Antimicrobial Resistance Patterns Amid Community-Acquired Uropathogens in Outpatient Settings of a Tertiary Care Hospital in Thailand

Sangsuwan, Tharntip; Jariyasoonthornkit, Khongkrit; Jamulitrat, Silom

doi:10.33192/smj.2021.65

Cited by 2 publications

(2 citation statements)

References 40 publications

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“…High resistance rates were observed for ampicillin, ciprofloxacin, and cotrimoxazole (32.7–67.0%), while resistance to third-generation cephalosporins (cefotaxime, ceftriaxone) and levofloxacin remained <20%. Compared with previous studies on CA-UTIs caused by Enterobacterales in central Thailand, our study shows that rates of resistance to cotrimoxazole, third-generation cephalosporins, and ciprofloxacin were lower, 32.7% vs. ~41–60%, ~14% vs. ~20–22% and 34.0% vs. 42–49%, respectively [ 4 , 17 ].…”

Section: Discussioncontrasting

confidence: 85%

“…Kidney disease was identified as an associated risk factor for CA-UTIs caused by ESBL-producing bacteria in children, while in adult patients, previous UTIs with ESBL-producing E. coli and prior use of antibiotics (cephalosporin and penicillin) were identified as independent risk factors. Furthermore, appropriate antibiotic therapy was delayed for patients with CA-UTIs due to ESBL-producing bacteria [ 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Community-Acquired Urinary Tract Infections Caused by Multidrug-Resistant Enterobacterales in Thailand

et al. 2022

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The dissemination of multidrug-resistant Enterobacterales (MDRE) in community settings is becoming a great concern. This study aimed to assess the incidence and risk factors associated with community-acquired urinary tract infections (CA-UTIs) caused by MDRE. A prospective case–control study was undertaken among patients with UTIs visiting an outpatient department in Phitsanulok Province, Thailand. Urine samples were collected and screened to include only patients with Enterobacterales infections. Risk factors were analyzed by multivariate logistic regression analysis. Of the 284 patients with CA-UTIs, 25.7% (n = 73) and 74.3% (n = 211) were positive for MDRE (case) and non-MDRE (control), respectively. Being a farmer was identified as an independent risk factor for MDRE-associated CA-UTIs (adjusted odds ratio = 3.101; 95% confidence interval = 1.272–7.564; p = 0.013). A total of 309 Enterobacterales isolates were recovered, and Escherichia coli was the most frequently detected (86.4%). The highest resistance rate was observed for ampicillin (67.0%), followed by ciprofloxacin (34.0%) and cotrimoxazole (32.7%), while resistance to third-generation cephalosporins (cefotaxime, ceftriaxone) and levofloxacin remained <20%. Resistance to ampicillin–gentamicin–cotrimoxazole was the most common pattern among MDRE isolates. Interestingly, we detected a colistin-resistant Enterobacter cloacae harboring mcr-9 (colistin MIC = 16 µg/mL). mcr-9 was transferable at high frequency (4.5 × 10−4) and resided on IncF plasmid. This study demonstrates that being a farmer is a risk factor for MDRE-associated CA-UTIs. Interestingly, this is the first report to identify mcr-9-positive E. cloacae from a Thai patient in the community.

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Section: Discussioncontrasting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Community-Acquired Urinary Tract Infections Caused by Multidrug-Resistant Enterobacterales in Thailand

et al. 2022

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Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke

Jitpratoom¹,

Boonyasiri

2023

BMC Neurol

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Background Stroke is a major cause of morbidity and mortality worldwide. Urinary tract infection (UTI) is a common post-acute ischemic stroke (AIS) complication. We assessed the incidence, determinant factors, infection characteristics, post-stroke complications, and outcomes of hospitalized AIS patients with UTI. Methods This retrospective cohort study included AIS patients admitted within 7 days of stroke onset. The patients were divided into the UTI group and the non-UTI (control) group. Clinical data were collected and compared between the groups. Results There were 342 AIS patients (31 with UTIs and 311 controls). The multivariate analysis showed that an initial National Institutes of Health Stroke Scale (NIHSS) score of ≥ 15 (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.33–18.72) and Foley catheter retention (OR 14.10, 95% CI 3.25–61.28) were risk factors for UTI, whereas smoking (OR 0.08, 95% CI 0.01–0.50), an initial systolic blood pressure (SBP) of > 120 mmHg (OR 0.06, 95% CI 0.01–0.31), and statin use (OR 0.02, 95% CI 0.0006–0.42) were protective factors. Twenty cases (64.5%) were community-acquired and 11 cases (35.3%) were hospital-acquired. Ten patients (32.3%) had catheter-associated UTIs. The most common pathogen was Escherichia coli (13 patients, 41.9%). Post-stroke complications were significantly more common in the UTI group, including pneumonia, respiratory failure, sepsis, brain edema, seizure, symptomatic hemorrhagic transformation, congestive heart failure, atrial fibrillation with a rapid ventricular response, acute kidney injury, and hyponatremia. The median length of stay (LOS) in the UTI group was 12 days versus 3 days in the control group (p < 0.001). The median 3-month modified Rankin Scale score was higher (5 in UTI and 2 in control; p < 0.001) and the median 3-month Barthel Index was lower (0 in UTI and 100 in control; p < 0.001) in the UTI group than in the control group. Conclusions The risk factors for post-AIS UTI included severe stroke (NIHSS score ≥ 15) and urethral catheter indwelling. An initial SBP of > 120 mmHg and statin use were protective factors. The UTI group had significantly worse post-stroke complications, a longer LOS, and worse 3-month outcomes. Smoking was protective, which requires further investigation.

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Antimicrobial Resistance Patterns Amid Community-Acquired Uropathogens in Outpatient Settings of a Tertiary Care Hospital in Thailand

Cited by 2 publications

References 40 publications

Risk Factors for Community-Acquired Urinary Tract Infections Caused by Multidrug-Resistant Enterobacterales in Thailand

Risk Factors for Community-Acquired Urinary Tract Infections Caused by Multidrug-Resistant Enterobacterales in Thailand

Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke

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