Uropathogens antibiotic susceptibility as an indicator for the empirical therapy used for urinary tract infections: a retrospective observational study

  • Raad Saad Luty Mail Department of Oral and Maxillofacial Surgery, University of Basrah, College of Dentistry, Basrah, Iraq
  • Adil Ghalib Fadil Department of Pediatric and Preventive Dentistry, University of Basrah, College of Dentistry, Basrah, Iraq
  • Jasim Mohammed Najm Department of Laboratories, Laboratory of Microbiology, Al-Basrah Teaching Hospital, Basrah, Iraq
  • Hala Haitham Abduljabbar Department of Pharmacy, Al-Basrah Teaching Hospital, Basrah, Iraq
  • Sarmad Abdul Abbas Kashmar Department of Pharmacy, Al-Fayhaa Teaching Hospital, Basrah, Iraq
Keywords:
Urinary tract infections;, Antibiotics resistance;, Escherichia coli;, Klebsiella pneumoniae

Abstract

Background and Objectives: Urinary tract infection (UTI) is a common infection affects people of different ages. It is important to explore the antibiotics susceptibility of the bacterial agents to improve the empirical antibacterial prescription because of emerging of multi-drug resistant (MDR) bacteria.
Materials and Methods: This is a retrospective observational study including 322 patients with UTI at the largest hospital at the center of Al-Basrah Governorate in the far south of Iraq from August 2018 to November 2019. Bacterial isolates from urine samples with significant bacteria were investigated by automated VITEK® 2 compact system to determine the causative bacteria and their antibiotics susceptibility.
Results: Escherichia coli and Klebsiella pneumoniae were the first and second most frequent Gram-negative isolates, whereas Staphylococcus haemolyticus and Enterococcus faecalis were the first and second most frequent Gram-positive isolates. Fosfomycin, tigecycline, colistin, meropenem, imipenem, amikacin and nitrofurantoin had high susceptibility rates against Gram-negative isolates. Nitrofurantoin, tigecycline, daptomycin, teicoplanin, vancomycin and linezolid had a high effect against Gram-positive isolates.
Conclusion: The leading causative isolates especially the most predominant Gram-negative isolates E. coli and K. pneumoniae show high resistance rates against important antibiotics including penicillin/β-lactamase inhibitors piperacillin/tazobactam, third-generation cephalosporins as ceftazidime, and cefepime quinolones as ciprofloxacin and levofloxacin and trimethoprim/sulfamethoxazole which call for reconsidering them for treatment of UTI.

