Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines?

Background: Antibiotic resistance of urinary tract pathogens has increased worldwide. Knowledge of the antibiotic resistance patterns of uropathogens in specific geographical locations is an important factor for choosing an appropriate empirical antimicrobial treatment. The aim of this study was to provide information regarding local resistance patterns of urinary pathogens to the commonly used antibiotics in Tehran, Iran. Methodology: Urine samples collected and submitted to two pathobiology laboratories in Tehran were identified by conventional methods over a period of three years (December 2006 to May 2009). Antimicrobial resistance testing was performed by the standard disk diffusion technique in accordance with the recommendations of the Clinical and Laboratory Standards Institute. Results: Of the total 13,333 mid-stream urine samples collected from suspected cases of urinary tract infection, 840 (6.3%) were positive for pathogenic bacteria. Escherichia coli (E. coli) was the most common isolate (68.8%) followed by Proteus spp. (12.4%), and Klebsiella spp. (9.6%). E. coli isolates were mostly susceptible to nitrofurantoin (71.3%), followed by ciprofloxacin (68.1%); however, only 38.2% of E. coli isolates were susceptible to trimethoprim-sulfamethoxazole. Conclusion: Nitrofurantoin may be considered as a first-line empiric antibacterial agent for urinary tract infections in outpatients in Tehran, Iran.

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“…The proportion of bacterial species isolated was similar to those described in several previous studies [12,13,15,16]. Proteus spp.…”

Section: Discussionsupporting

confidence: 88%

Antimicrobial susceptibility patterns of community-acquired uropathogens in Tehran, Iran

Kashef

Djavid

Shahbazi

2010

J Infect Dev Ctries

116

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“…Escherichia coli has been reported as the most common cause of urinary tract infections 10,[36][37] . The overall incidence of antibiotic resistant of Escherichia coli in this study was high.…”

Section: Discussionmentioning

confidence: 99%

Resistant plasmid profile analysis of multidrug resistant <i>Escherichia coli</i> isolated from urinary tract infections in Abeokuta, Nigeria

Akingbade¹,

Balogun²,

Ojo³

et al. 2015

Afr H. Sci.

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Background: Multi-drug resistant Escherichia coli has become a major threat and cause of many urinary tract infections (UTIs) in Abeokuta, Nigeria. Objectives: This study was carried out to determine the resistant plasmids of multidrug resistant Escherichia coli isolated from (Urinary tract infections)UTIs in Abeokuta. Methods: A total of 120 Escherichia coli isolates were obtained from urine samples collected from patients attending inpatient and outpatient clinics presenting UTI; with their biodata. Antibiotics susceptibility was performed and multi-drug resistant isolates were selected for plasmid profiling. Plasmids were extracted by the alkaline lysis method, electrophoresed on 0.8% agarose gel and profiled using a gel-photo documentation system gel. Results: Escherichia coli isolates obtained shows high resistance to cloxacillin (92.5%), amoxicillin (90.8%), ampicillin (90.8%), erythromycin (75.8%), cotrimoxazole (70.0%), streptomycin (70.0%) and tetracycline (68.3%) while 85.8% and 84.2% were susceptible to gentamycin and ceftazidime respectively. Sixteen Escherichia coli strains were observed to be resistant to more than two classes of antibiotics. The resistant plasmid DNA was detectable in 6(37.5%) of the 16 multidrug resistant Escherichia coli having single sized plasmids of the same weight 854bp and were all resistant to erythromycin, cefuroxime, cloxacillin, amoxicillin, ampicillin and cotrimoxazole. Conclusion: This study has highlighted the emergence of multidrug resistant R-plasmids among Escherichia coli causing urinary tract infections in Abeokuta, Nigeria. There is a high level of resistance to many antimicrobials that are frequently used in Abeokuta, Nigeria.

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“…Resistance to fluoroquinolone has become an increasing problem and now has the highest resistance rates in Latin American countries (Andrade et al, 2006;Sader et al, 2001), and is associated with mutations in the quinolone resistance-determining regions (QRDRs), especially the genes encoding DNA gyrase (gyrA) and topoisomerase IV (parC) (Higgins et al, 2003;Lee et al, 2005;Mouneimné et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

