BD Vacutainer™ Urine Culture & Sensitivity Preservative PLUS Plastic Tubes Minimize the Harmful Impact of Stressors Dependent on Temperature and Time Storage in Uropathogenic Bacteria.

Background: Urinary tract infection is a worldwide health problem. According to the Clinical Laboratory Improvement Amendments and the European Urinalysis Guideline, urine samples should be tested within 2 h of collection. Thus, using chemical preservatives that guarantee the pre-analytical conditions is a practical tool. However, the effects of temperature and storage time as uropathogenic bacteria stressors are unclear. Methods: Gram-negative and -positive ATTC strains, E. coli, P. mirabilis, E. faecalis, and S. aureus, were used in this study. Strains in liquid media were stored at 4, 25, and 37 °C for 0, 2, 12, 24, and 48 h in tubes with and without preservatives. Then, reactive oxygen species (ROS) levels, viable but non-culturable bacteria (VBNC), and bacteria growth were analyzed. Results: A high ROS level was associated with the presence of VBNC and dead bacteria with low CFU counts, but a low ROS level increased the CFU number, depending on temperature and storage time in tubes without preservatives (boric acid, sodium borate, and formate). The BD Vacutainer™ Urine Culture & Sensitivity Preservative PLUS Plastic Tubes (C&S-PP) prevent this ROS increase, maintaining the CFU number for longer. Conclusions: C&S-PP tubes minimize the stressor effects (temperature and time storage) on uropathogenic bacteria when stored, improving the pre-analytical conditions of cultures realized by the clinical laboratory.

Bacterial profile, antimicrobial resistance, and molecular detection of ESBL and quinolone resistance gene of uropathogens causing urinary tract infection in the southeastern part of Bangladesh.

Humans frequently contract urinary tract infections (UTIs), which can be brought on by uropathogens (UPs) that are multi-drug resistant. Treatment for UTIs brought on by pathogenic UPs that produce extended-spectrum lactamases (ESBLs) is more costly and potentially fatal. As a result, the objective of this study was to use culture, biochemical, and 16S rRNA sequencing to identify and characterize UPs isolated from outpatients in Noakhali, Bangladesh, who had symptoms of UTIs. ESBL gene identification and quinolone resistance gene typing were then performed on the isolates using polymerase chain reaction (PCR). Throughout the trial's 8-month duration, 152 (76%) of 200 urine samples were positive for the presence of UPs. The overall number of UPs recovered was 210, with 39 individuals having multiple UPs present in their samples. Among all of the isolates, Escherichia coli (45.24%, 95/210; 95% confidence interval (CI): 35.15-57.60%), Enterobacter spp. (24.76%, 52/210; CI: 19.15-35.77%), Klebsiella spp. (20.95%; 44/210; CI: 15.15-30.20%), and Providencia spp. (9.05%; 19/210; CI: 4.95-19.25%) were the four most prevalent bacteria found in the isolates. The UPs displayed a very high level of resistance to piperacillin 96.92% (126/130), ampicillin 90% (117/130), nalidixic acid 77.69% (101/130), cefazolin 70% (91/130), amoxicillin 50% (55/130), cefazolin 42.31% (55/130), nitrofurantoin 43.08% (56/130), and ciprofloxacin 33.08% (43/130), whereas resistance to netilmicin (3.85%), amikacin (4.62%), and imipenem (9.23%) was low. Individually, every species of E. coli and Providencia spp. showed greater ampicillin, amikacin, cefazolin, cefazolin, and nalidixic acid resistance than the others. The bivariate results indicate several antibiotic pairings, and isolates had meaningful associations. All MDR isolates were subjected to PCR, which revealed that blaCTX-M-15 genes predominated among the isolates, followed by the blaTEM class (37%). Isolates also had the qnrS, aac-6´-Ib-cr, and gyrA genes. The findings provide worrying indications of a major expansion of MDR isolates in the study locations, particularly the epidemiological balCTX-M 15, with the potential for the transmission of multi-drug-resistant UP strains in the population.

Antimicrobial Activity of Spices Popularly Used in Mexico against Urinary Tract Infections.

Urinary tract infections (UTIs) are the most common infectious diseases worldwide. These infections are common in all people; however, they are more prevalent in women than in men. The main microorganism that causes 80-90% of UTIs is Escherichia coli. However, other bacteria such as Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus mirabilis, and Klebsiella pneumoniae cause UTIs, and antibiotics are required to treat them. However, UTI treatment can be complicated by antibiotic resistance and biofilm formation. Therefore, medicinal plants, such as spices generally added to foods, can be a therapeutic alternative due to the variety of phytochemicals such as polyphenols, saponins, alkaloids, and terpenes present in their extracts that exert antimicrobial activity. Essential oils extracted from spices have been used to demonstrate their antimicrobial efficacy against strains of pathogens isolated from UTI patients and their synergistic effect with antibiotics. This article summarizes relevant findings on the antimicrobial activity of cinnamon, clove, cumin, oregano, pepper, and rosemary, spices popularly used in Mexico against the uropathogens responsible for UTIs.

Prevalence and distribution of ampc beta-lactamase producing escherichia coli and klebsiella pneumoniae isolates obtained from urine samples at a tertiary care hospital in the caribbean.

