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Mohamed FY, Dahie HA, Mohamoud JH, Adam MH, Dirie HM. Prevalence, antimicrobial susceptibility profile, and associated risk factors of uropathogenic Escherichia coli among pregnant women attending Dr. Sumait Hospital Mogadishu, Somalia. Front Public Health 2024; 11:1203913. [PMID: 38328535 PMCID: PMC10847321 DOI: 10.3389/fpubh.2023.1203913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
Background Uropathogenic Escherichia coli (UPEC) is a strain of E. coli commonly associated with urinary tract infections. In addition, antibiotic resistance in UPEC is one of the most significant health problems. This study was conducted to determine the prevalence, antimicrobial resistance, and factors linked to uropathogenic Escherichia coli (UPEC) in pregnant women. Methods This cross-sectional study was conducted within a hospital setting between August 2022 and December 2022. Using consecutive convenient sampling, the research enrolled 220 pregnant women. The urine samples obtained from these women were cultured on MacConkey and blood agar and incubated at 37°C overnight, followed by sub-culturing on Mueller Hinton media. Bacterial identification involved Gram staining and biochemical characterization (TSI, indole, citrate, methyl red, urea agar, and motility tests). Conversely, susceptibility tests were performed using the Kirby-Bauer disk diffusion method. A binary logistic regression model and analysis of odds ratios (ORs) were employed to evaluate the risk factors associated with E. coli infection, and statistical significance was attributed to p-values of ≤0.05. Results Out of the 220 urine samples examined, 42 (19%) exhibited a positive culture, indicating an E. coli infection in pregnant women. Our analysis revealed that income, gestational age, and history of UTIs were identified as risk factors associated with E. coli infection. Most E. coli isolates demonstrated sensitivity to amikacin (100%), nitrofurantoin (85.7%), amoxicillin/clavulanic acid, and meropenem (83.3%). Conclusion The prevalence of E. coli was remarkable. It could be recommended that pregnant women in antenatal care have routine culture and antimicrobial susceptibility tests to prevent transmission of resistant pathogens and complications in both pregnant mothers and the unborn baby.
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Affiliation(s)
- Fartun Yasin Mohamed
- Departments Microbiology and Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | | | - Jamal Hassan Mohamoud
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Mohamed Hussein Adam
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Hassan Mohamud Dirie
- Departments Microbiology and Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
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Seijas-Pereda L, Rescalvo-Casas C, Hernando-Gozalo M, Angmorkie-Eshun V, Agyei E, Adu-Gyamfi V, Sarsah I, Alfonso-Romero M, Cuadros-González J, Soliveri-de Carranza J, Pérez-Tanoira R. The Antimicrobial Resistance (AMR) Rates of Enterobacterales in a Rural Hospital from the Eastern Region, Ghana: A Retrospective Study, 2022. Antibiotics (Basel) 2023; 12:1321. [PMID: 37627741 PMCID: PMC10451727 DOI: 10.3390/antibiotics12081321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance and often lack adequate surveillance due to a paucity of microbiological studies. In this 2022 study, our goal was to contribute to a more precise antimicrobial treatment by understanding the prevalence of resistance in a rural environment, promoting antibiotic stewardship, and raising awareness about antimicrobial resistance. We assessed the prevalence of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Enterobacterales in clinical samples from 2905 patients being treated at Saint Dominic's Hospital, Akwatia, in the countryside of the Eastern Region, Ghana, in the year 2022. To this purpose, the samples were cultured on agar plates prepared in the laboratory using purified Oxoid™ Thermo Scientific™ agar (Thermo Fisher Scientific; Waltham, MA, USA). Cystine Lactose Electrolyte-Deficient (CLED) agar was used for urine samples, while blood agar, chocolate agar, and MacConkey agar were used for the rest of the specimens tested (HVS, blood, BFA, sputum). Antimicrobial susceptibility was determined on site using the disc diffusion method (Kirby-Bauer test). MDR bacteria accounted for more than half (53.7%) of all microorganisms tested for three or more antibiotics and 37.3% of these were XDR. Multivariate regression analysis was performed to identify risk factors associated with acquiring MDR/XDR bacteria. The results showed an increased likelihood of MDR acquisition linked to being male (OR 2.39, p < 0.001 for MDR and OR 1.95, p = 0.027 for XDR), higher age (OR 1.01, p = 0.049 for MDR), non-sputum samples (OR 0.32, p = 0.009 for MDR), and urine samples (OR 7.46, p < 0.001 for XDR). These findings emphasize the urgency for surveillance and control of antimicrobial resistance; to this end, making accurate diagnostics, studying the microorganism in question, and conducting susceptibility testing is of the utmost importance.
