Antimicrobial Resistance among Community-Acquired Uropathogens in Mashhad, Iran

Background. Antimicrobial resistance among community-acquired uropathogens is an emerging concern over the past decades that warrants a continuing reevaluation of the appropriateness of recommended empiric antimicrobial regimens for treatment of urinary tract infections (UTIs). Aims. To describe the microbial spectrum and resistance profile of community-acquired uropathogens and predictors of isolation of resistant strains. Methods. Between October 2017 and June 2019, individuals who visited the outpatient clinics for diagnosis of UTIs or screening of asymptomatic bacteriuria were included in the study if they were tested for urine culture in one of the three main medical diagnostic laboratories of Mashhad, Iran. The standard disk diffusion antimicrobial susceptibility testing was used, with the Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens. Results. Three hundred thirty cases were included with a median age of 47 years. Two hundred seventy-six (83.6%) were female. The most common isolated uropathogens were Escherichia coli in 201 (60.9%) cases and Klebsiella species in 46 (13.9%) cases. E. coli isolates showed the highest rates of susceptibility to nitrofurantoin (89.3%), cefixime (75%), and gentamicin (72.4%). Exposure to antibiotics in the past 3 months was a predictor of resistance to ciprofloxacin (OR: 2.8, 95% CI: 1.33–6.28), and older age was a predictor of resistance to TMP-SMX (OR: 2.1, 95% CI: 1.07–3.97) among E. coli isolates. Conclusion. E. coli and Klebsiella species accounted for about two-thirds of community-acquired uropathogens. In regard to the high susceptibility rates, nitrofurantoin was identified as the first-choice agent for empiric treatment of community-acquired cystitis, while cefixime and gentamicin might be the second-choice alternatives. Ciprofloxacin and TMP-SMX, on the other hand, cannot be considered appropriate agents for empiric therapy of community-acquired UTIs, particularly in those who had exposure to antibiotics in the past 3 months and the elderly.

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Antimicrobial Resistance Patterns and ESBL of Uropathogens Isolated from Adult Females in Najran Region of Saudi Arabia

Clinics and Practice ◽

10.3390/clinpract11030080 ◽

2021 ◽

Vol 11 (3) ◽

pp. 650-658

Author(s):

Mohammed Yahia Alasmary

Keyword(s):

Escherichia Coli ◽

Saudi Arabia ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Urine Samples ◽

Klebsiella Species ◽

E Coli ◽

Government Hospitals ◽

Resistance Patterns ◽

Tract Infections

Background: To explore the prevalence of urinary tract infections (UTIs) among female patients in the Najran region of Saudi Arabia and determine their antimicrobial resistance pattern. Methods: This study was conducted on 136 urine samples collected from outpatient departments (OPDs) of the different government hospitals in the Najran region of Saudi Arabia. Over one year, the results of susceptibility testing reports of outpatient midstream urine samples from three government hospitals were prospectively evaluated. Results: Of 136 urine samples, only 123 (90.45%) were found to show significant growth for UTIs, from which 23 different uropathogens were identified. Escherichia coli (58.5%) was the most commonly isolated organism, followed by Klebsiella pneumoniae (8.1%). The isolated microorganism showed increased resistance patterns from 3.3% to 62.6%, with an overall resistance of 27.19%. Meropenem was the most effective antimicrobial, followed by amikacin and ertapenem (0.47%, 0.91%, and 1.5% resistance, respectively). At the same time, ampicillin and cephazolin were the least (62.6% and 59.5% resistance, respectively) effective. Overall, eleven (8.94%) uropathogens isolates were ESBLs, among which there were eight (6.5%) Escherichia coli, one (0.81%) Klebsiella pneumoniae, one (0.81%) Klebsiella oxytoca, and one (0.81%) Citrobacter amalonaticus. Conclusions: E. coli remains the most commonly isolated causative uropathogens, followed by Klebsiella species. The prevalence of pathogenic E. coli and Klebsiella species underscores the importance of developing cost-effective, precise, and rapid identification systems to minimize public exposure to uropathogens. Antibiotic susceptibility data revealed that most of the isolates were resistant to the majority of the antibiotics. The patients with UTIs in the Najran region of Saudi Arabia are at a high risk of antibiotic resistance, leading to significant problems in outpatient department (OPD) treatment outcomes and raising the alarm for the physician to change their empiric treatment.

