scholarly journals Trends in the epidemiology of urinary tract infections in pregnancy at a tertiary hospital in Johannesburg: Are contemporary treatment recommendations appropriate?

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Trusha Nana ◽  
Shastra Bhoora ◽  
Vindana Chibabhai
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Treatment Recommendations ◽  
High Rate ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Obstetric Population ◽  
Tract Infections ◽  
In Pregnancy

Background: Urinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications. Empiric antibiotic choices in pregnancy require consideration of efficacy and safety, resulting in limited oral options. With rapidly evolving antibiotic resistance, surveillance to guide empiric treatment recommendations is essential.Methods: A retrospective analysis of urine culture isolates from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Obstetrics Department for 1 January 2015 to 31 December 2020 was performed.Results: The top 3 pathogens were Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae. For E. coli susceptibility to cefuroxime declined (95% to 81%, p 0.0001). Similarly, the E. coli extended spectrum beta-lactamase rate increased from 5% to 10% (p = 0.04). E. coli susceptibility to nitrofurantoin (93%) and fosfomycin (96%) remained high. In 2019, carbapenem-resistant K. pneumoniae emerged. Ampicillin susceptibility was high amongst the E. faecalis isolates. Amoxicillin-clavulanate demonstrated high levels of activity against the top 3 uropathogens.Conclusion: The Essential Drug List recommended antibiotics for lower UTIs, nitrofurantoin and fosfomycin, are appropriate empiric options for E. coli, the most common uropathogen in the CMJAH obstetric population. The high rate of E. faecalis susceptibility to nitrofurantoin reported from other Gauteng tertiary obstetric patients, suggests that nitrofurantoin will provide adequate empiric cover for a large proportion of UTIs. However, the determination of the E. faecalis nitrofurantoin and fosfomycin susceptibility rates in the CMJAH obstetric population will provide useful data. Periodic surveillance at the various levels of antenatal care in different regions of South Africa and the determination of risk factors for infections with resistant uropathogens is needed.

Molecular Characterization of Extended Spectrum Beta – Lactamase Producing Escherichia Coli Isolated from Pregnant Women with Urinary Tract Infections Attending Ante–Natal Clinics in Ilorin Metropolis

2021 ◽  
Vol 17 (1) ◽  
pp. 119-129
Author(s):  
R.H. Bello ◽  
Y.K.E. Ibrahim ◽  
B.O. Olayinka ◽  
A.A.G. Jimoh ◽  
N.B. Afolabi-Balogun ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pregnant Women ◽  
Urinary Tract Infections ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Bacteriological Method ◽  
Antibiotics Susceptibility ◽  
Tract Infections ◽  
In Pregnancy

Background: The emergence of multidrug- resistance Enterobacteriaceae especially in E. coli bacteria  associated with Urinary Tract Infections (UTIs) in pregnancy is a serious menace globally posing health challenges and confounding successful empirical treatment as well as increasing pregnancy – related  complications.Objectives: The aim of this study is to determine the phenotypic and genotypic characteristics of Extended Spectrum Beta – Lactamases (ESBLs) producing E. coli (ESBLs – EC) isolates in pregnant women attending ante – natal clinics within Ilorin - Kwara State, Nigeria.Materials and methods: A total of 53 non - repeated E. coli isolates from urine samples of pregnant women were presumptively identified using standard bacteriological method and confirmed by commercially available Microgen® Identification Kits. Phenotypic detection of ESBLs was determined using antibiotics susceptibility test and double disc synergy Method for screening and confirmation respectively. Polymerase Chain Reaction (PCR) was further used for the genotypic detection of ESBLs genes.Results: A total 88.67% (47/53) of E. coli exhibited resistance to the cephalosporins of which aztreonam was the highest (75.47%) and the least was cefpodoxime (35.84%) while 85.10% were confirmed positive for ESBL production. The genotypic detection showed the most occurring genotype was blaTEM (50%) blaOXA (27.7%), blaGES (22.5%), blaSHV (15%), blaCTXM and blaVEB (7.5%) while sixty – four (64%) of isolates co – harbored two or more gene. BlaTEM and blaOXA were dominant.Conclusion: This study showed high resistance of E. coli to the third generation cephalosporins harboring different ESBL genes which increases UTIs complexity and limit therapeutic options in pregnancy. Therefore, continuous monitoring of resistance in E. coli, effective appraisal of antibiotic control policies and rational use of antibiotics is therefore encouraged.

scholarly journals Relative Fecal Abundance of Extended-Spectrum-β-Lactamase-Producing Escherichia coli Strains and Their Occurrence in Urinary Tract Infections in Women

2013 ◽  
Vol 57 (9) ◽  
pp. 4512-4517 ◽  
Author(s):  
Etienne Ruppé ◽  
Brandusa Lixandru ◽  
Radu Cojocaru ◽  
Çağrı Büke ◽  
Elisabeth Paramythiotou ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Virulence Factors ◽  
Urinary Tract Infections ◽  
Predictive Values ◽  
Content Type ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Tract Infections

