Resistance against broad-spectrum β-lactams among uropathogens in children (original) (raw)
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The Journal of Community Health Management, 2023
Introduction: Urinary Tract Infection (UTI) continues to be one of the commonly occurring infections in medical practice despite the widespread availability of antibiotics. Presence of risk factors like elderly age, diabetes, immune-suppression, and other pose a challenge in its treatment. Over the years, the etiology and antibiotic resistance of the has been inconsistent. Therefore, it is important to determine the causative agents of UTI and their resistance patterns locally, in each region, so that appropriate empiric therapy can be started before the culture and antibiotic sensitivity results are available. Aim: This study aims to highlight the prevalence of and determine the antibiotic sensitivity pattern over the period of five years. Materials and Methods: The urine samples from patients with suspected urinary tract infections (UTI) received in the laboratory at Nanavati Max Super hospital were processed by standard protocol from January 2018 to December 2022. Antibiotic susceptibility test for the bacterial isolates was carried out by the VITEK2 automated system and interpreted as per CLSI guidelines. The data collected over the study period of five years was interpreted by using the WHO Net Antibiotic Susceptibility Surveillance Software in February 2023. Results: From a total of 8068 urine samples received over five years, were isolated in 4209 (52.16%) samples. E.coli was the most common isolate causing UTI, with prevalence of 380(46.7%) in 2018 and 480(50.6%) in 2022 of total samples. Amongst gram positive organisms, a rise in Enterococcus species was seen from 41(5%) in 2018 to 87(9%) in 2022, with significantly fewer Staphylococcus species isolated, from 32(4%) in 2018 to 7(0.7%) in 2022. The Enterobacteriaceae showed high sensitivity to , and all throughout the study. However, rise in resistance to Nitrofurantoin and , antibiotics commonly used for , was observed. the prevalence of Extended Spectrum of Beta (ESBL) producers decreased from 213(36%) to 127(17%) with a rise in producing Enterobacteriaceae from 48(8%) to 298(40%) over the five years study period. Amongst Lactose gram negative bacilli only 32 % were sensitive to and 37% sensitive to .By 2022, Enterococcus species showed an increase in sensitivity to Nitrofurantoin (27%), High level (37%), (25%) and Ampicillin (37%). Conclusion: The change in antibiotic sensitivity patterns over time and rise in resistance to antibiotics commonly used in empirical treatment of warrants the need for regular surveillance, so the physicians can be updated regarding the most prevalent organism and its susceptibility and the empirical treatment for can be modified accordingly. This can help curb indiscriminate use of antibiotics and development of antibiotic resistance. Keywords: Uropathogens, Antibiotic Resistance, Empirical Treatment
Research Square (Research Square), 2023
Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) are common pathogens of UTI in children and their prevalence is increasing worldwide. The aim of this study was to determine risk factors for ESBL-positive UTI and susceptibility to antibiotic treatments. Methods A retrospective cohort study conducted at Rambam Health Care Campus, a tertiary hospital in northern Israel. The study included patients younger than < 18 years old and ESBL positive UTI between January 2017 and December 2019. Patient demographics, previous antibiotic treatment, previous UTI episode, genitourinary tract abnormalities, identi ed organisms in urine cultures, and sensitivity to antibiotics were recorded. The current recommendation of empiric treatment of community acquired UTI may lead to inappropriate treatment. What Is New Known ESBL carriers and recent antibiotic treatment are risk factors for UTI caused by ESBL pathogens. Lack of oral empiric antibiotic treatment and prophylactic treatment for UTI caused by ESBL pathogens. Once-daily amikacin is useful as empiric treatment in anticipation of culture susceptibility and facilitates outpatient treatment. Supplementary Files This is a list of supplementary les associated with this preprint. Click to download. supplementary gure1.tif Supplementary gure2.tif
Irish Journal of Medical Science, 2013
An 11-year analysis of the prevalent uropathogens and the changing pattern of Escherichia coli antibiotic resistance in 38,530 community urinary tract infections, An 11-year analysis of the prevalent uropathogens and the changing pattern of Escherichia coli antibiotic resistance in 38,530 community urinary tract infections, Dublin Abstract Background Knowledge of local antimicrobial resistance patterns is essential for evidence-based empirical antibiotic prescribing, and a cutoff point of 20 % has been suggested as the level of resistance at which an agent should no longer be used empirically. We sought to identify the changing incidence of causative uropathogens over an 11-year period. We also examined the trends in antibiotic resistance encountered in both the pooled urine samples and those where the causative organism was Escherichia coli. Patient and methods A retrospective analysis of the antimicrobial resistance within the positive community urine isolates over the 11-year period, 1999 to 2009, in a single Dublin teaching hospital was performed. Results In total 38,530 positive urine samples processed at our laboratory originated in the community of which 23,838 (56.7 %) had E. coli as the infecting organism. The prevalence of E. coli has been increasing in recent years in community UTIs with 70.4 % of UTIs in the community caused by E.coli in 2009. Ampicillin and trimethoprim were the least-active agents against E. coli with mean 11-year resistance rates of 60.8 and 31.5 %, respectively. Significant trends of increasing resistance over the 11-year period were identified for trimethoprim, co-amoxyclav, cefuroxime and gentamicin. Ciprofloxacin remains a reasonable empirical antibiotic choice in this community with an 11-year resistance rate of 10.6 %. Higher antibiotic resistance rates were identified in the male population and in children.