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Affiliation(s)
- Laura Seijas-Pereda
- Departamento de Biomedicina y Biotecnología, Facultad de Medicina, Universidad de Alcalá, 28805 Madrid, Spain; (C.R.-C.); (J.C.-G.); (J.S.-d.C.)
- Departamento de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, 28805 Madrid, Spain;
| | - Carlos Rescalvo-Casas
- Departamento de Biomedicina y Biotecnología, Facultad de Medicina, Universidad de Alcalá, 28805 Madrid, Spain; (C.R.-C.); (J.C.-G.); (J.S.-d.C.)
- Departamento de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, 28805 Madrid, Spain;
| | - Marcos Hernando-Gozalo
- Departamento de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, 28805 Madrid, Spain;
- Departamento de Química Orgánica y Química Inorgánica, Facultad de Farmacia, Universidad de Alcalá, 28805 Madrid, Spain
| | - Vida Angmorkie-Eshun
- Laboratory of Microbiology, Saint Dominic’s Hospital, Akwatia P.O. Box 59, Ghana; (V.A.-E.); (E.A.); (V.A.-G.); (I.S.); (M.A.-R.)
| | - Eunice Agyei
- Laboratory of Microbiology, Saint Dominic’s Hospital, Akwatia P.O. Box 59, Ghana; (V.A.-E.); (E.A.); (V.A.-G.); (I.S.); (M.A.-R.)
| | - Vivian Adu-Gyamfi
- Laboratory of Microbiology, Saint Dominic’s Hospital, Akwatia P.O. Box 59, Ghana; (V.A.-E.); (E.A.); (V.A.-G.); (I.S.); (M.A.-R.)
| | - Isaac Sarsah
- Laboratory of Microbiology, Saint Dominic’s Hospital, Akwatia P.O. Box 59, Ghana; (V.A.-E.); (E.A.); (V.A.-G.); (I.S.); (M.A.-R.)
| | - Maite Alfonso-Romero
- Laboratory of Microbiology, Saint Dominic’s Hospital, Akwatia P.O. Box 59, Ghana; (V.A.-E.); (E.A.); (V.A.-G.); (I.S.); (M.A.-R.)
| | - Juan Cuadros-González
- Departamento de Biomedicina y Biotecnología, Facultad de Medicina, Universidad de Alcalá, 28805 Madrid, Spain; (C.R.-C.); (J.C.-G.); (J.S.-d.C.)
- Departamento de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, 28805 Madrid, Spain;
| | - Juan Soliveri-de Carranza
- Departamento de Biomedicina y Biotecnología, Facultad de Medicina, Universidad de Alcalá, 28805 Madrid, Spain; (C.R.-C.); (J.C.-G.); (J.S.-d.C.)
| | - Ramón Pérez-Tanoira
- Departamento de Biomedicina y Biotecnología, Facultad de Medicina, Universidad de Alcalá, 28805 Madrid, Spain; (C.R.-C.); (J.C.-G.); (J.S.-d.C.)
