Antibiograms of uropathogens in obstetric patients

Background: Urinary tract infections (UTI) are the most commonly encountered infections inobstetric patients. Aim: The current study was undertaken to find the spectrum of micro-organismsresponsible for causing UTI in obstetric patients and to find out the most appropriate antibiotic.Materials and Methods: Consecutive patients in different stages of pregnancy with or withoutsymptoms of UTI attending the antenatal clinic from June 2019 to November 2020 were screenedfor significant bacteriuria. The bacterial uropathogens isolated were then subjected to antimicrobialsusceptibility testing and screened for ESBL production and methicillin resistance. Results: Duringthe 18-month study period, out of the 110 samples screened, a total of 66 (60%) samples of urinefrom pregnant females, in different stages of pregnancy were found to be positive on culture. TheEnterobacteriaceae accounted for nearly 69.69% of the isolates and E. coli alone accounted for42.42% of the urinary isolates followed by Acinetobacter 19.69%. Among the Gram-positive cocci,Enterococcus 25.75% were more frequently isolated than Staphylococcus aureus (4.54%).Significantly high resistance was noted to the beta-lactam group of antimicrobials, fluoroquinolonesand cotrimoxazole, both by the Gram-negative bacilli as well as Gram-positive cocci. Resistance wasquite low against the aminoglycosides and nitrofurantoin and virtually absent against imipenem.Conclusion: The susceptibility patterns seen in our study seem to suggest that it is necessary toobtain sensitivity reports before initiation of antibiotic therapy in cases of suspected UTI.

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Rising Prevalence of Antimicrobial Resistance in Urinary Tract Infections During Pregnancy: Necessity for Exploring Newer Treatment Options

Journal of Laboratory Physicians ◽

10.4103/0974-2727.86842 ◽

2011 ◽

Vol 3 (02) ◽

pp. 098-103 ◽

Cited By ~ 33

Author(s):

Meher Rizvi ◽

Fatima Khan ◽

Indu Shukla ◽

Abida Malik ◽

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Antimicrobial Susceptibility ◽

Methicillin Resistance ◽

Asymptomatic Bacteriuria ◽

Gram Positive ◽

Gram Negative ◽

Tract Infections ◽

Gram Positive Cocci

ABSTRACT Background: Urinary tract infections (UTI) are one of the most common medical complications of pregnancy. The emergence of drug resistance and particularly the Extended-spectrum beta-lactamase production by Escherichia coli and methicillin resistance in Staphylococci, limits the choice of antimicrobials. Materials and Methods: Patients in different stages of pregnancy with or without symptoms of urinary tract infection attending the antenatal clinic of obstetrics and gynaecology were screened for significant bacteriuria, by standard loop method on 5% sheep blood agar and teepol lactose agar. Isolates were identified by using standard biochemical tests and antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. Results: A total of 4290 (51.2%) urine samples from pregnant females showed growth on culture. Prevalence of asymptomatic bacteriuria 3210 (74.8%) was higher than symptomatic UTI 1080 (25.2%). Escherichia coli was the most common pathogen accounting for 1800 (41.9%) of the urinary isolates. Among the gram-positive cocci, coagulase negative species of Staphylococci 270 (6.4%) were the most common pathogen. Significantly high resistance was shown by the gram negative bacilli as well as gram positive cocci to the β-lactam group of antimicrobials, flouroquinolones and aminoglycosides. Most alarming was the presence of ESBL in 846 (47%) isolates of Escherichia coli and 344 (36.9%) isolates of Klebsiella pneumoniae, along with the presence of methicillin resistance in 41% of Staphylococcus species and high-level aminoglycoside resistance in 45(30%) isolates of Enterococcus species. Glycopeptides and carbepenems were the only group of drugs to which all the strains of gram positive cocci and gram negative bacilli were uniformly sensitive, respectively. Conclusions: Regular screening should be done for the presence of symptomatic or asymptomatic bacteriuria in pregnancy and specific guidelines should be issued for testing antimicrobial susceptibility with safe drugs in pregnant women so that these can be used for the treatment. For empirical treatment cefoperazone-sulbactum can be recommended, which is a safe drug, covering both gram positive and gram negative organisms and with a good sensitivity.

