UTI due to ESBL-producing E. coli are emerging, and also in a country with low antibiotic use. Because of increasing antibiotic resistance rates of E. coli to current standard therapy and because of the resistance patterns of ESBL-producing E. coli, guidelines for the management of UTIs must be revised. Fosfomycin or nitrofurantoin are recommended for the first-line empirical oral treatment of community-acquired uncomplicated UTIs. Abstract Background Extended-spectrum b-lactamases (ESBLs) are an increasing challenge in the treatment of urinary tract infections (UTIs), and also in the community. We aimed to investigate the characteristics of patients with UTIs due to ESBL-producing Escherichia coli and to assess the risk factors for ESBLs in community-acquired isolates. Methods We performed a retrospective study from January 1, 2007 to December 31, 2009 at a tertiary care teaching hospital in Switzerland, comparing patients with community-acquired versus healthcare-associated UTIs due to ESBL-producing E. coli. Additionally, we investigated the antimicrobial susceptibility of these isolates. Results A total of 123 patients were studied, of whom 79 (64%) had community-acquired and 44 (36%) had healthcare-associated UTIs. Community-acquired isolates were associated with acute uncomplicated UTIs (odds ratio [OR] 6.62, 95% confidence interval [CI] 1.83-36.5, P \ 0.001). Risk factors were recurrent UTI (OR 3.04, 95% CI 1.14-9.14, P = 0.022) and female sex (OR 2.46, 95% CI 1.01-6.08). Community-acquired ESBL-producing E. coli urinary isolates showed high resistance rates to most of the currently used oral antimicrobial agents, including b-lactam antibiotics (amoxicillin-clavulanic acid, 69.6% resistance), quinolones (ciprofloxacin, 84.8% resistance; norfloxacin, 83.9% resistance), and trimethoprim-sulfamethoxazole (75.9% resistance), except for nitrofurantoin (15% resistance) and fosfomycin (0% resistance). Conclusion UTI due to ESBL-producing E. coli are emerging, and also in a country with low antibiotic use. Because of increasing antibiotic resistance rates of E. coli to current standard therapy and because of the resistance patterns of ESBL-producing E. coli, guidelines for the management of UTIs must be revised. Fosfomycin or nitrofurantoin are recommended for the first-line empirical oral treatment of community-acquired uncomplicated UTIs.
SummaryNitrogen fixation is often enhanced in the rhizosphere as compared with bulk soil, due to asymbiotic microorganisms utilizing root exudates as an energy source. We have studied the activity and composition of asymbiotic soil diazotrophs following pulse additions of artificial root exudates and single carbon sources, simulating the situation of bulk soil coming into contact with exudates from growing roots. Artificial root exudates and single sugars rapidly induced nitrogen fixation. The population of potential diazotrophs was studied using universal and group-specific nifH polymerase chain reaction (PCR) and denaturing gradient gel electrophoresis (DGGE) analysis. Reverse transcription PCR of nifH mRNA confirmed that phylotypes with an apparently increasing population size also expressed the nitrogenase system. According to our results, the actively nitrogen-fixing population represents only a fraction of the total diazotroph diversity, and the results of group-specific nifH PCR and phylogenetic analysis of cloned nifH and 16S rRNA gene fragments identified active species that belonged to the genus Azotobacter . Rapid changes of transcriptional activity over time were observed, indicating different growth and activation strategies in different Azotobacter strains. Only sugar-containing substrates were able to induce nitrogen fixation, but substrate concentration and the presence of organic acids may have additional selective effects on the active diazotroph population.
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