scholarly journals 1371. Trends in Antibiotic Resistance Among Uropathogens in the Pediatric Population: A Single Center Experience in the US

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S695-S695
Author(s):  
Leena B Mithal ◽  
Sebastian Otero ◽  
Shan Sun ◽  
Mehreen Arshad
Keyword(s):  
Antibiotic Resistance ◽  
Urine Culture ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Fourth Generation ◽  
Care Hospital ◽  
Beta Lactams ◽  
Positive Urine Culture ◽  
Positive Urine ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are common infections in children. Overuse of antibiotics has led to an increasing prevalence of antibiotic resistance among uropathogens in adults; however, data on pediatric trends have not been previously reported. Our objective was to characterize antibiotic resistance trends in uropathogens among children at a tertiary care hospital in a diverse urban US city. Methods Positive urine culture data (>20,000 CFU/ml) from January 1st, 2010 through December 31st, 2019 were obtained from the electronic medical records (inpatient and outpatient). Yearly antibiotic agent-specific resistance rates were calculated based on culture, patient, and organism level data. Results A total of 7,512 patients had ≥1 positive urine culture, with 13,327 positive individual cultures. The average age at sample collection was 6 yrs (IQR 2-11). Overall, 66% of cultures showed resistance to at least 1 antibiotic. Ampicillin resistance (50.1% IQR: 48.2%-52.4%) was the most common and remained stable over the study period. However, resistance against amoxicillin-sulbactam, third and fourth generation cephalosporins, and fluoroquinolones has increased significantly over this period (Figure 1). There was also a corresponding increase in the prevalence of extended spectrum beta-lactamase (ESBL) Enterobacteriaceae (Figure 2). Among infants < 1 year, a similar trend in increasing resistance against beta-lactams was noted (ampicillin-sulbactam 0% to 38%, ceftriaxone 0% to 9% and cefepime 0% to 4%, Figure 3). Figure 1 Figure 2 Figure 3 Conclusion There are rising rates of antibiotic resistance to broad spectrum antibiotics, including beta-lactams and quinolones, in a pediatric population over the last 10 years, with a notable increase in resistance starting in 2015-2016. While we were not able to distinguish patients with community acquired UTI, the increase in resistance among infants < 1 year suggests a community reservoir of multi-drug resistant gram-negative bacteria. Colonization by resistant uropathogens has implications for empiric antibiotic choice, limited oral therapy options, and clinical outcomes which necessitate further study. Disclosures All Authors: No reported disclosures

scholarly journals Predictors of Hospital-Acquired Urinary Tract–Related Bloodstream Infection

2012 ◽  
Vol 33 (10) ◽  
pp. 1001-1007 ◽  
Author(s):  
M. Todd Greene ◽  
Robert Chang ◽  
Latoya Kuhn ◽  
Mary A. M. Rogers ◽  
Carol E. Chenoweth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Bloodstream Infection ◽  
Urine Culture ◽  
Conditional Logistic Regression ◽  
Tertiary Care ◽  
Incidence Density ◽  
Care Hospital ◽  
Positive Urine Culture ◽  
Positive Urine

Objective.Bloodstream infection (BSI) secondary to nosocomial urinary tract infection is associated with substantial morbidity, mortality, and additional financial costs. Our objective was to identify predictors of nosocomial urinary tract-related BSI.Design.Matched case-control study.Setting.Midwestern tertiary care hospital.Patients.Casesn= 298) were patients with a positive urine culture obtained more than 48 hours after admission and a blood culture obtained within 14 days of the urine culture that grew the same organism. Controls (n= 667), selected by incidence density sampling, included patients with a positive urine culture who were at risk for BSI but did not develop one.Methods.Conditional logistic regression and classification and regression tree analyses.Results.The most frequently isolated microorganisms that spread from the urinary tract to the bloodstream wereEnterococcusspecies. Independent risk factors included neutropenia (odds ratio [OR], 10.99; 95% confidence interval [CI], 5.78-20.88), renal disease (OR, 2.96; 95% CI, 1.98-4.41), and male sex (OR, 2.18; 95% CI, 1.52-3.12). The probability of developing a urinary tract-related BSI among neutropenic patients was 70%. Receipt of immunosuppressants (OR, 1.53; 95% CI, 1.04-2.25), insulin (OR, 4.82; 95% CI, 2.52-9.21), and antibacterials (OR, 0.66; 95% CI, 0.44-0.97) also significantly altered risk.Conclusions.The heightened risk of urinary tract-related BSI associated with several comorbid conditions suggests that the management of nosocomial bacteriuria may benefit from tailoring to certain patient subgroups. Consideration of time-dependent risk factors, such as medications, may also help guide clinical decisions in reducing BSI.Infect Control Hosp Epidemiol2012;33(10):1001-1007

scholarly journals Epidemiology and Resistance Levels of Enterobacteriaceae Isolates from Urinary Tract Infections Expressed as Multiple Antibiotic Resistance (MAR) Indices

