Beta-lactam antibiotic resistance among Escherichia coli isolates from patients with urinary tract infections in Vietnam:A systematic review and meta-analysis

Objective:To investigate the evolving patterns of antimicrobial resistance against beta-lactam antibiotics in Escherichia coli isolates from urinary tract infection patients in Vietnam,covering the period from 2005 to 2022.Methods:29 Descriptive studies published between 2010 and 2022 in English and Vietnamese were included in the analysis.Data on resistance rates to beta-lactam antibiotics,including cephalosporins and carbapenems,were extracted and analyzed.Weighted pooled resistance rates were calculated using random-effects models.Annual trends in resistance were assessed using linear regression analysis.Results:Among the beta-lactam antibiotics studied,Escherichia coli exhibited varying levels of resistance,with cephalosporins showing higher resistance rates compared to carbapenems.Weighted pooled resistance rates were 66%for cefotaxime,65%for ceftriaxone,54%for ceftazidime,and 56%for cefepime.In contrast,carbapenems demonstrated lower resistance rates,with weighted pooled resistance rates ranging from 3%to 4%for meropenem,ertapenem,and imipenem.Resistance rates were also observed for amoxicillin/clavulanate(35%),ticarcillin/clavulanate(26%),and piperacillin/tazobactam(12%).Significant annual increases in resistance were noted for imipenem(0.56%,P<0.001).Conclusions:This study highlights the critical issue of antimicrobial resistance in urinary tract infections in Vietnam and emphasizes the importance of prudent antibiotic use and the regular monitoring of resistance patterns.These insights are useful for guiding healthcare professionals in optimizing treatment strategies and for policymakers in formulating evidence-based clinical guidelines to combat antibiotic resistance effectively.

Epidemiologic Profile Urinary Tract Infections: Experience of the Microbiology Laboratory of the University Hospital Mohamed VI in Tangier

Urinary tract infection is one of the most common bacterial infections in humans. The urine cytobacteriological examination is the key test for its diagnosis. This work aims to Evaluate the prevalence of urinary tract infection at the Microbiology Laboratory of the University Hospital Mohamed VI in Tangier and to highlight its epidemiological and bacteriological characteristics. It was a descriptive study with retrospective data collection which took place from January 2021 to June 2022, at the Microbiology Laboratory of the university hospital Mohamed VI in Tangier. It covered all urine cytobacteriological examinations (ECBU) during the study period. We identified 77 cases of urinary tract infections out of 300 requests for (ECBU), that is a positivity rate of 25 %. The mean age was 55 years. The male gender was predominant. The epidemiological profile of the isolated strains was dominated by Enterobacteriaceae 81 %, followed by Gram-positive cocci 11 % and non-fermenting gram-negative bacteria 8 %. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli 42 %, Klebsiella pneumoniae 20 %, Enterobacter cloacae 9 %, Staphylococcus aureus 6 %, Pseudomonas aeruginosa 5 % and Acinetobacter baumannii 3%. Most of the analyzed organisms showed resistance, especially to the beta-lactam antibiotic;the enterobacteria strains isolated had revealed resistance to amoxicillin: 74%, to amoxicillin-clavulanic acid in 40% of cases, and to third-generation cephalosporins in 24%. In terms of resistance mechanisms, 11 % of the Enterobacteriaceae were extended-spectrum β-lactamase producers and 9 % of the specimens were identified as carbapenemase producers. Of the Staphylococcus aureus strains isolated, 75% were resistant to meticillin. The Glycopeptides and linezolid were the most active molecules on these isolated strains. 15% of Enterococcus species isolated in our laboratory were resistant to glycopeptides (vancomycin and teicoplanin).

