High prevalence of multidrug resistant uropathogens: A recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh

Cranberry-derived bioactives for the prevention and treatment of urinary tract infections: antimicrobial mechanisms and global research trends in nutraceutical applications

Introduction

Urinary tract infections (UTIs) are a global health concern, increasingly complicated by antibiotic resistance. Cranberry-derived bioactive compounds, particularly proanthocyanidins (PACs), have emerged as a promising non-antibiotic strategy for UTI prevention. This review examines their efficacy, mechanisms of action, and the evolving research landscape through bibliometric analysis.

Methods

A comprehensive literature review was conducted to assess the role of cranberry metabolites in UTI prevention, focusing on anti-adhesive and antimicrobial mechanisms. Additionally, a bibliometric analysis of publications from 1962 to 2024 was performed to evaluate research trends, collaboration networks, and thematic developments.

Results

Cranberry metabolites, particularly A-type PACs, flavonoids, and phenolic acids, inhibit Escherichia coli adhesion to urothelial cells, reducing UTI recurrence. Gut microbiota-driven transformation of PACs into bioactive metabolites enhances their efficacy, while cranberry oligosaccharides disrupt biofilm formation in high-risk populations. Bibliometric analysis reveals a surge in research interest post-2000, with increasing global collaborations and a focus on clinical applications.

Discussion and conclusion

Cranberry bioactives demonstrate significant potential in UTI management, yet variations in formulation, dosage, and metabolic bioavailability present challenges. The growing research interest underscores the need for standardized clinical studies to optimize therapeutic efficacy and establish evidence-based guidelines for their use.

Emergence of Extended spectrum β-lactamase (ESBL) and carbapenemase producing Escherichia coli (E. coli) in mid-stream urine cultures of patients presenting in outpatient department of tertiary care hospital with uncomplicated cystitis (2016-2022): A retrospective analysis of Laboratory data

Objective

To determine the prevalence of antimicrobial resistance (AMR) in E. coli isolated from urine cultures of patients with uncomplicated cystitis in Pakistan. Another objective was to analyze and compare the resistance rates of E. coli to specific antibiotics, conducting a year-by-year evaluation of these rates to identify trends and changes over the past seven years.

Methods

Retrospective analysis of susceptibility data of E. coli isolated from midstream urine culture samples of patients presenting in outpatient department with uncomplicated cystitis, from January 2016 to December 2022 in the section of Microbiology, Liaquat University of Medical and Health Sciences was done. All the demographic data, clinical information and susceptibility results were obtained from laboratory data base. All the cultures were performed on CLED agar and E. coli was identified using biochemical tests, susceptibility test was performed by disk diffusion method and clavulanate inhibition test for analysis of extended spectrum β-lactamase (ESBL) was performed.

Results

A total of 5169 patients with uncomplicated cystitis with no history of renal disease, pregnancy, hospitalization, catheterization and no elderly or pediatric population were included, 76% of which were of females. Mean age was 37 ±11 years Rising trends of resistance were observed in ampicillin (86.3%-95.3%), cotrimoxazole (12.8-48.6%), ciprofloxacin (57.3-81.6%) and low rates of resistance were seen in fosfomycin (0.57-2.96%), nitrofurantoin (0.72-2.96%) and amikacin (2.09-3.15%). Presence of ESBL and emerging resistance to ceftriaxone (15.7-48.7%), piperacillin/tazobactam (0-4.84%) and carbapenems (0-0.39%) was observed.

Conclusion

The national guidelines offer an empirical treatment regimen for patients with uncomplicated cystitis. However, regional variations in antimicrobial resistance (AMR) complicate adherence to these guidelines. Our study supports the use of fosfomycin and nitrofurantoin in management of uncomplicated cystitis, However, ongoing annual regional surveillance is essential to keep clinicians informed about the latest trends in AMR.

