Iranian Journal of Pathology

Activity Assessment of Antibiotics Used Against Different Bacterial Etiological Agents of UTI in Najaf, Iraq

Document Type : Original Research

Author

Mohammed Al-Shamarti

Department of Pathological Analysis, Faculty of Science, University of Kufa, Najaf, Iraq

https://doi.org/10.30699/ijp.2024.2027209.3293
Abstract
Background & Objective: Antibiotic resistance in urinary tract infection (UTI) is increasing nowadays, therefore, the aim of this study was to evaluate the resistance patterns of many pathogens toward several antibiotics that are in common use in our hospitals.
Methods: Subculture and identification of pathogenic bacteria were performed on 1148 hospitals' bacterial primary cultures which were considered positive for UTI. An antibiotic sensitivity test was performed by using the disc diffusion method. The rates of resistance were statistically analyzed and correlated with the types of antibiotics and bacteria.
Results: It was found that 1148 out of 2087 urine samples were UTI positive, the majority of cases (76%) were from females (P<0.0001). Escherichia coli and Klebsiella were the most isolated Gram-negative bacteria, while Staphylococcus spp. was the most isolated Gram-positive pathogen. E. coli showed the highest resistance rate among all bacteria, while Streptococcus spp. was the most sensitive. The highest resistance was noticed to be against gentamicin and ampicillin, while the most effective drugs were imipenem and amikacin. There was a significant difference in resistance rates among the different bacterial categories (P<0.0001), while no significant difference was noticed in resistance rates among antibiotics categories (P>0.05).
Conclusion: Elevated rates of antibiotic resistance were noticed in this study in UTI-causing bacteria; therefore, it is highly important at least to every general hospital to investigate the antibiotic resistance rates occasionally to determine the proper antimicrobial treatment as well as re-evaluate antibiotics which were considered as empirical.

Keywords

Antibiotic resistance
urinary tract infection
pathogenic bacteria

Subjects

  1. Al-Badr A, Al-Shaikh G. Recurrent urinary tract infections management in women: a review. Sultan Qaboos University Med J. 2013;13(3):359. [DOI:10.1001/jama.2014.303] [PMID]
  2. Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014;311(8): 844-54.
  3. Zone, C. and S. Guide, Antimicrobial resistance and urinary tract infections in the community. Signs. 2017. 6:3531-93.
  4. Singh V, Jaryal M, Gupta J, Kumar P. Antibacterial activity of medicinal plants against extended spectrum beta-lactamase producing bacteria causing urinary tract infection. Int J Drug Res Tech. 2012;2:263-7.
  5. Stamm, W.E. and S.R. Norrby, Urinary tract infections: disease panorama and challenges. J Infect Dis. 2001. 183(Supplement_1):S1-S4. [DOI:10.1086/318850] [PMID]
  6. Gupta, K., T.M. Hooton, and W.E. Stamm, Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med. 2001. 135(1):41-50. [DOI:10.7326/0003-4819-135-1-200107030-00012] [PMID]
  7. Gottlieb, T. and G.R. Nimmo, Antibiotic resistance is an emerging threat to public health: an urgent call to action at the Antimicrobial Resistance Summit 2011. Med J Aust. 2011. 194(6):281-3. [DOI:10.5694/j.1326-5377.2011.tb02973.x] [PMID]
  8. Sadeghabadi AF, Ajami A, Fadaei R, Zandieh M, Heidari E, Sadeghi M, et al. Widespread antibiotic resistance of diarrheagenic Escherichia coli and Shigella species. J Res Med Sci Official J Isfahan Univ Med Sci. 2014 Mar;19(Suppl 1):S51.
  9. Organization, W.H., Antimicrobial resistance. 2022: World Health Organization.

 

