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.

A Case of Cytomgalovirus Infection Presenting as Nodule and Ulcer in an Immunocompromised Patient / 대한피부과학회지

We report the case of a 48-year-old man presenting with a pubic nodule and multiple ulcers on penis and scrotum. He had a kidney transplantation two months ago and has been taking cyclosporine, prednisolone, and mycophenolate mofetil. The biopsy specimen from the nodule showed vasculitis and multiple cytomegalic cells in dermis. The biopsy specimen from the scrotal ulcer showed a cluster of multinucleated giant cells and acantholysis in epidermis and cytomegalic cells and vasculitis in dermis, suggestive of HSV infection in epidermis and CMV infection in dermis. Specific immunoperoxidase for CMV antigens positively stained cytomegalic endothelial cells and fibroblasts in both specimens. Evidence of CMV viremia as pp65 was detected in circulating polymorphonuclear leukocytes by immunocytochemical tests although there was no evidence of other organ involvement. Immediately, he was placed on intravenous ganciclovir therapy for 3 weeks. The lesions cleared leaving scars and he was discharged in good general condition.

Broncho-alveolar lavage: An aid to diagnosis in immuncompromised children with pulmonary lesion.

Conventional broncho-alveolar lavage with flexible bronchoscope has proven to be an effective method for the diagnosis of pulmonary lesions, especially in immunocompromised patients. The disadvantage of flexible endoscopy is that it can not be performed safely in pediatric patients with compromised airway due to the lack of ventilating channel. We designed an alternative method for broncho-alveolar lavage by target bronchus and secure the airway at the same time. We performed brocho-alveolar lavage via that method in 15 immunocompromised paediatric patients with signs and symptoms of pneumonia from December 1995 to September 1997. The group comprised eight males and seven females with a mean age of 30.35+24.60 months. Most of the patients had positive HIV titre (86.67 percent). Causative agents were identified in 11 of 15 patients (77.33 percent) Pneumocystis carinii was found in four cases (26.7 percent) followed by fungus (four cases, 26.7 percent), Mycobacterium tuber culosis (one cases, 6.7 percent) and Respiratory syncytial virus (one cases, 6.7 percent). No complications were reported. Compared to the literature control which gave an average yield of 45-84 percent, this technique of brocho-alveolar lavage was proven to be an effective, safe diagnostic method which gave satisfactory results.