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Molecular Characterization of Uropathogenic Escherichia coli Reveals Emergence of Drug Resistant O15, O22 and O25 Serogroups

Medicina ◽

10.3390/medicina55110733 ◽

2019 ◽

Vol 55 (11) ◽

pp. 733 ◽

Cited By ~ 3

Author(s):

Ruta Prakapaite ◽

Frederic Saab ◽

Rita Planciuniene ◽

Vidmantas Petraitis ◽

Thomas J. Walsh ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Asymptomatic Bacteriuria ◽

Empirical Therapy ◽

Uropathogenic Escherichia Coli ◽

Phylogenetic Groups ◽

E Coli ◽

Tract Infections ◽

Resistance Rates

Background and Objectives: Uropathogenic Escherichia coli (UPEC) are common pathogens causing urinary tract infections (UTIs). We aimed to investigate the relationship among clinical manifestation, serogroups, phylogenetic groups, and antimicrobial resistance among UPEC. Materials and Methods: One-hundred Escherichia coli isolates recovered from urine and ureteral scrapings were used for the study. The prevalence of antimicrobial resistance was determined by using European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations. E. coli serogroups associated with UTI, as well as phylogenetic diversity were analyzed using multiplex PCR reactions. Results: Eighty-seven strains (87%) were isolated from females, while 13 (13%) from males. A high frequency of resistance to cephalosporins (43%) and fluoroquinolones (31%) was observed. Among UTI-associated serogroups O15 (32.8%), O22 (23.4%), and O25 (15.6%) were dominant and demonstrated elevated resistance rates. The E. coli phylogenetic group B2 was most common. These observations extended to pregnant patients with asymptomatic bacteriuria. Conclusions: Due to high rates of resistance, strategies using empirical therapy of second-generation cephalosporins and fluoroquinolones should be reconsidered in this population.

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Molecular Characterisation of Uropathogenic Escherichia coli Reveals Emergence of Drug Resistant O15, O22, and O25 Serogroups

10.21203/rs.2.11385/v1 ◽

2019 ◽

Author(s):

Ruta Prakapaite ◽

Frederic Saab ◽

Rita Planciuniene ◽

Vidmantas Petraitis ◽

Thomas J. Walsh ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Asymptomatic Bacteriuria ◽

Empirical Therapy ◽

Uropathogenic Escherichia Coli ◽

Phylogenetic Groups ◽

E Coli ◽

Tract Infections ◽

Resistance Rates ◽

The Relationship

Abstract Background Uropathogenic Escherichia coli (UPEC) are common pathogens causing urinary tract infections (UTIs). We aimed to investigate the relationship among clinical manifestation, serogroups, phylogenetic groups, and antimicrobial resistance among UPEC. Methods One-hundred Escherichia coli isolates recovered from urine and ureteral scrapings were used for the study. The prevalence of antimicrobial resistance was determined by using EUCAST recommendations. E. coli serogroups associated with UTI, as well as phylogenetic diversity was analysed using multiplex PCR reactions. Results Eighty-seven strains (87%) were isolated from females, while 13 (13%) from males. A high frequency of resistance to cephalosporins (43%) and fluoroquinolones (31%) was observed. Among UTI-associated serogroups, O15 (32.8%), O22 (23.4%), and O25 (15.6%) were dominant and demonstrated elevated resistance rates. The E. coli phylogenetic group B2 was most common. These observations extended to pregnant patients with asymptomatic bacteriuria. Conclusions Due to high rates of resistance, strategies using empirical therapy of second-generation cephalosporins and fluoroquinolones for treatment of UPEC infections should be reconsidered.

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Bacterial Pathogens and Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: A Four-Year Surveillance Study (2009–2012)

International Journal of Pediatrics ◽

10.1155/2014/126142 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 33

Author(s):

Seyed Reza Mirsoleymani ◽

Morteza Salimi ◽

Masoud Shareghi Brojeni ◽

Masoud Ranjbar ◽

Mojtaba Mehtarpoor

Keyword(s):

