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Uncomplicated bacterial uroinfections: aetiological structure and antimicrobial susceptibilityof bacterial isolates

By Boris

Volume 11, Issue 1

Original Article / Published: November 2023

DOI: https://www.doi.org/10.57045/jemis/1111123.pp56-63

I. Gergova, D. Petrova, O. Gatsev, I. Saltirov

Microbiology Laboratory, Department of Microbiology, Virology, Clinical Laboratory and Immunology, Military Medical Academy, Sofia, Clinic of Nephrology, Department of Urology and Nephrology, Military, Medical Academy, Sofia
Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia

Abstract

Introduction and objective: The increasing resistance to antimicrobials also affects uropathogens, the causative agents of uncomplicated urinary tract infections (UTIs), and is a frequent cause of failure of empirical antimicrobial therapy. The purpose of the study is to analyze the aetiological structure and susceptibility to antimicrobials of the most common bacterial causative agents of UTIs.
Material and Methods: A prospective analysis of microbial findings was performed in patients with clinical evidence of UTIs. A total of 9,426 urine cultures were examined (female: 5,157; male: 4,269).
Results: Microbial growth was found in 29.7% of female urine cultures and in 19.1% of male urine cultures. A total of 2,364 microbial isolates were identified. The aetiological structure of the isolates in both groups was similar – female: E. coli 51.3 %, Enterococcus spp. 18.9%, K. pneumoniae 13.1%, P.mirabilis 4.6%, Candida spp. 1.2%; male: E. Coli 23.5 %, Enterococcus spp.27.4%, K. pneumoniae 19.5%, P. mirabilis 6.4%, Candida spp. 2.8%. A high frequency of resistance was found to cephalosporinsIII generation (ceftriaxone: K.pneumoniae 31.7 %, P. mirabilis 15.2 %), fluoroquinolones (ciprofloxacin: E.faecium 74.0 %, K.pneumoniae 34.4 %, E. faecalis 27.9 %, E. coli 27.0 %, P. Mirabilis 24.0 %) and trimethoprim/sufamethoxazole (K. pneumoniae 33.9 %, P. mirabilis 33.6 %, E. coli 25.3 %,). Resistance to fosfomycin and nitrofurantoin was low. ESBL-producers were more frequent among K. pneumoniae (31.7 %) compared to E. coli (9.3 %). Resistance to carbapenems was found only in K. pneumoniae (14.9 %).
Conclusion: The study showed that the main uropathogens are often resistant to the antimicrobials recommended for empiric antimicrobial therapy in UTIs, necessitating a revision of local recommendations.

