scholarly journals 477. Characterization of Extended-Spectrum Β-Lactamase (ESBL) Producing Gram-negative (GN) Urinary Tract Infections (UTI) in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S233-S233
Author(s):  
Leslie Stach ◽  
Regina Orbach ◽  
Kanokporn Mongkolrattanothai
Keyword(s):  
Urinary Tract ◽  
Pediatric Patients ◽  
Selective Pressure ◽  
Once Daily ◽  
E Coli ◽  
Colony Forming Units ◽  
Amoxicillin Clavulanate ◽  
Tract Infections ◽  
Abnormal Urinary Tract

Abstract Background There has been an increase in antimicrobial resistance among GN pathogens, not only in adults, but also pediatrics. UTIs are common in pediatrics; however, reports of pediatric UTI with ESBL producing GN are limited. Methods All urine cultures positive for ESBL producing GN from 5/1/18 to December 31/18 were retrospectively reviewed. Proven infection (PI) defined as ≥50,000 colony-forming units (CFU)/mL of bacteria plus pyuria or positive leukocyte esterase for catheterized or clean catch specimens. Relapsed infection defined as same pathogen cultured within 30 days of infection. Abnormal urinary tract systems or functions (AUTS) include neurogenic bladder, structural anomalies, or intermittent catheterization. Results A total of 107 urine cultures for ESBL producing GN, from 85 patients, were included. Majority of specimens [78/107 (73%)] were obtained from the ED or outpatient clinics. 43% of specimens were from patients with AUTS. E. coli was the majority (95%) of ESBL isolates. 57% of ESBL producing GNs were susceptible to amoxicillin/clavulanate (AC) or trimethoprim/sulfamethoxazole (TMP/SMX). 88% were nitrofurantoin susceptible. Only 1 isolate was meropenem resistant. Antibiotics (ABX) were prescribed for UTI in 67/107 episodes. However, only 52 episodes were PI. Of these, 38 were empirically treated with oral ABX and 29 with intravenous ABX. The most commonly prescribed empiric ABX was oral cephalexin (25/67, 37%.) Ineffective empiric ABX for UTI was very common, 83% (43/52). Of these, 5/43 never received effective therapy and none had relapse. Most common duration of ABX was 10 days (range 5–17 days.) 43% (23/52) of PI were treated with oral AC or TMP/SMX. 15% (8/52) of PI were treated with nitrofurantoin. 12% of PI were treated with a once-daily aminoglycoside. Only 6% of PI were treated with a carbapenem. Conclusion Many ESBL UTI isolates remain susceptible to oral ABX. Although small numbers, patients treated with ineffective ABX did not return with relapsed infection. Non-carbapenem ABX are a reasonable option to minimize selective pressure or unnecessary use. Empiric narrow-spectrum antibiotic therapy may still be appropriate. Disclosures All authors: No reported disclosures.

scholarly journals SENSITIVITY AND RESISTANCE TO ANTIMICROBIAL AGENTS ESBL-PRODUCING AND NOT PRODUCING ESBL STRAINS OF E. COLI IN PATIENTS WITH URINARY TRACT INFECTION

2019 ◽  
Vol 64 (2) ◽  
pp. 104-110
Author(s):  
N. I. Dimitrova ◽  
T. D. Gasretova ◽  
E. L. Alutina ◽  
G. G. Kharseeva
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Agents ◽  
Beta Lactamase ◽  
Test Results ◽  
Beta Lactams ◽  
Esbl Production ◽  
E Coli ◽  
Amoxicillin Clavulanate ◽  
Resistant Strains ◽  
Tract Infections

As a result of the conducted researches it is shown that 44.1% of urinary tract infections (UTIS) caused by E. coli are accounted for by producers of beta-lactamase of the extended spectrum of action (ESBL). Associated resistance to fluoroquinolones and co-trimoxazole was found in 93.3% of BLRS-producing E. coli strains. All studied strains regardless of ESBL production were sensitive to imipenem, the majority showed sensitivity to ertapenem, gentamicin and resistance to doxycycline. Not producing ESBL strains of E. coli were sensitive to fosfomycin. Comparison of data obtained during testing of isolated cultures on ESBL, study of their sensitivity and resistance to beta-lactams (amoxicillin/clavulanate, ceftazidime, ceftriaxone, cefotaxime, imipenem) indicates the need to test isolates for AmpC products. To this end, during the screening test for ESBL and the method of «double disks», along with cephalosporins of III generation, it is necessary to use a phenotypic test for sensitivity to cefepime. The use of test results of E. coli isolates isolated from patients with UTIS for the production of ESBL, ampC enzymes, carbapenemase and sensitivity to AMP will improve the effectiveness of antimicrobial therapy and will help to curb the formation and spread of antimicrobial-resistant strains.