Türk Üroloji Dergisi/Turkish Journal of Urology
Objective: Urinary tract infection is a common pediatric problem with the potential to produce long-term morbidity. Therefore, appropriate diagnosis and prompt treatment is required. However, studies about magnitude of uropathogenicity and antimicrobial resistance pattern of pediatric urinary tract infection (UTI) are lacking in resource limited countries including Ethiopia. This study was aimed to determine bacterial isolates, antimicrobial susceptibility pattern among pediatric patients with UTI. Material and methods: A cross-sectional study was conducted. Pathogenic bacterial isolates were identified by culture and biochemical methods following standard procedures. Antimicrobial susceptibility testing of the isolates for commonly used antibiotics was done using the standard disc diffusion method on Muller Hinton agar. Associations between dependent and independent variables were measured using chisquare test and within 95% confidence interval. P values <0.05 were considered as statistically significant. Results: A total of 310 pediatric patients were included in the study, and 82 (26.45%) bacterial isolates were detected. Gram-negative bacteria were predominant etiologic agents of UTI in this study. E. coli was the most frequently occurring pathogen (n=45; 54.88%) followed by S. aureus and P.aeruginosa (n=8; 9.75% for both), P. vulgaris, P.aeruginosa (n=4; 4.88%, for both) and Enterococcus species (n=3; 3.66%). All K. pneumoniae, P. mirabilis, and K. ozanae straines were 100% resistance to ampicillin, followed by P. aeruginosa (87.5%) and E. coli (69%). While all Gram-positive bacterial isolates were 100% sensitive to ciprofloxacin. Malnutrition, history of catherization and previous history of UTI were independently associated with UTI (p=0.000). Conclusion: There was a high prevalence of uropathogenic bacteria and drug resistance particularly to ampicillin (72%) and tetracycline (37.80%). This condition indicates that antibiotic selection should be based on knowledge of the local prevalence of bacterial organisms and antibiotic sensitivities rather than empirical treatment.
American Journal of Infection Control, 2014
Background: We conducted a retrospective analysis on the identification and antibiogram of all bacteria isolated from urine samples with microbiological confirmation of urinary tract infection (UTI) in a Spanish reference hospital over a 7-year period. Methods: A retrospective analysis was performed of the identification and antibiogram data. Results: A total of 31,758 uropathogens were isolated. Escherichia coli accounted for the majority (55.2%) of these, followed by Enterococcus faecalis (18.0%) and Klebsiella spp (10.3%). The highest E coli susceptibility rates were to imipenem (93.0%-99.8%), amikacin (97.3%-99.5%), nitrofurantoin (96.7%-98.9%), and fosfomycin (95.3%-100%), and the lowest were to cefuroxime (67.8%-86.4%), ciprofloxacin (61.2%-69.8%), and co-trimoxazole (55.0%-65.5%). We highlight the overall high activity of imipenem, piperacillintazobactam, nitrofurantoin, and fosfomycin on isolates versus the low activity of fluoroquinolones, co-trimoxazole, or cephalosporins. The activity of amoxicillin-clavulanic acid and fosfomycin decreased significantly over the 7-year study period. Conclusions: Imipenem and piperacillin-tazobactam appear to be good options for the empiric treatment of UTI acquired in hospital or requiring hospitalization, whereas nitrofurantoin and fosfomycin can be first-choice antibiotics for the treatment of uncomplicated community-acquired cystitis. However, surveillance studies are required to detect resistance to these antibiotics, given that an increase in uropathogen resistance rates may contraindicate its future use in empiric UTI therapy.