Trends in Antimicrobial Resistance of Uropathogens Isolated from Urinary Tract Infections in a Tertiary Care Hospital in Dhaka, Bangladesh

Background/Objectives: Urinary tract infection (UTI) is a prevalent microbial infection in medical practise, leading to significant patient morbidity and increased treatment costs, particularly in developing countries. This retrospective study, conducted at a tertiary care hospital in Dhaka, Bangladesh, aims to examine the antimicrobial resistance (AMR) patterns of uropathogens and evaluate whether these patterns are influenced by demographic factors such as gender, age, or patient status. Methods: Standard microbiological techniques were used to identify uropathogens, and AMR patterns were determined using the Kirby-Bauer disc diffusion method. Results: Out of 6549 urine samples, 1001 cultures were positive. The infection was more prevalent in females compared to males. The incidence of UTIs in children aged 0-10 years accounted for 12.59% of the total cases, with this age group also exhibiting the highest rate of polymicrobial infections. Among the bacterial uropathogens, 71.19% of isolates were multidrug resistant (MDR) and 84.27% were resistant to at least one antibiotic. Escherichia coli (n = 544, 73.90% MDR) and Klebsiella species (n = 143, 48.95% MDR) were the most common Gram-negative uropathogens, while Enterococcus species (n = 78, 94.87% MDR) was the predominant Gram-positive isolate in this study. Our results indicate that most uropathogens showed resistance against ceftazidime, followed by cefuroxime, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, and netilmicin. Moderate levels of resistance were observed against ciprofloxacin, levofloxacin, aztreonam, and cefpodoxime. Conclusions: Amikacin was observed to be effective against Gram-negative uropathogens, whereas cefixime was more active against Gram-positive microorganisms, such as Enterococcus species. Moreover, a principal coordinate analysis (PCoA) depicted no significant influence of gender, patient status, or age on AMR patterns. For the continued usefulness of most antibiotics, periodic analysis of the AMR patterns of uropathogens can help assess the rise of MDR bacteria, and therefore guide the selection of appropriate antibiotic treatment strategies.

Uropathogens and their antibiotic susceptibility patterns among diabetic patients at st. john of god hospital, duayaw nkwanta, Ghana: a cross-sectional study

Background

Uropathogens are microorganisms that cause urinary tract infections (UTIs). Owing to higher blood glucose levels and compromised immune functions, treatment of uropathogens in diabetic patients is a challenge.

Aim

This study aims to assess the prevalence of uropathogens and their antibiotic susceptibility among diabetic patients at St. John of God Hospital at Duayaw Nkwanta (SJGHDN) in the Ahafo region of Ghana.

Methods

The cross-sectional study recruited 175 diabetic patients at SJGHDN between August and September 2023. Questionnaires were used to collect patients' background information. Fasting Blood Sugar (FBS) was assessed by using a glucometer. Urine samples were examined for the presence of uropathogens. A sterile inoculating loop with a calibrated volume of 2 µl was used for plating. Each colony equals 500 CFU/mL. Significant uropathogen was determined by multiplying the counted colonies by 500 to obtain CFU/mL. Positive uropathogen was defined as CFU ≥ 105/mL. Significant uropathogen was defined as ≥200 colonies per sample. The disc diffusion method was used to determine antibiotic susceptibility.

Results

Out of the 175 patients, 19.4% expressed various uropathogens with Escherichia coli being the predominant. Suboptimal glucose level was the most significant risk factor (p = 0.038). Glucosuria (p = 0.036), hazy urine (p = 0.028), positive leukocyte esterase (p = 0.001), and pus cells in urine sediment (p = 0.020) were significant indicators of uropathogen occurrence. Klebsiella pneumonia and Proteus mirabilis were resistant to ≥4 antibiotics. Amikacin, nitrofurantoin, levofloxacin, ciprofloxacin, and ceftriaxone demonstrated efficacy against the isolates.

Conclusion

This study underscores the notable prevalence of uropathogens in diabetic patients and the alarming levels of antibiotic resistance observed. The results highlight the critical need for vigilant monitoring and customized treatment approaches, particularly for diabetic patients exhibiting risk factors such as elevated urine glucose levels, cloudy urine, and presence of leukocyte esterase and pus cells in urine sediment. The significant resistance to frequently used antibiotics like co-trimoxazole and tetracycline points to the necessity of routine susceptibility testing and the use of alternative antibiotics for effective treatment. These findings can assist healthcare providers in more effectively managing and preventing UTIs in diabetic populations.