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The Prevalence and Antimicrobial Susceptibility Pattern of Gram-Positive Pathogens: Three-Year Study at a Private Tertiary Care Hospital in Mumbai, India

Journal of Laboratory Physicians ◽

10.1055/s-0041-1731136 ◽

2021 ◽

Author(s):

Sweta Shah ◽

Ritika Rampal ◽

Pooja Thakkar ◽

Sushima Poojary ◽

Shweta Ladi

Keyword(s):

Antimicrobial Susceptibility ◽

Tertiary Care Hospital ◽

Methicillin Resistance ◽

Tertiary Care ◽

Resistance Pattern ◽

Steady Increase ◽

Coagulase Negative Staphylococcus ◽

Care Hospital ◽

Gram Positive ◽

Tract Infections

Abstract Introduction The growing resistance pattern of the gram-positive pathogens along with a steady increase in minimum inhibitory concentration of the currently available antibiotics have led to an increase in morbidity and mortality rates in India. This study aims to access the shifting antibiotic susceptibility paradigm of the gram-positive pathogens in various infections at a tertiary care center. Methods This is a 3-year retrospective observational study which was performed from January 2016 to December 2018 at a tertiary care hospital in Mumbai. All clinically significant gram-positive cocci isolated from a variety of clinical specimens were studied for their prevalence and antimicrobial susceptibility. Results Out of 4,428 gram-positive isolates, Staphylococcus aureus (35.3%) was the commonly encountered pathogen, followed by Enterococcus spp. (32.1%) and coagulase-negative Staphylococcus (CoNS) (25.7%). S. aureus was majorly isolated from skin and soft tissue infections (60.3%), followed by patients with respiratory tract infections (18.2%) and blood stream infections (13%). Among S. aureus, particularly methicillin-resistant S.aureus (MRSA), prevalence increased from 29.5% in 2016 to 35.1% in 2018, with an overall prevalence of 33.6%. All S. aureus isolates were 100% sensitive toward vancomycin, linezolid, tigecycline, and teicoplanin. However, the CoNS isolates showed a higher resistance rate with reduced susceptibility toward linezolid and teicoplanin. High prevalence of resistance was observed across gram-positive isolates with commonly used antibiotics such as ciprofloxacin, levofloxacin, and erythromycin. While the prevalence of linezolid-resistant enterococcus (LRE) was 3.6%, vancomycin (VRE) and teicoplanin resistance among the enterococcus species was as high as 7.7% and 7.5%, respectively. Conclusion Rising methicillin resistance among the Staphylococcal species (MRSA and MR-CoNS) along with reduced susceptibility toward currently available anti-MRSA agents is a matter of serious concern as it limits the therapeutic options for treating multidrug resistant (MDR) gram-positive infections.

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Comparing the Performance of the New Fully Automated Urine Particle Analyzer UF-5000 with UF-1000i and Gram Stain in Predicting Bacteria Growth Patterns in Women with Uncomplicated Urinary Tract Infections

10.21203/rs.3.rs-120218/v1 ◽

2020 ◽

Author(s):

Stephen Shei-Dei Yang ◽

Chun-Chun yang ◽

Yi-Shen Chen ◽

Shangjen chang

Keyword(s):

Urinary Tract ◽

Urine Analysis ◽

Growth Patterns ◽

Gram Stain ◽

Gram Positive ◽

Gram Negative ◽

Bacterial Patterns ◽

Tract Infections ◽

Sensitivity Specificity ◽

Gram Positive Cocci

Abstract BackgroudTo compare the performance of the new flow cytometer UF-5000 with UF-1000i (Sysmex, Kobe, Japan) and Gram stain in predicting the bacterial patterns in urine samples MethodsWomen with symptoms suggestive of urinary tract infection were enrolled. Mid-stream urine sample was collected for gram staining, urine analysis and urine culture. Bacterial patterns were classified though UF1000i (none, cocci bacteria or rods/mixed growth), UF-5000 (none, cocci, rods or mixed growth) and Gram stain. Results Among the 102 samples, there were 10 gram-positive cocci, 2 gram-positive bacilli, 66 gram-negative rods, and 24 mixed growth. The sensitivity/specificity of the UF-1000i was 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of the UF-5000 was 80.0/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci.ConclusionsThe UF-5000 demonstrated the good sensitivity and specificity for Gram-negative bacilli bacteria and demonstrated an improved sensitivity for detecting Gram-positive cocci.

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Sepsis in cancer patients residing in Zimbabwe: Spectrum of bacterial and fungal aetiologies and their antimicrobial susceptibility patterns.

10.21203/rs.2.10948/v1 ◽

2019 ◽

Author(s):

FRANK CHINOWAITA ◽

Wendy Chaka ◽

Tinashe K Nyazika ◽

Tendai C Maboreke ◽

Inam Chitsike ◽

...