scholarly journals Evaluation of Immunocompetent Urinary Tract Infected Balb/C Mouse Model For the Study of Antibiotic Resistance Development Using Escherichia Coli CFT073 Infection

Antibiotics ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 170 ◽  
Author(s):  
Ashok Chockalingam ◽  
Sharron Stewart ◽  
Lin Xu ◽  
Adarsh Gandhi ◽  
Murali K. Matta ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Bladder Tissue ◽  
Resistance Development ◽  
Once Daily ◽  
E Coli ◽  
Low Levels ◽  
Tract Infections

Urinary tract infections (UTI) are common worldwide and are becoming increasingly difficult to treat because of the development of antibiotic resistance. Immunocompetent murine models of human UTI have been used to study pathogenesis and treatment but not for investigating resistance development after treatment with antibiotics. In this study, intravesical inoculation of uropathogenic Escherichia coli CFT073 in immunocompetent Balb/c mice was used as a model of human UTI. The value of the model in investigating antibiotic exposure on in vivo emergence of antibiotic resistance was examined. Experimentally infected mice were treated with 20 or 200 mg/kg ampicillin, 5 or 50 mg/kg ciprofloxacin, or 100 or 1000 mg/kg of fosfomycin. Ampicillin and ciprofloxacin were given twice daily at 8 h intervals, and fosfomycin was given once daily. Antibiotic treatment began 24 h after bacterial inoculation and ended after 72 h following the initial treatment. Although minimum inhibitory concentrations (MIC) for the experimental strain of E. coli were exceeded at peak concentrations in tissues and consistently in urine, low levels of bacteria persisted in tissues in all experiments. E. coli from bladder tissue, kidney, and urine grew on plates containing 1× MIC of antibiotic, but none grew at 3× MIC. This model is not suitable for studying emergent resistance but might serve to examine bacterial persistence.

Molecular characterization of Escherichia coli isolates from patients with urinary tract infections in Palestine

2014 ◽  
Vol 63 (2) ◽  
pp. 229-234 ◽  
Author(s):  
Kamel Adwan ◽  
Naser Jarrar ◽  
Awni Abu-Hijleh ◽  
Ghaleb Adwan ◽  
Elena Awwad
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Enterobacterial Repetitive Intergenic Consensus ◽  
The West ◽  
E Coli ◽  
Amoxicillin Clavulanic Acid ◽  
Tract Infections ◽  
Resistance Rates

Antibiotic resistance of Escherichia coli isolated from urinary tract infections (UTIs) is increasing worldwide. A total of 41 E. coli isolates were obtained from urine samples from hospitalized patients with a UTI in three hospitals in the northern districts of the West Bank, Palestine during March and June 2011. Resistance rates were: erythromycin (95 %), trimethoprim–sulfamethoxazole (59 %), ciprofloxacin (56 %), gentamicin (27 %), imipenem (22 %), amoxicillin (93 %), amoxicillin–clavulanic acid (32 %), ceftazidime (66 %) and cefotaxime (71 %). No meropenem-resistant isolates were identified in this study. Among the isolates, phylogenetic group B2 was observed in 13 isolates, D in 12 isolates, A in 11 isolates and B1 in five isolates. Thirty-five of the isolates were positive for an extended-spectrum β-lactamase phenotype. Among these isolates, the bla CTX-M gene was detected in 25, and eight harboured the bla TEM gene. None of the isolates contained the bla SHV gene. Transformation experiments indicated that some of the β-lactamase genes (i.e. bla CTX-M and bla TEM) with co-resistance to erythromycin and gentamicin were plasmid encoded and transmissible. Apart from this, enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) revealed that the 41 isolates were genetically diverse and comprised a heterogeneous population with 11 ERIC-PCR profiles at a 60 % similarity level.

Localization and Therapy of Urinary Tract Infections of Childhood

PEDIATRICS ◽  
1979 ◽  
Vol 63 (3) ◽  
pp. 467-474 ◽  
Author(s):  
Raoul L. Wientzen ◽  
George H. McCracken ◽  
Mary L. Petruska ◽  
Susan G. Swinson ◽  
Bertil Kaijser ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
C Reactive Protein ◽  
E Coli ◽  
Reactive Protein ◽  
Tract Infections ◽  
Antibody Coating

