102UROSEPSIS WITH GRAM-NEGATIVE BACTERAEMIA AUDIT: DEVELOPING A URINARY TRACT INFECTION PREVENTION CHECKLIST

Abstract Background For new antibiotics developed to treat antibiotic-resistant Gram-negative infections, the US Food and Drug Administration (FDA) regulatory pathway includes complicated urinary tract infection (cUTI) clinical trials in which the clinical isolates are susceptible to the active control. This allows for inferential testing in a noninferiority study design. Although complying with regulatory guidelines, individual clinical trials may differ substantially in design and patient population. To determine variables that impacted patient selection and outcome parameters, 6 recent cUTI trials that were pivotal to an new drug application (NDA) submission were reviewed. Methods This selective descriptive analysis utilized cUTI trial data, obtained from publicly disclosed information including FDA documents and peer-reviewed publications, from 6 new antibiotics developed to treat multidrug-resistant Gram-negative infections: ceftolozane-tazobactam, ceftazidime-avibactam, meropenem-vaborbactam, cefiderocol, plazomicin, and fosfomycin. Eravacycline was not approved for cUTI and is not included. Results Microbiologic modified intent-to-treat sample size, age, proportions of female patients, acute pyelonephritis (AP), Escherichia coli and other pathogens at baseline, protocol-specified switch to oral antibiotic, and the noninferiority margin were compared. Outcome data included clinical response, microbiologic eradication, and composite outcomes, including a subset of patients with AP. Conclusions A study design can follow regulatory guidelines but still have variable populations. The proportion of AP within a study varied greatly and influenced population demographics (age, gender) and baseline microbiology. A smaller proportion of AP resulted in an older patient population, fewer females, less E coli, and lower proportions of patients achieving success. Fluoroquinolones and piperacillin/tazobactam should be reconsidered as active comparators given the high rates of resistance to these antibiotics.

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Canine Cystitis Caused by Salmonella enterica subsp. enterica

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.90075 ◽

2019 ◽

Vol 47 ◽

Author(s):

Raylson Pereira De Oliveira ◽

Débora Mirelly Sobral da Silva ◽

Maria De Nazaré Santos Ferreira ◽

Camila Maria Coutinho Moura ◽

Rômulo Francelino Freitas Dias ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Salmonella Enterica ◽

