Prevalence and Antimicrobial Resistance of Bacterial Uropathogens Isolated from Iranian Kidney Transplant Recipients: A Systematic Review and Meta-Analysis

Moghaddam, Abbas Shapouri; Arfaatabar, Maryam; Afshari, Jalil Tavakol; Shakerimoghaddam, Ali; Mohammadzamani, Zahra; Khaledi, Azad

doi:10.18502/ijph.v48i12.3547

Cited by 8 publications

(13 citation statements)

References 37 publications

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“…Similar to our results, the results indicated that cotrimoxazole, nalidixic acid, cefixime, and ceftazidime had a high level of antibiotic resistance. 34 Moreover, a similar resistant pattern was also reported by Shokouhi Mostafavi et al 35 and Farajzadah Sheikh et al 8 in Iran.…”

Section: Discussionsupporting

confidence: 76%

Characterization of Extended-Spectrum β-Lactamase-Producing Uropathogenic Escherichia coli Among Iranian Kidney Transplant Patients

Halaji¹,

Shahidi²,

Atapour³

et al. 2020

IDR

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The aim of this study was to investigate the antimicrobial susceptibility pattern and the presence of ESBLs among the uropathogenic Escherichia coli (UPEC) isolated from kidney transplant patients (KTP) and community-acquired urinary tract infections (UTIs) using phenotypic and molecular methods. Materials and Methods: A total of 111 pure cultures of UPEC isolates were collected from 65 and 46 of non-KTP and KTPs with UTIs. The pattern and ESBL production of the strains were evaluated. PCR reaction to detect the presence of bla SHV , bla TEM , and bla CTX-M genes was performed. Results: The results revealed that most of UPEC isolates obtained from KTPs and control group were resistant to trimethoprim/sulfamethoxazole (84.8% vs 46.2%), while carbapenems (100% sensitivity) were the most effective against UPEC isolates. ESBL-producing strains were significantly more frequent in KTPs compared with control group (43.5% vs 23.1%, P = 0.021). The molecular results revealed that 53.2% (59/111), 45% (50/111), and 5.4% (6/111) of isolates harbored bla CTX-M , bla TEM , and bla SHV genes, respectively. Of the genes investigated, bla CTX-M and bla TEM genes were significantly higher among KTP than the control group. Conclusion: Our results showed a high proportion of multidrug-resistant and ESBL-producing isolates, which most of them harbor blaCTX-M. A significant high co-resistance to different classes of antibiotics was reported from ESBL-producing UPEC from KTPs, which remains a serious clinical challenge.

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Section: Discussionsupporting

confidence: 76%

Characterization of Extended-Spectrum β-Lactamase-Producing Uropathogenic Escherichia coli Among Iranian Kidney Transplant Patients

Halaji¹,

Shahidi²,

Atapour³

et al. 2020

IDR

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“…Urinary tract infections (UTIs) are common among kidney transplant recipients in the first year after transplantation. The reported incidence varies from 11.7% to 67.5% based on the definition and the design of studies [ 1 , 2 ]. UTIs remain a leading cause of hospitalization after kidney transplantation [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Urinary Tract Infections in the First 6 Months after Renal Transplantation

Arabi

Thiab

Altheaby

et al. 2021

International Journal of Nephrology

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Purpose. Urinary tract infections (UTIs) are common in the first 6 months after renal transplantation, and there are only limited data about UTIs after transplantation in Saudi Arabia in general. Methods. A retrospective study from January 2017 to May 2020 with 6-month follow-up. Results. 279 renal transplant recipients were included. Mean age was 43.4 ± 16.0 years, and114 (40.9%) were women. Urinary stents were inserted routinely during transplantation and were removed 35.3 ± 28 days postoperatively. Ninety-seven patients (35%) developed urinary tract infections (UTIs) in the first six months after renal transplantation. Of those who developed the first episode of UTI, the recurrence rates were 57%, 27%, and 14% for having one, two, or three recurrences, respectively. Late urinary stent removals, defined as more than 21 days postoperatively, tended to have more UTIs (OR: 1.43, P: 0.259, CI: 0.76–2.66). Age >40, female gender, history of neurogenic bladder, and transplantation abroad were statistically significant factors associated with UTIs and recurrence. Diabetes, level of immunosuppression, deceased donor renal transplantation, pretransplant residual urine volume, or history of vesicoureteral reflux (VUR) was not associated with a higher incidence of UTIs. UTIs were asymptomatic in 60% but complicated with bacteremia in 6% of the cases. Multidrug resistant organisms (MDROs) were the causative organisms in 42% of cases, and in-hospital treatment was required in about 50% of cases. Norfloxacin + Bactrim DD (160/800 mg) every other day was not associated with the lower risk of developing UTIs compared to the standard prophylaxis daily Bactrim SS (80/400 mg). Conclusion. UTIs and recurrence are common in the first 6 months after renal transplantation. Age >40, female gender, neurogenic bladder, and transplantation abroad are associated with the increased risk of UTIs and recurrence. MDROs are common causative organisms, and hospitalization is frequently required. Dual prophylactic antibiotics did not seem to be advantageous over the standard daily Bactrim.

