Characteristics of urinary tract infection pathogens and their in vitro susceptibility to antimicrobial agents in China: data from a multicenter study

Abstract

ObjectiveThis study assessed the characteristics of pathogens identified in clinical isolates from patients with urinary tract infection (UTI) and their in vitro sensitivity to commonly used antibiotics in the clinical setting in China.Design and settingMulticenter study was conducted between January and December 2011 in 12 hospitals in China.ParticipantsUrine samples were collected from 356 symptomatic patients treated in the study hospitals for acute uncomplicated cystitis, recurrent UTI or complicated UTI.Primary and secondary outcome measuresMinimal inhibitory concentrations (MICs) were measured using broth microdilution according to the Clinical and Laboratory Standards Institute 2011 guidelines. Thirteen antimicrobial agents were tested: fosfomycin tromethamine, levofloxacin, moxifloxacin, cefdinir, cefixime, cefaclor, cefprozil, cefuroxime, amoxicillin/clavulanic acid, cefotaxime, azithromycin, nitrofurantoin and oxacillin. Escherichia coli isolates were screened and extended spectrum β-lactamases (ESBL) production was confirmed by a double-disk synergy test.Results198 urine samples were culture-positive and 175 isolates were included in the final analysis. E coli was detected in 50% of cultures, followed by Staphylococcus epidermidis (9%), Enterococcus faecalis (9%) and Klebsiella pneumoniae (5%). The detection rate of ESBL-producing E coli was 53%. Resistance to levofloxacin was the most common among all the isolates. Nitrofurantoin and fosfomycin tromethamine had the greatest activity against E coli; overall, 92% and 91% of isolates were susceptible to these antimicrobials. E faecalis had the highest susceptibility rates to fosfomycin tromethamine (100%).ConclusionsThe most frequently identified pathogens in our patients were ESBL-producing E coli and E faecalis. Fosfomycin tromethamine and nitrofurantoin showed a good antimicrobial activity against UTI pathogens. They may represent good options for the empiric treatment of patients with UTI.

Synergy between antibiotics and natural agents results in increased antimicrobial activity against Staphylococcus epidermidis

“…Our study showed that the majority of S. epidermidis isolates were resistant to one or more tested antibiotics, which supports earlier studies showing a high rate of resistance in S. epidermidis against quinolones and a moderate resistance rate to second-generation and third-generation cephalosporins [15]. In our study, we found gentamycin and ofloxacin to be the most effective antibiotics against our S epidermidis isolates.…”

Antibiotic Resistance Trends and The ESBL Prevalence of Escherichia coli and Klebsiella spp Urinary Isolates in In-and Outpatients in a Tertiary Care Hospital in Istanbul, 2004 - 2012

“…In both inpatients and outpatients, roughly 70% of ESBL producing E. coli were resistant to both trimethoprimsulfamethoxazole and fluoroquinolones. Several studies have been shown fluoroquinolones and trimethoprimsulfamethoxazole to be highly active against E. coli (24-28) in contrast to dramatically decreasing susceptibility rates among ESBL-producers (20,21,25,29). Fluoroquinolone resistance was reported 85% in ESBL producing E. coli isolates in a study in Nepal in 2012 (29) and in 2010 Italian study reported this rate to be even higher (85% -90%) in ESBL-producing E. coli isolates (30).…”

“…However, China (21) and Tanzania (22) have higher rates when compared to our study. The prevalence of ESBL-producing E. coli for inpatients in Switzerland is 6.6% (23), 10.4% in Saudi Arabia (8) and 52.9% in China (21). ESBL producing E. coli incidences was significantly higher in females (73.6%) than males (26.4%) at the end of study.…”

“…2017; 10(5):e13098. 5 ies (21,29,31). A study conducted in Brazil reported a higher resistance rate of 35% for nitrofurantoin in ESBL-producing E. coli (19).…”

Investigation of P Fimbriae Presence in Escherichia coli Strains Isolated from Urine Samples in Human, and Their Antibacterial Resistance

“…These rates were higher than 70% for fluoroquinolones, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. The prevalence of ESBLproducing E. coli for inpatients in Switzerland is 6.6% (21), 10.4% in Saudi Arabia (22) and 52.9% in China (23). In our study, 49.7% of the isolates were phenotypically ESBL positive.…”