Characterization of Extended Spectrum Beta-lactamase and Carbapenamase Producing Enterobacteriaceae Causing Urinary Tract Infection among Children in Kenya: A Cross-Sectional Study

Introduction: Enterobacteriaceae causing urinary tract infections (UTI) have developed resistance to the commonly used antibiotics due to emergence of Extended Spectrum Beta-Lactamases (ESBLs) and Carbapenamase producing Enterobactericeae which are a public health problem worldwide. This study aims to determine the prevalence and characterize ESBLs and carbapenamase producing Enterobactericeae. Method: A cross-sectional study was carried out in Gertrude’s Children’s Hospital, Nairobi. 238 urine samples were collected from patients with urinary symptoms attending the outpatient department within the period 2020-2021. The urine were examined macroscopically and microscopically. Identification and antimicrobial susceptibility testing were done using VITEK® 2 Compact system (BioMérieux). Double disc synergy test and modified hodge tests were done as confirmatory tests for ESBLs and Carbapenamase phenotypes respectively. Polymerase Chain Reaction was used for the detection of blaCTX-M, blaTEM, blaSHV, blaKPC and blaOXA-48 genes. Results: From the 238 children sampled the prevalence of UTI caused by Enterobactericeae was 22.3%. The Enterobacteriaceae species isolated were Escherichia coli (84.9%), Klebsiella pneumoniae (5.66%), Proteus mirabillis (5.66%), Enterobacter aerogenes (1.89%) and Morganella morganii (1.89%). The isolated species were resistant to ampicillin. Meropenem had the highest susceptibility. Only E. coli species had the ESBLs (26.4%) and carbapenamase (1.9%) phenotypes. 100% had BlaCTX-M while 50% had blaTEM resistant gene. There was a significant association (p Conclusion: Ampicillin resistance resulted to use of alternative drugs and Meropenem was the drug of choice where increased resistance to the recommended drugs was noted. Further research on resistant genes is recommended.

Urinary Tract Infection in Pediatric Emergency Department of Mohamed VI Hospital in Marrakech: Epidemiological Profile and Antibiotic Resistance

Background: Urinary tract infection (UTI) is one of the most frequent bacterial infections in pediatrics. The aim of our work was to establish the epidemiological and bacteriological profile of UTIs in children and then to study the sensitivity of the bacterial strains isolated to antibiotics. Materials and methods: This is a retrospective descriptive study over 3 years (2019-2022), including all cytobacteriological examination of urine (CBEU), performed in children aged 3 months to 14 years, admitted and treated for UTI, in the pediatric emergency department of Mohamed VI University Hospital. Results: A total of 239 children were included in our study. The mean age was 26 months. The sex ratio was 1.08. Escherichia coli was the most isolated bacterial strain in 79% of samples. The tested strains showed a high level of sensitivity to susceptibility rate toward amikacin (91%) and ciprofloxacin (100%) and whereas the level of resistance was high to the most current recommended antibiotics, mainly beta-lactams. Management was based, in severe forms of pyelonephritis, dual antibiotic therapy based on Third-generation cephalosporins combined with gentamycin. Favorable outcome was noted in 94% of children. Conclusion: Awareness-raising on the proper use of antibiotics, issuing national recommendations for the treatment of urinary tract infections in order to standardize therapeutic regimens is strongly recommended. Effective control of these infections requires a global prevention strategy that implies close collaboration between epidemiologists, clinicians, bacteriologists, hygienists and the health care team.

Outpatient Urinary-Tract-Infection-Like Symptoms: Causative Microbial Survey Utilizing Multiplex Quantitative Polymerase Chain Reaction Methodology

Urinary tract infections (UTIs) are among the most common maladies afflicting the human population globally. A wide variety of microbial pathogens are responsible for causing UTIs that are often recurrent, especially in the elderly population, resulting in an economic burden of billions of dollars annually. In this study, we present data from a large population of symptomatic UTI patients tested using a multiplexed, real time quantitative polymerase chain reaction (qRT-PCR) strategy. Our data demonstrate that instances of UTI increase with age for all the tested pathogens, with the exception of Mycoplasma spp. and Ureaplasma spp., which were found to be significantly higher in the younger population. Furthermore, the use of the qRT-PCR approach was also found to be effective in detecting polymicrobial UTIs. With the limitations of classical microbial culture techniques traditionally used for UTI diagnosis, we demonstrate that a rapid and comprehensive technique like RT-PCR can be an effective tool for detecting and managing UTIs.

