Comparison of uropathogens and antibiotic susceptibility patterns in catheterized ambulant middle-aged and elderly Nigerian patients with bladder outlet obstruction

Prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa: systematic review and meta-analysis

BACKGROUND

Multidrug-resistant (MDR) bacteria are a global health threat, notably in low- and middle-income countries. The aim of this review was to estimate the prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa.

METHODS

In accordance with PRISMA guidelines, we searched PubMed, CINAHL, African Index Medicus, and other databases for studies published from 2010 onward. Data on MDR bacterial prevalence, study characteristics, and infection types were extracted and analyzed via R software. Subgroup analyses were performed to explore differences in prevalence across infection settings and sample types.

RESULTS

Out of the 5,320 articles identified, 50 studies from 13 West African countries met the inclusion criteria, with the majority from Nigeria (34%) and Ghana (22%). Among the 35,820 bacteria isolated in these studies, gram-negative bacteria (GNB), particularly Escherichia coli and Klebsiella sp., were the most frequently isolated species, accounting for 63.3% of the bacteria. The overall prevalence of MDR bacteria was 59% (95% CI: 48-69%), with significant heterogeneity between studies (I² = 98%, p < 0.001). Subgroup analysis revealed a 7% increase in MDR bacteria prevalence from the first five-year period to the last two five-year periods, and a greater prevalence of MDR bacteria in nosocomial infections (65%, 95% CI: 45-81%) than in community-acquired infections (53%, 95% CI: 31-74%). The prevalence of MDR bacteria in mixed infection settings was 58% (95% CI: 44-71%). The MDR prevalence was highest in the urine samples (72%, 95% CI: 57-84%) and superficial skin samples (69%, 95% CI: 29-92%), whereas it was lowest in the nasopharyngeal samples (26%, 95% CI: 21-33%).

CONCLUSION

The high prevalence of MDR bacteria in West Africa underscores the need for strengthened infection control measures, improved surveillance, and stricter antibiotic use policies. Enhanced regional collaboration is essential to mitigate the spread of AMR in both healthcare and community settings.

PROSPERO REGISTRATION NUMBER

CRD42023470363.

Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management

Urinary tract infections (UTIs) are the second most common infectious disease, predominantly impacting women with 150 million individuals affected globally. It increases the socio-economic burden of society and is mainly caused by Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter spp., and Staphylococcus spp. The severity of the infection correlates with the host factors varying from acute to chronic infections. Even with a high incidence rate, the diagnosis is mainly based on the symptoms, dipstick analysis, and culture analysis, which are time-consuming, labour-intensive, and lacking sensitivity and specificity. During this period, medical professionals prescribe empirical antibiotics, which may increase the antimicrobial resistance rate. Timely and precise UTI diagnosis is essential for addressing antibiotic resistance and improving overall quality of life. In response to these challenges, new techniques are emerging. The review provides a comprehensive overview of the global burden of UTIs, associated risk factors, implicated organisms, traditional and innovative diagnostic methods, and approaches to UTI treatment and prevention.

Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens

Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.

Comparative study of the bacterial distribution and antimicrobial susceptibility of uropathogens in older and younger patients with urinary stones

Background

This study compared the bacterial spectrum and antibiotic susceptibility of uropathogens in older and younger patients with urinary stones to provide appropriate antibiotic management.

Methods

We retrospectively reviewed urinary tract infection patients with urolithiasis, presented to Xiangya Hospital from March 2014 to April 2021. Patients were divided into older and younger groups according to 60 years of age. The bacterial spectrum and drug sensitivity of uropathogens were compared.

Results

A total of 542 strains of uropathogens (177 in older and 365 in younger groups) were isolated from 507 patients. E. coli (41.8% vs 43.6%) remains the most common pathogen, followed by E. faecalis (6.2% vs 9.6%) in older and younger groups, respectively. Particularly, K. pneumoniae was significantly more frequent in older (9.6%) than in younger group (4.7%, P < .05). E. faecium was substantially more prevalent in older group (6.2%) than in younger group (2.7%, P < .05). The proportion of males increased in older patients (47.3%) than in younger patients (34.9%, P = 0.007). In both groups, major Gram-negative bacteria (E. coli and K. pneumoniae) revealed a high sensitivity over 70% to piperacillin/tazobactam, imipenem and amikacin, whereas the resistance level was high to penicillin, tetracycline and vancomycin. Major Gram-positive (E. faecalis and E. faecium) isolates demonstrated high sensitivity of over 50% to gentamicin and vancomycin in both groups. Furthermore, uropathogens isolated from younger urolithiasis patients were more susceptible to antimicrobials than those isolated from older patients.

Conclusions

The male increased in the older urolithiasis patients with UTI and uropathogens microbial spectrum in older urolithiasis patients are different from younger. High susceptibility and age should be utilized in empirical antibiotic selection to avoid increased multidrug-resistant bacteria.