Keyword(s):

Blood Culture ◽

Cancer Patients ◽

Antimicrobial Susceptibility ◽

Methicillin Resistance ◽

Antimicrobial Treatment ◽

Blood Cultures ◽

Gram Negative ◽

E Coli ◽

Patients With Cancer ◽

Susceptibility Patterns

Abstract Introduction: Cancer and sepsis comorbidity is a major public health problem in most parts of the world including Zimbabwe. The microbial aetiologies of sepsis and their antibiograms vary with time and locations. Knowledge on local microbial aetiologies of sepsis and their susceptibility patterns is critical in guiding empirical antimicrobial treatment choices. Methods: This was a descriptive cross sectional study which determined the microbial aetiologies of sepsis from blood cultures of paediatric and adult cancer patients obtained between July 2016 and June 2017. The TDR-X120 blood culture system and TDR 300B auto identification machine were used for incubation of blood culture bottles and identification plus antimicrobial susceptibility testing, respectively. Results: A total of 142 participants were enrolled; 50 (35.2%) had positive blood cultures with 56.0% gram positive, 42.0% gram negative bacteria and 2.0% yeast isolates. Most common isolates were Coagulase Negative Staphylococcus (CoNS) (22.0%), Escherichia coli (16.0%), Klebsiella pneumoniae (14.0%), Enterococcus faecalis (14.0%) and Staphylococcus aureus (8.0%) in all cancer patients. These isolates were similar in both haematological and solid cancers. Amikacin and meropenem showed 85.7% and 95.2% activity respectively against all gram negative isolates while vancomycin and linezolid were effective against 96.2% and 100.0% of all gram positive isolates respectively. Ten (66.7%) isolates of E. coli and K. pneumoniae were extended spectrum β-lactamase (ESBL) positive and the same proportion was observed on methicillin resistance among Staphylococcus species. Conclusions: The major microbial aetiologies of sepsis among patients with cancer in Zimbabwe were CoNS, E. coli, K. pneumoniae, E. faecalis and S. aureus. Most isolates were resistant to commonly used empirical antibiotics and there was high level of ESBL and methicillin resistance carriage. A nationwide survey on microbial aetiologies of sepsis and their susceptibility patterns would assist in the guidance of effective sepsis empiric antimicrobial treatment among patients with cancer.

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Oral beta-lactam step down in bacteremic E. coli urinary tract infections

BMC Infectious Diseases ◽

10.1186/s12879-020-05498-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Stephan Saad ◽

Neil Mina ◽

Colin Lee ◽

Kevin Afra

Keyword(s):

Urinary Tract ◽

Propensity Score ◽

Urinary Tract Infections ◽

Clinical Cure ◽

Beta Lactam ◽

Beta Lactams ◽

E Coli ◽

Secondary Outcomes ◽

Step Down ◽

Tract Infections

Abstract Background Literature is scarce regarding oral step down to beta-lactams in bacteremic urinary tract infections. Oral fluoroquinolones are an accepted and common step down for bacteremic urinary tract infections; however, their use is associated with mounting safety concerns. We compared clinical cure in patients with E. coli bacteremic urinary tract infections who were stepped down to oral beta-lactams compared to oral fluoroquinolones. Methods This multicentre retrospective cohort study included patients with first positive concurrent urine and blood cultures from January 2016 to December 2016. Patients were included if they received empiric intravenous beta-lactam therapy with step down to either oral beta-lactam or fluoroquinolone for treatment completion. The primary outcome was clinical cure. Secondary outcomes were length of hospitalization, all-cause mortality and C. difficile infection. Multivariate analysis and propensity score were used to control for confounding. Results A total of 207 patients were identified with bacteremic E.coli urinary tract infections. Clinical cure was achieved in 72/77 (94%) in the oral beta-lactam group versus 127/130 (98%) in the oral fluoroquinolone group (absolute difference − 4.2, 95% confidence interval [CI] -10.3 to 1.9%, p = 0.13). The adjusted odds ratio (OR) for clinical cure with oral beta-lactams was 0.31 (95% CI 0.05–1.90, p = 0.21); propensity score adjusted analysis showed a similar result. There was no statistically significant difference in secondary outcomes. Conclusions Oral beta-lactams appear to be a safe and effective step down option in bacteremic E. coli urinary tract infections compared to oral fluoroquinolones.

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Escherichia coli from community-acquired urinary tract infections resistant to fluoroquinolones and extended-spectrum beta-lactams

The Journal of Infection in Developing Countries ◽

10.3855/jidc.361 ◽

2007 ◽

Vol 1 (03) ◽

pp. 257-262 ◽

Cited By ~ 25

Author(s):

Samuel Kariuki ◽

Gunturu Revathi ◽

John Corkill ◽

John Kiiru ◽

Joyce Mwituria ◽

...