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Márió Gajdács
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Urine Samples ◽  
Diffusion Method ◽  
Care Hospital ◽  
Multiple Antibiotic Resistance ◽  
E Coli ◽  
Positive Urine ◽  
Tract Infections

Aims: To assess the epidemiology of UTIs affecting inpatients and outpatients and the antibiotic resistance levels, expressed as multiple antibiotic resistance (MAR) indices from the isolated species at a tertiary-care hospital in Hungary, during a 10-year study period. Study Design: Retrospective microbiological study. Place and Duration of Study: 1st of January 2008 - 31st of December 2017 at the University of Szeged, which is affiliated with the Albert Szent-Györgyi Clinical Center, a primary- and tertiary-care teaching hospital in the Southern Great Plain of Hungary. Methodology: Antimicrobial susceptibility testing (AST) was performed using disk diffusion method and when appropriate, E-tests on Mueller–Hinton agar (MHA) plates. The multiple antibiotic resistance (MAR) index of the isolates was determined. Results: During the 10-year study period, the Institute of Clinical Microbiology received 21,150 urine samples from outpatient clinics and 19,325 samples from inpatient departments that turned out to be positive for a significant urinary pathogen. Out of the positive urine samples, E. coli represented the overwhelming majority of all positive urine samples. The resistance levels in inpatient isolates were higher than in the outpatient isolates (average MAR indices: 0.347 vs. 0.410, 0.267 vs. 0.435 and 0.318 vs. 0.473 for the E. coli/Klebsiella, CES and Proteae group, respectively). Conclusion: As the therapeutic options are becoming increasingly limited in the current antibiotic resistance climate, more effort should be put into the prudent use of antibiotics and the development of novel antimicrobial agents.

Evaluation of Parental Knowledge, Attitudes and Practices Regarding Antibiotic Use in Acute Upper Respiratory Tract Infections in Children in a Tertiary Care Hospital in Turkey

2021 ◽  
Author(s):  
Aslınur Albayrak ◽  
Nazmi Mutlu Karakaş ◽  
Bensu Karahalil
Keyword(s):  
Antibiotic Resistance ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Care Hospital ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

Abstract BackgroundUpper respiratory tract infections (URTIs) are common in children. Most URTIs have been shown to be of viral origin. Inappropriate use of antibiotics is one of the main causes of antibiotic resistance. The problem of unnecessary antibiotic use among children is a concern for antibiotic resistance in low- and middle-income developing countries.MethodsOur study is a cross-sectional survey study. It was carried out between 14 December 2020 and 1 April 2021 for parents over 18 years of age with a child under 18 years’ old who applied to the general pediatrics outpatient clinics of Gazi University Faculty of Medicine Hospital Department of Pediatrics.Results554 parents responded to the questionnaire. A total of 15.7% of parents stated to use antibiotics in any child with fever. 37% of parents believed that antibiotics could cure infections caused by viruses. 6.3% of parents declared that they put pressure on pediatricians to prescribe antibiotics. 85.6% of the parents stated that they never gave their children non-prescription antibiotics when they had a high fever. 80.9% of them declared that they never used past antibiotics in the presence of a new infection. Female gender, high level of education, high income level and low number of antibiotics used in the last 1 year were found to be statistically significant with the better knowledge level of the parents (p <0.05).ConclusionAccording to the results of our study of parents' lack of knowledge about antibiotics in Turkey, though generally it shows proper attitude and behavior. It shows that some of the restrictions imposed by the National Action Plan are partially working. However, it is still necessary to continue to inform parents, pediatricians and pharmacists about the use of antibiotics, and to be more sensitive about the prescribing of antibiotics, and if necessary, sanctions should be imposed by the state in order to prevent unnecessary antibiotic prescriptions.

