Etiological Spectrum and Antimicrobial Resistance among Bacterial Pathogen Association with Urinary Tract Infection in Wasit Governorate/ Iraq
Keywords:
urinary tract infection, etiology, antimicrobial resistance, VITEK system, Iraq
Abstract
Objectives: This study aimed to determine the prevalence of uropathogens that cause urinary tract infections (UTIs) in Wasit Governorate, Iraq, and evaluate their patterns of antimicrobial resistance.
Methods: The study involved the examination of 840 urine samples taken from patients visiting the Al-Karama and Al-Zahraa Teaching Hospitals in Wassit province. The samples were collected from February 2022 to March 2023. Using a VITEK 2 compact system, we identified and tested the microorganisms responsible for the infections.
Results: Of the 840 urine samples of symptomatic patients with UTI, 669 (79.6%) were found to show significant growth of UTI, among whom the females were 470 (70.2%) episodes.
E. coli was the most frequently isolated uropathogen in both sex groups (42.2%, n=284), followed by S. aureus (21.2%, n=131), E. faecalis (12.5%, n=284), other staphylococci (5.8%, n=39), Proteus (4.7%, n=32), Group B Streptococcus (3.8%, n=26), Enterobacter (2.8%, n=19), and Pseudomonas (0.7%, n=5).
Based on Gram-negative isolates (n=389), resistance rates decreased in the following order: Ampicillin 68%< Piperacillin/tazobactam 49% < Cefoxitin 47% < Ceftriaxone 32% <Trimethoprim/Sulfamethoxazole and Ceftazidime 28% <Cefepime 27% <Ciprofloxacin 25%<Nitrofurantoin 23% Levofloxacin 22%<Gentamicin 21%<Amikacin 19% <Imepenem 2% on the other hand,
In the group of Gram-positive isolates (n=280) in decreasing order were Oxacillin 33% <Tetracycline 38% <Levofloxacin 24% <Clindamycin 21%< Nitrofurantoin and Trimethoprim/sulfamet hoxazole 19%< Rifampicin 13%< Tobramycin 11%< Gentamicin 10% <Teicoplanin and Vancomycin 8%.
Conclusion: In Wassit Governorate, Iraq, the primary cause of UTIs was E. coli, with S. aureus being the second most common. Among Gram-negative uropathogens, high resistance rates were found for ampicillin, second and third-generation cephalosporins, trimethoprim/sulfamethoxazole, and quinolones. However, aminoglycosides exhibited comparatively lower resistance rates. Imipenem (for Gram-negative bacteria) and vancomycin and teicoplanin (for Gram-positive bacteria) maintained strong activity, making them suitable choices for antimicrobial treatment of complicated UTIs when other options are unavailable.
References
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25. Fadhel, A.N.; Abureesha, R.A. and Al-azzawi, R.H. (2013). Prevalence of S.epidermidis and S. aureus and their biofilm ability among Iraqi patients suffering from urinary tract infection Iraqi Journal of Science, 54(3): 547-552
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27. Weekes, L.M. (2015). Antibiotic resistance changing management of urinary tract infections in aged care. Med J Aust., 203(9): 352.
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29. Hadi, A.M.; Sheri, F.H. and Jaccob, A.A. (2014). Urinary Tract Infection Prevalence and Antibiotic Resistance A Retrospective Study in Basra Governorate, Iraq. AlMustansiriyah Journal of Pharmaceutical Sciences (AJPS), 14(2): 129-135.
30. Mellon M, Benbrook C, BENBROOK L. Estimates of antimicrobial Abusein livestock, vol. 9. Washington: Union of Concerned Scientists Publications; 2001.
31. McIsaac WJ, Mazzulli T, Moineddin R, Raboud J, Ross S. Uropathogen antibiotic resistance in adult women presenting to family physicians with acute uncomplicated cystitis. Can J Infect Dis Medical Microbiol. 2004;15(5):266.
32. Farrell D, Morrissey I, De Rubeis D, Robbins M, Felmingham D. A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. J Infect. 2003;46(2):94–100.
33. Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrob Agents Chemother. 2002;46(8):2540–5
34. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–e20.
35. US Food and Drug Administration. Fluoroquinolone antibacterial drugs. Drug Safety Communication - FDA advises restricting use for certain uncomplicated infections. Posted May12,2016.http://www.fda.gov/Safety/ MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm5 00665.htmAccessed May 15, 201 .Accessed May 15, 2016
36. Gupta K, Stamm WE. Outcomes associated with trimethoprim/ sulphamethoxazole (TMP/SMX) therapy in TMP/SMX resistant community-acquired UTI. Int J Antimicrob Agents 2002;19:554-6.