Fosfomycin—A Promising Oral Antibiotic for the Treatment of Urinary Tract Infection (UTI)

Background: Among the common morbid causes that are prevalent among all age groups, urinary tract infections top the list. In our country, most of the UTI patients visiting hospitals (OPD or IPD) are already on empirical antibiotics even before getting the sensitivity report in their hand. The purpose of this research was to examine the susceptibility patterns of commonly used antibiotics, particularly fosfomycin, against common uropathogens. Methodology: This was a prospective observational study conducted between January and March 2021 in four private tertiary hospitals in Dhaka, Bangladesh. All the urine samples referred to these four laboratories, obtained from patients of all ages and both genders, clinically diagnosed to have UTI, were included. Urine culture was performed by a semiquantitative method on blood agar media and MacConkey agar media. Following identification, antimicrobial sensitivity testing was performed using the modified Kirby Bauer disk diffusion method in accordance with CLSI standards. The data was put into Statistical Package for Social Sciences (SPSS) statistical software version 25 for the analysis. Results: A total of 5389 urine samples were received from four private hospitals in Dhaka over three months, and of these, 934 (17.33%) isolates were obtained from culture. About 95% of the isolates were gram-negative bacilli (GNBs). The most common isolate was Escherichia coli 615 (65.85%), followed by Klebsiella spp. 154 (16.49%), Pseudomonas spp. 64 (6.85%) and 51 (5.46%) isolates of Enterobacter. Among the gram-positive cocci, the most common were Enterococci fecalis 18 (1.93%) and Staphylococcus aureus 17 (1.82%). Of all the antibiotics tested, fosfomycin sensitivity was 98.4%, 88.88%, and 100% for Escherichia coli, Enterococci fecalis, and Staphylococcus aureus, respectively. All the isolates tested were susceptible to Meropenem (77% - 100%), Amoxiclav (78% - 100%) and Nitrofurantoin (45% - 94%). Sensitivity amongst all the uropathogens for ceftriaxone, ciprofloxacin, and cotrimoxazole was nearly 50% - 77%. Conclusion: The positivity of urinary isolates is 17.33%, with the most common pathogen being Escherichia coli. Common uropathogens show the highest in vitro susceptibility to fosfomycin. So, fosfomycin should be considered as a highly potent and promising alternative oral antibiotic treatment for UTI.

Incidence of Urinary Tract Infections (UTI) amongst Patients Attending Primary Health Centres in Anambra State

Urinary tract infections (UTIs) are one of the most prevalent extra-intestinal bacterial infections. It is a common disease encountered in medical practice affecting people of all ages, from neonate to geriatric age group. These infections are on the increase for outpatients attending Primary Health Centres in Anambra State, Nigeria, therefore the need for this study. The prevalence rate of urinary tract infection, age distribution and influence of sex were determined. Susceptibility pattern of the infectious organisms to antimicrobial agent were examined. Clean-catch midstream urine samples were collected and examined. Out of 3000 urine samples examined, 528 bacterial isolates were recovered and characterized. These include: Escherichia coli (24.2%), Klebsiella spp. (18.2%), Staphylococcus aureus (18.2%), Proteus mirabilis (9.1%), Pseudomonas aeruginosa (9.1%), Enterococcus faecalis (9.1%), Citrobacter intermedius (6.1%) and Staphylococcus saprophyticus (6.1%). More females (52%) were infected than males (48%) and in both sexes, the highest incidence was found amongst the age group, 26 - 38 years. Gram negative rods had the highest incidence in both sexes. Among the towns in Anambra state, Umunya in southern province was observed to have the highest incidence rate of UTI. Susceptibility test of the bacterial isolates to antimicrobial agents showed that Staphylococcus aureus was sensitive to Cephalexin, Penicillin V, Erythromycin and Gentamycin while Pseudomonas aeruginosa was resistant to all the antibiotics. Escherichia coli and Klebsiella spp. were resistant to all the antibiotics except Gentamycin while Citrobacter intermedius was resistant only to Cephalexin and Erythromycin. This study provides the evidence of urinary tract infections amongst outpatients of primary health centres and the drugs for their control.

