Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa

Lewis, David A.; Gumede, Lindy; Hoven, Louis A van der; Gita, Gloria N de; Kock, Elsabe J E de; Lange, Telsa de; Maseko, Venessa; Kekana, Valentia; Smuts, Francois P; Perovic, Olga

doi:10.7196/samj.6722

Cited by 37 publications

(57 citation statements)

References 14 publications

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“…All the isolates in this study were trimethoprim-resistant, although trimethoprim-sulfamethoxazole is no longer recommended for treatment of outpatient conditions such as urinary tract infections in South Africa and internationally because of the high prevalence of resistance [63][64][65] . Similarly, fosfomycin, used in the outpatient setting for urinary tract infections may not be efficacious since most isolates had the fosA gene, a finding only recently described in Enterobacteriaceae in South Africa 7,64,65 .…”

Section: Discussionmentioning

confidence: 88%

Pathogenomics and Evolutionary Epidemiology of Multi-Drug Resistant Clinical Klebsiella pneumoniae Isolated from Pretoria, South Africa

Mbelle

Feldman

Sekyere

et al. 2020

Sci Rep

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Antibiotic-resistant Klebsiella pneumoniae is increasingly being implicated in invasive infections worldwide with high mortalities. forty-two multidrug resistant (MDR) K. pneumoniae isolates were collected over a 4-month period. Antimicrobial susceptibility was determined using Microscan. The evolutionary epidemiology, resistome, virulome and mobilome of the isolates were characterised using whole-genome sequencing and bioinformatics analysis. All isolates contained the bla ctX-M gene, whilst 41/42(97%) contained bla teM , 36/42(86%) contained bla oXA and 35/42(83%) harboured bla SHV genes. other resistance genes found included bla Len , aac(6′)-lb-cr, qnrA, qnrB, qnrS, oqxAB, aad, aph, dfr, sul1, sul2, fosA, and cat genes. fluoroquinolone and colistin resistance-conferring mutations in parc, gyrAB, pmrAB, phopQ and kpnEF were identified. The bla Len gene, rarely described worldwide, was identified in four isolates. The isolates comprised diverse sequence types, the most common being ST152 in 7/42(17%) isolates; clone-specific O and K capsule types were identified. Diverse virulence genes that were not clone-specific were identified in all but one isolate. IncF, IncH and IncI plasmid replicons and two novel integrons were present. the bla CTX-M-15 and bla TEM-1 genes were bracketed by Tn3 transposons, ISEc9, a resolvase and IS91 insertion sequence. There were 20 gene cassettes in 14 different cassette arrays, with the dfrA and aadA gene cassettes being the most frequent. phylogenetic analysis demonstrated that the isolates were evolutionarily associated with strains from both South Africa and abroad. These findings depict the rich resistome, mobilome and virulome repertoire in clinical K. pneumoniae strains, which are mainly transmitted by clonal, multiclonal and horizontal means in South Africa.Antibiotic resistance (ABR) is a global phenomenon widely described in the literature 1,2 , and is associated with treatment failure, as well as increased morbidity and mortality 3-5 . Dissemination of resistance in bacteria, particularly among Enterobacteriaceae, is mainly due to the exchange of ABR genes (ARGs) between and within species, mediated by mobile genetic elements (MGEs) harbouring ARGs 6-8 . MGEs include plasmids, transposons and integrons that are known to transmit ABR in both Gram-positive and Gram-negative bacteria, including cephalosporin-and carbapenem-resistant Enterobacteriaceae that have been classified as critical priority pathogens by the WHO 9 . Integrons that capture cassettes i.e., single gene fragments, usually insert into transposons, enabling their movement between bacteria. Of the eight integron classes described, class 1, 2 and 3 are associated with antimicrobial resistance although class 1 is more frequently described in the literature 6,10-12 .

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Section: Discussionmentioning

confidence: 88%

Pathogenomics and Evolutionary Epidemiology of Multi-Drug Resistant Clinical Klebsiella pneumoniae Isolated from Pretoria, South Africa

Mbelle

Feldman

Sekyere

et al. 2020

Sci Rep

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“…E. coli is the most prevalent uropathogen and is responsible for approximately 80% of lower UTIs, while Staphylococcus saprophyticus, Klebsiella spp., Proteus spp., and other uropathogens are less prevalent (6)(7)(8)(9)(10)(11), according to European Centre for Disease Prevention and Control (ECDC) surveillance data from 2012 (12). E. coli more commonly causes community-acquired UTIs than nosocomial UTIs (13,14).…”

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confidence: 99%

Flow Cytometry Analysis Using Sysmex UF-1000i Classifies Uropathogens Based on Bacterial, Leukocyte, and Erythrocyte Counts in Urine Specimens among Patients with Urinary Tract Infections