Urine Culture ◽

Clinical Signs ◽

Blood Agar ◽

Salmonella Spp ◽

Gram Negative ◽

Northeast Region

Background: Urinary tract infection in dogs is usually associated with the presence of bacteria, with a higher prevalence of Gram-negative bacteria, represented mainly by enteric bacteria such as Escherichia coli and Proteus spp., followed by Gram-positive bacteria such as Staphylococcus spp., and Streptococcus spp. There are scant reports of Salmonella spp. as the causative agent of urinary tract infection in dogs. Indeed, the literature describes only a few cases, most of which involve the isolation of these bacteria in feces. This paper reports a case of canine cystitis caused by Salmonella enterica subsp. enterica in the northeast region of Brazil.Case: A female dog of the Fila Brasileiro breed, about 9 year-old, wormed but unvaccinated, was evaluated at the Veterinary Hospital of the Federal University of Pernambuco – UFRPE. The dog showed clinical signs of apathy, cachexia, polyphagia, polyuria and opacity of the crystalline lens. The dog’s owner stated that the animal was fed with commercial dog food. In the clinical exam, the patient presented pale mucosa, cachexia, absence of ectoparasites, and her rectal temperature was 39.5°C. Moreover, cardiorespiratory auscultation of the patient revealed tachycardia (190 bpm) and tachypnea (36 bpm). The owner’s main complaint was the clinical condition of frequent urination (polyuria). A urinalysis and urine culture with antibiogram were requested as complementary exams, after collecting the urine by cystocentesis. The volume obtained in the physical examination of urinalysis was 7 mL of yellow urine with a putrid smell, cloudy appearance and density of 1.024. The chemical examination revealed pH 6.5, protein (+++), bilirubin (+), normal urobilinogen and negative reactions for glycoses, ketone, nitrite and urine occult blood. Bacteriuria and pyuria were detected in a urine sediment test. Urine was cultured on blood agar and Levine agar in a bacteriological incubator at 37°C under aerobiosis, for 24 h. This culture produced an exuberant and pure growth of glossy grey bacterial colonies on blood agar and glossy colonies on Levine agar. The Gram test revealed gram-negative bacilli. The sample was subjected to biochemical tests to identify Gram-negative enterobacteria, whose results provided a presumptive identification of Salmonella species. The microbial species was identified using a VITEK 2 Compact®, and was followed by a serology test for the identification of the serogroup using a polyvalent serum, which enabled the identification of Salmonella enterica subsp. enterica. The antibiogram showed sensitivity to ciprofloxacin, gentamicin and penicillin, and resistance to amoxicillin and ampicillin.Discussion: Clinical signs of cachexia and polyuria may be related to canine urinary tract infection caused by Salmonella enterica subsp. enterica, since these symptoms had already been recorded previously in a case of a bacterial infection by the same serogroup. Isolation of Salmonella spp. in a non-selective medium was determinant in identifying these bacteria. Since these are not commensal bacteria of the canine urinary tract, their isolation in this tract indicates that they are responsible for the infection or disease, although such cases are rare. Another aspect that should be highlighted is the risk of human infection, because of the zoonotic potential of Salmonella spp., which may be transmitted by contact with dog urine. This is the first report of the isolation of Salmonella enterica subsp. enterica in a case of canine cystitis on the northeast region of Brazil, and underscores the importance of complementary diagnostic exams such as urine culture.

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Prevalence of SUL(1,2), GYR(A, B) and OXA genes among multidrug resistance Klebsiella pneumoniae isolates recovered from women suffering urinary tract infection

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i2.2234 ◽

2020 ◽

Vol 11 (2) ◽

pp. 2424-2432

Author(s):

Nabil Salim Saaid Tuwaij ◽

Huda Jameel Baker Al-khilkhali ◽

Haneen Mohamed Mohsen

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Vitek 2 ◽

Resistant Microorganism ◽

Urine Specimens

Klebsiella pneumoniae is a significant concern multidrug-resistant microorganism and a one common gram negative bacteria associated with infections of women urinary tract. Therefore, this work aimed to the molecular screening of Sul(1and 2), Gyr(A and B) and OXA genes among K. pneumoniae isolates in Najaf City, Iraq. Out of 250 urine specimens were collected from women showing symptoms of urinary tract infection during five months January to of May 2019, bacterial growth was157 isolates, included 133 gram negative compared with 24 gram positive bacteria while 98 specimens were no growth. According to the Vitek-2 system, 30 K. pneumoniae isolates were obtained.Data on current work revealed that the 26-35 age group was the highest 14 K. pneumoniae isolates. Results of antimicrobial susceptible recorded all isolates were multi-drug resistant (MDR) and they have a different range of resistance. However, all 30 isolates(100%) resistant to ampicillin drugs, while the lowest rate was 1(3.33%) forImipenemdrug. PCR assay revealed exist of oxa, sul-1, sul-2, gyr-A and gyr-B genes among K. pneumoniae isolates with rates 20(66.66%), 11(36.66%), 22(73.33%), 3(10%) and 17(56.66%) respectively.