One hundred four patients with 124 episodes of urinary tract infection were studied. Serum C-reactive protein (CRP) was determined on diagnosis of each patient. Children with a CRP equal to or greater than 30 µg/ml (CRP-pos) differed significantly from those with values less than 30 µ/ml (CRP-neg) in age, clinical presentation, K type of Escherichia coli causing disease, frequency or radiographic abnormalities, and presence of antibody coating of bacteria in the urinary sediment. E coli K1 strains caused disease significantly more often in CRP-pos than in CRP-neg patients, and children with K1 infections were younger than those with non-K1 infections. The antibody-coated bacteria test was neither sensitive nor specific for localization of infection in pediatric patients. Determination of K1 antibody concentrations in serum and urine of E coli K1-infected children provided data supporting the measurement of CRP as one means of localizing urinary tract infections. Patients with CRP-neg infections were treated as successfully with four days of antimicrobial therapy as with ten days.

scholarly journals Gender and Age-Dependent Etiology of Community-Acquired Urinary Tract Infections

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Enrico Magliano ◽  
Vittorio Grazioli ◽  
Loredana Deflorio ◽  
Antonia Isabella Leuci ◽  
Roberto Mattina ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Agents ◽  
Age And Gender ◽  
E Coli ◽  
Gender And Age ◽  
Amoxicillin Clavulanate ◽  
And Gender ◽  
Tract Infections

Urinary tract infections (UTIs) are among the most frequent community-acquired infections worldwide.Escherichia coliis the most common UTI pathogen although underlying host factors such as patients’ age and gender may influence prevalence of causative agents. In this study, 61 273 consecutive urine samples received over a 22-month period from outpatients clinics of an urban area of north Italy underwent microbiological culture with subsequent bacterial identification and antimicrobial susceptibility testing of positive samples. A total of 13 820 uropathogens were isolated and their prevalence analyzed according to patient’s gender and age group. OverallEscherichia coliaccounted for 67.6% of all isolates, followed byKlebsiella pneumoniae(8.8%),Enterococcus faecalis(6.3%),Proteus mirabilis(5.2%), andPseudomonas aeruginosa(2.5%). Data stratification according to both age and gender showedE. coliisolation rates to be lower in both males aged ≥60 years (52.2%),E. faecalisandP. aeruginosabeing more prevalent in this group (11.6% and 7.8%, resp.), as well as in those aged ≤14 years (51.3%) in whomP. mirabilisprevalence was found to be as high as 21.2%.Streptococcus agalactiaeoverall prevalence was found to be 2.3% although it was shown to occur most frequently in women aged between 15 and 59 years (4.1%). Susceptibility ofE. colito oral antimicrobial agents was demonstrated to be as follows: fosfomycin (72.9%), trimethoprim/sulfamethoxazole (72.9%), ciprofloxacin (76.8%), ampicillin (48.0%), and amoxicillin/clavulanate (77.5%). In conclusion, both patients’ age and gender are significant factors in determining UTIs etiology; they can increase accuracy in defining the causative uropathogen as well as providing useful guidance to empiric treatment.

scholarly journals Antimicrobial Resistance in Urinary Tract Pathogens in Canada from 2007 to 2009: CANWARD Surveillance Study

2011 ◽  
Vol 55 (7) ◽  
pp. 3169-3175 ◽  
Author(s):  
James A. Karlowsky ◽  
Philippe R. S. Lagacé-Wiens ◽  
Patricia J. Simner ◽  
Melanie R. DeCorby ◽  
Heather J. Adam ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Surveillance Study ◽  
Multivariate Logistic Regression Model ◽  
Content Type ◽  
E Coli ◽  
Oral Agents ◽  
Amoxicillin Clavulanate ◽  
Tract Infections ◽  
Resistance Rates

ABSTRACTFrom January 2007 to December 2009, an annual Canadian national surveillance study (CANWARD) tested 2,943 urinary culture pathogens for antimicrobial susceptibilities according to Clinical and Laboratory Standards Institute guidelines. The most frequently isolated urinary pathogens were as follows (number of isolates, percentage of all isolates):Escherichia coli(1,581, 54%), enterococci (410, 14%),Klebsiella pneumoniae(274, 9%),Proteus mirabilis(122, 4%),Pseudomonas aeruginosa(100, 3%), andStaphylococcus aureus(80, 3%). The rates of susceptibility to trimethoprim-sulfamethoxazole (SXT) were 78, 86, 84, and 93%, respectively, forE. coli,K. pneumoniae,P. mirabilis, andS. aureus. The rates of susceptibility to nitrofurantoin were 96, 97, 33, and 100%, respectively, forE. coli, enterococci,K. pneumoniae, andS. aureus. The rates of susceptibility to ciprofloxacin were 81, 40, 86, 81, 66, and 41%, respectively, forE. coli, enterococci,K. pneumoniae,P. mirabilis,P. aeruginosa, andS. aureus. Statistical analysis of resistance rates (resistant plus intermediate isolates) by year forE. coliover the 3-year study period demonstrated that increased resistance rates occurred only for amoxicillin-clavulanate (from 1.8 to 6.6%;P< 0.001) and for SXT (from 18.6 to 24.3%;P= 0.02). For isolates ofE. coli, in a multivariate logistic regression model, hospital location was independently associated with resistance to ciprofloxacin (P= 0.026) with higher rates of resistance observed in inpatient areas (medical, surgical, and intensive care unit wards). Increased age was also associated with resistance to ciprofloxacin (P< 0.001) and with resistance to two or more commonly prescribed oral agents (amoxicillin-clavulanate, ciprofloxacin, nitrofurantoin, and SXT) (P= 0.005). We conclude that frequently prescribed empirical agents for urinary tract infections, such as SXT and ciprofloxacin, demonstrate loweredin vitrosusceptibilities when tested against recent clinical isolates.