Research progress in urinary tract infection and its therapeutic drugs

Objective: The objective of this study was to understand the pathological mechanism and therapeutic progress in the study of urinary tract infections to provide references for clinical diagnosis and identification and development of therapeutic drugs.Methods: We summarized the types, pathological mechanisms, and therapeutic drugs for urinary tract infections on the basis of recent publications on these infections, both domestic and abroad.Results and conclusions: Urinary tract infection is mainly caused by pathogenic bacterial infection and treated by targeting bacterial adhesion, bacterial toxin, protease, urease, and siderophores, as well as using pili as vaccines and small-molecule drugs. Vaccines that target bacterial adhesion can block well the interaction between pathogens and the body, thereby reducing the incidence of urinary tract infections. The clinical efficacy of vaccines targeting bacterial toxins and proteases needs further evaluation. Vaccines targeting iron carriers retard disease progression and attenuate bacterial colonization. Urease-targeted small-molecule drugs exhibit certain curative effects and serious side effects. Small pili-targeted drugs can prevent and treat urinary tract infections by blocking the colonization and invasion of pathogens in animal models of urinary tract infections on the bladder. Adhesive FimH antibodies have entered Phase Ⅰ clinical trials. However, pilicides, mannosides, and vaccines that target pili, iron carriers, and other virulence factors are still in the experimental or preclinical stages of research.

Contribution of the Urine Dipstick to Urinary Tract Infection Diagnosis among Children in Two Hospitals in Cotonou-Benin

Introduction: Urinary tract infections are a daily concern in pediatric nephrology with long-term risks for high blood pressure and renal failure. The purpose of this study was to determine the contribution of a urine dipstick (UD) to the diagnosis of urinary infections among children at the CNHU-HKM and the Lagoon Mother and Child University Teaching Hospital (CHU-MEL) of Cotonou. Patients and Methods: This study is a cohort, descriptive and analytical study focused on children with suspected urinary infections in the pediatric units of the CNHU-HKM and CHU-MEL of Cotonou from March 25 to August 25, 2015. Results: Two hundred and four children out of a total of 5125 admitted children (4%) presented with at least one clinical sign of a urinary tract infection. Children under 36 months of age were predominant (41%). The main clinical signs of urinary infections were fever (60.8%) and urinary disorders (38.2%). The urinary dipstick test was positive in 145 children (71.2%). A urinary tract infection was confirmed by urine culture in 38 children (18.6%). In cases with leucocyturia- and nitrituria-positive urine dipstick tests, the sensitivity was estimated to be 13.2%, and the specificity was 95.2%, with a negative predictive value (NPV) of 82.8%. Only when the leucocyturia test was positive, the sensitivity was 76.3%, and the specificity was 31.9%. When the leucocyturia test was negative, the specificity was estimated to be 94%, and the sensitivity was 83% in the nitrituria-positive cases and 15.8% in the nitrituria-negative cases. The main isolated pathogens were Escherichia coli (n = 21) and Klebsiella pneumoniae (n = 14). Conclusion: In our environment, a negative leucocyturia test may help exclude urinary tract infections in most cases.

Epidemiological, Clinical, Paraclinical and Evolutionary Aspects of Urinary Tract Infection in Diabetics Hospitalized at the Department of Medicine of Abass Ndao Hospital from January 01, 2018, to December 31, 2018

