scholarly journals OXA-48 Carbapenemase-Encoding Transferable Plasmids of Klebsiella pneumoniae Recovered from Egyptian Patients Suffering from Complicated Urinary Tract Infections

Biology ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 889
Author(s):  
Ann A. Elshamy ◽  
Sarra E. Saleh ◽  
Mohammad Y. Alshahrani ◽  
Khaled M. Aboshanab ◽  
Mohammad M. Aboulwafa ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Agents ◽  
Bacterial Species ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Gram Negative ◽  
E Coli ◽  
Tract Infections

Gram-negative bacteria are common causes of urinary tract infections (UTIs). Such pathogens can acquire genes encoding multiple mechanisms of antimicrobial resistance, including carbapenem resistance. The aim of this study was to detect the carbapenemase-producing ability of some Gram-negative bacterial isolates from urine specimens of patients suffering from complicated UTIs at two vital tertiary care hospitals in Cairo, Egypt; to determine the prevalence of carbapenemase genes among plasmid-bearing isolates; and explore the possibility of horizontal gene transfer to other bacterial species. The collected isolates were subjected to antimicrobial susceptibility testing, phenotypic analysis of carbapenemase production, and molecular detection of plasmid-borne carbapenemase genes, then the extracted plasmids were transformed into competent E. coli DH5α. A total of 256 Gram-negative bacterial clinical isolates were collected, 65 (25.4%) isolates showed carbapenem resistance of which 36 (55.4%) were carbapenemase-producers, and of these 31 (47.7%) harbored plasmids. The extracted plasmids were used as templates for PCR amplification of blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP carbapenemase genes. The blaOXA-48 gene was detected in 24 (77.4%) of the tested isolates while blaVIM gene was detected in 8 (25.8%), both blaKPC and blaNDM genes were co-present in 1 (3.2%) isolate. Plasmids carrying the blaOXA-48 gene from 4 K. pneumoniae clinical isolates were successfully transformed into competent E. coli DH5α. The transformants were carbapenemase-producers and acquired resistance to some of the tested antimicrobial agents as compared to untransformed E. coli DH5α. The study concluded that the rate of carbapenem resistance among Gram-negative bacterial uropathogens in Cairo, Egypt is relatively high and can be transferred horizontally to other bacterial host(s).

scholarly journals Single Clinical Isolates from Acute Uncomplicated Urinary Tract Infections Are Representative of Dominant In Situ Populations

mBio ◽  
2014 ◽  
Vol 5 (2) ◽  
Author(s):  
Dana Willner ◽  
Serene Low ◽  
Jason A. Steen ◽  
Narelle George ◽  
Graeme R. Nimmo ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Clinical Isolates ◽  
Content Type ◽  
E Coli ◽  
Strain Diversity ◽  
Amplicon Pyrosequencing ◽  
Culture Independent ◽  
Tract Infections

ABSTRACTUrinary tract infections (UTIs) are one of the most commonly acquired bacterial infections in humans, and uropathogenicEscherichia colistrains are responsible for over 80% of all cases. The standard method for identification of uropathogens in clinical laboratories is cultivation, primarily using solid growth media under aerobic conditions, coupled with morphological and biochemical tests of typically a single isolate colony. However, these methods detect only culturable microorganisms, and characterization is phenotypic in nature. Here, we explored the genotypic identity of communities in acute uncomplicated UTIs from 50 individuals by using culture-independent amplicon pyrosequencing and whole-genome and metagenomic shotgun sequencing. Genus-level characterization of the UTI communities was achieved using the 16S rRNA gene (V8 region). Overall UTI community richness was very low in comparison to other human microbiomes. We strain-typedEscherichia-dominated UTIs using amplicon pyrosequencing of the fimbrial adhesin gene,fimH. There were nine highly abundantfimHtypes, and each UTI sample was dominated by a single type. Molecular analysis of the corresponding clinical isolates revealed that in the majority of cases the isolate was representative of the dominant taxon in the community at both the genus and the strain level. Shotgun sequencing was performed on a subset of eightE. coliurine UTI and isolate pairs. The majority of UTI microbial metagenomic sequences mapped to isolate genomes, confirming the results obtained using phylogenetic markers. We conclude that for the majority of acute uncomplicatedE. coli-mediated UTIs, single cultured isolates are diagnostic of the infection.IMPORTANCEIn clinical practice, the diagnosis and treatment of acute uncomplicated urinary tract infection (UTI) are based on analysis of a single bacterial isolate cultured from urine, and it is assumed that this isolate represents the dominant UTI pathogen. However, these methods detect only culturable bacteria, and the existence of multiple pathogens as well as strain diversity within a single infection is not examined. Here, we explored bacteria present in acute uncomplicated UTIs using culture-independent sequence-based methods.Escherichia coliwas the most common organism identified, and analysis ofE. colidominant UTI samples and their paired clinical isolates revealed that in the majority of infections the cultured isolate was representative of the dominant taxon at both the genus and the strain level. Our data demonstrate that in most cases single cultured isolates are diagnostic of UTI and are consistent with the notion of bottlenecks that limit strain diversity during UTI pathogenesis.

