Propensity for biofilm formation by clinical isolates from urinary tract infections: developing a multifactorial predictive model to improve antibiotherapy

A group of biofilm-producing bacteria isolated from patients with urinary tract infections was evaluated, identifying the main factors contributing to biofilm formation. Among the 156 isolates, 58 (37.2 %) were biofilm producers. The bacterial species (P<0.001), together with patient’s gender (P = 0.022), were the factors with the highest influence for biofilm production. There was also a strong correlation of catheterization with biofilm formation, despite being less significant (P = 0.070) than species or gender. In fact, some of the bacteria isolated were biofilm producers in all cases. With regard to resistance profile among bacterial isolates, β-lactam antibiotics presented the highest number of cases/percentages – ampicillin (32/55.2 %), cephalothin (30/51.7 %), amoxicillin/clavulanic acid (22/37.9 %) – although the carbapenem group still represented a good therapeutic option (2/3.4 %). Quinolones (nucleic acid synthesis inhibitors) also showed high resistance percentages. Furthermore, biofilm production clearly increases bacterial resistance. Almost half of the biofilm-producing bacteria showed resistance against at least three different groups of antibiotics. Bacterial resistance is often associated with catheterization. Accordingly, intrinsic (age and gender) and extrinsic (hospital unit, bacterial isolate and catheterization) factors were used to build a predictive model, by evaluating the contribution of each factor to biofilm production. In this way, it is possible to anticipate biofilm occurrence immediately after bacterial identification, allowing selection of a more effective antibiotic (among the susceptibility options suggested by the antibiogram) against biofilm-producing bacteria. This approach reduces the putative bacterial resistance during treatment, and the consequent need to adjust antibiotherapy.

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Dispensing of Food Supplements in the Treatment and Prevention of Urinary Tract Infections

Medical Sciences Forum ◽

10.3390/msf2021005001 ◽

2021 ◽

Vol 5 (1) ◽

pp. 1

Author(s):

Beatriz Setoca ◽

Ana I. Fernandes

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Health Professionals ◽

Bacterial Resistance ◽

Food Supplements ◽

Public Health Issue ◽

Therapeutic Approaches ◽

Treatment And Prevention ◽

Tract Infections ◽

Perception Of Health

Urinary tract infections constitute an important public health issue due to recurrence and antibiotic resistance. Currently, antibiotics are the standard therapy but non-antibiotic approaches, such as food supplements, could be beneficial and reduce bacterial resistance. This work aimed at a better understanding of the perception of health professionals involved in dispensing and counselling, in the community pharmacy, regarding the utility of these products as preventive alternatives and therapeutic approaches.

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Assessment of Fosfomycin for Complicated or Multidrug-Resistant Urinary Tract Infections: Patient Characteristics and Outcomes

Chemotherapy ◽

10.1159/000449422 ◽

2016 ◽

Vol 62 (2) ◽

pp. 100-104 ◽

Cited By ~ 18

Author(s):

Stephanie E. Giancola ◽

Monica V. Mahoney ◽

Michael D. Hogan ◽

Brian R. Raux ◽

Christopher McCoy ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Bacterial Resistance ◽

Clinical Success ◽

Patient Characteristics ◽

Multidrug Resistant ◽

Enterococcus Spp ◽

Tract Infections ◽

Microbiological Cure

Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.

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Increased human pathogenic potential of Escherichia coli from polymicrobial urinary tract infections in comparison to isolates from monomicrobial culture samples

Journal of Medical Microbiology ◽

10.1099/jmm.0.020602-0 ◽

2011 ◽

Vol 60 (1) ◽

pp. 102-109 ◽

Cited By ~ 37

Author(s):

Gemma Croxall ◽

Vivienne Weston ◽

Susan Joseph ◽

Georgina Manning ◽

Phil Cheetham ◽

...