Introduction: Urinary tract infection (UTI) is a major public health problem because of its morbidity and mortality. It occurs with increased frequency during diabetes. The objective of this work was to study the frequency and etiologies of urinary tract infections in diabetics hospitalized at the department of medicine of Abass Ndao Hospital. Patients and Methods: This work was a cross-sectional, descriptive, and analytical study conducted from January 01, 2018, to December 31, 2018. It focused on hospitalized diabetic patients with urinary tract infection. Epidemiological, clinical, and evolutionary data of UTI were evaluated. Results: One hundred and twenty-eight (128) diabetic patients had a cytobacteriological urine exam (CUE). 44 of who had a positive CUE (34.4%). The age group [60 - 69] years was the most represented (31.8%). Women predominated (61.4%) with a sex ratio (m/f) of 0.63. Abdominal pain was the most frequent reason for consultation, followed by polydipsia. Fever was recorded in 21 patients (47.7%). Type 2 diabetes was found in most patients (70.5%). Glycemia above 2g/l was found in 34 patients (89.5%). Anemia accounted for more than half of the patients with 29 cases (65.9%). Leukocytosis was noted in 28 patients (63.6%) and a positive CRP in 33 patients (75%). An increase in urea-creatinine was noted in 23 cases (52.3%). The results of the CUE revealed Escherichia coli as predominant (43.2%, n = 19), followed by Candida with 22.7% (n = 10). Antibiotic therapy was given to all patients. The mostly used antibiotic in the treatment of UTI was Cefotaxime 27.3% (n = 12). Older age and female gender were associated with the presence of E. coli. Four (4) deaths were recorded (9%). They were all male over the age of 65. Conclusion: UTI in diabetes is an important cause of morbidity and mortality. The development and implementation of a prevention and management program are essential.

Determinants of quinolone resistance in Escherichia coli causing community-acquired urinary tract infection in Bejaia,Algeria

Objective:To investigate the mechanisms of quinolone resistance and the association with other resistance markers among Esherichia coli(E.coli) strains isolated from outpatient with urinary tract infection in north of Algeria.Methods:A total of 30 nalidixic acid-resistant E.coli isolates from outpatient with urinary tract infections from January 2010 to April 2011 in north of Algeria(Bejaia) were studied.Antimicrobial susceptibility was determined by disc diffusion assay,minimal inhibitory concentrations(MIC) of quinolone were determined by microdilution.Mutations in the Quinolone Resistance-Determining Region(QRDR) of gyra and parC genes and screening for qnr(A,B and S) and bla genes were done by PCK and UNA sequencing.Results:Most of the E.coli isolates(56.66%) were shown to carry mutations in gyrA and parC,igyra:Ser83Leu + Asp87Asn and parC:Ser80Iler.While.16.66 had only an alteration in gyrA:Ser83Leu.One isolate produced qnrB-like and two qnrS-like.Four isolates were CTXM-15 producers associated with TEM-1 producing in one case.Co-expression of bla_(LTV,M)_(15) and qnrB was determined in one E.coli isolate.Conclusions:Our findings suggested the community emergence of gyrA and parC alterations and Qnr determinants that contributed to the development and spread of fluoroquinolone resistance in Algerian E.coli isolates.

Clinical Investigation on the Correlation between Lower Urinary Tract Infection and Cystitis Glandularis

Summary: In order to study the association between lower urinary tract infection and cystitis glandularis (CG), 120 cases of CG were diagnosed by cystoscopic biopsy in the suspicious foci of the bladder. Among them, 72 cases were subjected to bacterial counting culture of urine and microscopic examination of urinary sediment, and 60 cases to fluorescence quantitative polymerase chain reaction (FQ-PCR) assay to detect HPV, CMV and HSV DNA in urine samples. In the 72 cases of CG, the positive rate of bacterial counting culture of urine was 15.3 % (11/72), and gray zone rate was 18.1 % (13/72). 31.9 % (23/72) patients were positive in bacterioscopy of urinary sediment. There was statistically significant difference as compared with the control group (P<0.01). Only 4 of 60 urine samples were positive by FQ-PCR in detection of the three viruses mentioned above with the positive rate being 6.67 %. Compared with the control group, there was no significant difference (P>0.05). It was concluded that the genesis of CG was closely correlated with the chronic lower urinary tract infection, especially caused by Esch coli.

Elizabethkingia miricola :A rare non-fermenter causing urinary tract infection

Elizabethkingia miricola(E.miricola) is a gram-negative non-fermentative bacterium which is rarely encountered.It is usually misidentified or considered as a contaminant in routine microbiology laboratories due to the limitations in conventional biochemical techniques.However,with the advent of the matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOFMS),the identification of non-fermenters has become easy and this has led to enhanced understanding of the clinical significance of these uncommonly isolated microorganisms.The genus Elizabethkingia has only two species E.meningoseptica and E.miricola.Both of these organisms are known to be multi-drug resistant and therefore,their accurate identification and antimicrobial susceptibility testing are necessary prior to the initiation of appropriate therapy.In the world literature till date,only 3 cases of sepsis caused by E.miricola have been reported.We present the first case of E.miricola association with urinary tract infection.