37. Livermore DM, Pearson A. Antibiotic resistance: Location, location, location. Clin Microbiol Infect 2007;13 Suppl 2:7-16.
38. Magliano E, Grazioli V, Deflorio L, Leuci AI, Mattina R, Romano P, et al. Gender and age-dependent etiology of community-acquired urinary tract infections. ScientificWorldJournal 2012;2012:349597.
39. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-77. doi: 10.1093/cid/ ciw118.
2. Heinz J, Röver C, Furaijat G, et al.: Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and metaanalysis including individual patient data. BMJ Open. 2020, 10:e035883. 10.1136/bmjopen-2019-035883.
3. Manshahia PS, Bisht M, Mittal A, Bhatia M, Handu SS: A prospective, follow up study to assess guidelines compliance in uncomplicated urinary tract infection. J Family Med Prim Care. 2020, 9:4292-4297. 10.4103/jfmpc.jfmpc_849_20.
4. Foxman, B., Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. The American journal of medicine, 2002. 113(1): p. 5-13.
5. Nguyen HT. Bacterial Infections of the Genitourinary Tract. Smith’s General Urology. 16th ed New York (USA): Mcgraw-Hill Medical; 2004. p. 220.
6. Momoh A, Orhue P, Idonije O, Oaikhena A, Nwoke E, Momoh A. The antibiogram types of Escherichia coli isolated from suspected urinary tract infection samples. J Microbiol Biotech Res 2011;1:57-65.
7. Ikuta, K.S., et al., Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 2022. 400(10369): p. 2221-2248.
8. Mortazavi-Tabatabaei, S.A.R., et al., Pattern of antibacterial resistance in urinary tract infections: A systematic review and meta-analysis. International Journal of Preventive Medicine, 2019. 10.
9. Mamuye, Y., Antibiotic resistance patterns of common Gram-negative uropathogens in St. Paul’s Hospital Millennium Medical College. Ethiopian Journal of Health Sciences, 2016. 26(2): p. 93-100.
10. Wagenlehner, F., et al., The global prevalence of infections in urology study: a long-term, worldwide surveillance study on urological infections. Pathogens, 2016. 5(1): p. 10.
11. Kyu, H.H., et al., Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019. The Lancet Infectious Diseases, 2022. 22(11): p. 1626-1647.
12. Sweileh, W.M., et al., Global research output in antimicrobial resistance among uropathogens: A bibliometric analysis (2002–2016). Journal of Global Antimicrobial Resistance, 2018. 13: p. 104-114.
13. L. Nicolle, P. A. Anderson, J. Conly et al., “Uncomplicated urinary tract infection in women. Current practice and the effect of antibiotic resistance on empiric treatment,” Canadian Family Physician Medecin de famille canadien, vol. 52, no. 5, pp. 612–618, 2006.
14. D. L. Kasper, A. S. Fauci, S. L. Hauser, D. L. Longo, J. L. Jameson, and J. Loscalzo, Harrison’s Principles of Internal Medicine 20 e, McGraw-Hill Education, New York, NY, USA, 2018.
15. Arul Prakasam, K.C.; Dileesh Kumar, K. G. and Vijayan, M.A .Cross sectional study on distribution of urinary tract infection and their antibiotic utilisation pattern in Kerala. Int. J. Pharm.Tech Res. 2012. Vol. 4 (3). Pp: 1309-1316.
16. Foxman, B. and Frerichs, R. R. Epidemiology of Urinary Tract Infection: 1. Diaphragm Use and Sexual Intercourse. A J P H November 1985. Vol. 75 (11).
17. Mohammad-Jafari, H., et al., Increasing antibiotic resistance among uropathogens isolated during years 2006-2009: impact on the empirical management. International braz j urol, 2012. 38: p. 25-32.
18. Rasheed, N.A. and N.R. Hussein, Staphylococcus aureus: an overview of discovery, characteristics, epidemiology, virulence factors and antimicrobial sensitivity. European Journal of Molecular & Clinical Medicine, 2021. 8(3): p. 1160-1183.
19. Rasheed, N.A. and N.R. Hussein, Characterization of different virulent factors in methicillin-resistant Staphylococcus aureus isolates recovered from Iraqis and Syrian refugees in Duhok city, Iraq. PloS one, 2020. 15(8): p. e0237714.
20. Assafi, M.S., et al., Urinary bacterial profile and antibiotic susceptibility pattern among patients with urinary tract infection in duhok city, kurdistan region, Iraq. International Journal of Pure and Applied Sciences and Technology, 2015. 30(2): p. 54.