- Departamento de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, 28805 Madrid, Spain;
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Carrasco Calzada F, Jairo Aguilera J, Moreno JE, Cuadros González J, Roca Biosca D, Prieto-Pérez L, Pérez-Tanoira R. Differences in Virulence Factors and Antimicrobial Susceptibility of Uropathogenic Enterococcus spp. Strains in a Rural Area of Uganda and a Spanish Secondary Hospital. Trop Med Infect Dis 2023; 8:tropicalmed8050282. [PMID: 37235330 DOI: 10.3390/tropicalmed8050282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Enterococcus faecalis and Enterococcus faecium have become two of the most important agents of nosocomial diseases due to their constantly growing resistance. Enterococcal infections are associated with biofilms, which are intrinsically sensitive to antimicrobials. The main goal of this study was to compare and relate their capacity to form biofilm and their antimicrobial sensitivity, as well as their virulence factors and their implicated genes, of strains isolated from patients with urinary tract infection (UTI) in a rural hospital in Uganda and a secondary hospital in Spain. A prospective study was conducted with 104 strains of E. faecalis and E. faecium isolated from patients with suspected UTI and who presented leukocyturia at the Saint Joseph Kitgum hospital (Uganda) and at the Hospital Universitario Principe de Asturias (Spain). All microorganisms were identified in Spain by MALDI-TOF mass spectrometry. Antimicrobial susceptibility studies were carried out using the Vitek® 2 system (Biomériux, France). The biofilm formation capacity was studied by photospectrometry. Phenotypic and genotypic virulence factors were studied in all cases by PCR or expression techniques. In Uganda, we found a higher incidence of E. faecium (65.3%, n = 32), contrary to the situation found in Spain where most of the bacteria found belonged to E. faecalis (92.7%, n = 51). All E. faecalis strains were found to have very low levels of resistance to ampicillin, imipenem, and nitrofurantoin. However, E. faecium exhibited more than 25% resistance to these antibiotics. Although the esp gene has been shown in the results obtained to be an important initial agent in biofilm formation, we have also demonstrated in this study the intervention of other genes when esp is not present, such as the ace1 gene. No statistically significant relationships were found between the presence of agg and gelE genes and increased biofilm formation. The significant difference between the incidence of E. faecalis and E. faecium and biofilm formation, between samples from Spain and Uganda, shows us very different profiles between countries.
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Affiliation(s)
- Félix Carrasco Calzada
- Clinical Microbiology Department, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Spain
- Health Sciences Department, Faculty of Med, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - John Jairo Aguilera
- IIS-Fundación Jiménez Díaz, 28007 Madrid, Spain
- CIBERINFEC-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28222 Madrid, Spain
| | - Jaime Esteban Moreno
- IIS-Fundación Jiménez Díaz, 28007 Madrid, Spain
- CIBERINFEC-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28222 Madrid, Spain
| | - Juan Cuadros González
- Clinical Microbiology Department, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Spain
- Health Sciences Department, Faculty of Med, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
- Máster Medicina Tropical y Salud Internacional, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - David Roca Biosca
- Máster Medicina Tropical y Salud Internacional, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Fundación El Alto, 12500 Vinaroz, Spain
| | - Laura Prieto-Pérez
- IIS-Fundación Jiménez Díaz, 28007 Madrid, Spain
- Máster Medicina Tropical y Salud Internacional, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Ramón Pérez-Tanoira
- Clinical Microbiology Department, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Spain
- Health Sciences Department, Faculty of Med, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
- Máster Medicina Tropical y Salud Internacional, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Hasan SM, Ibrahim KS. Molecular Characterization of Extended Spectrum β-Lactamase (ESBL) and Virulence Gene-Factors in Uropathogenic Escherichia coli (UPEC) in Children in Duhok City, Kurdistan Region, Iraq. Antibiotics (Basel) 2022; 11:antibiotics11091246. [PMID: 36140025 PMCID: PMC9495206 DOI: 10.3390/antibiotics11091246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background: The presence of extended-spectrum β-lactamase (ESBL)-producing bacteria among uropathogens is significantly increasing in children all over the world. Thus, this research was conducted to investigate the prevalence of E. coli and their antimicrobial susceptibility pattern, and both genes of ESBL-producing E. coli resistant and virulence factor in UTIs patients among children in Duhok Province, Kurdistan, Iraq. Method: a total of 67 E. coli were identified from 260 urine samples of pediatric patients diagnosed with UTIs aged (0−15 years) which were collected from Heevi Pediatric Teaching Hospital, from August 2021 to the end of February 2022. Result: a high proportion of UPEC infections at ages <5 years and the rates among girls (88%) were significantly higher than those among the boys. A wide variety of E. coli are resistant to most antibiotics, such as Amoxicillin, Ampicillin and Tetracycline, and 64% of them were positive for ESBL. Interestingly, the presence of both the ESBL marker genes (blaTEM, and blaCTX-M) as well as both virulence marker genes (pai and hly) were detected in above 90% of E. coli. Conclusion: the data illustrate an alarming increase in UPEC with ESBL production and the emergence of multidrug-resistant drugs in the early age of children. The public health sectors should further monitor the guidelines of using antibiotics in Kurdistan, Iraq.