Antimicrobial Resistance ◽

Empirical Therapy ◽

Empiric Therapy ◽

National Guidelines ◽

Antibiotic Selection ◽

E Coli ◽

Resistance Patterns ◽

The Common ◽

Bandar Abbas ◽

Tract Infections

The aims of this study were to assess the common bacterial microorganisms causing UTI and their antimicrobial resistance patterns in Bandar Abbas (Southern Iran) during a four-year period. In this retrospective study, samples with a colony count of ≥105 CFU/mL bacteria were considered positive; for these samples, the bacteria were identified, and the profile of antibiotic susceptibility was characterized. From the 19223 samples analyzed, 1513 (7.87%) were positive for bacterial infection. UTI was more frequent in male (54.9%).E. coliwas reported the most common etiological agent of UTI (65.2%), followed byKlebsiellaspp. (26%),Pseudomonas aeruginosa(3.6%), andStaphylococcuscoagulase positive (3.7%). Results of antimicrobial susceptibility analysis forE. colito commonly used antibiotics are as follows: Amikacin (79.7%), Ofloxacin (78.3%), Gentamicin (71.6%), Ceftriaxone (41.8), Cefotaxime (41.4%), and Cefixime (27.8%). Empirical antibiotic selection should be based on awareness of the local prevalence of bacterial organisms and antibiotic sensitivities rather than on universal or even national guidelines. In this study, Amikacin and Gentamicin were shown to be the most appropriate antibiotics for empiric therapy of pyelonephritis, but empirical therapy should only be done by specialist physicians in cases where it is necessary while considering sex and age of children.

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Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

Children ◽

10.3390/children8070597 ◽

2021 ◽

Vol 8 (7) ◽

pp. 597

Author(s):

Luca Pierantoni ◽

Laura Andreozzi ◽

Simone Ambretti ◽

Arianna Dondi ◽

Carlotta Biagi ◽

...

Keyword(s):

Escherichia Coli ◽

Metropolitan Area ◽

Bacterial Infections ◽

Asymptomatic Bacteriuria ◽

Multidrug Resistant ◽

Resistance Rate ◽

First Line ◽

E Coli ◽

First Line Therapy ◽

Tract Infections

Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of E. coli isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of E. coli-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (p < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (p = 0.007). The prevalence of multidrug-resistant E. coli rose from 3.9% to 9.2% (p = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant E. coli among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines.

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Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2665-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 7

Author(s):

Anne CC Lee ◽

Luke C. Mullany ◽

Alain K. Koffi ◽

Iftekhar Rafiqullah ◽

Rasheda Khanam ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Asymptomatic Bacteriuria ◽

Population Based ◽

E Coli ◽

Maternal Undernutrition ◽

Low Middle Income Countries ◽

Tract Infections ◽

In Pregnancy

Abstract Background Urinary tract infection (UTI) in pregnancy, including asymptomatic bacteriuria, is associated with maternal morbidity and adverse pregnancy outcomes, including preterm birth and low birthweight. In low-middle income countries (LMICs), the capacity for screening and treatment of UTIs is limited. The objective of this study was to describe the population-based prevalence, risk factors, etiology and antimicrobial resistance patterns of UTIs in pregnancy in Bangladesh. Methods In a community-based cohort in Sylhet district, Bangladesh, urine specimens were collected at the household level in 4242 pregnant women (< 20 weeks gestation) for culture and antibiotic susceptibility testing. Basic descriptive analysis was performed, as well as logistic regression to calculate adjusted odds ratios (aOR) for UTI risk factors. Results The prevalence of UTI was 8.9% (4.4% symptomatic UTI, 4.5% asymptomatic bacteriuria). Risk factors for UTI in this population included maternal undernutrition (mid-upper arm circumference <23 cm: aOR= 1.29, 95% CI: 1.03–1.61), primiparity (aOR= 1.45, 95% CI: 1.15–1.84), and low paternal education (no education: aOR= 1.56, 95% CI: 1.09–2.22). The predominant uro-pathogens were E. coli (38% of isolates), Klebsiella (12%), and staphyloccocal species (23%). Group B streptococcus accounted for 5.3% of uro-pathogens. Rates of antibiotic resistance were high, with only two-thirds of E. coli susceptible to 3rd generation cephalosporins. Conclusions In Sylhet, Bangladesh, one in 11 women had a UTI in pregnancy, and approximately half of cases were asymptomatic. There is a need for low-cost and accurate methods for UTI screening in pregnancy and efforts to address increasing rates of antibiotic resistance in LMIC.

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Routine laboratory surveillance of antimicrobial resistance in community-acquired urinary tract infections adequately informs prescribing policy in England

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlaa022 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Vicky Watts ◽

Benjamin Brown ◽

Maria Ahmed ◽

André Charlett ◽

Carolyn Chew-Graham ◽

...

