Optimizing antimicrobial therapy in urinary tract infections: A focus on urine culture and sensitivity testing

Alkhawaldeh, Rama; Farha, Rana Abu; Hammour, Khawla Abu; Alefishat, Eman

doi:10.3389/fphar.2022.1058669

Cited by 10 publications

(7 citation statements)

References 38 publications

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“…Over the past 70 years, the successive discoveries of numerous antibiotics and the subsequent increase in antibiotic resistance have set the antimicrobial era apart. Antimicrobial resistance (AMR), which is linked to higher rates of morbidity and mortality, is largely influenced by the abuse of antibiotics [1][2][3]. AMR is particularly alarming in low-to middle-income countries, like Jordan, because of the recent growth in inappropriate use of licensed antimicrobial medicines [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The prevalence of Carbapenem Resistance Gram negative pathogens in a Tertiary Teaching Hospital in Jordan

Hammour,

Abu-Farha,

Itani

et al. 2023

BMC Infect Dis

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Background With the absence of new antimicrobial drugs being developed to replace those facing resistance, bacterial resistance continues to grow. Despite previous studies conducted in various countries, there is a lack of comprehensive local reporting on the occurrence of carbapenem resistance among gram-negative bacteria. Objective This study aims to identify the prevalence of carbapenem-resistant gram-negative bacterial isolates. Method A retrospective cross-sectional study was conducted at an academic hospital in Jordan over an eight-month period, spanning from November 2021 to June 2022. The study involved screening electronic medical records to identify patients with clinical cultures showing the growth of Gram-negative bacteria. Antimicrobial susceptibility results of the Gram-negative isolates were recorded. Results A total of 1,043 isolated Gram-negative bacteria were analyzed for carbapenem susceptibility. Among the species tested, the most common carbapenem-resistant bacteria were Acinetobacter baumannii (153/164, 93.3%), followed by Klebsiella pneumonia (184/311, 59.2%), and Pseudomonas aeruginosa (67/160, 41.9%). The least commonly isolated species resistant to carbapenem were Escherichia coli (25/361, 6.9%) and Proteus mirabilis (1/30, 3.3%). None of Serratia marcescens or Proteus vulgaris isolates were resistant to carbapenem (0%). Overall, the prevalence of carbapenem-resistance gram-negative isolates was 41.2% (430 out of 1,043). Conclusion This study provides population-specific data that are crucial for guiding empirical antimicrobial treatment decisions not only within the participating hospital but also in other nearby healthcare facilities. The results underscore the urgent need for coordinated efforts to address antibiotic resistance in Jordan. Comprehensive measures such as strict infection control methods, annual nationwide surveillance programs, and effective antimicrobial stewardship programs at the national level are imperative to reduce the overuse of broad-spectrum antibiotics.

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Section: Introductionmentioning

confidence: 99%

The prevalence of Carbapenem Resistance Gram negative pathogens in a Tertiary Teaching Hospital in Jordan

Hammour,

Abu-Farha,

Itani

et al. 2023

BMC Infect Dis

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“…Liquid-based laboratories, such as urine analyses with microscopy and culturing, represent the standard for the initial diagnosis of UTI to suspect pathologies of the urinary system and to specify indications for an instrumental approach [ 6 •, 7 ]. Currently, it is well known that UTI-associated urine changes could be present in non-infection urinary tract pathologies, leading to decreased urine microscopy accuracy [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Smart Diagnosis of Urinary Tract Infections: is Artificial Intelligence the Fast-Lane Solution?

Naik,

Talyshinskii,

Shetty

et al. 2023

Curr Urol Rep

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Purpose of Review Artificial intelligence (AI) can significantly improve physicians’ workflow when examining patients with UTI. However, most contemporary reviews are focused on examining the usage of AI with a restricted quantity of data, analyzing only a subset of AI algorithms, or performing narrative work without analyzing all dedicated studies. Given the preceding, the goal of this work was to conduct a mini-review to determine the current state of AI-based systems as a support in UTI diagnosis. Recent Findings There are sufficient publications to comprehend the potential applications of artificial intelligence in the diagnosis of UTIs. Existing research in this field, in general, publishes performance metrics that are exemplary. However, upon closer inspection, many of the available publications are burdened with flaws associated with the improper use of artificial intelligence, such as the use of a small number of samples, their lack of heterogeneity, and the absence of external validation. AI-based models cannot be classified as full-fledged physician assistants in diagnosing UTIs due to the fact that these limitations and flaws represent only a portion of all potential obstacles. Instead, such studies should be evaluated as exploratory, with a focus on the importance of future work that complies with all rules governing the use of AI. Summary AI algorithms have demonstrated their potential for UTI diagnosis. However, further studies utilizing large, heterogeneous, prospectively collected datasets, as well as external validations, are required to define the actual clinical workflow value of artificial intelligence.

