Clinical Characteristics of Bacterial Spectrum and Antimicrobial Resistance in Urine and Stone Cultures From Patients With Kidney Stone Disease

Background It is important to understand the clinical characteristics of bacterial spectrum and antibiotic resistance of urine and stone pathogens for the prevention and treatment of urolithiasis and perioperative infection. Methods Consecutive patients with kidney stones treated by percutaneous nephrolithotomy (PCNL) from September 2016 to September 2018 were included. The bacterial species and antibiotic sensitivity test of the germs cultured from clean middle-stream urine and from stones intraoperatively were evaluated. Results In 1055 patients, the rate of positive bacterial test was higher in stones than in urine (337, 31.0% vs. 221, 20.9%, p=0.016). 167(15.8%) patients had both positive urine culture (UC) and stone culture (SC), of which 137 (82.0%) had identical bacteria in both cultures. In infection stone patients, the positive rate of bacteria was 34.7% (91/262) in urine and 52.3% (137/262) in stone, and in non-infection stone patients, was 16.4% (130/793) and 25.2% (200/793). The positive rate of SC in patients with different types of stones were higher than that of UC. E. coli was the most common organism not only in both UC (54.3% ,120/221) and SC (43.9%,148/337) but also in urine and stones from patients with infection stones (44.0%,32.8%) or non-infection stones (61.5%,51.8%). Furthermore, the pathogens isolated from urine and stones showed high resistance to fluoroquinolones, ceftriaxone, cefazolin, cefuroxime, β-lactamases and sulfonamides (all resistance>20%). Conclusions The bacterial spectra demonstrated in stones and urine samples were significantly different. Positive SC was more commonly encountered than positive UC. Compared with non-infection stones, infection stones were accompanied by higher rates of positive tests in both cultures. The antibiotic resistance was comparable between bacteria in the two cultures. A combination of antibiotic sensitivity results in urine and stones might be a useful guide for selection of effective and appropriate treatment aiming at reduced problems with bacterial antibiotic resistance.

Patterns of Bacterial Isolates and their Resistance to Antibiotics in Patients with Chemotherapyinduced Febrile Neutropenia at a University Hospital

Objectives: Febrile neutropenia is a major complication of cytotoxic chemotherapy and is associated with a high rate of mortality and morbidity if not treated appropriately. Consequently, it is important to know the bacterial spectrum and pattern of its resistance in each hospital to formulate an appropriate empiric antibiotic regimen. We sought to study the bacterial spectrum in patients with chemotherapy-induced neutropenia and report their resistance patterns. Methods: We conducted a retrospective study on patients admitted with febrile neutropenia between January 2010 and December 2016 in the oncology unit at Sultan Qaboos University Hospital in Oman. Consecutive patients diagnosed with non-hematological malignancies who had febrile neutropenia and positive blood culture were included in this study. Results: A total of 76 bacterial isolates were documented in 67 episodes in 62 patients. There were 26 male and 36 female patients. The median age was 51 (14–81) years. The most common cancers were breast cancer (17.7%), non-Hodgkin lymphoma (16.1%), and colon cancer (14.5%). Gramnegative and gram-positive organisms accounted for 73.7% and 26.3% of all isolates, respectively. The most common gram-negative organisms were Pseudomonas aeruginosa (26.8%), Escherichia coli (23.2%), Klebsiella species (17.9%), and Acinetobacter baumannii (12.5%). The most common gram-positive organisms were Staphylococcus aureus (30.0%), followed by coagulase-negative Staphylococcus (25.0%). There were 14 multidrugresistant organisms and eight extended-spectrum beta-lactamases (ESBL). The resistance among gram-negative organisms to the commonly used broad-spectrum antibiotics was 23.5–55.6%. No resistance was recorded against vancomycin amongst the gram-positive organisms. Eight (12.1%) patients died while neutropenic. Conclusions: Gram-negative organisms were the predominant organisms. There is a high rate of resistance to the commonly used antibiotics. Using a combination of antibiotics is warranted in patients presenting with chemotherapy-induced febrile neutropenia.

The bacterial spectrum of spontaneous bacterial peritonitis in patients with cirrhosis of liver.

Objectives: To identify the bacterial spectrum of SBP in patients with cirrhosis of liver. Study Design: Descriptive Cross-sectional study. Setting: Department of Gastroenterology and Hepatology, Madina Teaching Hospital, Faisalabad. Period: 1st November, 2018 – 30th June, 2019. Material & Methods: Two hundred and fifty cirrhotic patients having ascites and clinical symptoms and signs of SBP, consecutively admitted in the ward or presented to OPD were included in the study. Results: A total of 250 patients included in this study. SBP was diagnosed according to the predetermined criteria in 140 patients. The culture-negative ascites was found in 77 (55%) and culture-positive ascites was found in 63 (45%) patients. The most common organism was E.Coli 28 (47.45%) followed by Enterococcus 10 (16.94%), Klebsiella Pneumoniae 6 (10.17%), Streptococcal Pneumoniae 5 (8.47%), S.aureus 5 (8.47%), Acinetobacter 3 (5.08%) and miscellaneous 2 (3.38%). Conclusion: The percentage of SBP is quite high among patients having cirrhosis and ascites and the Gram-negative bacterial spectrum is still much common in our region.