Resistance and Co-Resistance of Metallo-Beta-Lactamase Genes in Diarrheal and Urinary-Tract Pathogens in Bangladesh

Carbapenems are the antibiotics of choice for treating multidrug-resistant bacterial infections. Metallo-β-lactamases (MBLs) are carbapenemases capable of hydrolyzing nearly all therapeutically available beta-lactam antibiotics. Consequently, this research assessed the distribution of two MBL genes and three β-lactamases and their associated phenotypic resistance in diarrheal and urinary-tract infections (UTIs) to guide future policies. Samples were collected through a cross-sectional study, and β-lactamase genes were detected via PCR. A total of 228 diarrheal bacteria were isolated from 240 samples. The most predominant pathogens were Escherichia coli (32%) and Klebsiella spp. (7%). Phenotypic resistance to amoxicillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 50.4%, 65.6%, 66.8%, 80.5%, 54.4%, 41.6%, 25.7%, 41.2%, 37.2%, and 42.9%, respectively. A total of 142 UTI pathogens were identified from 150 urine samples. Klebsiella spp. (39%) and Escherichia coli (24%) were the major pathogens isolated. Phenotypic resistance to amoxicillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 93.7%, 75.0%, 91.5%, 93.7%, 88.0%, 72.5%, 13.6%, 44.4%, 71.1%, and 43%, respectively. Twenty-four diarrheal isolates carried blaNDM-1 or blaVIM genes. The overall MBL gene prevalence was 10.5%. Thirty-six UTI pathogens carried either blaNDM-1 or blaVIM genes (25.4%). Seven isolates carried both blaNDM-1 and blaVIM genes. MBL genes were strongly associated with phenotypic carbapenem and other β-lactam antibiotic resistance. blaOXA imparted significantly higher phenotypic resistance to β-lactam antibiotics. Active surveillance and stewardship programs are urgently needed to reduce carbapenem resistance in Bangladesh.

Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease

Identifying and appropriately managing urinary tract infections (UTIs) among chronic kidney disease (CKD) patients are essential to reduce further disease complications and economic burden. Hence, this study aims to determine the prevalence of UTIs among CKD patients and study the antibiogram of the bacterial isolates. Four hundred eighty-two clean catch midstream urine samples were collected from CKD patients during the study period. The samples were cultured, and bacteria were isolated using standard microbiological techniques. Antibiotic susceptibility testing was performed by the Kirby-Bauer disc diffusion method following the Clinical and Laboratory Standards Institute guidelines. Of the 482 CKD patients, 15.8% were culture positive, and the majority was elderly aged group population. Most bacterial isolates were Escherichia coli 50%, followed by Pseudomonas aeruginosa 15.80%, Enterococcus species 15.80%, and Klebsiella pneumoniae 11.84%. The majority of bacteria were found to be resistant to beta-lactam antibiotics, ampicillin (94.67%), ceftriaxone (89.04%), cefotaxime (87.5%), and ceftazidime (84.0%), while polymyxin, colistin, vancomycin, meropenem, and imipenem were the most sensitive antibiotics. In our study, higher levels of antibiotic resistance were observed among urinary isolates. Therefore, our findings suggest clinicians to choose better antibiotic options to treat UTIs among CKD patients.

Antibiotic resistance pattern of microorganisms causing urinary tract infection: a 10-year comparative analysis in a tertiary care hospital of Bangladesh

BACKGROUND

Antimicrobial resistance is an emerging concern globally in recent years. Management of common infectious diseases like urinary tract infection (UTI) has become challenging. In this context, the purpose of this study is to compare the shifting trends in bacteriology and antibiotic resistance pattern among uropathogens to similar studies conducted at various times in Bangladesh.

METHODS

It was a cross-sectional study conducted at the CUMILLA MEDICAL COLLEGE HOSPITAL'S MEDICINE DEPARTMENT in three phases (2011, 2016, 2021. Patients who visited the outpatient and inpatient departments of the study center with symptoms suggestive of a urinary tract infection were undergone urine culture. Those who yielded positive growth in urne culture were finally included in the study.