Introduction: The aim of this study was to investigate the prevalence and distribution of AmpC beta-lactamases (BLs) in uropathogens (E. coli and K. pneumoniae) at the University Hospital of the West Indies Jamaica (UHWI). Method: De-duplicated consecutive urine samples, collected from January to March 2020 at the UHWI, were analyzed. Screening and phenotypic confirmatory tests were conducted using resistance to cefoxitin and the Disc Approximation Test (DAT) respectively, for isolates of interest. Multiplex PCR was performed on cefoxitin resistant (CR) isolates for the detection of bla CIT, bla MOX, bla FOX, bla ACC, and bla DHA genes. Whole genome sequencing (WGS) was used to further detect AmpC BL genes in PCR negative isolates with indeterminate phenotypic results. Results: Sixty-four Gram negative isolates were obtained from 61 patients (55% female), aged 18 months to 88 years old. At least 35% (26) had complicated urinary tract infections. Only 7 out of 64 isolates were E. coli or K. pneumoniae, had antibiograms suggestive of possible AmpC BL production and were CR. DATs confirmed AmpC BL in two of these (1 K. pneumoniae; 1 E. coli), one tested negative (E. coli) and four had inconclusive results (K. pneumoniae). PCR detected bla DHA and bla CIT in two CR isolates. WGS further detected bla CMY-42 in one isolate. The prevalence of screened CR isolates with AmpC BL is 57.14% (4 of 7), representing 6.25% of the sample. AmpC BL producers tested had 100% susceptibility to meropenem and nitrofurantoin. Conclusion: AmpC BL prevalence among E. coli and K. pneumoniae, common urinary pathogens, in the studied isolates is low. Although cefoxitin screening is helpful, phenotypic screening using the DAT can yield indeterminate results best clarified by molecular testing.

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)

Chlorpromazine-impregnated catheters as a potential strategy to control biofilm-associated urinary tract infections.

Aim: This study proposes the impregnation of Foley catheters with chlorpromazine (CPZ) to control biofilm formation by Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae. Materials & methods: The minimum inhibitory concentrations (MICs) for CPZ and the effect of CPZ on biofilm formation were assessed. Afterward, biofilm formation and the effect of ciprofloxacin and meropenem (at MIC) on mature biofilms grown on CPZ-impregnated catheters were evaluated. Results: CPZ MIC range was 39.06-625 mg/l. CPZ significantly reduced (p < 0.05) biofilm formation in vitro and on impregnated catheters. In addition, CPZ-impregnation potentiated the antibiofilm activity of ciprofloxacin and meropenem. Conclusion: These findings bring perspectives for the use of CPZ as an adjuvant for preventing and treating catheter-associated urinary tract infections.

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.

Role of nutrient limitation in the competition between uropathogenic strains of Klebsiella pneumoniae and Escherichia coli in mixed biofilms.

Klebsiella pneumoniae and Escherichia coli form mixed species biofilms in catheter-associated urinary tract infections. Recently, a detrimental effect of K. pneumoniae over E. coli was observed in mixed species biofilms grown in an artificial urine medium. The mechanism behind this competitive interaction was studied. K. pneumoniae partially outcompeted E. coli in early-stage batch-fed biofilms, whereas both microorganisms co-exist at longer times (K. pneumoniae:E. coli ratio, 55:1), as shown by cell counts and confocal microscopy. E. coli cells were scattered along the K. pneumoniae biofilm. Biofilm supernatants did not appear to contain either antimicrobial or anti-biofilm activities against E. coli. Biofilms grown under continuous flow prevented interspecies competition. K. pneumoniae showed both increased siderophore production and better growth in iron-limited media compared to E. coli. In summary, these results indicate the importance of nutrient (particularly iron) competition in the modulation of the bacterial composition of mixed species biofilms formed by uropathogenic K. pneumoniae and E. coli.

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.

Role of interspecies interactions in dual-species biofilms developed in vitro by uropathogens isolated from polymicrobial urinary catheter-associated bacteriuria.

Most catheter-associated urinary tract infections are polymicrobial. Here, uropathogen interactions in dual-species biofilms were studied. The dual-species associations selected based on their prevalence in clinical settings were Klebsiella pneumoniae-Escherichia coli, E. coli-Enterococcus faecalis, K. pneumoniae-E. faecalis, and K. pneumoniae-Proteus mirabilis. All species developed single-species biofilms in artificial urine. The ability of K. pneumoniae to form biofilms was not affected by E. coli or E. faecalis co-inoculation, but was impaired by P. mirabilis. Conversely, P. mirabilis established a biofilm when co-inoculated with K. pneumoniae. Additionally, E. coli persistence in biofilms was hampered by K. pneumoniae but not by E. faecalis. Interestingly, E. coli, but not K. pneumoniae, partially inhibited E. faecalis attachment to the surface and retarded biofilm development. The findings reveal bacterial interactions between uropathogens in dual-species biofilms ranged from affecting initial adhesion to outcompeting one bacterial species, depending on the identity of the partners involved.

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.

A New Multiplex-PCR for Urinary Tract Pathogen Detection Using Primer Design Based on an Evolutionary Computation Method.

This work describes a new strategy for optimal design of Multiplex-PCR primer sequences. The process is based on the Particle Swarm Optimization-Simplex algorithm (Mult-PSOS). Diverging from previous solutions centered on heuristic tools, the Mult-PSOS is selfconfigured because it does not require the definition of the algorithm's initial search parameters. The successful performance of this method was validated in vitro using Multiplex- PCR assays. For this validation, seven gene sequences of the most prevalent bacteria implicated in urinary tract infections were taken as DNA targets. The in vitro tests confirmed the good performance of the Mult-PSOS, with respect to infectious disease diagnosis, in the rapid and efficient selection of the optimal oligonucleotide sequences for Multiplex-PCRs. The predicted sequences allowed the adequate amplification of all amplicons in a single step (with the correct amount of DNA template and primers), reducing significantly the need for trial and error experiments. In addition, owing to its independence from the initial selection of the heuristic constants, the Mult-PSOS can be employed by non-expert users in computational techniques or in primer design problems.

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.

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

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.