References

1. McLellan LK, Hunstad DA. Urinary tract infection: pathogenesis and outlook. Trends Mol Med 2016; 22:946-957.
2. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: Epidemiology, mechanisms of infection, and treatment options. Nat Rev Microbiol 2015; 13:269-284.
3. Jean S-S, Coombs G, Ling T, Balaji V, Rodrigues C, Mikamo H, et al. Epidemiology and antimicrobial susceptibility profiles of pathogens causing urinary tract infections in the Asia-Pacific region: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2010–2013. Int J Antimicrob Agents 2016; 47:328-334.
4. Lee YC, Hsiao CY, Hung MC, Hung SC, Wang HP, Huang YJ, et al. Bacteremic urinary tract infection caused by multidrug-resistant Enterobacteriaceae are associated with severe sepsis at admission. Medicine (Baltimore) 2016; 95(20):e3694.
5. Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis. BMC Infect Dis 2017; 17:279.
6. Tandogdu Z, Wagenlehner FME. Global epidemiology of urinary tract infections. Curr Opin Infect Dis 2016;29:73-79.
7. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the infectious diseases society of America and the European society for microbiology and infectious diseases. Clin Infect Dis 2011;52(5):e103-20.
8. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T 2015; 40:277-283.
9. Zaman S Bin, Hussain MA, Nye R, Mehta V, Mamun KT, Hossain N. A review on antibiotic resistance: alarm bells are ringing. Cureus 2017; 9(6):e1403.
10. Bader MS, Loeb M, Brooks AA. An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgrad Med 2017; 129:242-258.
11. Bartoletti R, Cai T, Wagenlehner FM, Naber K, Bjerklund Johansen TE. Treatment of urinary tract infections and antibiotic stewardship. Eur Urol Suppl 2016; 15:81-87.
12. Asadi Karam MR, Habibi M, Bouzari S. Urinary tract infection: Pathogenicity, antibiotic resistance and development of effective vaccines against Uropathogenic Escherichia coli. Mol Immunol 2019; 108:56-67.
13. Waller TA, Pantin SAL, Yenior AL, Pujalte GGA. Urinary tract infection antibiotic resistance in the United States. Prim Care 2018;45:455-466.
14. Shakhatreh MAK, Sweden SF, Al-Odat MA, Khabour OF. Uropathogenic Escherichia coli (UPEC) in Jordan: Prevalence of urovirulence genes and antibiotic resistance. J King Saud Univ Sci 2019; 31: 648-652.
15. Cynthia Nau Cornelissen, Bruce D. Fisher RAH (2013). Lippincott’s Illustrated Reviews: Microbiology, 3rd ed.Lippincott Williams & Wilkins. Philadelphia.
16. Donay JL, Mathieu D, Fernandes P, Prégermain C, Bruel P, Wargnier A, et al. Evaluation of the automated phoenix system for potential routine use in the clinical microbiology laboratory. J Clin Microbiol 2004; 42:1542-1546.
17. Al-Naqshbandi AA, Chawsheen MA, Abdulqader HH. Prevalence and antimicrobial susceptibility of bacterial pathogens isolated from urine specimens received in rizgary hospital-Erbil. J Infect Public Health 2019;12: 330-336.
18. Al Wutayd O, Al Nafeesah A, Adam I, Babikir IH. The antibiotic susceptibility patterns of uropathogens isolated in qassim, Saudi arabia. J Infect Dev Ctries 2018;12:946-952.
19. Bitew A, Molalign T, Chanie M. Species distribution and antibiotic susceptibility profile of bacterial uropathogens among patients complaining urinary tract infections. BMC Infect Dis 2017;17:654.
20. Stefaniuk E, Suchocka U, Bosacka K, Hryniewicz W. Etiology and antibiotic susceptibility of bacterial pathogens responsible for community-acquired urinary tract infections in Poland. Eur J Clin Microbiol Infect Dis 2016; 35:1363-1369.
21. Zanichelli V, Huttner A, Harbarth S, Kronenberg A, Huttner B, Swiss Centre For Antibiotic Resistance Anresis. Antimicrobial resistance trends in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis urinary isolates from Switzerland: a retrospective analysis of data from a national surveillance network over 8 years (2009-2016). Swiss Med Wkly 2019;149:w20110.
22. Kresken M, Körber-Irrgang B, Biedenbach DJ, Batista N, Besard V, Cantón R, et al. Comparative in vitro activity of oral antimicrobial agents against Enterobacteriaceae from patients with community-acquired urinary tract infections in three European countries. Clin Microbiol Infect 2016; 22(1):63.e1-63.e5.
23. Curto C, Rosendo I, Santiago L. Antimicrobial susceptibility patterns in outpatient urinary tract infection in the district of Coimbra, Portugal: A cross-sectional study. Acta Med Port 2019; 32:568-575.
24. Lee JH, Subhadra B, Son YJ, Kim DH, Park HS, Kim JM, et al. Phylogenetic group distributions, virulence factors and antimicrobial resistance properties of uropathogenic Escherichia coli strains isolated from patients with urinary tract infections in South Korea. Lett Appl Microbiol 2016; 62:84-90.
25. Losada I, Barbeito G, García-Garrote F, Fernández-Pérez B, Malvar A, Hervada X, et al. Antimicrobial susceptibility of Escherichia coli producers of community urinary tract infections in Galicia (Spain). Aten Primaria 2020; 52:462-468.
26. Ny S, Edquist P, Dumpis U, Gröndahl-Yli-Hannuksela K, Hermes J, Kling AM, et al. Antimicrobial resistance of Escherichia coli isolates from outpatient urinary tract infections in women in six European countries including Russia. J Glob Antimicrob Resist 2019; 17:25-34.
27. Sanchez GV, Baird AMG, Karlowsky JA, Master RN, Bordon JM. Nitrofurantoin retains antimicrobial activity against multidrug-resistant urinary Escherichia coli from US outpatients. J Antimicrob Chemother 2014; 69:3259-3262.
28. Walker E, Lyman A, Gupta K, Mahoney MV, Snyder GM, Hirsch EB. Clinical management of an increasing threat: outpatient urinary tract infections due to multidrug-resistant uropathogens. Clin Infect Dis 2016; 63:960-965.
29. Cohen-Nahum K, Saidel-Odes L, Riesenberg K, Schlaeffer F, Borer A. Urinary tract infections caused by multi-drug resistant proteus mirabilis: Risk factors and clinical outcomes. Infection 2010; 38:41-46.
30. Khawcharoenporn T, Vasoo S, Singh K. Urinary tract infections due to multidrug-resistant Enterobacteriaceae: prevalence and risk factors in a Chicago emergency department. Emerg Med Int 2013; 2013:258517.
Published
2020-10-31
How to Cite
1.
Saad Luty R, Ghalib Fadil A, Mohammed Najm J, Haitham Abduljabbar H, Abdul Abbas Kashmar S. Uropathogens antibiotic susceptibility as an indicator for the empirical therapy used for urinary tract infections: a retrospective observational study. Iran J Microbiol. 12(5):395-403.
Section
Original Article(s)