RESULTS

Escherichia coli (62% in 2021, 86% in 2016 and 76% in 2011) and Klebsiella species (11% in 2021, 10% in 2016 and 11% in 2011) were the most frequently isolated bacteria. Overall, in Gram-negative organisms, resistance was almost > 50% to all the tested antibiotics. Very high frequency of resistance ranging from 66.67 to 93.75% to cotrimoxazole, ciprofloxacin, cefuroxime, cephradine, amoxicillin and nalidixic acid, moderately high resistance to ceftriaxone (64.52%) and gentamicin (53.13%) and low resistance to nitrofurantoin (25.38%) were shown by the most commonly isolated organisms. Resistance to common antibiotics has been significantly increased over time in the isolated orgnaisms, especially in carbapenem and aminoglycoside group.

CONCLUSION

Resistance of uropathogens against conventional antibiotics used to treat UTI is high and the proportion has been increased over time. The situation might be grave in upcoming years if rational consumption of antibiotics is not warranted.

Evaluation of chromogenic agar medium, can it be a suitable alternative to conventional culture system for identification of uropathogens?

Background and Objectives

Urinary tract infections (UTI) account for major proportion of outpatient load and hospital admission globally. In most of the clinical microbiology laboratories MacConkey agar (MAC) and Cystine lactose electrolyte-deficient (CLED) agar are being used for identification of uropathogens. The main objective of the present study was to evaluate the usefulness of HiCrome^TM UTI by comparing isolation rate and presumptive identification of uropathogens against CLED and MAC agar.

Materials and Methods

This study was conducted over a period of three months on 672 non-duplicate midstream and/or catheter-catch urine samples. All samples were inoculated on to HiCrome^TM UTI, CLED agar and MacConkey agar.

Results

Among the 672 samples received for culture, 113 (16.8%) showed significant growth. Among the 672 samples, 95 (14.1%) showed growth of a single organism while 18 (2.7%) showed polymicrobial growth. The rate of isolation and presumptive identification of the isolates and polymicrobial growth was found significantly higher on HiCrome^TM UTI Agar.

Conclusion

HiCrome^TM UTI Agar has the potential to streamline processing of samples for urine culture in a way that will reduce the workload for technicians, reduce turnaround time which in turn will benefit the laboratory ultimately leading to better patient care.

Isolation and drug susceptibility pattern of uropathogens in Saudi diabetic and non-diabetic patients with urinary tract infection

Urinary tract infection (UTI), contribute substantially to healthcare burden. Diabetes predispose to UTI with high glycosuria being fertile medium for bacterial growth. With changing bacterial drug resistance patterns; the problem needs to be studied periodically to ensure a rational therapy, minimize adverse effects, and cost. Therefore, it is of interest to compare the profile and susceptibility pattern of uropathogens isolated from diabetic and non-diabetic patients with UTI. Mid-stream urine samples of 1100 patients (diabetic and non-diabetic), presenting with UTI symptoms were aseptically collected and inoculated into CLED medium. Colony counts of 105cfu/ml or 104cfu/ml and >5 pus cells per high power microscopic field were regarded as significant bacteriuria. Colonies from CLED were sub-cultured onto sheep blood agar and MacConkey agar. Bacterial identification was performed on the basis of colony morphology, gram staining, and series of biochemical tests though Analytical Profile Index (API) test strips. Drug susceptibility was done by standard Kirby-Bauer disk diffusion. Data was analyzed by SPSS ver. 25.Clinically significant bacteriuria was 32.8% and 19.2% in diabetics and non-diabetics respectively. The frequency of male and female patients was 153 and 208 in diabetic group; and 69 and 142 respectively in non-diabetic group. Diabetics were twice at risk of UTI; [Odds ratio; 2.04 (CI: 1.68-2.48, p<0.05)]. .Escherichia coli and klebsiella were most common gram-negative, while Staphylococcus aureus and Coagulase-negative staphylococci (CoNS) were most common gram-positive bacteria in both the groups. Most effective antibiotics against gram-negative bacteria were carbapenems, amikacin, colistin, and piperacillin/tazobactam; while ampicillin/amoxicillin, fluoroquinolones and cephalexin were least effective. For gram-positives, vancomycin, linezolid and tigecycline were most effective. No significant difference in bacterial profile and susceptibility pattern was found between diabetics and non-diabetics. However, diabetics were twice at risk of UTI compared to non-diabetics.