Prevalence and antimicrobial resistance pattern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya

Objective: To investigate the prevalence of urinary tract infection among patients at Messalata Central Hospital, Libya, to identify the causative bacteria, and to explore their resistance pattern to antimicrobials. Methods: A total number of 1 153 urine samples were collected from patients, who attended daily to Messalata Central Hospital, Libya, in a study extended for one year. Antimicrobial susceptibility testing and isolates typing were done using Phoenix BD(BD diagnostic). Resistance was confirmed manually using agar disk diffusion method. Results: Of the 1 153 urine samples tested, 160(13.9%) samples were positive, from which 17 different, solely Gram negative, uropathogens were identified. Escherichia coli were the most prevalent(55.6%) bacteria, followed by Klebsiella pneumoniae subspecies pneumoniae(16.3%), Proteus mirabilis(6.3%), Pseudomonas aeruginosa(5.6%), Enterobacter cloacae and Klebsiella oxytoca(2.5%, each), Citrobacter koseri and Providencia rettgeri(1.9%, each), Acinetobacter baumannii, Enterobacter aerogenes and Proteus vulgaris(1.3%, each), and Aeromonas caviae, Citrobacter freundii, Cronobacter sakazakii, Enterobacter amnigenus biogroup 2, Pseudomonas putida and Serratia marcescens(0.6%, each). The isolated uropathogens showed increased levels of resistance ranged from 10.5% to 64.5%, with an overall resistance of 28.9%. Amikacin was the most effective antimicrobial followed by Imipenem and Meropenem(0%, 0.6% and 2.5% resistance, respectively); while, Cephalothin and Ampicillin were the least(80.6% and 90.0% resistance, respectively) effective. Conclusions: The obtained results emphasized the emergence of highly resistant bacteria to most of tested antimicrobials and raise the alarm for physicians to change their treatment pattern depending on antimicrobial susceptibility results.

Epidemiological trends of urinary tract infections,urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019

Background:Urinary tract infections(UTI),urolithiasis,and benign prostatic hyperplasia(BPH)are three of the most common nonmalignant conditions in urology.However,there is still a lack of comprehensive and updated epidemiological data.This study aimed to investigate the disease burden of UTI,urolithiasis,and BPH in 203 countries and territories from 1990 to 2019.Methods:Data were extracted from the Global Burden of Disease 2019,including incident cases,deaths,disabilityadjusted life-years(DALYs)and corresponding age-standardized rate(ASR)from 1990 to 2019.Estimated annual percentage changes(EAPC)were calculated to evaluate the trends of ASR.The associations between disease burden and social development degrees were analyzed using a sociodemographic index(SDI).Results:Compared with 1990,the incident cases of UTI,urolithiasis,and BPH increased by 60.40%,48.57%,and 105.70%in 2019,respectively.The age-standardized incidence rate(ASIR)of UTI increased(EAPC=0.08),while urolithiasis(EAPC=–0.83)and BPH(EAPC=–0.03)decreased from 1990 to 2019.In 2019,the age-standardized mortality rate(ASMR)of UTI and urolithiasis were 3.13/100,000 and 0.17/100,000,respectively.BPH had the largest increase(110.56%)in DALYs in the past three decades,followed by UTI(68.89%)and urolithiasis(16.95%).The burden of UTI was mainly concentrated in South Asia and Tropical Latin America,while the burden of urolithiasis and BPH was recorded in Asia and Eastern Europe.Moreover,the ASIR and SDI of urolithiasis in high-SDI regions from 1990to 2019 were negatively correlated,while the opposite trend was seen in low-SDI regions.In 2019,the ASIR of UTI in females was 3.59 times that of males,while the ASIR of urolithiasis in males was 1.96 times higher than that in females.The incidence was highest in the 30–34,55–59,and 65–69 age groups among the UTI,urolithiasis,and BPH groups,respectively.Conclusions:Over the past three decades,the disease burden has increased for UTI but decreased for urolithiasis and BPH.The allocation of medical resources should be based more on the epidemiological characteristics and geographical distribution of diseases.

