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Zhu Z, Du W, Yang Y, Zhang Y, Feng J, Wang Y. Enterococci independently increase the risk for initial antibiotic treatment failure and prolonged hospitalization in adult patients with complicated urinary tract infection: a retrospective cohort study. Infection 2025; 53:307-315. [PMID: 39196517 DOI: 10.1007/s15010-024-02372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES We aimed to investigate the impact of enterococci on initial antibiotic treatment (IAT) failure and prolonged hospitalization in complicated urinary tract infection (cUTI) cases, and to identify risk factors for enterococcal cUTI. METHODS Adult cUTI patients were analyzed to compare the differences between the Enterococcus and non-Enterococcus groups. Univariate and multivariate analyses were employed to identify independent risk factors. RESULTS This study included 419 patients, with the Enterococcus group showing significantly higher IAT failure rates and an extended average length of stay by 4.4 days compared to the non-Enterococcus group. Multivariate analysis identified enterococci, hospital-acquired UTIs (HA-UTI), indwelling catheters, and bed rest (bedridden) as independent risk factors for IAT failure. Enterococci were notably linked to prolonged hospitalization, other independent risk factors included IAT failure, prior antimicrobial use, age-adjusted Charlson comorbidity index (ACCI) ≥ 4, hypoalbuminemia, and bed rest. Urological cancer, HA-UTI, indwelling catheters, urinary retention, and urologic surgery were risk factors for enterococcal cUTI. CONCLUSION We provide the first evidence that enterococci independently increase the risk for IAT failure and prolonged hospitalization in adults with cUTIs, highlighting the significance of timely identification to optimize measures including antibiotic regimens. Risk factors for enterococcal cUTI have also been identified to aid clinicians in managing this condition.
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Affiliation(s)
- Zhigang Zhu
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Wenying Du
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yuze Yang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yan Zhang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Jing Feng
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yubao Wang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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Alharthi KF, Baotob SM, Bankhar AM, Alsehli AA, Idris IA, Badawood MS, Alharbi WK, Almatrafi MM, Mahrous AJ, Thabit AK. Characteristics and outcomes of urinary tract infections caused by Enterococci: A multicenter retrospective study from two tertiary hospitals in Saudi Arabia. J Infect Chemother 2024; 30:1190-1193. [PMID: 38942290 DOI: 10.1016/j.jiac.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/20/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024]
Abstract
Enterococci are Gram-positive coccus bacteria that are normally present in the gastrointestinal tract and ordinarily function commensally with humans. Very few studies have investigated the characteristics of enterococcal infections. We aimed to characterize patients with urinary tract infections (UTIs) due to Enterococci and their outcomes. This was a retrospective cohort study between June 2012-November 2022. Patients who had clinically and microbiologically confirmed Enterococcal UTI based on a urine culture positive for E. faecalis or E. faecium with a count of ≥105 CFU/mL and having urinary tract symptoms were included. A total of 396 patients were eligible and included. The patients had a median age of 61 years and were mostly females (56.8 %). The most common characteristics were hospitalization in a non-ICU ward, having a urinary catheter, and recent use of antibiotics within the last 3 months (66.4 %, 59.3 %, and 51.8 %, respectively). Infection with E. faecalis was more common than E. faecium (77.3 % vs. 22.7 %). However, the latter exhibited higher rates of antibiotic resistance (P < 0.001 to several antibiotics) and was associated with significantly higher median C-reactive protein level (26.7 vs. 13 mg/dL; P = 0.025), mortality (23 % vs. 10.1 %; P = 0.002), and median length of stay (25 vs. 11.5 days; P < 0.001). We found that most patients with enterococcal UTIs had a history of having a urinary catheter and recent antibiotic use and were mostly females and hospitalized in non-ICU wards. E. faecium-infected patients experienced more severe episodes and poorer outcomes compared to patients infected with E. faecalis; thus, would need more aggressive therapy.
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Affiliation(s)
- Khaled F Alharthi
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salem M Baotob
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Atheer A Alsehli
- College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Israa A Idris
- College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | | | | | - Malak M Almatrafi
- Department of Pharmaceutical Care, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ahmad J Mahrous
- Department of Pharmaceutical Practice, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abrar K Thabit
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
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Shen L, Fu T, Huang L, Sun H, Wang Y, Sun L, Lu X, Zhang J, Yang Z, Ni C. 7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study. BMC Infect Dis 2023; 23:825. [PMID: 38001413 PMCID: PMC10668367 DOI: 10.1186/s12879-023-08711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Catheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control. METHODS Based on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group. RESULTS CAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P < 0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n = 132, 47.83%), followed by gram-positive bacteria (n = 91, 32.97%) and fungi (n = 53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P < 0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by ¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001). CONCLUSION The situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.
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Affiliation(s)
- Li Shen
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Ting Fu
- Department of Military Prevention Medicine, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Luguang Huang
- Department of information, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Huiying Sun
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Yu Wang
- Neurosurgical ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Lili Sun
- Neurological ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Xiaoyun Lu
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Jing Zhang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Zhaoxu Yang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
| | - Chunping Ni
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
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El-Atrees DM, El-Kased RF, Abbas AM, Yassien MA. Characterization and anti-biofilm activity of bacteriophages against urinary tract Enterococcus faecalis isolates. Sci Rep 2022; 12:13048. [PMID: 35906280 PMCID: PMC9336127 DOI: 10.1038/s41598-022-17275-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/22/2022] [Indexed: 11/21/2022] Open
Abstract
Strong biofilm-forming Enterococcus feacalis urinary tract pathogens (n = 35) were used to determine the lytic spectrum of six bacteriophages isolated from sewage samples. Only 17 Enterococcus feacalis isolates gave lytic zones with the tested bacteriophages from which five isolates were susceptible to all of them. The isolated enterococcal phages are characterized by wide range of thermal (30–90 °C) and pH (3–10) stability. They belong to order Caudovirales, from which four bacteriophages (EPA, EPB, EPD, EPF) belong to family Myoviridae and two (EPC, EPE) belong to family Siphoviridae. In addition, they have promising antibiofilm activity against the tested strong-forming biofilm E. faecalis isolates. The enterococcal phages reduced the formed and preformed biofilms to a range of 38.02–45.7% and 71.0–80.0%, respectively, as compared to the control. The same promising activities were obtained on studying the anti-adherent effect of the tested bacteriophages on the adherence of bacterial cells to the surface of urinary catheter segments. They reduced the number of adherent cells to a range of 30.8–43.8% and eradicated the pre-adherent cells to a range of 48.2–71.1%, as compared to the control. Overall, the obtained promising antibiofilm activity makes these phages good candidates for application in preventing and treating biofilm associated Enterococcus faecalis infections.
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Affiliation(s)
- Doaa M El-Atrees
- Department of Microbiology, Faculty of Pharmacy, The British University in Egypt (BUE), El-Sherouk City, 11837, Cairo, Egypt
| | - Reham F El-Kased
- Department of Microbiology, Faculty of Pharmacy, The British University in Egypt (BUE), El-Sherouk City, 11837, Cairo, Egypt
| | - Ahmad M Abbas
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, African Union Organization Street, Abbasia, Cairo, 11566, Egypt.,Department of Microbiology and Immunology, Faculty of Pharmacy, King Salman International University, Sinai, Egypt
| | - Mahmoud A Yassien
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, African Union Organization Street, Abbasia, Cairo, 11566, Egypt.
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