21. Surveillance of antimicrobial resistance in Bulgaria--a synopsis from BulSTAR 2018. Available at: https:// bam-bg.net//
22. Martin, O.; Adamu, A.A.; Julius, T.; Josephat, N.M.; Eddie, W.; Charles, D.K.; Ezera, A. and Joel, B. (2019). Prevalence of Bacterial Urinary Tract Infections and Associated Factors among Patients Attending Hospitals in Bushenyi District, Uganda. International Journal of Microbiology. Volume 2019, Article ID 4246780, 8
23. Alhamdany, M.H.A. (2018). Antibiotic Susceptibility of Bacteria Isolated from Patients with Diabetes Mellitus and Recurrent Urinary Tract Infections in Babylon Province, Iraq. Medical Journal of Babylon, 15(1): 63- 68.
24. Bien, J.; Sokolova, O. and Bozko, P. (2012). Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage. Int J Nephrol. 681473.
25. Fadhel, A.N.; Abureesha, R.A. and Al-azzawi, R.H. (2013). Prevalence of S.epidermidis and S. aureus and their biofilm ability among Iraqi patients suffering from urinary tract infection Iraqi Journal of Science, 54(3): 547-552
26. Alshabi, A.M.; Alshahrani, M.S.; Alkahtani, S.A. and Akhtar, M.S. (2019). Prevalence of urinary tract infection and antibiotic resistance pattern in pregnant women, Najran region, Saudi Arabia. African Journal of Microbiology Research. 13(26): 407-413.
27. Weekes, L.M. (2015). Antibiotic resistance changing management of urinary tract infections in aged care. Med J Aust., 203(9): 352.
28. Mahde, S.A.A.; Nashwan, M.R.; Ibrahim, N.R.; Hussein, A.A.T. and Amer, A.B. (2015). Urinary Bacterial Profile and Antibiotic Susceptibility Pattern among Patients with Urinary Tract Infection in Duhok City, Kurdistan Region, Iraq. Int. J. Pure Appl. Sci. Technol., 30(2): 54-63.
29. Hadi, A.M.; Sheri, F.H. and Jaccob, A.A. (2014). Urinary Tract Infection Prevalence and Antibiotic Resistance A Retrospective Study in Basra Governorate, Iraq. AlMustansiriyah Journal of Pharmaceutical Sciences (AJPS), 14(2): 129-135.
30. Mellon M, Benbrook C, BENBROOK L. Estimates of antimicrobial Abusein livestock, vol. 9. Washington: Union of Concerned Scientists Publications; 2001.
31. McIsaac WJ, Mazzulli T, Moineddin R, Raboud J, Ross S. Uropathogen antibiotic resistance in adult women presenting to family physicians with acute uncomplicated cystitis. Can J Infect Dis Medical Microbiol. 2004;15(5):266.
32. Farrell D, Morrissey I, De Rubeis D, Robbins M, Felmingham D. A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. J Infect. 2003;46(2):94–100.
33. Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrob Agents Chemother. 2002;46(8):2540–5
34. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–e20.
35. US Food and Drug Administration. Fluoroquinolone antibacterial drugs. Drug Safety Communication - FDA advises restricting use for certain uncomplicated infections. Posted May12,2016.http://www.fda.gov/Safety/ MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm5 00665.htmAccessed May 15, 201 .Accessed May 15, 2016
36. Gupta K, Stamm WE. Outcomes associated with trimethoprim/ sulphamethoxazole (TMP/SMX) therapy in TMP/SMX resistant community-acquired UTI. Int J Antimicrob Agents 2002;19:554-6.
37. Livermore DM, Pearson A. Antibiotic resistance: Location, location, location. Clin Microbiol Infect 2007;13 Suppl 2:7-16.
38. Magliano E, Grazioli V, Deflorio L, Leuci AI, Mattina R, Romano P, et al. Gender and age-dependent etiology of community-acquired urinary tract infections. ScientificWorldJournal 2012;2012:349597.
39. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-77. doi: 10.1093/cid/ ciw118.
Published
2023-04-26
How to Cite
Qaddoori, B. H. (2023). Etiological Spectrum and Antimicrobial Resistance among Bacterial Pathogen Association with Urinary Tract Infection in Wasit Governorate/ Iraq. Central Asian Journal of Medical and Natural Science, 4(2), 552-562. Retrieved from https://cajmns.centralasianstudies.org/index.php/CAJMNS/article/view/1465
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Articles