scholarly journals A study of risk factors for bacteremia caused by urinary tract infections

2018 ◽  
Vol 9 (5) ◽  
pp. 25-30
Author(s):  
Muralidhar Varma ◽  
Sravan Kumar Peravali ◽  
Vandana KE ◽  
Asha Kamath ◽  
Rahul Singh
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Medical Sciences ◽  
E Coli ◽  
Tract Infections ◽  
Control Study

Background: Urinary tract infections are not only one of the most common infections, but also one of the most common sources of bacteremia in both the general population and hospitalized patients.Aims and Objectives: The objective of this study was to identify risk factors for bacteremia caused by urinary tract infections.Materials and Methods: This was a prospective case control study conducted from October 2012 to July 2014in a tertiary care teaching hospital in southern India. Urinary tract infections were diagnosed based on the CDC criteria.Patients witha set of blood cultures and urine culture isolating same organism were grouped as cases while patients with urine culture alone isolating organism with sterile blood cultures were identified as controls.Results: Out of the 198 patientsin the study, 66 were cases while 132 were controls. E coli was the most organism isolated (81% of cases and 66% of controls). Risk factors for bacteremia based on univariate and multivariate analysis were diabetes mellitus with uncontrolled sugars (univariate: p=0.001; OR=5.250 [2.044-13.582]; and multivariate: p=0.01; OR= 6.023 [1.52-23.51]) and pyelonephritis (univariate: p=0.001; OR=6.56 [2.87-1.48]; and multivariate: p=0.047; OR=4.95 [1.02-24.12]).Conclusion: Upper UTI and complicated UTI patients should be evaluated for bacteremia since prompt and targeted treatment may be required.Asian Journal of Medical Sciences Vol.9(5) 2018 25-30

scholarly journals Pharmacodynamic Evaluation of Fosfomycin against Escherichia coli and Klebsiella spp. from Urinary Tract Infections and the Influence of pH on Fosfomycin Activities

2017 ◽  
Vol 61 (8) ◽  
Author(s):  
Nayara Helisandra Fedrigo ◽  
Josmar Mazucheli ◽  
James Albiero ◽  
Danielle Rosani Shinohara ◽  
Fernanda Gomes Lodi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Oral Dose ◽  
Single Oral Dose ◽  
Urinary Tract Infections ◽  
Bacterial Isolates ◽  
Gram Negative ◽  
Content Type ◽  
E Coli ◽  
Tract Infections

ABSTRACT Fosfomycin is widely used for the treatment of uncomplicated urinary tract infection (UTI), and it has recently been recommended that fosfomycin be used to treat infections caused by multidrug-resistant (MDR) Gram-negative bacilli. Whether urine acidification can improve bacterial susceptibility to fosfomycin oral dosing regimens has not been analyzed. The MIC of fosfomycin for 245 Gram-negative bacterial isolates, consisting of 158 Escherichia coli isolates and 87 Klebsiella isolates which were collected from patients with urinary tract infections, were determined at pH 6.0 and 7.0 using the agar dilution method. Monte Carlo simulation of the urinary fosfomycin area under the concentration-time curve (AUC) after a single oral dose of 3,000 mg fosfomycin and the MIC distribution were used to determine the probability of target attainment (PTA). Fosfomycin was effective against E. coli (MIC90 ≤ 16 μg/ml) but not against Klebsiella spp. (MIC90 > 512 μg/ml). Acidification of the environment increased the susceptibility of 71% of the bacterial isolates and resulted in a statistically significant decrease in bacterial survival. The use of a regimen consisting of a single oral dose of fosfomycin against an E. coli isolate with an MIC of ≤64 mg/liter was able to achieve a PTA of ≥90% for a target pharmacodynamic index (AUC/MIC) of 23 in urine; PTA was not achieved when the MIC was higher than 64 mg/liter. The cumulative fractions of the bacterial responses (CFR) were 99% and 55% against E. coli and Klebsiella spp., respectively, based on simulated drug exposure in urine with an acidic pH of 6.0. A decrease of the pH from 7.0 to 6.0 improved the PTA and CFR of the target pharmacodynamic index in both E. coli and Klebsiella isolates.