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Nalidixic Acid ◽

Urinary Tract Infections ◽

Acid Resistance ◽

Beta Lactam ◽

E Coli ◽

Extended Spectrum ◽

Tract Infections ◽

Multiple Drugs

Background: Uropathogenic Escherichia coli are increasingly becoming resistant to flouroquinolones and to other commonly available antimicrobials. We sought to investigate the genetic basis for fluoroquinolone and extended spectrum beta-lactam (ESBL) resistance in 17 fluoroquinolone-resistant (MIC of levofloxacin and ciprofloxacin >32 μg/ml) E. coli isolated from patients with urinary tract infections (UTIs). Methods: We applied PCR and Pulsed Field Gel Electrophoresis (PFGE) to characterize resistance genes and to determine clonal relatedness of strains, respectively. Results: Twelve of the 17 E. coli were resistant to multiple drugs, including ampicillin, co-amoxyclav, cefotaxime, ceftriaxone, ceftazidime and gentamicin and nalidixic acid and produced plasmid-mediated CTX-M-15 type ESBLs and CMY-2 AmpC type enzymes. The other 5 E. coli that were non-ESBL-producing were multiply resistant to ampicillin, nitrofurantoin, cefoxitin, nalidixic acid. Resistance to fluoroquinolones resulted from a combination of the presence of qnrA, qnrB, ciprofloxacin acetylating enzyme designated aac(6’)-1b-cr, and mutations in the two amino acid substitutions; 83 Serine (TCG) to Leucine (TTG) and 87 Aspartic acid (GAC) to Asparagine (AAC). Conclusion: Antibiogram patterns and PFGE of E. coli showed that these were community acquired UTI caused by pockets of clonally-related and some discreet strain types. Plasmid-mediated CTX-M-15 beta-lactamases and CMY-2 AmpC enzymes and fluoroquinolone resistant E. coli are becoming increasingly prevalent in hospitals in Kenya, posing a major challenge in the management of UTIs.

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Phylogenetic groups and antimicrobial susceptibility patterns of uropathogenic Escherichia coli clinical isolates from patients at Mulago National Referral Hospital, Kampala, Uganda

F1000Research ◽

10.12688/f1000research.20930.1 ◽

2019 ◽

Vol 8 ◽

pp. 1828 ◽

Cited By ~ 1

Author(s):

Paul Katongole ◽

Daniel Bulwadda Kisawuzi ◽

Henry Kyobe Bbosa ◽

David Patrick Kateete ◽

Christine Florence Najjuka

Keyword(s):

Escherichia Coli ◽

Antimicrobial Susceptibility ◽

Phylogenetic Group ◽

Diffusion Method ◽

Clinical Microbiology Laboratory ◽

Phylogenetic Groups ◽

E Coli ◽

Pcr Method ◽

Tract Infections ◽

Susceptibility Patterns

Introduction: Uropathogenic Escherichia coli (UPEC) remains the most common cause of urinary tract infections (UTIs). They account for over 80-90% of all community-acquired and 30-50% of all hospital-acquired UTIs. E. coli strains have been found to belong to evolutionary origins known as phylogenetic groups. In 2013, Clermont classified E. coli strains into eight phylogenetic groups using the quadruplex PCR method. The aim of this study was to identify the phylogenetic groups of UPEC strains in Uganda using Clermont’s quadruplex PCR method and to assess their antibiotic susceptibility patterns in Uganda. Methods: In this cross-sectional study, 140 stored uropathogenic E. coli isolates from the Clinical Microbiology Laboratory, Department of Medical Microbiology, College of Health Sciences Makerere University were subjected to phylogenetic typing by a quadruplex PCR method. Antimicrobial susceptibility testing was performed by disk diffusion method according to Clinical & Laboratory Standards Institute (CLSI) guidelines. Phenotypic detection of extended-spectrum beta-lactamase, AmpC and carbapenemases was done according to CLSI guidelines and Laboratory SOPs. Results: Phylogenetic group B2 (40%) was the most predominant, followed by A (6.23%), clade I and II (5%), D and E (each 2.14%), B1 (1.43%) and F and C (each 0.71%). The most common resistant antibiotic was trimethoprim-sulphamethoxazole (90.71%) and the least was imipenem (1.43%). In total, 73.57% of isolates were multi-drug resistant (MDR). Antibiotic resistance was mainly detected in phylogenetic group B2 (54%). Conclusions: Our findings showed the high prevalence of MDR E. coli isolates, with the dominance of phylogenetic group B2. About 9% of E. coli isolates belonged to the newly described phylogroups C, E, F, and clade I and II.