scholarly journals ANTIBACTERIAL SURVEILLANCE: AN APPROACH TO MITIGATING MULTI-DRUG RESISTANCE MENACE AMONG CLINICAL UROPATHOGENS IN EKITI STATE, NIGERIA

2020 ◽  
Vol 3 (2) ◽  
pp. 10
Author(s):  
Seye Julius Oladeji ◽  
Gbenga Victor Kayejo
Keyword(s):  
Antibiotic Resistance ◽  
Tertiary Care ◽  
Multi Drug Resistance ◽  
Care Hospital ◽  
Gram Negative ◽  
Microbiological Methods ◽  
Resistance Patterns ◽  
Etiological Agents ◽  
Tract Infections ◽  
Urine Specimens

Urinary tract infections (UTIs) are among the most common human infections with the distribution of etiological agents and antibiotic resistance patterns varying from region to region and from time to time. The aims of this study were to ascertain the prevalence and antibiotic resistance profiles of common Gram-negative uropathogens among patients attending a Tertiary Care Hospital in Ekiti State, Nigeria. One hundred and fifty clean-catch midstream urine specimens were obtained and cultured within 2 hours of collection for the detection of Gram-negative uropathogens. The isolated organisms were identified by standard microbiological methods. Of the total 150 urine specimens analyzed, 82 (54.67%) specimens were positive for Gram-negative uropathogen with significant bacteriuria of which 34 (41.46%) were males and 48 (58.54%) were females. Klebsiella spp. 38 (46.34%) and Escherichia coli 32 (39.02%) were the most frequently isolated Gram-negative uropathogens, followed by Proteus mirabilis 10 (12.20%) while the least occurring uropathogen was observed to be Pseudomonas aeruginosa 2 (2.44%). All the isolated uropathogens were observed to be highly resistant to the commonly prescribed antibiotics. Emerging resistance to carbapenems was also observed. Nevertheless, carbapenems showed highest susceptibility compared to other tested antibiotics. Conclusively, high levels of resistance of uropathogens to antibiotics exist in our setting. This therefore calls for continuous antibiotic surveillance and improved antibiotic stewardship.  

scholarly journals Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243741
Author(s):  
Basima A. Almomani ◽  
Rawand A. Khasawneh ◽  
Rola Saqan ◽  
Munther S. Alnajjar ◽  
Lara Al-Natour
Keyword(s):  
Hospital Admissions ◽  
Urine Culture ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Positive Urine Culture ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Positive Urine ◽  
Tract Infections ◽  
Positive Results

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients’ medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863–0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018–1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289–0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234–0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.

scholarly journals Active immunoprophyilaxis with uromune® decreases the recurrence of urinary tract infections at three and six months after treatment without relevant secondary effects

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Cristóbal Ramírez Sevilla ◽  
Esther Gómez Lanza ◽  
Juan Llopis Manzanera ◽  
Jose Antonio Romero Martín ◽  
Miguel Ángel Barranco Sanz
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Positive Urine Culture ◽  
Recurrent Urinary Tract Infections ◽  
First Choice ◽  
Menopausal Women ◽  
Positive Urine ◽  
History Of ◽  
Tract Infections

Abstract Background To prospectively analyze the efficacy of uromune® in the prevention of uncomplicated recurrent urinary tract infections at 3 and 6 months, and according to gender and menopause. Methods From September 2011 to December 2017 uromune® was administered sublingually every 24 h along 3 months to 784 patients with history of three or more uncomplicated urinary tract infections in the 12 months prior to the first visit. The variables analyzed with statistical package system for science version 15.0 were age, gender, number of urinary tract infections with positive urine culture in the first consultation, and 3 and 6 months after the end of treatment. The results with positive urine culture were registered at 3 and 6 months after the end of the treatment according to gender and also in the menopausal group with respect to pre-menopausal women. Results Mean age was 73.5 years. 82.7% were women and 94.3% menopausal. The number of episodes of urinary tract infections in the 12 months prior to uromune® were 3 in 37.2%, 4 in 28.1%, 5 in 19.5%, 6 in 9.6%, 7 in 4%, 8 in 1.4%, 9 in 0.1% and 10 in 0.1%. Three months after uromune® 44.1% had 0 urinary tract infections and 27.6% had 1. After 6 months the results were 0 urinary tract infections in 32.3% and 1 in 32.4%. Women had 0 urinary tract infections after 3 months in 45.4% and 1 in 28.5%. At 6 months the female had 0 episodes in 32.7% and 1 in 33.2%. Menopausal women had 0 urinary tract infections at 3 months in 46.5% and 1 in 28% and at 6 months scored 0 episodes in 33.6% and 1 in 32.9%. Conclusions Uromune® was highly effective to reduce the number of episodes of urinary tract infections at three and six months of follow-up. Uromune® reduced the number of episodes to zero or one in 71.7 and 64.7% at three and six months with minimal side effects. The best results were observed in women over 50 years old. Sublingual immunoprophylaxis with uromune® could be the treatment of first choice in the prevention of uncomplicated recurrent urinary tract infections according to the sample analyzed.