Keyword(s):

Urinary Tract ◽

Elderly Patients ◽

Urinary Tract Infections ◽

Standard Procedure ◽

Bacterial Species ◽

Cell Infection ◽

Pathogenic Potential ◽

Increased Risk ◽

Tract Infections

The current diagnostic standard procedure outlined by the Health Protection Agency for urinary tract infections (UTIs) in clinical laboratories does not report bacteria isolated from samples containing three or more different bacterial species. As a result many UTIs go unreported and untreated, particularly in elderly patients, where polymicrobial UTI samples are especially prevalent. This study reports the presence of the major uropathogenic species in mixed culture urine samples from elderly patients, and of resistance to front-line antibiotics, with potentially increased levels of resistance to ciprofloxacin and trimethoprim. Most importantly, the study highlights that Escherichia coli present in polymicrobial UTI samples are statistically more invasive (P<0.001) in in vitro epithelial cell infection assays than those isolated from monomicrobial culture samples. In summary, the results of this study suggest that the current diagnostic standard procedure for polymicrobial UTI samples needs to be reassessed, and that E. coli present in polymicrobial UTI samples may pose an increased risk to human health.

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Antimicrobial Evaluation of Bacterial Isolates from Urine Specimen of Patients with Complaints of Urinary Tract Infections in Awka, Nigeria

International Journal of Microbiology ◽

10.1155/2016/9740273 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Perpetua A. Ekwealor ◽

Malachy C. Ugwu ◽

Ifeanyi Ezeobi ◽

George Amalukwe ◽

Belinda C. Ugwu ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Antimicrobial Susceptibility ◽

Bacterial Species ◽

Resistance Index ◽

Diffusion Method ◽

Urine Specimen ◽

Anambra State ◽

Tract Infections ◽

Susceptibility Patterns

Urinary tract infections (UTIs) account for one of the major reasons for most hospital visits and the determination of the antimicrobial susceptibility patterns of uropathogens will help to guide physicians on the best choice of antibiotics to recommend to affected patients. This study is designed to isolate, characterize, and determine the antimicrobial susceptibility patterns of the pathogens associated with UTI in Anambra State Teaching Hospital, Amaku, Anambra State, Nigeria. Clean catch urine samples of inpatient and outpatient cases of UTI were collected and bacteriologically analyzed using standard microbiological procedures. Antibiogram was done by the Kirby-Bauer disc diffusion method. The most prevalent isolates wereS. aureus(28%),E.coli(24.6%), andS. saprophyticus(20%). The antibacterial activities of the tested agents were in the order of Augmentin < Ceftazidime < Cefuroxime < Cefixime < Gentamicin < Ofloxacin < Ciprofloxacin < Nitrofurantoin. It was found that all the organisms were susceptible in varying degrees to Nitrofurantoin, Ciprofloxacin, and Ofloxacin. It was also observed that all the bacterial species exceptStreptococcusspp. have a Multiple Antibiotic Resistance Index (MARI) greater than 0.2. For empiric treatment of UTIs in Awka locality, Nitrofurantoin, Ciprofloxacin, and Ofloxacin are the first line of choice.

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Changes in bacterial resistance patterns in children with urinary tract infections on antimicrobial prophylaxis at University Hospital in Split

Medical Science Monitor ◽

10.12659/msm.881845 ◽

2011 ◽

Vol 17 (7) ◽

pp. CR355-CR361 ◽

Cited By ~ 10

Author(s):

Tanja Ilić ◽

Sanda Gračan ◽

Adela Arapović ◽

Vesna Čapkun ◽

Mirna Šubat-Dežulović ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Bacterial Resistance ◽

Antimicrobial Prophylaxis ◽

University Hospital ◽

Resistance Patterns ◽

Tract Infections

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Vitamin C in the Presence of Sub-Inhibitory Concentration of Aminoglycosides and Fluoroquinolones Alters Proteus mirabilis Biofilm Inhibitory Rate

Antibiotics ◽

10.3390/antibiotics8030116 ◽

2019 ◽

Vol 8 (3) ◽

pp. 116 ◽

Cited By ~ 5

Author(s):

Joanna Kwiecińska-Piróg ◽

Krzysztof Skowron ◽

Tomasz Bogiel ◽

Agata Białucha ◽

Jana Przekwas ◽

...