Intervention effect and mechanism of curcumin in chronic urinary tract infection in rats

Objective: To analyze the invention effect of curcumin on chronic urinary tract infection in rats and explore its possible mechanism of action. Methods: The experimental animals were randomly divided into three groups, normal, model and curcumin group. Chronic urinary tract infection models were built for model group and curcumin group by injecting coliform fluid into the cavity of bladder. From the first day of modeling, rats in the curcumin group were injected with 150 mg/kg curcumin, while rats in normal group and model group were given no other treatment. The treatment lasted for 14 d. The white blood cell counts in blood and urine, bacterial colony count in urine and renal tubular functional indexes of rats in all groups at day I, 7, and 14 after treatment were detected. Urine beta 2-microglobulin (beta 2-MG), urinary N-acetyl-D glucosaminidase (NAG) levels were used to detected the inflammatory cytokines in serum after treatment including the contents of IL-6, IL-8, IL-10 and monocyte chemoattractant protein-I(MCP-1), and real-time PCR was employed to determine the expression of mRNA of toll-like receptor 2(TLR-2) and TLR-4 in renal tissues and bladder tissues of all groups after treatment. Results: The white blood cell counts at day I and 7 after treatment in rats of model group and curcumin group were significantly higher than those of normal group at the same time points, while the white blood cell counts of the curcumin group were significantly lower than those of model group (P < 0.05). The urine white blood cell counts in rats of model group at day 1, 7 and 14 were all significantly higher than those of normal group at the same time points: those in the curcumin group were significantly lower than those of the model group at day I, 7 and 14 at the same time points (p < 0.05). The bacterial colony counts of urine in rats of model group and curcumin group at day I. 7 and 14 were all significantly higher than those of normal group at the same time points, while the counts of curcumin group were significantly lower than those of model group at the same time points (P < 0.05). Levels of urine beta 2-MG, NAG, IL-6, IL-8, IL-10, MCP-1 and expression of TLR2 mRNA and TLR4 mRNA in renal and bladder tissues in rats of model group were significantly higher than those of the normal group, while these variables of the cercumin group were significantly higher than those of the normal group but lower than those of model group (P < 0.05). Conclusions: Curcumin can significantly improve the symptoms of chronic urinary tract infections. protect renal tubular function, and also decline inflammatory responses by influencing the expressions of TLR2 mRNA and TLR4 mRNA so as to exert its curative effect on chronic urinary tract infections.

Integron frequency of Escherichia coli strains from patients with urinary tract infection in Southwest of Iran

Objective: To investigate the frequency of integrase genes intI1, intI2 and intI3 of Escherichia coli strains, and their association with resistance to routinely used antibiotics. Methods: A total of 120 Escherichia coli strains were collected from patients with urinary tract infection in Ahvaz, Southwest of Iran. Antibiotic susceptibility testing was performed. The presence of intI1, intI2, and intI3 genes was determined by polymerase chain reaction. Results: Antibiotic susceptibility testing disclosed the highest resistance rate to ampicillin (91.7%) followed by trimethoprim/sulfamethoxazole (65.8%), and ceftazidime (56.7%). The imipenem susceptibility rate was 91.7%. IntI1 and intI2 were identified in 74 (61.6%) and 8 (6.6%) of Escherichia coli strains, respectively, but intI3 was not found in any isolates. The presence of integrons was significantly associated with resistance to ampicillin, trimethoprim/sulfamethoxazole, ceftazidime, and ciprofloxacin antibiotics (P<0.05). Conclusions: The high resistant Escherichia coli isolates harboring class 1 integrons (intI1) were detected in patients with urinary tract infection in our region. Therefore, preventive strategies are necessary to restrict further dissemination of resistant strains.