Monsen

Rydén

2015

J Clin Microbiol

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c Urinary tract infections (UTIs) are the second most common bacterial infection. Urine culture is the gold standard for diagnosis, but new techniques, such as flow cytometry analysis (FCA), have been introduced. The aim of the present study was to evaluate FCA characteristics regarding bacteriuria, leukocyturia, and erythrocyturia in relation to cultured uropathogens in specimens from patients with a suspected UTI. We also wanted to evaluate whether the FCA characteristics can identify uropathogens prior to culture. From a prospective study, 1,587 consecutive urine specimens underwent FCA prior to culture during January and February 2012. Outpatients and inpatients (79.6% and 19.4%, respectively) were included, of whom women represented 67.5%. In total, 620 specimens yielded growth, of which Escherichia coli represented 65%, Enterococcus spp. 8%, Klebsiella spp. 7%, and Staphylococcus spp. 5%. For the uropathogens, the outcome of FCA was compared against the results for specimens with E. coli and those with a negative culture. E. coli had high bacterial (median, 17,914/l), leukocyte (median, 348/l), and erythrocyte (median, 23/l) counts. With the exception of Klebsiella spp., the majority of the uropathogens had considerable or significantly lower bacterial counts than that of E. coli. High leukocyte counts were found in specimens with Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, and group C streptococci. Elevated erythrocyte counts were found for P. vulgaris, P. aeruginosa, and group C streptococci, as well as for Staphylococcus saprophyticus. In essence, FCA adds new information about the bacterial, leukocyte, and erythrocyte counts in urine specimens for different uropathogens. Based on FCA characteristics, uropathogens can be classified and identified prior to culture. E. coli and Klebsiella spp. have similar FCA characteristics. U rinary tract infections (UTIs) are caused by pathogenic microorganisms in the urinary tract, causing an inflammatory response, as well as the presence of red and white blood cells in the urine. The inflammatory response and clinical manifestations depend on the etiologic organism, severity of infection, and immune status of the patient (1).UTIs are the second most common bacterial infection and are associated with high morbidity and costs. The annual incidence is estimated to be Ͼ175 million UTI episodes worldwide. In the United States, UTIs annually account for Ͼ7 million physician visits, Ͼ1 million emergency department visits, and Ͼ100,000 hospitalizations (2, 3).In outpatients, UTIs are the most frequent kind of bacterial infection, and antibiotics given for their treatment represent approximately 15% of all antibiotics prescribed to humans in the United States, with an estimated annual cost of Ͼ$1 billion (3). In addition, the indirect annual cost is estimated to be approximately $1.6 billion (4).The bacteria in urine can be classified as primary, secondary, tertiary, or doubtful uropathogens, according to their pathogenic capacity, frequency of appearan...

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“…Again, these findings are not peculiar to Namibia. 26,29 It is not clear what informs the doctors in their choice of antibiotic because, for almost all presented infections, their choice is in line with neither the recommendations as set out in the STGs nor the local/regional laboratory data. For example, Escherichia coli is the most frequent pathogen for UTI.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, a study conducted in neighbouring South Africa also reported high sensitivity of Escherichia coli to nitrofurantoin (91.7%). 26 Local laboratory data show only 68% sensitivity of E. coli to the respondents' first choice, ciprofloxacin. Similarly, the STG recommends amoxicillin as first-line treatment for respiratory tract infections with the exception of pharyngitis.…”

Section: Resultsmentioning

confidence: 99%

“…6,18,22,24 Similarly, looking at other studies we would have expected to find variations in prescribing practices based on qualifications and region of practice. 7,[20][21][22]25,26 For all listed infections, doctors treat empirically. This is consistent with literature findings which stated that fear was one of the factors influencing behaviour.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic use in Namibia: prescriber practices for common community infections

Pereko

Lubbe

Essack

2015

South African Family Practice

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Background: Despite the threat of resistance, the use of antibiotics globally is high and continues to increase. Much of this use is attributed to overprescribing by physicians. The objective of this study was to assess doctors' management of common community-acquired infections in Namibia. Methodology: A cross-sectional survey based on a web-based self-administered questionnaire was conducted. Doctors belonging to the local professional associations comprised the study population. Data were collected from March to July 2014. Results: A 10% (n = 44) response rate was achieved. Respondents were from across the country and practised mainly in the private health sector. Both awareness of local antimicrobial sensitivity rates and ownership of national Standard Treatment Guidelines were poor (20% and 31% respectively). Common practice in managing common infections, with the exception of chronic otitis media, cystitis and pyelonephritis, is to treat empirically. The reported first-line antibiotics of choice were the combination of amoxicillin with clavulanic acid for upper respiratory tract infections and ciprofloxacin for urinary tract infections. Management of infections was the same across all socio-demographic factors and was not influenced by patient workload. Conclusion: This survey revealed that first-line antibiotic choices of doctors are not informed by the Namibia Standard Treatment Guidelines and the local and regional antimicrobial sensitivity data. Interventions to improve antibiotic prescribing in Namibia should include better dissemination of guidelines and information regarding local antimicrobial sensitivity rates as well as strategies for the implementation of guidelines.

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Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa

Cited by 37 publications

References 14 publications

Pathogenomics and Evolutionary Epidemiology of Multi-Drug Resistant Clinical Klebsiella pneumoniae Isolated from Pretoria, South Africa

Pathogenomics and Evolutionary Epidemiology of Multi-Drug Resistant Clinical Klebsiella pneumoniae Isolated from Pretoria, South Africa

Flow Cytometry Analysis Using Sysmex UF-1000i Classifies Uropathogens Based on Bacterial, Leukocyte, and Erythrocyte Counts in Urine Specimens among Patients with Urinary Tract Infections

Antibiotic use in Namibia: prescriber practices for common community infections

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