ABSTRACTExtended-spectrum-beta-lactamase (ESBL)-producingEscherichia coli(ESBLE. coli) strains are of major concern because few antibiotics remain active against these bacteria. We investigated the association between the fecal relative abundance (RA) of ESBL-producingE. coli(ESBL-RA) and the occurrence of ESBLE. coliurinary tract infections (UTIs). The first stool samples passed after suspicion of UTI from 310 women with subsequently confirmedE. coliUTIs were sampled and tested for ESBL-RA by culture on selective agar. Predictive values of ESBL-RA for ESBLE. coliUTI were analyzed for women who were not exposed to antibiotics when the stool was passed. ESBLE. coliisolates were characterized for ESBL type, phylogroup, relatedness, and virulence factors. The prevalence of ESBLE. colifecal carriage was 20.3%, with ESBLE. coliUTIs being present in 12.3% of the women. The mean ESBL-RA (95% confidence interval [CI]) was 13-fold higher in women exposed to antibiotics at the time of sampling than in those not exposed (14.3% [range, 5.6% to 36.9%] versus 1.1% [range, 0.32% to 3.6%], respectively;P< 0.001) and 18-fold higher in women with ESBLE. coliUTI than in those with anotherE. coliUTI (10.0% [range, 0.54% to 100%] versus 0.56% [range, 0.15% to 2.1%[, respectively;P< 0.05). An ESBL-RA of <0.1% was 100% predictive of a non-ESBLE. coliUTI. ESBL type, phylogroup, relatedness, and virulence factors were not found to be associated with ESBL-RA. In conclusion, ESBL-RA was linked to the occurrence of ESBLE. coliUTI in women who were not exposed to antibiotics and who had the same clone ofE. coliin urine samples and fecal samples. Especially, a low ESBL-RA appeared to be associated with a low risk of ESBLE. coliinfection.

scholarly journals Intestinal carriage of Extended Spectrum Beta-Lactamase producing E. coli in women with urinary tract infections, Cameroon

2016 ◽  
Vol 10 (10) ◽  
pp. 1135-1139 ◽  
Author(s):  
Ingrid Cécile Djuikoue ◽  
Paul-Louis Woerther ◽  
Michel Toukam ◽  
Charles Burdet ◽  
Etienne Ruppé ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Relative Abundance ◽  
Carriage Rate ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Fecal Carriage ◽  
Extended Spectrum ◽  
Associated Risk Factors ◽  
Tract Infections

Introduction: During the last decade, the prevalence of the intestinal carriage of extended spectrum beta-lactamases – producing Escherichia coli (ESBL-E. coli) has continued to increase worldwide in the community, especially in developing countries. Hence, we undertook a study to determine the ESBL-E. coli fecal carriage rate and the associated risk factors in Cameroonian women. Methodology: A total of 86 women suspected of community-acquired urinary tract infections (UTI) were included in 10 health structures from May 2011 to April 2012. After filling a questionnaire, they provided a stool sample that was plated on selective media for ESBL producing bacteria. The identification of strains was obtained with mass spectrometry and the antibiotic susceptibility by disk diffusion in agar media. The ESBL type was determined by PCR. The relative abundance of ESBL-E. coli was measured for positive samples. Eventually, the presence of antibiotics in stool was assessed. Results: The carriage rate of ESBL-E. coli was 57/86 (66.3%). Phenotypic and molecular characterization showed that all ESBL-E. coli strains contained group 1 CTX-M enzymes. Multivariate analysis showed that ESBL-E. coli fecal carriage was associated with the presence of antibiotics in stools (p < 0.05). Although not significant, mean ESBL relative abundance tended to be higher in patients with antibiotic exposure. Conclusions: Our results show that the carriage of ESBL-E. coli fecal carriage in women with UTI suspicion from the Cameroonian community is extremely high and associated with recent antibiotic intake.

scholarly journals Moderate and Timely Water Intake Followed By Micturition Reduces Frequency of Recurrent Urinary Tract Infections and the Prevalence of Virulent Uropathogens in Adult Women

2020 ◽  
Vol 5 (08) ◽  
pp. 268-270
Author(s):  
Kamel El-Reshaid ◽  
Shaikha Al-Bader
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Water Intake ◽  
Married Women ◽  
High Rate ◽  
Plain Water ◽  
Adult Women ◽  
E Coli ◽  
Recurrent Urinary Tract Infections ◽  
Tract Infections