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“…Other researches indicated a similar pattern of the etiological agents of UTI. [ 14 19 ] Although significant variation exists in some others, for instance, E. coil (44%), followed by S. aureus (20%), coagulase-negative Staphylococci (16%), and K. pneumoniae (8%) were the predominant uropathogens. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of uropathogens and their resistance to antimicrobials showed a lot of variations. [ 12 13 14 ] E. coli and Klebsiella pneumoniae were shown to represent 78.8% and 75.3% resistance to three or more drugs, respectively. This study showed that cefotaxime revealed higher activity (87.1%) against mainstream uropathogens, which was followed by norfloxacin (83.3%).…”

Section: Introductionmentioning

confidence: 99%

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Susceptibility of hospital-acquired uropathogens to first-line antimicrobial agents at a tertiary health-care hospital, Saudi Arabia

Hassan

Hamid

2021

Urol Ann

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Context: Management of urinary tract infections (UTIs) is caused by antibiotic resistance uropathogens. Aim: This study aimed to determine the important uropathogens and their resistance to first-line urinary tract antimicrobial agents. Settings and Design: The region of Aseer, Southern Saudi Arabia, between 2013 and 2016. Materials and Methods: A total of 1506 isolates were recovered from the urine samples of patients that were identified and tested against nine first-line UTI antimicrobial agents. Laboratory analysis was done as per the standard methods. Confirmation of bacterial identity and antimicrobial susceptibility assay was achieved by the VITEK 2 automated system. Statistical Analysis Used: Statistical Package for the Social Sciences software version 21.0 was used for the statistical analysis. Results: The dominant uropathogens were Escherichia coli (E. coli) 507 (33.7%); Klebsiella pneumoniae (K. pneumoniae) , 229 (15.21%); Pseudomonas aeruginosa , 153 (10.2%); Acinetobacter baumannii , 80 (5.3%); Enterococcus faecalis , 71 (4.7%); and Proteus mirabilis , 61 (4.1%). Of all culture-positive uropathogens, 51.5% were resistant to the 39 agents, whereas 48.5% were sensitive ( P = 0.7969). Regarding the susceptibility to the first-line agent, the most effective against the dominant ( in vitro ) agents against E. coli were fosfomycin and nitrofurantoin (93.5%) and (85.4%), respectively. Whereas those worked well against K. pneumoniae were cefoxitin (57.1). Conclusions: The present study recommends the use of fosfomycin, cefoxitin, nitrofurantoin, and amoxicillin/clavulanate as the first choice UTIs treatment given their relatively high in vitro activity against major uropathogens. Knowledge of the bacterial species and their antimicrobial sensitivity patterns are always necessary to serve as a base for selecting the empirical treatment of UTIs as resistance rates vary geographically and with time.

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Prevalence and Antimicrobial Resistance of Bacterial Uropathogens Isolated from Iranian Kidney Transplant Recipients: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 37 publications

<p>Characterization of Extended-Spectrum β-Lactamase-Producing Uropathogenic <em>Escherichia coli</em> Among Iranian Kidney Transplant Patients</p>

<p>Characterization of Extended-Spectrum β-Lactamase-Producing Uropathogenic <em>Escherichia coli</em> Among Iranian Kidney Transplant Patients</p>

Urinary Tract Infections in the First 6 Months after Renal Transplantation

Susceptibility of hospital-acquired uropathogens to first-line antimicrobial agents at a tertiary health-care hospital, Saudi Arabia

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