lipoprotein and low density lipoprotein (VLDL+S4, 5LDL) cholesterol levels were decreased. However, total blood cholesterol and aortic cholesterol levels were normal. There was decreased synthesis of cholesterol and its content in the liver. Intestinal cholesterol mobilisation (studied using [U-14C]glucose) towards lymph was normal in spite of decreased synthesis by intestines. Decreased fecal excretion of bile acids and neutral sterols and normal intestinal contribution may be mainly involved in the blood cholesterol homeostasis.

Staphylococcus saprophyticus: importância como agente etiológico das infecçöes do trato urinário / Staphylococcus saprohyticus: importance as etiologic agent of urinary tract infections

O encontro de uma nova cepa de estafilococo coagulase-negativa e resistente à novobiocina, denominado Staphylococcus saprophyticus, vem se mostrando de grande importância na etiopatogenia da infecçäo urinária. Durante 1983 e 1985, 67 pacientes com queixa de infecçäo urinária comprovada por urocultura foram estudadas na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. As amostras de urina foram colhidas através de jato intermediário após rigorosa assepsia dos genitais externos e imediatamente semeados em meios apropriados. Os principais resultados foram: 1- Treze (19,4%) pacientes apresentaram uroculturas positivas para S. saprophyticus; 2- A faixa etária das pacientes acometidas por S. saprophyticus foi menor que as demais (p<0,05); 3- A baixa porcentagem de proteinúria positiva encontrada em pacientes com S. saprophyticus sugere que a infecçäo se restringe ao trato urinário baixo; 4- O S. saprophyticus mostrou-se sensível a vários agentes microbianos, destacando-se a ampicilina e a amicacina

Frecuencia etiológica de bacteriurias en el Hospital Central "Dr. Urquinaona": susceptibilidad de los micro-organismos aislados a los agentes, antimicrobianos / Etiologic frequence of bacteriuria in the Dr. Urquinaona Central Hospital: isolated microorganisms susceptibility to antimicrobial agents

Se revisan los resultados de 2.541 urocultivos de pacientes del Hospital Central "Dr. Urquinaona" de Maracaibo, desde enero de 1980 hasta diciembre de 1983 procesados por la Sección de Bacteriología de dicha Institución. De los resultados revisados 689 (27,12%) muestran contajes significativos, de los cuales el 92,89% fueron positivos a un sólo micro-organismo y en el 7,11% restante se observó la presencia de dos gérmenes. Del total de micro-organismos aislados el 91,4% corresponden a los bacilos Gram negativos, el 7,0% a cocos Gram positivos y el 1,6% restante corresponden a Levaduras sp. Los micro-organismos más frecuentemente aislados fueron en orden decreciente: Escherichia coli 47,8% (339), Pseudomonas aeruginosa 12,6% (89), Klebsiella pneumoniae 12,3% (87), Proteus mirabilis 8,2% (58), Staphylococcus aureus 2% (14). Se determinó el patrón de susceptibilidad de los micro-organismos aislados a los agentes antimicrobianos utilizando el disco único de alta potencia, según los criterios establecidos por Bauer Kirby; incluyendo entre ellos los de mayor uso en el tratamiento de las infecciones urinarias, encontrándose que Escherichia coli fue sensible por encima del 98,0% a Sisomicina, Cefamandol, Furadantina, Amikacina, Acido Nalidíxico y Colimicina. mientras que el porcentaje de resistencia para Tetraciclinas, Sulfas y Ampicilina fue superior al 66,0%; en el caso de Pseudomonas aeruginosa los antimicrobianos con mayor porcentaje de efectividad fueron Colimicina y Polimixina B 100%, Amikacina 97,5%, Tobramicina 72,9% y Gentamicina 64,0%; en relación a Klebsiella pneumoniae el 95,4% de las cepas resultaron sensibles a Cefalosporinas; con respecto a Proteus mirabilis la sensibilidad observada fue de 100% para Tobramicina y por encima del 96,6% para Cefalosporinas y Amikacina

Frecuencia etiológica de las bacteriurias significativas el Hospital Central "Dr. Urquinaona": susceptibilidad de los micro-organismos aislados a los agentes antimicrobianos / Etiologic frequence of significative bacteriuria in the Dr Urquinaona Central Hospital: isolated microorganisms susceptibility to antimicrobial agents

Se estudian 2.471 urocultivos de pacientes del Hospital Central "Dr. Urquinaona" de Maracaibo, desde abril de 1976 hasta diciembre de 1979, aplicando el criterio establecido por Kass, de la existencia de infección urinaria cuando el recuento cuantitativo revela cifras iguales o superiores a 100.000 colonias por ml. de orina. De los urocultivos procesados, 657 (26,59%) muestran contajes significativos y el 11,42% de ellos fueron positivos a dos micro-organismos. Del total de micro-organismos aislados, 78,55% pertenecen a la familia Enterobacteriaceae y el 12,16% al grupo de los Bacilos Gram Negativos No Fermentadores. Los micro-organismos más comúnmente aislados, fueron en orden decreciente: Escherichia coli 41,53% (304), Klebsiella pneumoniae 16,39% (120), Proteus mirabilis 9,97% (73) y Pseudomonas aeruginosa 7,38% (54). En las especies bacterianas se determinó, el patrón de susceptibilidad a los agentes antimicrobianos, incluyendo entre ellos los de mayor uso en el tratamiento de las infecciones urinarias; encontrándose que para Escherichia coli casi el 95% de las cepas resultaron sensibles a Tobramicina, Gentamicina, Acido Nalidíxico y Nitrofurantonía; en el caso de Klebsiella pneumoniae el 83,3% resultaron sensibles a Cefalosporinas y el 89,1% resistentes a Ampicilina; el 100% de las cepas de Proteus mirabilis fueron sensibles a Gentamicina y Tobramicina, siendo preocupante el 44,4% y 47,4% de resistencia presentado por Pseudomonas aeruginosa a Gentamicina y Tobramicina respectivamente