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Evaluation of Antibacterial Potential of Ethanol Fruit Peel Extract of Mangifera indica against Isolated UTI Pathogens

Nigerian Journal of Pure and Applied Sciences ◽

10.48198/njpas/21.a14 ◽

2021 ◽

pp. 3998-4005

Author(s):

Adeyinka A. Aderinola ◽

Jane Ejiofor ◽

Lukmon Ogunjimi ◽

Akanji A. Murtala ◽

Oladapo E. Oyinloye

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Mangifera Indica ◽

Inhibition Zone ◽

Fruit Peel ◽

Gram Negative ◽

Peel Extract

Effective use of antimicrobial agents for treatment/management of infectious diseases is decreasing due to emergency of multi-drug and cross resistant strains of pathogenic microbes. Medicinal plants are now increasingly used alone or as an adjunct in the management of infectious diseases as a result of their claimed efficacy and safety. This research focused on evaluating the antimicrobial potential of ethanol fruit peel extract of Mangifera indica against isolated Urinary tract infection (UTI) pathogens. Urinary tract infection (UTI) bacterial strains (staphylococcus aureus, escherichia coli and pseudomonas aeruginosa) were isolated from midstream urine of infected students using standard procedures after which the isolated Urinary tract infection pathogens were subjected to antimicrobial susceptibility test by agar-well diffusion method (Cup plate method) and the mean diameter of growth inhibition zones (n=3) of the extract at different concentrations were compared against the controls (sterile water and ciprofloxacin). Ethanol fruit peel extract of Mangifera indica significantly and dose dependently inhibit the growth of all the isolated Urinary tract infection pathogens with E.coli exhibiting the highest inhibition zone ranging from 16.83 to 28.23 mm, this was followed by pseudomonas aeruginosa with inhibition zone of 24.33 mm and staphylococcus aureus least susceptible with 22.63 diameter of zone inhibition. Ethanol fruit peel extract of Mangifera indica demonstrated a dose dependent antimicrobial activity with more pronounced effect exhibited by E. coli suggesting that the extract is more effective against gram negative bacteria despite their permeability barrier, thus suggesting Mangifera indica fruit peel as a potential candidate for the management of bacterial infections especially those caused by gram negative organisms.

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Types of Interventions

Preventing Hospital Infections ◽

10.1093/med/9780197509159.003.0003 ◽

2021 ◽

pp. 24-39

Author(s):

Jennifer Meddings ◽

Vineet Chopra ◽

Sanjay Saint

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Medical Record ◽

Electronic Medical Record ◽

Infection Prevention ◽

Indwelling Catheters ◽

Inappropriate Use ◽

Day Hospitals ◽

Healthcare Associated

Infection prevention programs were slow to develop—they were a rarity as recently as the 1950s—but they have become a staple of modern-day hospitals. Great strides have been made in identifying clinician activities that can control or prevent various healthcare-associated infections. This chapter describes the contents of an infection prevention bundle for catheter-associated urinary tract infection (CAUTI). In the case of CAUTI, the so-called bladder bundle sets forth appropriate and inappropriate use of indwelling catheters. A nursing checklist, on paper or as a template in the electronic medical record, is used to track patients’ daily urinary catheter status. Doctors and nurses are asked to rethink when a Foley is called for, what alternatives should be considered, what catheter equipment should be used, and how long the Foley should remain in place.

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Taking on Clostridioides difficile

Preventing Hospital Infections ◽

10.1093/med/9780197509159.003.0010 ◽

2021 ◽

pp. 141-157

Author(s):

Jennifer Meddings ◽

Vineet Chopra ◽

Sanjay Saint

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Clostridium Difficile ◽

Tract Infection ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Infection Prevention ◽

Hospital Staff ◽

Clostridioides Difficile

The adaptive approach used in the previous chapters to prevent catheter-associated urinary tract infection (CAUTI) is applied to an initiative to prevent Clostridioides difficile (formerly Clostridium difficile) infection. These two initiatives differ regarding their scope, the members of their teams, and the elements of their bundles. For preventing C. difficile, for example, the most important bundle item is antimicrobial stewardship since the use of broad-spectrum antibiotics vastly increases a person’s risk of becoming infected. Infectious diseases physicians or clinical pharmacists are to examine the circumstances of antimicrobial prescriptions they have filled to see whether they meet infection prevention standards; if not, the prescribing physician will receive prompt feedback. Differences aside, the basic elements of the CAUTI framework apply, from the C-suite’s decision to go ahead with the initiative to the tactics used to sell the C. difficile bundle to the hospital staff.

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