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Affiliation(s)
- Salwa Muhsin Hasan
- Department of Medical Lab Technology, College of Health and Medical Technology/Shekhan, Duhok Polytechnic University, Duhok 42001, Kurdistan Region, Iraq
| | - Khalid S. Ibrahim
- Department of Biology, Faculty of Sciences, University of Zakho, Zakho 42002, Kurdistan Region, Iraq
- Correspondence: ; Tel.: +964-750-450-4417
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Nana T, Bhoora S, Chibabhai V. Trends in the epidemiology of urinary tract infections in pregnancy at a tertiary hospital in Johannesburg: Are contemporary treatment recommendations appropriate? S Afr J Infect Dis 2021; 36:328. [PMID: 34957292 PMCID: PMC8678934 DOI: 10.4102/sajid.v36i1.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications. Empiric antibiotic choices in pregnancy require consideration of efficacy and safety, resulting in limited oral options. With rapidly evolving antibiotic resistance, surveillance to guide empiric treatment recommendations is essential. METHODS A retrospective analysis of urine culture isolates from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Obstetrics Department for 1 January 2015 to 31 December 2020 was performed. RESULTS The top 3 pathogens were Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae. For E. coli susceptibility to cefuroxime declined (95% to 81%, p < 0.0001). Similarly, the E. coli extended spectrum beta-lactamase rate increased from 5% to 10% (p = 0.04). E. coli susceptibility to nitrofurantoin (93%) and fosfomycin (96%) remained high. In 2019, carbapenem-resistant K. pneumoniae emerged. Ampicillin susceptibility was high amongst the E. faecalis isolates. Amoxicillin-clavulanate demonstrated high levels of activity against the top 3 uropathogens. CONCLUSION The Essential Drug List recommended antibiotics for lower UTIs, nitrofurantoin and fosfomycin, are appropriate empiric options for E. coli, the most common uropathogen in the CMJAH obstetric population. The high rate of E. faecalis susceptibility to nitrofurantoin reported from other Gauteng tertiary obstetric patients, suggests that nitrofurantoin will provide adequate empiric cover for a large proportion of UTIs. However, the determination of the E. faecalis nitrofurantoin and fosfomycin susceptibility rates in the CMJAH obstetric population will provide useful data. Periodic surveillance at the various levels of antenatal care in different regions of South Africa and the determination of risk factors for infections with resistant uropathogens is needed.
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Affiliation(s)
- Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
- Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Services, Johannesburg, South Africa
| | - Shastra Bhoora
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital, South Africa
- Gauteng Department of Health, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Baylor College, Houston, United States of America
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
- Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Services, Johannesburg, South Africa
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Veeraraghavan B, Bakthavatchalam YD, Sahni RD. Oral Antibiotics in Clinical Development for Community-Acquired Urinary Tract Infections. Infect Dis Ther 2021; 10:1815-1835. [PMID: 34357517 PMCID: PMC8572892 DOI: 10.1007/s40121-021-00509-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/21/2021] [Indexed: 01/26/2023] Open
Abstract
The treatment of urinary tract infections (UTIs) has been complicated by the emergence of multidrug-resistant, β-lactamase-expressing pathogens. As a result of the limited treatment options, patients often require hospitalization and intravenous therapy. In essence, a strong unmet need for oral antibiotics, active against extended-spectrum β-lactamase (ESBL) uropathogens has emerged. Oral carbapenems (tebipenem and sulopenem) and oral cephalosporin/β-lactamase inhibitor combinations are in various stages of clinical development for the treatment of uncomplicated and complicated UTI. Tebipenem, if approved, will be the first oral treatment for complicated UTI while sulopenem will be for uncomplicated UTI. The β-lactamase inhibitors ETX0282, VNRX7145, ARX1796, and QPX7728 are combined with cefpodoxime proxetil or ceftibuten that achieve favorable exposures in urine compared to other uropathogen-active oral cephalosporins. The combination ceftibuten-QPX7728 has potential broad-spectrum coverage against carbapenemase producers including metallo β-lactamase producers. Other novel combinations, namely cefpodoxime/ETX0282, ceftibuten/VNRX-7145, and ceftibuten/ARX1796, have also demonstrated excellent activity against Klebsiella pneumoniae carbapanemase (KPC) and OXA-48-like producers. All these agents, upon their arrival for commercial use, would strengthen the outpatient therapy.
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Affiliation(s)
- Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
| | | | - Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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