Urinary Tract Infection among Pregnant Women at Pumwani Maternity Hospital, Nairobi, Kenya: Bacterial Etiologic Agents, Antimicrobial Susceptibility Profiles and Associated Risk Factors

Urinary Tract Infections (UTIs) during pregnancy are among the most common infections worldwide and can lead to poor perinatal and maternal outcomes. This study determined the prevalence of UTIs during pregnancy, associated risk factors and antimicrobial susceptibility profiles of associated bacterial pathogens. A cross-sectional study was conducted among 210 pregnant women attending antenatal clinic at Pumwani Maternity hospital. Their social-demographic profiles were obtained using a structured questionnaire. Cultures were done from midstream urine and antimicrobial susceptibility testing determined using the disc diffusion test. The overall prevalence of UTI was 15.7% regardless of the women’s age, parity and stage of gestation. Prevalence of asymptomatic and symptomatic bacteriuria was 4.3% and 11.4% respectively. Material of undergarment and frequency of changing the undergarments were found to contribute significantly to the acquisition of UTI (P < 0.05). E. coli was the most predominant UTI organism at (44.5%) followed by K. pneumoniae (21.2%) and S. aureus (15.1%). Almost a half (over 49%) of all Gram-negative organisms showed resistance prevalence against third generation cephalosporins, fluoroquinolones, Sulfamethoxazole-Trimethoprim, Cefoxitin, Nitrofurantoin and Amoxicillin-clavulanic acid. Gram-positive strains were susceptible to Amoxicillin-clavulanic acid, Nitrofurantoin, Linezolid and Ofloxacin. The prevalence of multi-drug resistance (MDR) in all study isolates was 96%. Our data suggest a serious resistance trend among UTI strains and more should be done to slow down this trend. Pregnant women should be screened by urine culture and treatment be guided by the antimicrobial susceptibility data.

Urinary Myeloperoxidase to Creatinine Ratio as a New Marker for Diagnosis of Urinary Tract Infection

Objective To determine whether urinary myeloperoxidase to creatinine ratio(MCR) can serve as a marker for diagnosis of urinary tract infection(UTI).Methods Patients suspected of UTI were consecutively enrolled and further divided into the culture positive and the sterile groups according to urine culture results. Subsequently, MCR, white blood cell(WBC) and bacteria in the urinary samples from patients were detected and compared between the two groups.Results Finally, 253 patients were enrolled including 157 urine culture positive patients and 96 urine culture negative patients(sterile group). After logarithmic transformation in 2 as the base, the MCR, WBC, and bacteria were separately presented as log_2^(MCR), log_2^(WBC)(quantitative), and logbacteria2. The values of log_2^(MCR)(8.6±2.5 vs. 5.4±1.5, t=-12.453, P=0.001), log_2^(WBC)(quantitative)(8.0±2.5 vs. 5.2±1.8, t=-10.332, P=0.001), logbacteria2(11.4±2.5 vs. 8.2±2.8, t=-9.297, P=0.001) and WBC(semi-quantitative) [2(interquartile range 1, 3) vs. 1(interquartile range 0.5, 1), Z=-7.580, P=0.001] showed significant difference between the urine culture positive group and the sterile group. Among the urine culture positive group, the values of log_2^(MCR) of the gram positive and gram negative subgroups were 7.2±2.5 and 9.0±2.4(t=4.016, P=0.001), respectively. The correlation between log_2^(MCR) and log_2^(WBC)(quantitative), log_2^(bacteria), WBC(semi-quantitative) was 0.708(Pearson correlation, P=0.001), 0.381(Pearson correlation, P=0.001), and 0.606(Spearman correlation, P=0.001), respectively.Conclusions MCR is positively correlated with WBC counts and could be ser ved as a promising biomarker for diagnosis of UTI. MCR could be even used for initial inference of infectious bacteria types of UTI.

Progress on the Prevention and Nursing of Urinary Tract Infection Associated with Radical Hysterectomy and Pelvic Lymphadenectomy

Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complications associated with RH and pelvic lymphadenectomy,as well as improve the therapeutic effects of administered drugs and patient prognosis.The writer refers to relevant literatures to analyze the reasons for postoperative UTIs and to provide a brief summary of the nursing methods for and progress in UTI prevention.