Keyword(s):

Ascorbic Acid ◽

Urinary Tract ◽

Vitamin C ◽

Urinary Tract Infections ◽

Proteus Mirabilis ◽

Biofilm Formation ◽

Common Species ◽

Inhibitory Effect ◽

Acid Addition ◽

Tract Infections

Vitamin C has antimicrobial activity and is often used as an oral supplement accompanying antibiotic treatment in urinary tract infections (UTI). Proteus mirabilis is the third common species responsible for UTIs that are mostly treated with fluoroquinolones or aminoglycosides. Treatment of the UTI caused by P. mirabilis is problematic due to the ability to form biofilm on the urinary catheters. The aim of the study was to evaluate the influence of ascorbic acid in combination with antibiotics on P. mirabilis abilities to form biofilm. The susceptibility of P. mirabilis reference strain ATCC® 29906™ and four clinical strains isolated from the urine samples of patients with urinary catheter were evaluated according to EUCAST recommendations. The influence of ascorbic acid (0.4 mg × mL−1) in combination with antibiotics on biofilm formation was evaluated spectrophotometrically. Aminoglycosides at sub-inhibitory concentrations more successfully limited biofilm formation by P. mirabilis strains without ascorbic acid addition. Inhibition rate differences at the lowest concentrations of gentamicin and amikacin were statistically significant (p ≤ 0.05). Ascorbic acid addition to the culture medium limited the inhibitory effect of fluoroquinolones, facilitating biofilm formation by P. mirabilis strains. The addition of ascorbic acid during aminoglycosides therapy may disturb treatment of urinary tract infections related to the presence of P. mirabilis biofilm.

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Bacterial Resistance to Leucyl-tRNA Synthetase Inhibitor GSK2251052 Develops during Treatment of Complicated Urinary Tract Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03774-14 ◽

2014 ◽

Vol 59 (1) ◽

pp. 289-298 ◽

Cited By ~ 49

Author(s):

Karen O'Dwyer ◽

Aaron T. Spivak ◽

Karen Ingraham ◽

Sharon Min ◽

David J. Holmes ◽

...

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Bacterial Resistance ◽

Multidrug Resistant ◽

Trna Synthetase ◽

Content Type ◽

Development Of Resistance ◽

Tract Infections ◽

Abdominal Infections

ABSTRACTGSK2251052, a novel leucyl-tRNA synthetase (LeuRS) inhibitor, was in development for the treatment of infections caused by multidrug-resistant Gram-negative pathogens. In a phase II study (study LRS114688) evaluating the efficacy of GSK2251052 in complicated urinary tract infections, resistance developed very rapidly in 3 of 14 subjects enrolled, with ≥32-fold increases in the GSK2251052 MIC of the infecting pathogen being detected. A fourth subject did not exhibit the development of resistance in the baseline pathogen but posttherapy did present with a different pathogen resistant to GSK2251052. Whole-genome DNA sequencing ofEscherichia coliisolates collected longitudinally from two study LRS114688 subjects confirmed that GSK2251052 resistance was due to specific mutations, selected on the first day of therapy, in the LeuRS editing domain. Phylogenetic analysis strongly suggested that resistantEscherichia coliisolates resulted from clonal expansion of baseline susceptible strains. This resistance development likely resulted from the confluence of multiple factors, of which only some can be assessed preclinically. Our study shows the challenges of developing antibiotics and the importance of clinical studies to evaluate their effect on disease pathogenesis. (These studies have been registered at ClinicalTrials.gov under registration no. NCT01381549 for the study of complicated urinary tract infections and registration no. NCT01381562 for the study of complicated intra-abdominal infections.)

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