References

  1. Wagenlehner FM, Schmiemann G, Hoyme U, Fünfstück R, Hummers-Pradier E, Kaase M, et al. Nationale S3-Leitlinie “Unkomplizierte Harnwegsinfektionen”: Empfehlungen zu Therapie und
    Management unkomplizierter bakterieller ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten [National S3 guideline on uncomplicated urinary tract infection:
    recommendations for treatment and management of uncomplicated community-acquired bacterial urinary tract infections in adult patients]. Urologe A. 2011 Feb; (2):153-69. German. doi:
    10.1007/s00120-011-2512-z. PMID: 21312083.
  2. Mazzariol A, Bazaj A, Cornaglia G. Multi-drug-resistant Gram-negative bac teria causing urinary tract infections: a review. J Chemother 2017; 29: 2–9.
  3. Bishop MC. Uncomplicated urinary tract infection. EAU Up date Series 2004; 2: 143–150.
  4. Wagenlehner FM, Hoyme U, Kaase M, Fünfstück R, Naber KG, Schmiemann G. Uncomplicated urinary tract infections. Dtsch Arztebl Int. 2011 Jun;108(24):415-23. doi: 10.3238/
    arztebl.2011.0415. Epub 2011 Jun 17. PMID: 21776311; PM CID: PMC3132618.
  5. Kranz J, Schmidt S, Lebert C, Schneidewind L, Schmiemann G, Wagenlehner F. Uncomplicated Bacterial Communi- ty-Acquired Urinary Tract Infection in Adults. Dtsch Arztebl Int. 2017 Dec
    15; 114(50):866-873. doi: 10.3238/arzte- bl.2017.0866. PMID: 29271346; PMCID: PMC5763001.
  6. World Health Organization. Global Antimicrobial Resistance Surveillance System (GLASS) report, early implementation 2017–2018. Geneva, Switzer land: WHO, 2019.
  7. Rosa R, Abbo LM, Raney K, Tookes HE 3rd, Supino M. Antimi- crobial resistance in urinary tract infections at a large urban ED: Factors contributing to empiric treatment failure. Am J Emerg
    Med 2017; 35: 397–401.
  8. Bullens M, de Cerqueira Melo A, Raziq S, Lee J, Khalid GG, Khan SN, et al. Antibiotic resistance in patients with urinary tract infections in Pakistan. Public Health Action. 2022 Mar
    21;12(1):48-52. doi: 10.5588/pha.21.0071. PMID: 35317540; PMCID: PMC8908872.
  9. Procop GW, Church D, Hall GS, et al. Introduction to Microbiology Part ІІ: Guidelines for the Collection, Transport, Processing, Analysis, and Reporting of Cultures from Specific Specimen. In
    Koneman’s Color Atlas & Textbook of Diagnocsic Microbiology, 7th Ed., Wolters Kluwer, 2017.
  10. Гергова И. Инструкция за вземане, съхранение и транспорт на клинични материали за микробиологично изследване в МБАЛ-София, Военномедицинска академия. Военна
    медицина, 2021, 1:61-66.
  11. Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol. 2018 Jul; 219(1):40-51. doi: 10.1016/j.ajog.2017.12.231. Epub 2018 Jan 2.
    PMID: 29305250.
  12. Bauer AW, Kirby WMM, Sherris JC, Turck M. Antibiotic sus- ceptibility testing by a standardized single disc method. Am J Clin Pathol, 1963, 45: 493-496.
  13. European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2021) European Society of Clinical Microbiology and Infectious Diseases. V 11
  14. European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2022) European Society of Clinical Microbiology and Infectious Diseases. V 12
  15. Jarlier V et al. Extended broad-spectrum β lactamases conferring transferable resistance to newer β lactam agents in Enterobacteriaceae & hospital prevalence and susceptibility
    patterns. Rev Infect Dis. 1988, 10:867-878.
  16. Справочник 2017. Мутафчийски В, Кацаров К, Одисеева Е, Гергова И, Робева Р, Василев К, и съавт. Справочник за емпирична терапия на най-честите инфекции във ВМА и
    подчинените й структури (2017г.). София, Изд. ВМА, 2017.
  17. Гергова И. Анализ на структурата на бактериалните инфекции и резистентността на изолираните микроорганизми към антимикробни средства във Военномедицинска академия
    за 2017 г. Бюлетин на ВМА, 2018.
  18. Гергова И. Анализ на структурата на бактериалните и микотични инфекции и резистентността на изолираните патогени към антимикробни средства в МБАЛ-София,
    Военномедицинска академия. Под ред. на Попов Г., София, Изд. ВМА, 2019.
  19. Гергова И. Анализ на ефекта от въвеждането на стратегия за превенция и ограничаване на микробната резистент-ност в МБАЛ-София, Военномедицинска академия. Под
    ред. на Мутафчийски В. София, Изд. ВМА, 2020.
  20. BulSTAR: https://www.bam-bg.net/index.php/bg/bulstar
  21. Kot B. Antibiotic resistance аmong uropathogenic Escheri- chia coli. Pol J Microbiol. 2019; 68(4):403-415. doi:10.33073/ pjm-2019-048.
  22. Tandogdu Z, Wagenlehner FME. Global epidemiology of urinary tract infec tions. Curr Opin Infect Dis 2016; 29: 73.
  23. Hooton TM, Gupta K. Acute simple cystitis in women. Up- toDate Mar 19, 2019 https://www.uptodate.com/contents/ acute-complicated-uri nary-tract-infection-including-pyelonephritisin-adults Accessed August 2019.
  24. Sabir S, Anjum AA, Ijaz T, Ali MA, Khan MR, Nawaz M. Isolation and antibiotic susceptibility of E. coli from urinary tract infections in a tertiary care hospital. Pak J Med Sci 2014; 30: 389–
    392.
  25. Kranz J, Schmidt S, Lebert C, Schneidewind L, Vahlensieck W, Sester U, et al. Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant
    erworbener Harnwegsinfektionen bei erwachsenen Patienten: Aktualisierung 2017 der interdisziplinären AWMF S3-Leitlinie [Epidemiology, diagnostics, therapy, prevention and management
    of uncomplicated bacterial outpatient acquired urinary tract infections in adult patients : Update 2017 of the interdisciplinary AWMF S3 guideline]. Urologe A. 2017 Jun; 56(6):746-758.
    German. doi: 10.1007/s00120-017- 0389-1. PMID: 28455578.
  26. Гергова И, Димов В, Одисеева Е, Кържин Е, Салтиров И, Мутафчийски В. Етиологична структура и антимикробна чувствителност на микробни изолати от урокултури на пациенти,
    лекувани в МБАЛ-София, Военномедицинска академия. Военна медицина, София, 2018, 1: 36-40.
  27. Silver LL. Fosfomycin: mechanism and resistance. Cold Spring Harb Perspect Med 2017; 7: a025262.
Volume 11, Issue 1
Article [pdf]

Keywords:

uncomplicated urinary tract infections, aetiological structure, antimicrobial resistance, empiric antimicrobial therapy.

How to cite this article:

I. Gergova, D. Petrova, O. Gatsev, I. Saltirov. Uncomplicated bacterial uroinfections: aetiological structure and antimicrobial
susceptibility of bacterial isolates. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2023; 11(1): 56-63

Corresponding author:

Assoc. Prof. Ivanka Gergova, MD, PhD, Military Medical Academy of Sofia, Department of Microbiology, Virolgy, Clinical laboratory and
Immunology Microbiology Laboratory, 3 Georgi Sofiiski blvd Sofia 1606
e-mail: gergova.ivana7@gmail.com