scholarly journals Asymptomatic Urinary Tract Infections and Associated Risk Factors in Pakistani Muslim Type 2 Diabetic Patients

2021 ◽  
Author(s):  
Azizul Hasan Aamir ◽  
Umar Yousuf Raja ◽  
Ali Asghar ◽  
Saeed Ahmed Mahar ◽  
Tahir Ghaffar ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Urine Culture ◽  
Diabetic Patients ◽  
Positive Urine Culture ◽  
Type 2 Diabetic Patients ◽  
Positive Urine ◽  
Tract Infections ◽  
Type 2 Diabetic

Abstract Background: One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Moreover, physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are also considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic. Methods: This was a cross-sectional, multi-centre study including diabetic patients from 12 clinical sites spread across major cities of Pakistan. The inclusion criteria were adult Pakistani population of age between 18 to 75 years both genders and suffering from T2DM irrespective of duration. A detailed clinical history of the past 3 months was recorded and, biochemical investigations of blood samples were conducted. Urine culture analysis performed identified the type of pathogen present and was done only for asymptomatic patients. Results: A total of 745 type 2 diabetic patients were initially screened, out of 545 patients considered for final analysis 501 (91.92%) were negative and the rest 44 (8.08%) had positive urine culture. Female gender had a significantly higher proportion of positive urine culture (77.27%, p-value<0.001). Body mass index and mean age had insignificant distribution among the two groups of positive and negative urine culture, with age 40-59 years having higher proportion (70.45%) in the positive group. Escherichia coli was detected in most of the positive samples (52.3%). All bacterial samples were found resistant to Ciprofloxacin. Conclusion: Diabetic female patients are identified to be at high risk of suffering from UTI and age more than 40 years is an important risk factor. Escherichia coli was the most common causative organism among people living in this geographical area.

scholarly journals Assessment of Urinalysis Reflex to Culture Criteria: Impact on Antimicrobial Usage

10.3823/851 ◽  
2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Mohammad Ourani ◽  
Nathan S Honda ◽  
William MacDonald ◽  
Jill Roberts
Keyword(s):  
Urine Culture ◽  
Laboratory Data ◽  
Acute Care Hospital ◽  
Urine Samples ◽  
Care Hospital ◽  
Positive Urine Culture ◽  
Predictive Values ◽  
Antimicrobial Usage ◽  
Positive Urine ◽  
A Prospective Study

Objectives: To assess the predictive value of the urinalysis (UA) reflex criteria’s parameters and to evaluate the criteria’s impact on antimicrobial usage Methods: A prospective study using laboratory data was conducted on inpatient urine samples with orders placed for Urinalysis Reflex Culture (UARC) in a 400-bed acute care hospital. A total of 4016 urine samples were collected and examined between February and April 2020. The UA results were then subjected to the laboratory UA reflex criteria for reflecting UA to culture.  Multivariable logistic regression was utilized in evaluating the effectiveness of the criteria’s parameters to predict positive urine cultures Results: The total number of the positive UA reflex samples was 1539, which accounted for 38.3% of all the UA samples. Moreover, those positive UA samples were reflexed to urine cultures. Among the urine samples that were cultured, 45.1% (n = 694) were negative urine cultures while 54.9% (n = 845) were positive urine cultures. The UA reflex criterion was associated with positive predictive values for positive urine cultures between 26.30% and 92.96%. Conclusions: The current Laboratory UA reflex criterion is not highly effective in predicting positive urine culture, thus potentially leading to the inappropriate antimicrobial usage.  

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