Keyword(s):

Urinary Tract ◽

Antimicrobial Resistance ◽

Urinary Tract Infections ◽

Laboratory Data ◽

Routine Data ◽

Sentinel Surveillance ◽

Routine Laboratory ◽

Diagnostic Laboratory ◽

E Coli ◽

Tract Infections

Abstract Objectives To assess whether resistance estimates obtained from sentinel surveillance for antimicrobial resistance (AMR) in community-acquired urinary tract infections (UTIs) differ from routinely collected laboratory community UTI data. Methods All patients aged ≥18 years presenting to four sentinel general practices with a suspected UTI, from 13 November 2017 to 12 February 2018, were asked to provide urine specimens for culture and susceptibility. Specimens were processed at the local diagnostic laboratory. Antibiotic susceptibility testing was conducted using automated methods. We calculated the proportion of Escherichia coli isolates that were non-susceptible (according to contemporaneous EUCAST guidelines) to trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin and amoxicillin/clavulanic acid, overall and by age group and sex, and compared this with routine estimates. Results Sentinel practices submitted 740 eligible specimens. The specimen submission rate had increased by 28 specimens per 1000 population per year (95% CI 21–35). Uropathogens were isolated from 23% (169/740) of specimens; 67% were E. coli (113/169). Non-susceptibility of E. coli to trimethoprim was 28.2% (95% CI 20.2–37.7) on sentinel surveillance (33.4%; 95% CI 29.5–37.6 on routine data) and to nitrofurantoin was 0.9% (95% CI 0–5.7) (1.5%; 95% CI 0.7–3.0 on routine data). Conclusions Routine laboratory data resulted in a small overestimation in resistance (although the difference was not statistically significant) and our findings suggest that it provides an adequate estimate of non-susceptibility to key antimicrobials in community-acquired UTIs in England. This study does not support the need for ongoing local sentinel surveillance.

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Escherichia coliSequence Type 410 Is Causing New International High-Risk Clones

mSphere ◽

10.1128/msphere.00337-18 ◽

2018 ◽

Vol 3 (4) ◽

pp. e00337-18 ◽

Cited By ~ 51

Author(s):

Louise Roer ◽

Søren Overballe-Petersen ◽

Frank Hansen ◽

Kristian Schønning ◽

Mikala Wang ◽

...

Keyword(s):

Escherichia Coli ◽

High Risk ◽

Antimicrobial Resistance ◽

Sequence Type ◽

Recurrent Infections ◽

Content Type ◽

E Coli ◽

The Past ◽

Carbapenemase Gene ◽

Globally Distributed

ABSTRACTEscherichia colisequence type 410 (ST410) has been reported worldwide as an extraintestinal pathogen associated with resistance to fluoroquinolones, third-generation cephalosporins, and carbapenems. In the present study, we investigated national epidemiology of ST410E. coliisolates from Danish patients. Furthermore,E. coliST410 was investigated in a global context to provide further insight into the acquisition of the carbapenemase genesblaOXA-181andblaNDM-5of this successful lineage. From 127 whole-genome-sequenced isolates, we reconstructed an evolutionary framework ofE. coliST410 which portrays the antimicrobial-resistant clades B2/H24R, B3/H24Rx, and B4/H24RxC. The B2/H24R and B3/H24Rx clades emerged around 1987, concurrently with the C1/H30R and C2/H30Rx clades inE. coliST131. B3/H24Rx appears to have evolved by the acquisition of the extended-spectrum β-lactamase (ESBL)-encoding geneblaCTX-M-15and an IncFII plasmid, encoding IncFIA and IncFIB. Around 2003, the carbapenem-resistant clade B4/H24RxC emerged when ST410 acquired an IncX3 plasmid carrying ablaOXA-181carbapenemase gene. Around 2014, the clade B4/H24RxC acquired a second carbapenemase gene,blaNDM-5, on a conserved IncFII plasmid. From an epidemiological investigation of 49E. coliST410 isolates from Danish patients, we identified five possible regional outbreaks, of which one outbreak involved nine patients withblaOXA-181- andblaNDM-5-carrying B4/H24RxC isolates. The accumulated multidrug resistance inE. coliST410 over the past two decades, together with its proven potential of transmission between patients, poses a high risk in clinical settings, and thus,E. coliST410 should be considered a lineage with emerging “high-risk” clones, which should be monitored closely in the future.IMPORTANCEExtraintestinal pathogenicEscherichia coli(ExPEC) is the main cause of urinary tract infections and septicemia. Significant attention has been given to the ExPEC sequence type ST131, which has been categorized as a “high-risk” clone. High-risk clones are globally distributed clones associated with various antimicrobial resistance determinants, ease of transmission, persistence in hosts, and effective transmission between hosts. The high-risk clones have enhanced pathogenicity and cause severe and/or recurrent infections. We show that clones of theE. coliST410 lineage persist and/or cause recurrent infections in humans, including bloodstream infections. We found evidence of ST410 being a highly resistant globally distributed lineage, capable of patient-to-patient transmission causing hospital outbreaks. Our analysis suggests that the ST410 lineage should be classified with the potential to cause new high-risk clones. Thus, with the clonal expansion over the past decades and increased antimicrobial resistance to last-resort treatment options, ST410 needs to be monitored prospectively.