“…In Brazil this problem is hih5ghly significant and some studies show a very high density of antibiotic use, especially of carbapenems and fluoroquinolones (Moreira et al, 2013;Porto et al, 2013). The resistance of P. aeruginosa to carbapenems is higher than 60 % in some Brazilian hospitals (Baumgart et al, 2010;Sader et al, 2005) and the production of metallo-b-lactamase (MBL) encoded by several genes, including bla SPM-1 , bla VIM and bla IMP , is considered the main mechanism of resistance to these antibiotics (Sader et al, 2005).Resistance to fluoroquinolone has become an increasing problem and now has the highest resistance rates in Latin American countries (Andrade et al, 2006;Sader et al, 2001), and is associated with mutations in the quinolone resistance-determining regions (QRDRs), especially the genes encoding DNA gyrase (gyrA) and topoisomerase IV (parC) (Higgins et al, 2003;Lee et al, 2005;Mouneimné et al, 1999).Recent studies have shown that a large number of genes expressed by P. aeruginosa clinical strains are implicated directly in the pathogenesis of severe infections caused by this micro-organism (Aldred et al, 2014;Bleves et al, 2010; Golovkine et al, 2014). Among these is the type III secretion system (TTSS), which delivers effector toxins (ExoS, ExoT, ExoY and ExoU) directly into host cells (Galán & Collmer, 1999;Hauser, 2009).…”

mentioning

confidence: 99%

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

Ferreira

Dantas

Faria

et al. 2015

Journal of Medical Microbiology

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This study evaluated the predictors of mortality and the impact of inappropriate therapy on the outcomes of patients with bacteraemia and ventilator-associated pneumonia (VAP). Additionally, we evaluated the correlation of the type III secretion system (TTSS) effector genotype with resistance to carbapenems and fluoroquinolones, mutations in the quinolone resistancedetermining regions (QRDRs), metallo-b-lactamase and virulence factors. A retrospective cohort was conducted at a tertiary hospital in patients with multidrug-resistant (MDR) P. aeruginosa bacteraemia (157 patients) and VAP (60 patients). The genes for bla IMP , bla VIM , bla SIM , bla GIM and bla SPM and virulence genes (exoT, exoS, exoY, exoU, lasB, algD and toxA) were detected; sequencing was conducted for QRDR genes on fluoroquinolone-resistant strains. The multivariate analyses showed that the predictors independently associated with death in patients with bacteraemia were cancer and inappropriate therapy. Carbapenem resistance was more frequent among strains causing VAP (53.3 %), and in blood we observed the bla SPM genotype (66.6 %) and bla VIM genotype (33.3 %). The exoS gene was found in all isolates, whilst the frequency was low for exoU (9.4 %). Substitution of threonine to isoleucine at position 83 in gyrA was the most frequent mutation among fluoroquinolone-resistant strains. Our study showed a mutation at position 91 in the parC gene (Glu91Lys) associated with a mutation in gyrA (Thre83Ile) in a strain of extensively drug-resistant P. aeruginosa, with the exoT + exoS + exoU + genotype, that has not yet been described in Brazil to the best of our knowledge. This comprehensive analysis of resistance mechanisms to carbapenem and fluoroquinolones and their association with TTSS virulence genes, covering MDR P. aeruginosa in Brazil, is the largest reported to date. INTRODUCTIONSevere infections such as bloodstream infection and ventilator-associated pneumonia (VAP) due to multidrugresistant (MDR) Pseudomonas aeruginosa result in greater morbidity and mortality, longer hospitalization and higher cost than infections caused by susceptible bacteria (Morales et al., 2012; Suárez et al., 2010;Voor In't Holt et al., 2014), and aspects related to epidemiology and the outcome of patients with these infections may change, resulting in high rates of resistance and as consequence difficulties in treatment (Kang et al., 2005; Lodise et al., 2007).Today, the emergence of MDR P. aeruginosa is a global problem (Sader et al., 2001; Van der Bij et al., 2011, resulting in the ability of this pathogen to develop resistance to almost all available antibiotics, either by selection of mutations in chromosomal genes or from horizontal gene transfer (Breidenstein et al., 2011). In Brazil this problem is hih5ghly significant and some studies show a very high density of antibiotic use, especially of carbapenems and fluoroquinolones (Moreira et al., 2013;Porto et al., 2013). The resistance of P. aeruginosa to carbapenems is higher than 60 % in some Brazilian hospitals ...

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Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines?

Abstract: Emerging resistance phenotypes and antimicrobial resistance rates among pathogens recovered from community-acquired urinary tract infections (CA-UTI) is an increasing problem in specific regions

Cited by 83 publications

References 29 publications

Antimicrobial susceptibility patterns of community-acquired uropathogens in Tehran, Iran

Antimicrobial susceptibility patterns of community-acquired uropathogens in Tehran, Iran

Resistant plasmid profile analysis of multidrug resistant <i>Escherichia coli</i> isolated from urinary tract infections in Abeokuta, Nigeria

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

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