scholarly journals The Clinical Efficacy and Safety of Ertapenem for the Treatment of Complicated Urinary Tract Infections Caused by ESBL-Producing Bacteria in Children

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Ayse Karaaslan ◽  
Eda Kepenekli Kadayifci ◽  
Serkan Atici ◽  
Gulsen Akkoc ◽  
Nurhayat Yakut ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Clinical Efficacy ◽  
Clinical Problem ◽  
Efficacy And Safety ◽  
Once Daily ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Important Clinical Problem ◽  
Tract Infections

Background. Urinary tract infections (UTIs) are common and important clinical problem in childhood, and extended-spectrum-beta-lactamase- (ESBL-) producing organisms are the leading cause of healthcare-related UTIs. In this study, we aimed to evaluate the clinical efficacy and safety of ertapenem therapy in children with complicated UTIs caused by ESBL-producing organisms.Methods. Seventy-seven children with complicated UTIs caused by ESBL-producing organisms were included in this retrospective study, and all had been treated with ertapenem between January 2013 and June 2014.Results. Sixty-one (79%) females and sixteen (21%) males with a mean ± standard deviation (SD) age of76.6±52months (range 3–204, median 72 months) were enrolled in this study.Escherichia coli(E. coli) (n=67; 87%) was the most common bacterial cause of the UTIs followed byKlebsiella pneumoniae(K. pneumoniae) (n=9; 11.7%) andEnterobacter cloacae(E. cloacae) (n=1; 1.3%). The mean duration of the ertapenem therapy was8.9±1.6days (range 4–11). No serious drug-related clinical or laboratory adverse effects were observed, and the ertapenem therapy was found to be safe and well tolerated in the children in our study.Conclusion. Ertapenem is a newer carbapenem with the advantage of once-daily dosing and is highly effective for treating UTIs caused by ESBL-producing microorganisms.

scholarly journals Phenotypic and Genotypic Characterization of Escherichia coli Causing Urinary Tract Infections in Kidney-Transplanted Patients

2019 ◽  
Vol 8 (7) ◽  
pp. 988 ◽  
Author(s):  
Jonas Abo Basha ◽  
Matthias Kiel ◽  
Dennis Görlich ◽  
Katharina Schütte-Nütgen ◽  
Anika Witten ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Graft Function ◽  
Clinical History ◽  
Control Group ◽  
E Coli ◽  
Immunocompromised Status ◽  
Tract Infections ◽  
And Control

Urinary tract infection (UTI), frequently caused by uropathogenic Escherichia coli (UPEC), is the most common infection after kidney transplantation (KTx). Untreated, it can lead to urosepsis and impairment of the graft function. We questioned whether the UPEC isolated from KTx patients differed from the UPEC of non-KTx patients. Therefore, we determined the genome sequences of 182 UPEC isolates from KTx and control patients in a large German university clinic and pheno- and genotypically compared these two isolated groups. Resistance to the β-lactams, trimethoprim or trimethoprim/sulfamethoxazole was significantly higher among UPEC from KTx than from control patients, whereas both the isolated groups were highly susceptible to fosfomycin. Accordingly, the gene content conferring resistance to β-lactams or trimethoprim, but also to aminoglycosides, was significantly higher in KTx than in control UPEC isolates. E. coli isolates from KTx patients more frequently presented with uncommon UPEC phylogroups expressing higher numbers of plasmid replicons, but interestingly, less UPEC virulence-associated genes than the control group. We conclude that there is no defining subset of virulence traits for UPEC from KTx patients. The clinical history and immunocompromised status of KTx patients enables E. coli strains with low uropathogenic potential, but with increased antibiotic resistance to cause UTIs.

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