  1. Mera RM, Miller LA, Daniels JJ, Weil JG, White AR. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States over a 10-year period: Alexander Project. Diagn Microbiol Infect Dis. 2005;51(3):195-200. [DOI:10.1016/j.diagmicrobio.2004.10.009] [PMID]
  2. Frère, J.-M. and S. Rigali. The alarming increase in antibiotic-resistant bacteria. Drug Target Rev. 2016. 3:26-30.
  3. Vogtländer NP, Van Kasteren ME, Natsch S, Kullberg BJ, Hekster YA, Van Der Meer JW. Improving the process of antibiotic therapy in daily practice: interventions to optimize timing, dosage adjustment to renal function, and switch therapy. Arch Intern Med. 2004;164(11):1206-12. [DOI:10.1001/archinte.164.11.1206] [PMID]
  4. Soleymani F, Rashidian A, Dinarvand R, Kebriaeezade A, Hosseini M, Abdollahi M. Assessing the effectiveness and cost-effectiveness of audit and feedback on physician’s prescribing indicators: study protocol of a randomized controlled trial with economic evaluation. DARU J Pharm Sci. 2012. 20:1-7. [DOI:10.1186/2008-2231-20-88] [PMID]
  5. Raveh D, Levy Y, Schlesinger Y, Greenberg A, Rudensky B, Yinnon AM. Longitudinal surveillance of antibiotic use in the hospital. QJM. 2001;94(3):141-52. [DOI:10.1093/qjmed/94.3.141] [PMID]
  6. Roberts KB, Downs SM, Finnell SM, Hellerstein S, Shortliffe LD, Wald ER, et al. Reaffirmation of AAP clinical practice guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2–24 months of age. Pediatrics. 2016 Dec 1;138(6). [DOI:10.1542/peds.2016-3026] [PMID]
  7. Ammenti A, Alberici I, Brugnara M, Chimenz R, Guarino S, La Manna A, et al. Updated Italian recommendations for the diagnosis, treatment and follow‐up of the first febrile urinary tract infection in young children. Acta Paediatr. 2020 Feb;109(2):236-47. [DOI:10.1111/apa.14988] [PMID]
  8. Cowan, S.T., Cowan and Steel's manual for the identification of medical bacteria. 1993: Cambridge university press.
  9. Wikler, M.A., Performance standards for antimicrobial susceptibility testing: Seventeenth informational supplement. 2007: Clinical and Laboratory Standards Institute.
  10. Paterson DL, Hujer KM, Hujer AM, Yeiser B, Bonomo MD, Rice LB, et al. Extended-spectrum β-lactamases in Klebsiella pneumoniae bloodstream isolates from seven countries: dominance and widespread prevalence of SHV-and CTX-M-type β-lactamases. Antimicrob Agents Chemother. 2003;47(11):3554-60. [DOI:10.1128/AAC.47.11.3554-3560.2003] [PMID]
  11. KÖMÜRLÜOĞLU A, AYKAÇ K, ÖZSÜREKÇİ Y, TANIR BAŞARANOĞLU S, BIÇAKÇIGİL A, LİSTE Ü, et al. Gram Negatif İdrar Yolu Enfeksiyonu Etkenlerinin Antibiyotik Direnç Dağılımı: Tek Merkez Deneyimi. J Pediatr Dis. 2018;12(1). [DOI:10.12956/tjpd.2017.279]
  12. Cag Y, Haciseyitoglu D, Ozdemir AA, Cag Y. Antibiotic resistance and bacteria in urinary tract infections in pediatric patients. Medeniyet Med J. 2021;36(3):217. [DOI:10.5222/MMJ.2021.78535]
  13. Mihankhah A, Khoshbakht R, Raeisi M, Raeisi V. Prevalence and antibiotic resistance pattern of bacteria isolated from urinary tract infections in Northern Iran. J Res Med sci. 2017;22(1):108. [DOI:10.4103/jrms.JRMS_889_16] [PMID] 
  14. Cristea OM, Avrămescu CS, Bălășoiu M, Popescu FD, Popescu F, Amzoiu MO. Urinary tract infection with Klebsiella pneumoniae in Patients with Chronic Kidney Disease. Current health sciences journal. 2017 Apr;43(2):137.
  15. Khoshbakht R, Salimi A, SHIRZAD AH, Keshavarzi H. Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Karaj, Iran. Jundishapur J Microbiol. 2012;6(1):86-90. [DOI:10.5812/jjm.4830]
  16. Rajabi Z, Dallal MM. Study on bacterial strains causing blood and urinary tract infections in the neonatal intensive care unit and determination of their antibiotic resistance pattern. Jundishapur J Microbiol. 2015 Aug;8(8). [DOI:10.5812/jjm.19654v2]
