What left for us for urinary tract infection treatment? An experience from the South of Iran

Mahmoudi, Ali; Moghadami, Mohsen; Shirazi, Babak; Tabari, Parinaz; Moosavi, Mahsa

What left for us for urinary tract infection treatment? An experience from the South of Iran

Document Type : Original Article

Authors

¹ Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

² The Department of Internal Medicine, Shiraz University of Medical Sciences, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

³ Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

⁴ Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: The aim of the study is to define the prevalence and antimicrobial susceptibility pattern of bacteria from cases of urinary tract infections (UTIs). Materials and Methods: A retrospective analysis of urinary pathogens and their antimicrobial susceptibility was done on urine cultures at Shiraz University Laboratory from 2015 to 2017. Antimicrobial susceptibility tests have done using the disk-diffusion technique as per the standard of CSLI. Results: During 2 years of study, 3489 samples were culture positive. Escherichia coli was the dominant isolate (84%), followed by Klebsiella spp. (10.7%) and Enterococci spp. (2,2%). The overall resistance rates to trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin were 56.1%, 47.2%, and 37%, respectively. The most frequently isolated bacteria were E. coli, which had resistance rates of 58.6%, 49.1% to TMP-STX, and cefixime, also sensitivity rates of 95.1% to nitrofurantoin (FM). Conclusions: In the study area, resistance rates to fluoroquinolones and cephalosporins were high. Because most isolates were sensitive to FM and aminoglycoside, they are suggested as appropriate antimicrobials for empirical treatment of UTIs before available urine culture results.