Urinary tract infection (UTI) is the most common type of infection in women. Preventive measures included local hygiene, clothing, diet, limiting activities, and prophylactic antibiotics. In this study; we evaluated the role of a simple technique of 5-timely oral water flushing of the urinary bladder in its prevention. The technique entailed an intake of 250 ml of plain water followed by micturition 15-30 minute later at; early morning, 30 minute after the 3 daily meals and 1 hour before night sleep. Moreover, married women had an additional similar bolus intake 30 minute before sexual intercourse and micturition immediately after coitus. This prophylactic regimen has been evaluated in 422 adult non-menopausal females with high-rate of recurrent UTI (>2 UTI/year) for a median duration of 33 months. Married women; had higher rate of UTI/patient year and incidence of non-E coli bacteriuria compared to non-married ones. Our prophylactic technique resulted in; (a) decrease in UTI rate/patient year on follow up from 2.3(0.8) to 0(0.3), (b) clearance of bacteriuria in 69% of women, and decrease of non-E coli pathogens from 31% to 2% (p< 0.001). The latter was due to limiting the use of antibiotics. Married women had similar encouraging results. In conclusion; moderate and timely water intake followed by micturition reduces frequency of recurrent urinary tract infections and the prevalence of virulent uropathogens in adult women.

scholarly journals Outbreak of extended spectrum beta-lactamase producing E. coli in a nursing home in Ireland, May 2006

2006 ◽  
Vol 11 (35) ◽  
Author(s):  
H Pelly ◽  
D Morris ◽  
E O’Connell ◽  
B Hanahoe ◽  
C Chambers ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Nursing Home ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Tract Infections

In May 2006, a consultant microbiologist noted two isolates of extended spectrum beta-lactamase (ESBL)-producing Escherichia coli associated with urinary tract infections in a single week in two residents in a nursing home in Ireland

scholarly journals Extended - spectrum beta - lactamase E. coli and K. pneumoniae urinary tract infections

2020 ◽  
Author(s):  
Prayong Vachvanichsanong ◽  
Edward B McNeil ◽  
Pornsak Dissaneewate
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Imaging Study ◽  
University Hospital ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Recurrent Uti ◽  
Extended Spectrum ◽  
Tract Infections

Abstract Background: The prevalences of extended - spectrum beta - lactamase (ESBL) Escherichia coli ( E . coli ) and Klebsiella pneumoniae ( K . pneumoniae ) urinary tract infections (UTI) in children are increasing worldwide. We aimed to investigate the prevalence, clinical findings, impact and risk factors of ESBL E . coli / K . pneumoniae UTI.Methods: The medical records of children with UTI aged <15 years admitted to Prince of Songkla University Hospital were reviewed. Results: Theirty-seven boys and 46 girls had ESBL in 102 UTI episodes; 85 boys and 103 girls had non-ESBL in all of their 222 UTI episodes. The median age at presentation was 1.5 (0.7 - 4.8) years for the ESBL group and 1.3 (0.6 - 3.9) for the non-ESBL group (p=0.2). Age and gender were not significantly different between the two groups. The prevalence of ESBL rose between 2004 and 2008 before plateauing at around 30-40% per year. The prevalences in first and recurrent UTI were 27.3% and 46.5%, respectively (p=0.003). Fever prior to UTI diagnosis was found in 78.4% of episodes in the non-ESBL group and 61.8% of episodes in the ESBL group (p=0.003). Multivariate analysis, children without fever (OR=2.14, 95% CI: 1.23-3.74) and those with recurrent UTI (OR=2.67, 95% CI: 1.37 – 5.19) were more likely to have ESBL UTI. The presence of CAKUT had no effect on ESBL UTI. Conclusions: ESBL was found in one-third of E . coli / K . pneumoniae UTI episodes. No clinical condition nor imaging study could predict ESBL. Recurrent UTI was the only independent risk factor.

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 Identity of blaCTX-M Carrying Plasmids in Sequential ESBL-E. coli Isolates from Patients with Recurrent Urinary Tract Infections

2021 ◽  
Vol 9 (6) ◽  
pp. 1138
Author(s):  
Nahid Karami ◽  
Sriram KK ◽  
Shora Yazdanshenas ◽  
Yii-Lih Lin ◽  
Daniel Jaén-Luchoro ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Rare Event ◽  
Coli Strain ◽  
Health It ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Recurrent Urinary Tract Infections ◽  
Global Threat ◽  
Tract Infections

Plasmid-mediated multidrug resistance in E. coli is becoming increasingly prevalent. Considering this global threat to human health, it is important to understand how plasmid-mediated resistance spreads. From a cohort of 123 patients with recurrent urinary tract infections (RUTI) due to extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli), only five events with a change of ESBL E. coli strain between RUTI episodes were identified. Their blaCTX-M encoding plasmids were compared within each pair of isolates using optical DNA mapping (ODM) and PCR-based replicon typing. Despite similar blaCTX-M genes and replicon types, ODM detected only one case with identical plasmids in the sequential ESBL E. coli strains, indicating that plasmid transfer could have occurred. For comparison, plasmids from seven patients with the same ESBL E. coli strain reoccurring in both episodes were analyzed. These plasmids (encoding blaCTX-M-3, blaCTX-M-14, and blaCTX-M-15) were unaltered for up to six months between recurrent infections. Thus, transmission of blaCTX-M plasmids appears to be a rare event during the course of RUTI. Despite the limited number (n = 23) of plasmids investigated, similar blaCTX-M-15 plasmids in unrelated isolates from different patients were detected, suggesting that some successful plasmids could be associated with specific strains, or are more easily transmitted.

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.

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