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Prevalence And Antimicrobial Susceptibility Patterns Of Bacteria Isolated From Urinary Tract Infections (UTIs) In Children At Children Hospital In Baghdad

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v13i1.137 ◽

2019 ◽

Vol 13 (1) ◽

pp. 102-107

Author(s):

Nadheema Hammood Hussein

Keyword(s):

Staphylococcus Aureus ◽

Urinary Tract ◽

Old Age ◽

Urinary Tract Infections ◽

Antimicrobial Susceptibility ◽

Age Group ◽

Gram Positive ◽

Gram Negative ◽

Tract Infections ◽

Susceptibility Patterns

Background: First six to twelve months after initial urinary tract infection, most infections are caused by Escherichiacoli, although in the first year of life Klebsiella pneumoniae, Pseudomonas, Enterobacter spp andEnterococcus spp, are more frequent than later in life, and there is a higher risk of urosepsis compared with adulthood Objectives: To determine the prevalence of bacterial isolates from Urinary Tract Infections of children at a children hospital in Baghdad and their antimicrobial susceptibility patterns. Type of the study: Cross-sectional study. Methods: During six months of study (1 June to 31 December, 2016), 117urine specimens were collected from a children hospital in Baghdad. Results: Out 38 isolates of Gram positive and Gram negative bacteria were obtained from urine specimens in a percentage of 5(13.2%) and 33(86.8%),respectively. The lowest incidence was among the 11-15 years old age group (11.9%) whereas the highest incidence was among the 1-5 years old age group (43.6%)(P≤0.05).Also out of 38positive cultures, the incidence was higher in females 31(81.6%)than that of males 7(18.4%). Out of 38 positive cultures, the isolation rate was 5(13.2%) for Gram positive isolates and 33(86.8%)for Gram negative isolates. The most frequently isolated bacteria was Escherichia coli19(50%)(P-value ≤ 0.05), while the only isolated Gram positive was Staphylococcus aureus5(42.86%) isolates.The most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor (100%) and for Gram negative isolates wasimipenem (100%). Ampicillin showed the highest resistance rate for both Gram positive and Gram negative isolates(100%) and Pesudomonas aeruginsa isolates showed the highest resistant rates to most antibiotics under study. Conclusions: The most frequently isolated bacteria was E. coli from all urine cultures and the most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor

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Laboratory Based Diagnosis of Bacteraemia among Inpatients and Outpatients with Acute Febrile Illness at Khwaja Yunus Ali Medical College and Hospital in Bangladesh

European Journal of Medical and Health Sciences ◽

10.34104/ejmhs.020.046051 ◽

2020 ◽

pp. 46-51 ◽

Cited By ~ 2

Keyword(s):

Antibiotic Susceptibility ◽

Tertiary Care ◽

Salmonella Typhi ◽

Susceptibility Test ◽

Gram Positive ◽

Blood Samples ◽

E Coli ◽

Antibiotic Susceptibility Test ◽

Acinetobacter Spp ◽

Gram Positive Cocci

Bacteraemia is one of the important causes of mortality and morbidity worldwide. The emergence of multidrug-resistant bacterial strains is a major problem in its management. To encourage the prudent use of appropriate antibiotics in a tertiary care study was undertaken. A total of 282 patients with suspected bacteraemia from indoor and outdoor patients were included in this study. Blood samples were processed in the microbiology laboratory and bacteria were recognized by standard laboratory methods and then antibiotic susceptibility test was performed following CLSI guidelines. Out of a total of 282 blood samples, 55(19.50%) were culture positive. Among 55 positive cultures, Gram-positive Cocci and Gram-negative Bacilli were 48(87.3%) and 7(12.7%) respectively. The most predominant organisms were Staphylococcus aureus comprising 42(76.36%), followed by Salmonella typhi 4(7.30%), E. coli 2(3.63%) and Acinetobacter spp 1(1.81%). Among the isolated Staphylococcus spp, only 6(10.9%) isolates were Coagulase-Negative (CoNS). In antibiotic susceptibility test, all of the isolated bacterial pathogens were found susceptible to imipenem and meropenem (100%). For Salmonella typhi, all 4 isolated strains were found resistant to amoxicillin, amoxicillin+clavulanic acid (amoxyclave) and cephradine and 3 out of 4(75%) were susceptible to ciprofloxacin and levofloxacin. Most of the Gram-positive Cocci (GPC) were susceptible to levofloxacin (90%), ciprofloxacin (85%), and amikacin (83%). Both of E. coli and Acinetobacter spp were sensitive to amikacin (100%). This study stresses the need for continuous screening and surveillance for antibiotic resistance that would influence appropriate empiric treatment and infection control strategies for bacteremic cases.

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