Keywords

References

1.	Foxman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Dis Mon 2003;49:53-70.
2.	Plate A, Kronenberg A, Risch M, Mueller Y, Di Gangi S, Rosemann T, et al. Treatment of urinary tract infections in Swiss primary care: Quality and determinants of antibiotic prescribing. BMC Fam Pract 2020;21:125.
3.	Grigoryan L, Trautner BW, Gupta K. Diagnosis and management of urinary tract infections in the outpatient setting: A review. JAMA 2014;312:1677-84.
4.	Kornfält Isberg H, Hedin K, Melander E, Mölstad S, Cronberg O, Engström S, et al. Different antibiotic regimes in men diagnosed with lower urinary tract infection – A retrospective register-based study. Scand J Prim Health Care 2020;38:291-9.
5.	Sedighi I, Solgi A, Amanati A, Alikhani MY. Choosing the correct empirical antibiotic for urinary tract infection in pediatric: Surveillance of antimicrobial susceptibility pattern of Escherichia coli by E-test method. Iran J Microbiol 2014;6:387-91.
6.	Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother 2012;56:2181-3.
7.	Linhares I, Raposo T, Rodrigues A, Almeida A. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: A ten-year surveillance study (2000-2009). BMC Infect Dis 2013;13:19.
8.	Kahlmeter G. Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study. Int J Antimicrob Agents 2003;22 Suppl 2:49-52.
9.	Prakash D, Saxena RS. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of Meerut city, India. ISRN Microbiol 2013.
10.	Naber KG, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): Implications for empiric therapy. Eur Urol 2008;54:1164-75.
11.	Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-20.
12.	Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis 2007;45:273-80.
13.	Echols RM, Tosiello RL, Haverstock DC, Tice AD. Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. Clin Infect Dis 1999;29:113-9.
14.	Aliaga L, Moreno M, Aomar I, Moya S, Ceballos Á, Giner P. Treatment of acute uncomplicated cystitis-A clinical review. Clin Med Investigations 2017;2:9
15.	Mirsoleymani SR, Salimi M, Shareghi Brojeni M, Ranjbar M, Mehtarpoor M. Bacterial pathogens and antimicrobial resistance patterns in pediatric urinary tract infections: A four-year surveillance study (2009-2012). Int J Pediatr 2014;2014:155-160
16.	Khoshbakht R, Salimi A, Shirzad Aski H, Keshavarzi H. Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Karaj, Iran. Journal of the Hellenic Veterinary Medical Society 2012;6:86-90.
17.	Mirzarazi M, Rezatofighi SE, Pourmahdi M, Mohajeri MR. Antibiotic resistance of isolated gram negative bacteria from urinary tract infections (UTIs) in Isfahan. Jundishapur J Microbiol. 2013;6 (1): 86-90
18.	Piranfar V, Mirnejad R, Erfani M. Incidence and antibiotic susceptibility pattern of most common bacterial pathogen causing urinary tract infection (UTI) in Tehran, Iran, 2012-2013. Int J Enteric Pathog 2014;2: Int J Enteric Pathog AA-SS.
19.	Nozarian Z, Abdollahi A. Microbial etiology and antimicrobial susceptibility of Bactria implicated in urinary tract infection in Tehran, Iran. Iran J Pathol 2015;10:54-60.
20.	Saffar MJ, Enayti AA, Abdolla IA, Razai MS, Saffar H. Antibacterial susceptibility of uropathogens in 3 hospitals, Sari, Islamic Republic of Iran, 2002-2003. East Mediterr Health J 2008;14:556-63.
21.	Rezaee MA, Abdinia B. Etiology and antimicrobial susceptibility pattern of pathogenic bacteria in children subjected to UTI: A referral hospital-based study in Northwest of Iran. Medicine (Baltimore) 2015;94:e1606.
22.	Pouryasin M, Shaheli M, Rahmani M, Heidarzadeh T, Sharafi H, Farvardin M. Effect of seasonal changes on the prevalence of uropathogens in 2010-2011and determination of antibiotic resistance pattern of Escherichia coli in three neighbor cities Shiraz, Marvdasht and Saadat-Shahr. Iran J Med Microb 2014;7:47-50.
23.	European Confederation of Laboratory Medicine. European urinalysis guidelines. Scand J Clin Lab Invest Suppl 2000;231:1-86.
24.	Wayne P. Performance Standards for Antimicrobial Susceptibility Testing; 20^th Informational Supplement. CLSI Document M100-S20: Clinical and Laboratory Standard Institute (CLSI); 2010.
25.	Khan MI, Xu S, Ali MM, Ali R, Kazmi A, Akhtar N, et al. Assessment of multidrug resistance in bacterial isolates from urinary tract-infected patients. J Radiat Res Appl Sci 2020;13:267-75.
26.	Ganesh R, Shrestha D, Bhattachan B, Rai G. Epidemiology of urinary tract infection and antimicrobial resistance in a pediatric hospital in Nepal. BMC Infect Dis 2019;19:420.
27.	Pezzani M, Antinori S. Introduction to urinary tract infections: An overview on epidemiology, risk factors, microbiology and treatment options. In: Imaging and Intervention in Urinary Tract Infections and Urosepsis. Springer, Cham ?; 2018. p. 7-16.
28.	Abelson B, Sun D, Que L, Nebel RA, Baker D, Popiel P, et al. Sex differences in lower urinary tract biology and physiology. Biol Sex Differ 2018;9:45.
29.	McLellan LK, Hunstad DA. Urinary tract infection: Pathogenesis and outlook. Trend Mol Med 2016;22:946-57.
30.	Kolawole AS, Kolawole OM, Kandaki-Olukemi Y, Babatunde SK, Durowade KA, Kolawole CF. Prevalence of urinary tract infections (UTI) among patients attending Dalhatu Araf Specialist Hospital, Lafia, Nasarawa state, Nigeria. Int J Med Med Sci 2009;1:163-7.
31.	Tavakol M, Momtaz H. Determination of antibiotic resistance profile in Klebsiella pneumonia strains isolated from urinary tract infections of patients hospitalized in Peyambaran hospital (Tehran-Iran). Feyz J Kashan Univ Med Sci 2017;21:74-82.
32.	Bours PH, Polak R, Hoepelman AI, Delgado E, Jarquin A, Matute AJ. Increasing resistance in community-acquired urinary tract infections in Latin America, five years after the implementation of national therapeutic guidelines. Int J Infect Dis 2010;14:e770-4.
33.	Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Curr Opin Infect Dis 2016;29:73-9.
34.	Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis 2009;13:140-4.
35.	Tabar MM, Mirkalantari S, Amoli RI. Detection of ctx-M gene in ESBL-producing E. coli strains isolated from urinary tract infection in Semnan, Iran. Electron Physician 2016;8:2686-90.
36.	Ghanavati R, Ohadi E, Kazemian H, Yazdani F, Torki A, Kalani BS, et al. Evaluation of fosfomycin activity against extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae isolated from three centers of Tehran, Iran. Recent Pat Antiinfect Drug Discov 2018;13:180-6.
37.	Mohsenpour B, Abaszade A, Afrasiabian S, Hajibagheri K, Barari M, Roshani D, et al. Risk factors, and antibiotic resistance pattern of Escherichia coli with extended-spectrum β-lactamase enzyme in west of Iran. J Med Physiol 2019;4:7.
38.	Lob SH, Nicolle LE, Hoban DJ, Kazmierczak KM, Badal RE, Sahm DF. Susceptibility patterns and ESBL rates of Escherichia coli from urinary tract infections in Canada and the United States, SMART 2010-2014. Diagn Microbiol Infect Dis 2016;85:459-65.
39.	Pietsch M, Eller C, Wendt C, Holfelder M, Falgenhauer L, Fruth A, et al. Molecular characterisation of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolates from hospital and ambulatory patients in Germany. Vet Microbiol 2017;200:130-7.
40.	Treviño M, Losada I, Fernández-Pérez B, Coira A, Peña-Rodríguez MF, Hervada X, et al. Surveillance of antimicrobial susceptibility of Escherichia coli producing urinary tract infections in Galicia (Spain). Rev Esp Quimioter 2016;29:86-90.
41.	Odongo I, Ssemambo R, Kungu JM. Prevalence of Escherichia coli and its antimicrobial susceptibility profiles among patients with UTI at Mulago Hospital, Kampala, Uganda. Interdiscip Perspect Infect Dis 2020;2020:8042540.
42.	Ghanbari F, Khademi F, Saberianpour S, Shahin M, Ghanbari N, Naderi K, et al. An epidemiological study on the prevalence and antibiotic resistance patterns of bacteria isolated from urinary tract infections in central Iran. Avicenna J Clin Microbiol Infect 2017;4, 42214-42214.
43.	Habibi Asl B, Asghari R, Ahangarzadeh Rezaee M, Mohammad Zadeh A, Abri R. Evaluation of etiologic agents and antimicrobial resistance pattern of urinary tract infections in the northwest of Iran. Journal of Research in Clinical Medicine, 2018;6:7-12.
44.	Chardavoyne PC, Kasmire KE. Appropriateness of antibiotic prescriptions for urinary tract infections. West J Emerg Med 2020;21:633-9.

Advanced Biomedical Research