scholarly journals URINARY TRACT INFECTIONS

2016 ◽  
Vol 23 (01) ◽  
pp. 010-014
Author(s):  
Muhammad Usman Anjum ◽  
Muhammad Safdar Khan ◽  
Abdul Razzaq Shahid ◽  
Syed Humayun Shah
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Susceptibility ◽  
Geographical Area ◽  
Gram Negative ◽  
E Coli ◽  
Amoxicillin Clavulanic Acid ◽  
Gram Negative Organisms ◽  
Tract Infections ◽  
Micro Organisms

Background: Urinary tract infections (UTIs) constitute important bacterialdisease which contributes to significant morbidity world-wide. Empirical treatment in patientssuffering from UTI depends upon the local knowledge of common microorganisms responsiblefor UTI in that geographical area as well as their antimicrobial susceptibility patterns.Objectives: To determine the frequency and antimicrobial susceptibility of uropathogenswhich are responsible for urinary tract infections. Study Design: Experimental study. Setting:Department of Pathology, Frontier Medical & Dental College and Mohi Ud Din Islamic MedicalCollege. Period: January 2015 to June 2015. Material & methods: Total of 113 patients wereincluded in the study. Urine samples were cultured on MacConkey’s agar and Cysteine LactoseElectrolyte Deficient (CLED) agar. Micro-organisms were identified using standard tests andantimicrobial susceptibility was checked using modified Kirby Bauer method following Clinicaland Laboratory Standards Institute (CLSI) guidelines. Results: The average age of patientswas 32.19±16.47 years. Gram negative organisms accounted for majority of cases, about 89(78.76%) cases. Escherichia coli was the most common micro-organism which was found in50 (44.24%) cases followed by Staphylococcus aureus in 24 (21.24%), Enterobacter spp. in19 (16.81%), Klebsiella spp. in 11 (9.73%) and Proteus spp. in 9 (7.96%) cases. E. coli wassensitive to imipenem and ciprofloxacin and was resistant to amoxicillin/clavulanic acid andgentamicin. Conclusion: Gram negative organisms are largely responsible for UTIs and E. colibeing the most common etiological agent. E. coli is sensitive to commonly prescribed drugs forUTI like ciprofloxacin.

scholarly journals Prevalence of Community Acquired Uropathogens and their Antimicrobial Susceptibility in Patients from the Urology Unit of A Tertiary Care Medical Center

2020 ◽  
Vol 14 (3) ◽  
pp. 2009-2015
Author(s):  
Manzoor Ahmad ◽  
Pushkar Kumar ◽  
Asfia Sultan ◽  
Anees Akhtar ◽  
Bhanu Chaudhary ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Medical Center ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Urine Specimen ◽  
Aminoglycoside Resistance ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Tertiary Care Medical Center ◽  
Tract Infections

Urinary tract infections (UTI) are one of the most common community acquired infections and can also present with similar lower urinary tract symptoms (LUTS). Moreover, UTI can be a complication of these urological diseases. Thus, this study was conducted in patients with LUTS to find out the prevalence of uro-pathogens and their antibiotic susceptibility pattern so that appropriate antibiotics can be started on clinical suspicion of UTI. The study was conducted over a period of 12 months. Culture and susceptibility of urine specimen was done as per standard microbiological guidelines. Apart from the growth of common bacteria with their antibiogram, Methicillin-resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) was investigated among Enterococci, and metallo beta-lactamases(MBL) production was production was investigated among gram-negative pathogens. Out of 407 urine samples included in the study, 80 (19.6%) samples showed bacterial growth. The commonest isolate was E. coli 44 (55 %). Majority of the isolates were multidrug resistant with two E.coli strains showing pan-resistance to the first line drugs tested. Carbapenem resistance was seen in 67.2% of all gram negative isolates tested. Metallo beta-lactamases production was found to be highest among the Klebsiella isolates. Among the Enterobacterales, highest susceptibility was noted to Fosfomycin (87.7%) followed by Nitrofurantoin (62.7%). Similarly in gram positive group, highest susceptibility was again to Fosfomycin followed by Nitrofurantoin. Overall the prevalence of MDR is increasing however Fosfomycin or Nitrofurantoin, both oral antibiotics, can be the considered for starting empirical antibiotic therapy.

