Methicillin-resistant Staphylococcus aureus as a uropathogen in an Irish setting

Abstract

Urinary tract infections are one of the most common infectious diseases diagnosed in the community and in the hospital setting. Their treatment is complicated by drug-resistant pathogens and the colonization by microbes of indwelling urinary catheters. This study assessed the occurrence and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) uropathogens isolated for 5 consecutive years at University Hospital Waterford between 2010 and 2014. We created 4 clinically relevant subdivisions, based on urine source: hospital inpatients, patients from the Emergency Department, patients referred from their General Practitioner, and Nursing Home patients. We performed a retrospective review from the hospital's electronic microbiological system and calculated resistance rates for each of the standard antimicrobial agents. During the 5-year study period, we studied 151 urine isolates obtained from 128 patients who had an MRSA cultured in their urine sample. There was 100% resistance of all MRSA isolates to Flucloxacillin and Coamoxiclav. Ninety-eight percent of isolates were resistant to Ciprofloxacin. The resistance rate for Trimethoprim was 7.4% and there was only 2.7% resistance for Nitrofurantoin. For a clinical subset of patients, we also demonstrated 100% sensitivity for samples tested against Teicoplanin and Vancomycin. Urinary MRSA is an infrequently studied phenomenon, but with the rising trend of hospital superbugs nationally, its management is of critical importance. Suitable agents to address this within our population include Nitrofurantoin in the well patient requiring urinary MRSA eradication or Vancomycin/Teicoplanin in the unwell patient requiring intravenous therapy. In all groups, fluoroquinolones should be avoided due to significant resistance rates.

Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal

“…Among gram-positive bacteria, 38% of S. aureus were MRSA; 95% of were resistant to penicillin, 60% to cephalexin and 54% to cotrimoxazole. A study conducted in Ireland concluded that 27.8% of S. aureus isolated from urine samples were MRSA [40]. Recent studies have reported the increasing prevalence of multi drug resistant S. aureus especially MRSA in UTIs [40, 41].…”

“…A study conducted in Ireland concluded that 27.8% of S. aureus isolated from urine samples were MRSA [40]. Recent studies have reported the increasing prevalence of multi drug resistant S. aureus especially MRSA in UTIs [40, 41]. Among E. faecalis, 95% were resistant to amikacin, 69% to penicillin and 68% towards ofloxacin.…”

The Antibacterial Activity of Human Amniotic Membrane against Multidrug-Resistant Bacteria Associated with Urinary Tract Infections: New Insights from Normal and Cancerous Urothelial Models

“…UTIs represent more than 30% of all healthcare-associated infections [ 112 ]. Most of the UTIs are caused by the uropathogenic E. coli , although MRSA is becoming an increasingly important uropathogen in the hospital setting [ 38 , 39 , 113 ]. It is disconcerting that 22% of patients in which urine MRSA was detected, developed invasive infections with MRSA in the next 12 months, such as endocarditis, osteomyelitis, and skin and soft tissue infections [ 114 ].…”

“…Furthermore, an increasing number of bacterial strains are multidrug resistant, which further limits the impact of the available antimicrobial agents [ 33 ]. UTIs are one of the most common healthcare-associated infections and reports of multidrug-resistant bacteria causing UTIs [ 37 ], especially methicillin-resistant Staphylococcus aureus (MRSA) [ 38 , 39 , 40 ], ESBL-producing Escherichia coli [ 41 , 42 , 43 ] and Klebsiella pneumoniae [ 7 , 44 , 45 ], multidrug-resistant Acinetobacter baumannii [ 46 , 47 , 48 ], vancomycin-resistant Enterococci (VRE) [ 49 , 50 , 51 ], and Pseudomonas aeruginosa [ 46 , 52 , 53 ], are increasing. All of these bacteria were included on the list of priority pathogens for research and development of new antibiotics published by the World Health Organization (WHO) in 2017.…”

Microbiology of Catheter Associated Urinary Tract Infection

“…These are the common gram positive bacteria usually responsible for skin and soft tissue infections but rarely cause CAUTI and bacteraemia [85]. The incidence of Staphylococcal UTI as well as CAUTI is increasing and the organisms carry wide variety of multidrug-resistant genes on plasmids, which augment spread of resistance among other species [86].…”