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Detection of biofilm formation by Escherichia coli with its antibiogram profile

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183562 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3771

Author(s):

Gaurab Risal ◽

Aayush Shrestha ◽

Saroj Kunwar ◽

Gajal Paudel ◽

Rameshwor Dhital ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Biofilm Formation ◽

Technical College ◽

Susceptibility Testing ◽

Diffusion Method ◽

E Coli ◽

Mueller Hinton ◽

Mueller Hinton Agar ◽

Tract Infections ◽

Descriptive Method

Background: In urinary tract infections, an important role is played by bacterial biofilms which are responsible for persistence infections together with the antimicrobial resistance. Higher resistance can be seen in biofilm forming uropathogens in comparison with free-floating bacteria. So, the present study was performed with a goal to find the prevalence of biofilm formation and also the antimicrobial resistant pattern of uropathogens.Methods: A descriptive method was conducted at Modern Technical College, Sanepa, Lalitpur in samples isolated from UTI suspected patients. The overall duration of this study was approximately 3 months. Total of 50 isolated E. coli was tested for biofilm formation and antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method on Mueller Hinton agar as per CLSI guidelines.Results: From the 50 isolates of E. coli, 32 were biofilm producers (3 strong and 29 moderate) and 18 were weak/non-biofilm producers. Among the biofilm producers, cefotaxime was more resistant in 20 of the isolates followed by ceftriaxone in 16 and amoxyclav in 13, whereas amikacin was least resistant in 2 of the isolates.Conclusions: Among the isolated E. coli, biofilm-forming isolates showed higher antimicrobial resistance as compared to the non-biofilm producer. Thus, uropathogen should be routinely screened for biofilm formation.

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Antimicrobial resistance patterns of the Enterobacteriaceae family isolated from urinary tract infections from a Peruvian high-Andean region

Revista del Cuerpo Médico del HNAAA ◽

10.35434/rcmhnaaa.2021.143.1255 ◽

2021 ◽

Vol 14 (3) ◽

pp. 337-343

Author(s):

Xossé Carreras ◽

Andrea S. Salcedo ◽

Bruno Millones ◽

Valeria S. Paredes ◽

Pamela Carpio-Vargas ◽

...

Keyword(s):

Antibiotic Resistance ◽

Urinary Tract ◽

Antimicrobial Resistance ◽

Urinary Tract Infections ◽

Age Groups ◽

The Elderly ◽

Andean Region ◽

Cross Sectional ◽

Resistance Patterns ◽

Tract Infections

Background: Antibiotic resistance is considered to be the next worldwide epidemic. Urinary tract infections (UTI) are the second most common cause of infection, which also has the highest resistance frequency. Nevertheless, in high Andean regions, little is known about the antibiotic resistance. Objectives : Determine the antimicrobial resistance patterns of the enterobacteriaceae family isolated from urinary tract infections of a Peruvian Andean region. Material and Methods: A retrospective cross-sectional review of 1717 records from the microbiology service of a private health institution from Puno - Peru, was done between the years 2014 and 2017. Antibiotic resistance by uropathogens was studied among different age groups. Statistical analysis included Chi2 test with a p<0.05. Poisson regression was used to calculate the prevalence ratio (PR) with a 95% confidence interval. Findings: There was a wide distribution of antibiotic resistance among all the antibiotics, mainly in Escherichia coli and Proteus spp. The elderly had the highest prevalence of antibiotic resistance. As age increased, resistance to all drugs also increased (p<0.01). Furthermore, the elderly had a risk probability of resistance of 1.22, 1.42, 1.20 and 1.32 to penicillins, cephalosporins, quinolones and other antibiotics respectively. Conclusion: The antimicrobial resistance patterns of the Peruvian Andean region were lower than national and international patterns.

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