scholarly journals Rapid diagnosis of Pseudomonas aeruginosa urinary tract infections by radioimmunoassay

1979 ◽  
Vol 9 (2) ◽  
pp. 253-258
Author(s):  
R B Kohler ◽  
L J Wheat ◽  
A White
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Solid Phase ◽  
Bacterial Species ◽  
Phase Growth ◽  
Gram Negative ◽  
Solid Phase Radioimmunoassay ◽  
Tract Infections ◽  
Urine Specimens

A solid-phase radioimmunoassay designed to detect serotype 6 Pseudomonas aeruginosa antigens was evaluated for its ability to rapidly diagnose urinary tract infections. Twelve P. aeruginosa serotypes were easily differentiated in the assay from eight other gram-negative bacterial species. During log-phase growth, the assay detected antigens in culture when approximately 10(6) or more serotype 6 P. aeruginosa organisms were present. Both cell-associated and solubilized antigens were detected. The assay detected antigens in 13 of 17 urine specimens which grew greater than 10(5) P. aeruginosa, 3 of 38 which grew other gram-negative rods, and none of 83 with no growth. Two of the three positive specimens from the other gram-negative rod group probably also contained P. aeruginosa. No preincubation of the urine specimens was required, and results were available within 2.5 h. The assay represents an improvement over other procedures for rapidly diagnosing urinary tract infections in that it allows diagnosis by species and should be adaptable to semiautomation.

scholarly journals Ciprofloxacin Resistance in Hospital and Community-acquired Urinary Tract Infections by Escherichia coli: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Guanyu Zhou ◽  
Xiaoju Lv
Keyword(s):  
Systematic Review ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Main Concern ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
E Coli ◽  
Ciprofloxacin Resistance ◽  
Tract Infections ◽  
Hospital Acquired

AbstractIn recent years, antimicrobial resistance has been increasingly reported. One main concern is the resistance of gram-negative bacteria like E. coli to ciprofloxacin (fluoroquinolones). Gram-negative bacteria are the main cause of community and hospital-acquired urinary tract infections (UTI). We aimed to review and analyze the data on ciprofloxacin resistance in hospital and community-acquired UTI. A literature search of three electronic databases (PubMed, Medline, and Cochrane) was performed. We considered the papers that were published from January 2004 to May 2019. The search yielded a total of 16097 studies besides 31 studies from a manual search. Filtering yielded 1297 relevant full-text papers. Eighty-three papers, equivalent of 99 cohorts, were finally included in this systematic review and in the analysis. The analysis results suggest that pooled ciprofloxacin resistance for community and hospital-acquired E. coli UTI is 0.27 (95% CI 0.246–0.303) and 0.30 (95% CI 0.22–0.38), respectively. Pooled resistance rates according to regions are 0.43 (95% CI 0.31–0.54) for Asia ensued by Africa 0.31 (95% CI 0.22–0.35), the Middle East 0.21(95% CI 0.13-0.30), Europe 0.18 (95% CI 0.13-0.22), and Australia 0.06 (95% CI 0.04-0.08). The pooled estimates revealed that ciprofloxacin resistance was higher in developing countries compared to that in developed countries, 0.35 (95% CI 0.30-0.40) and 0.13 (95% CI 0.10-0.16), respectively. Finally, plotting resistance over time deemed statistically significant (n= 79, r= 0.29, p= 0.038). Our findings suggest that ciprofloxacin resistance among UTI patients is a highly prevalent and serious issue. The suggested risks are low-income, acquiring hospital infection, and falling in highly-vulnerable regions like Asia and Africa. We also shed light on some approaches to correct the perception of patients and general practitioners (GPs) for antibiotic usage. We also suggest ideas to impede the progress of the post-antibiotic era in countries known for high antibiotic resistance.

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