  17. Czajkowski K, Broś-Konopielko M, Teliga-Czajkowska J. Urinary tract infection in women. Menopause Rev. 2021;20(1):40-7. [DOI:10.5114/pm.2021.105382] [PMID] 
  18. Dielubanza EJ, Schaeffer AJ. Urinary tract infections in women. Med Clin. 2011;95(1):27-41. [DOI:10.1016/j.mcna.2010.08.023] [PMID]
  19. Merga Duffa Y, Terfa Kitila K, Mamuye Gebretsadik D, Bitew A. Prevalence and antimicrobial susceptibility of bacterial uropathogens isolated from pediatric patients at yekatit 12 hospital medical college, Addis Ababa, Ethiopia. Int J Microbiol. 2018;2018(1):8492309. [DOI:10.1155/2018/8492309] [PMID]
  20. Eremenko R, Barmatz S, Lumelsky N, Colodner R, Strauss M, Alkan Y. Urinary Tract Infection in Outpatient Children and Adolescents: Risk Analysis of Antimicrobial Resistance. Israel Med Assoc J. 2020;22(4):236-40.
  21. Kashef N, Djavid GE, Shahbazi S. Antimicrobial susceptibility patterns of community-acquired uropathogens in Tehran, Iran. J Infect Dev Countries. 2010;4(04):202-6. [DOI:10.3855/jidc.540] [PMID]
  22. Wilson AP, Livermore DM, Otter JA, Warren RE, Jenks P, Enoch DA, Newsholme W, Oppenheim B, Leanord A, McNulty C, Tanner G. Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party. J Hosp Infect. 2016 Jan 4;92:S1-44. [DOI:10.1016/j.jhin.2015.08.007] [PMID]
  23. Moradi J, Hashemi FB, Bahador A. Antibiotic resistance of Acinetobacter baumannii in Iran: a systemic review of the published literature. Osong Public Health Res Perspect. 2015;6(2):79-86. [DOI:10.1016/j.phrp.2014.12.006] [PMID]
  24. Bayrak, E. and M.G. Gözel, Defining the Risk Factors for the Evolution of Pan-Drug Resistance (PDR) Acinetobacter baumanni Infections in Intensive Care Units. Çukurova Anestezi ve Cerrahi Bilimler Dergisi. 2023; 6(3):416-20. [DOI:10.36516/jocass.1359576]
  25. Frère JM. Beta‐lactamases and bacterial resistance to antibiotics. Molecul Microbiol. 1995 May;16(3):385-95. [DOI:10.1111/j.1365-2958.1995.tb02404.x] [PMID]
  26. Cantón R, Novais A, Valverde A, Machado E, Peixe L, Baquero F, Coque TM. Prevalence and spread of extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in Europe. Clin Microbiol Infect. 2008 Jan;14:144-53. [DOI:10.1111/j.1469-0691.2007.01850.x] [PMID]
  27. Martinez, P., D. Garzón, and S. Mattar, CTX-M-producing Escherichia coli and Klebsiella pneumoniae isolated from community-acquired urinary tract infections in Valledupar, Colombia. The Brazilian Journal of Infectious Diseases, 2012. 16(5): p. 420-425. [DOI:10.1016/j.bjid.2012.05.001] [PMID]
  28. Abdi S, Ranjbar R, Vala MH, Jonaidi N, Bejestany OB, Bejestany FB. Frequency of bla TEM, bla SHV, bla CTX-M, and qnrA among Escherichia coli isolated from urinary tract infection. Arch Clin Infect Dis. 2014;9(1). [DOI:10.5812/archcid.18690]
  29. Parajuli NP, Maharjan P, Joshi G, Khanal PR. Emerging Perils of Extended Spectrum β‐Lactamase Producing Enterobacteriaceae Clinical Isolates in a Teaching Hospital of Nepal. BioMed Res Int. 2016;2016(1): 1782835. [DOI:10.1155/2016/1782835] [PMID]
  30. Nayaju T, Upreti MK, Ghimire A, Shrestha B, Maharjan B, Joshi RD, Lekhak B, Shrestha UT. Higher prevalence of extended Spectrum β-lactamase producing Uropathogenic Escherichia coli among patients with diabetes from a tertiary Care Hospital of Kathmandu, Nepal. Am J Trop Med Hyg. 2021 Nov;105(5):1347. [DOI:10.4269/ajtmh.21-0691] [PMID]
  31. Thapa Shrestha U, Shrestha S, Adhikari N, Rijal KR, Shrestha B, Adhikari B, Banjara MR, Ghimire P. Plasmid profiling and occurrence of β-lactamase enzymes in multidrug-resistant uropathogenic Escherichia coli in Kathmandu, Nepal. Infect Drug Resist. 2020:1905-17. [DOI:10.2147/IDR.S250591] [PMID]
Iranian Journal of Pathology
Volume 19, Issue 3
Summer 2024
Pages 348-354

  • Receive Date 12 April 2024
  • Revise Date 28 July 2024
  • Accept Date 01 August 2024

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