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“… 6 Extensive use of antibiotics in the past has enhanced the survival of resistant strains. 7 In Nepal, around 13%–37% of Nepalese adults were estimated to attend and seek hospital services for UTIs. 8 – 10 In many cases, microorganism has developed resistance to first-line antibiotics and shows the necessity for second-line antibiotics, which is broad-spectrum, have a less favorable risk-benefit profile, are more expensive, and may be locally unavailable.…”

Section: Introductionmentioning

confidence: 99%

“… 7 In Nepal, around 13%–37% of Nepalese adults were estimated to attend and seek hospital services for UTIs. 8 – 10 In many cases, microorganism has developed resistance to first-line antibiotics and shows the necessity for second-line antibiotics, which is broad-spectrum, have a less favorable risk-benefit profile, are more expensive, and may be locally unavailable. 11 , 12 Isolated pathogen and prevalence of antibiotic resistance rates may vary on geographical location and regions of the country; therefore, it is prudent to adhere to the most up-to-date evidence and current guidelines when selecting antibiotics to optimize the treatment of UTIs.…”

Section: Introductionmentioning

confidence: 99%

“… 11 , 12 Isolated pathogen and prevalence of antibiotic resistance rates may vary on geographical location and regions of the country; therefore, it is prudent to adhere to the most up-to-date evidence and current guidelines when selecting antibiotics to optimize the treatment of UTIs. 7 , 13 To ensure appropriate therapy, updated understanding of the organisms that cause UTI and their susceptibility pattern is essential. Therefore, this study aims to identify common uropathogens and explore antibiotic-resistant patterns of uropathogens in this area of eastern Nepal concerning multidrug-resistant (MDR) and extensively drug-resistant (XDR) uropathogen as well as to explore the associated risk factor that determines the colonization of MDR/XDR.…”

Section: Introductionmentioning

confidence: 99%

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Uropathogens and their antimicrobial-resistant pattern among suspected urinary tract infections patients in eastern Nepal: A hospital inpatients-based study

Sah,

Dahal,

Mallik

et al. 2023

SAGE Open Medicine

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Background: Urinary tract infections are the primary factors that cause mortality and morbidity in patients with underlying comorbid conditions and are responsible for most hospital admissions worldwide. Objectives: The study aims to identify the common bacterial uropathogens and determine their antimicrobial susceptibility pattern, including multidrug-resistant/extensively drug-resistant bacteria. Methods: The descriptive cross-sectional study was conducted among inpatients provisionally suspected of urinary tract infections in the medical ward of Koshi Hospital, Biratnagar, Nepal. Samples were inoculated in a cystine lysine electrolyte-deficient medium, and pure growth of significant bacteria was further subjected Gram staining, biochemical identification, and antimicrobial susceptibility testing as per laboratory standard procedure and Clinical Laboratory Standards Institute guidelines, respectively. Descriptive and inferential statistical analysis was performed to analyze the outcomes and a p-value < 0.05 was considered statistically significant. Results: A total of 305 patients urine specimens were examined, of which 251 (82.29%) samples resulted in significant bacterial growth in the culture. Escherichia coli (62.94%) was the most predominantly isolated organism, followed by Klebsiella pneumoniae (12.35%), Staphylococcus aureus (9.16%), and Pseudomonas aeruginosa (8.76%). Among antimicrobials, colistin had shown absolute susceptibility (100%) toward gram-negative uropathogens followed by carbapenem and aminoglycosides in a majority of uropathogens. Escherichia coli was found to be the leading drug-resistant bacteria (70%) among uropathogens. The presence of multidrug-resistant/extensively drug-resistant bacteria uropathogens was found to be significantly associated with diabetes mellitus and those with combined antimicrobial therapies. Diabetic patients were twice (OR~2) more likely to colonize and develop uropathogens as compared to non-diabetics. Conclusion: Escherichia coli was the most common uropathogens followed by Klebsiella pneumoniae in urinary tract infection patients. The polymyxin group (colistin) of antimicrobials was found to be effective in all multidrug-resistant and extensively drug-resistant uropathogens. The study recommends the need of optimized antimicrobial stewardship program to develop effective strategies in the management of urinary tract infections in diverse healthcare settings.

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Optimizing antimicrobial therapy in urinary tract infections: A focus on urine culture and sensitivity testing

Cited by 10 publications

References 38 publications

The prevalence of Carbapenem Resistance Gram negative pathogens in a Tertiary Teaching Hospital in Jordan

The prevalence of Carbapenem Resistance Gram negative pathogens in a Tertiary Teaching Hospital in Jordan

Smart Diagnosis of Urinary Tract Infections: is Artificial Intelligence the Fast-Lane Solution?

Uropathogens and their antimicrobial-resistant pattern among suspected urinary tract infections patients in eastern Nepal: A hospital inpatients-based study

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