Alhagi maurorum extract modulates quorum sensing genes and biofilm formation in Proteus mirabilis

Proteus mirabilis (P. mirabilis) is a frequent cause of catheter-associated urinary tract infections. This study aims to investigate the anti-infective effect of Alhagi maurorum extract (AME), the traditional medicinal plant in the middle east, on the biofilm-forming P. mirabilis isolates. Hydroalcoholic extract and oil of A. maurorum were characterized by HPLC and GC–MS. The antiproliferative, anti-biofilm, and bactericidal activity of AME at various concentrations were assessed by turbidity, crystal violet binding, and agar well diffusion assays, respectively. The AME’s effect on adhesion and quorum sensing (QS) were investigated by in vitro adhesion assay on cell culture and agar overlay assay using Janthinobacterium lividum (ATCC 12472) as a biosensor strain. In addition, the expression level of selected genes involved in QS and biofilm regulation were determined by quantitative Real-Time PCR. Furthermore, the bladder phantom model was created to evaluate the assays and investigate the catheter’s calcium deposition. The most effective chemical compounds found in AME were tamarixetin, quercetin, and trans-anethole. Although AME did not inhibit swarming motility, it reduced biofilm production and exerted a concentration-dependent anti-adhesive and anti-QS activity against P. mirabilis. AME also downregulated the expression level of selected genes involved in biofilm formation and QS. This study showed that AME as a natural compound reduced biofilm formation of P. mirabilis by targeting virulence factor genes, quorum sensing, and other strategies that include preventing the adhesion of P. mirabilis to the cells. The results suggest that A. maurorum extract might have the potential to be considered for preventing UTIs caused by P. mirabilis.

Efficacy of Urine Dipstick Test in Diagnosing Urinary Tract Infection and Detection of the blaCTX-M Gene among ESBL-Producing Escherichia coli

A urine dipstick test used for prompt diagnosis of urinary tract infection (UTI) is a rapid and cost-effective method. The main objective of this study was to compare the efficacy of the urine dipstick test with culture methods in screening for UTIs along with the detection of the bla_CTX-M gene in extended spectrum β-lactamase (ESBL)-producing Escherichia coli. A total of 217 mid-stream urine samples were collected from UTI-suspected patients attending Bharatpur Hospital, Chitwan, and tested by dipstick test strip (COMBI-10SL, Germany) prior to the culture. E. coli isolates were identified by standard microbiological procedures and subjected to antimicrobial susceptibility testing by Kirby Bauer disc diffusion method following CLSI guideline. Primary screening of ESBL-producing E. coli isolates was conducted using ceftriaxone, cefotaxime and ceftazidime discs and phenotypically confirmed by combined disk diffusion test. Plasmid DNA of ESBL-producing strains was extracted by phenol-chloroform method and subjected to PCR for detection of the bla_CTX-M gene. Out of 217 urine samples, 48 (22.12%) showed significant bacteriuria. Among 46 (21.20%) Gram negative bacteria recovered, the predominant one was E. coli 37 (77.08%) of which 33 (89.19%) were multidrug resistant (MDR). E. coli isolates showed a higher degree of resistance towards cefazolin (62.16%) while 81.08% of the isolates were sensitive towards amikacin followed by nitrofurantoin (70.27%). Among 14 (37.84%) phenotypically confirmed ESBL isolates, only eight (21.62%) isolates carried the bla_CTX-M gene. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of urine dipstick test were 43.75%, 77.51%, 35.59% and 82.91%, respectively. Besides, the use of dipstick test strip for screening UTI was associated with many false positive and negative results as compared to the gold standard culture method. Hence, dipstick nitrite test alone should not be used as sole method for screening UTIs.