Increasing trend of antibiotic resistance and expression of Extended Spectrum Beta Lactamases (ESBLs) are serious threats for public health as they render the treatment ineffective. Present study was designed to elucidate the antibiotic-susceptibility patterns of ESBL and non-ESBL producing E. coli and K. pneumoniae causing urinary tract infections so that the ineffective antibiotics could be removed from the line of treatment. Methodology: The bacterial isolates obtained from the urine of patients visiting a tertiary health care facility were cultured for strain identification using API20E. Antimicrobial susceptibility and ESBL detection were done by Kirby-bauer diffusion technique. Results: Almost 53.4% isolates of E. coli and 24.5% isolates of K. pneumoniae were found to be ESBL producers. The ESBL producing bacteria were found to be more resistant towards various antibiotics. The most effective drugs against E. coli ESBL isolates were imipenem (99.54%), ampicillin-sulbactam (97.48%), piperacillin-tazobactam (96.86%), fosfomycin (94.51%), amikacin (92.26%) and nitrofurantoin (90.68%). The most effective drugs against K. pneumoniae ESBL isolates were imipenem (97.62%), piperacillin-tazobactam (95.35%), ampicillin-sulbactam (90.48%) and amikacin (88.37%). The antibiotics having the highest resistance, particularly by the ESBL producers were amoxicillin clavulanic acid, sulphamethoxalzole/ trimethoprim, cefuroxime, cefpirome, ceftriaxone and ciprofloxacin. Most of the isolates showed multi drug resistance (MDR). Conclusion: High frequency of ESBL producing E. coli and K. pneumoniae were observed as compared to previous data. Penicillins, cephalosporins and some representatives of fluoroquinolones were least effective against the common UTIs and are recommended to be removed from the line of treatment.
Five-year assessment of causative agents and antibiotic resistances in urinary tract infections
Türk Pediatri Arşivi, 2014
Aim: To show the distribution and changes of causative agents of urinary tract infections in children and resistance rates by years and select the most appropriate antibiotics. Material and Methods: In this study, the Başkent University Alanya Research and Application Hospital automation system microbiology recording book was screened retrospectively. Growth of a single microorganism above 105 colonies (cfu/mL) was included in the assessment. Throughout the study, 10 691 urinary cultures were studies and growth was found in 392 (3.7%). Results: Three hundred and nine (78.8%) of the samples with growth belonged to girls. Growth was found in the neonatal period in 32 patients (8.2%). The most commonly isolated microorganism was Escherichia coli (E. coli) which was found in 68.4% of the patients. Klebsiella spp. were found with a rate of 12.0%; Enterobacter spp. were found with a rate of 10.7% and proteus spp. were found with a rate of 5.1%. Resistance to cefalotin (62.1%), trimethoprim-sulfamethoxasole (43.1%), amoxycillin-clavulanate (34.8%), ampicillin (30.4%), cefixim (26.3%) and nitrofurantoin (3.6%) was found in E. coli species. The antibiotic which had the highest resistance rate was ampicillin with a rate of 93.2% for klebsiella and 83.4% for enterobacter. Klebsiella spp. were the most commonly grown pathogens in newborns (40.6%). In a follow-up period of 5 years, the resistance of E. coli to amoxycillin-clavulanate regressed from 40.3% to 31.3%, while the resistance to trimethoprim-sulfamethoxasole (TMP-SMX) regressed from 45.6% to 34.7%. Conclusions: A high resistance against first-generation cephalosporins, ampicillin, amoxycillin-clavulanate and TMP-SMX which are the first-line antibiotics in childhood urinary tract infections was found. Carbapenem (meropenem, imipenem) resistance was not found in our center. Nitrofurantoin, aminoglycosides and cefixime can be recommended for empirical treatment in our hospital because of low resistance. Antibiotic treatment should be redecided according to in vitro antibiotic sensitivity results.
Antibiotic resistance in uropathogenic enterobacteria
E3S Web of Conferences
Multidrug-resistant Enterobacteriaceae are a major public health threat worldwide. These germs are the most redoubtable because they are producers of beta-lactamases and possess other mechanisms of resistance to many antibiotics. The objective of this work is to identify isolated strains of Enterobacteriaceae and to study their antibiotic resistance profiles, thus contributing to the surveillance of antibioresistance. This is a retrospective study over a period of three years (2018-2020) including urine samples taken in the region of Rabat-Salé-Zaire and examined at the laboratory of Epidemic Diseases in National Institute of Hygiene of Rabat. Enterobacteriaceae were the most frequent germs with a predominance of Escherichia coli (68%) followed by Klebsiella pneumoniae (23%). Extended-spectrum beta-lactamase-producing Enterobacteriaceae accounted for 10.5%. The highest resistance was observed with amoxicillin, followed by ticarcillin, cefalotin, trimethoprim/sulfamethoxazole, amoxic...