Search Results (52)

Background: Serious bacterial infections (SBIs) in neonates present a significant diagnostic challenge due to nonspecific symptoms and immature immune responses. Early identification is essential to ensure timely treatment and prevent adverse outcomes. This study investigates clinical, laboratory, and epidemiological parameters associated with SBI in febrile neonates. Methods: A retrospective analysis was conducted on neonates hospitalized for suspected SBI at University Hospital Split from 1 January 2023 until 31 December 2024). The data was analyzed using descriptive statistics, Mann–Whitney U test and Chi-square test. Results: The study included 71 neonates hospitalized with suspected SBI, of whom 38 (53.5%) had a confirmed SBI. Neonates with SBI had a significantly longer hospital stay (p < 0.001). C-reactive protein (CRP) levels at admission were significantly higher in the SBI group (p = 0.020), while other laboratory parameters showed no significant differences. The most common diagnosis in the SBI group was urinary tract infection (50%). In urine analysis, abundant bacterial presence, strongly positive leukocyte esterase (3+), and positive nitrite findings were significantly associated with the presence of urinary tract infection (UTI). Conclusions: In neonates with suspected SBI, elevated CRP levels and prolonged hospital stay were significantly associated with confirmed SBI. Among specific diagnoses, UTI were most frequent, with urinalysis parameters (bacteria, leukocyte esterase, and nitrites) proving useful in identifying affected cases. However, individual clinical signs showed limited diagnostic value, highlighting the importance of combining clinical and laboratory data in early recognition of SBI. Full article

Background/Objectives: The rise in urinary tract infections caused by multidrug-resistant (MDR) bacteria presents a serious public health challenge across the Balkans, a region already burdened by aging populations, healthcare resource limitations, and fragmented antimicrobial surveillance systems. Methods: This review explores the epidemiology, risk factors, and consequences of MDR UTIs, particularly in the context of the COVID-19 pandemic, which significantly accelerated antimicrobial resistance (AMR) due to widespread, inappropriate antibiotic use. Results: The paper discusses region-specific data on resistance trends, highlights the gaps in diagnostic infrastructure, and evaluates emerging clinical strategies including antimicrobial stewardship (AMS), rapid diagnostic technologies, novel antibiotics, and non-antibiotic alternatives such as bacteriophage therapy and vaccines. Conclusions: Policy recommendations are provided to strengthen surveillance, promote evidence-based treatment, and ensure equitable access to diagnostic and therapeutic tools. A multidimensional and regionally coordinated response is essential to curb the MDR UTI burden and safeguard public health across the Balkans. Full article

Background/Objectives: Extraintestinal pathogenic Escherichia coli (ExPEC) strains, particularly those belonging to phylogenetic group B2, are clinically significant due to their frequent involvement in urinary tract infections (UTIs) and display antimicrobial resistance profiles. While the association of phylogroup B2 E. coli with human urinary tract infections is well established, the growing number of reports of ExPEC strains in canine UTIs highlights their clinical relevance in small animal medicine and raises concerns about their potential role in zoonotic transmission. This study investigated the microbiological and genomic features of E. coli strains isolated from dogs with UTIs in São Paulo, Brazil. Methods: Between March and May 2023, a total of 60 E. coli strains from canine UTIs were screened for antimicrobial susceptibility and phylotyping. Accordingly, four strains (6.6%) were identified as multidrug-resistant (MDR) or belonging to phylogroup B2 and, therefore, were submitted for characterization by whole-genome sequencing. Results: The four E. coli strains exhibited diverse antimicrobial resistance profiles, including resistance to third- and fourth-generation cephalosporins and fluoroquinolones. Phylogenetic groups B1, B2, and G, and sequence types (ST) 73, ST224, ST1193, and ST12960 were identified. The resistome included clinically important β-lactam resistance genes, such as bla_CTX-M-55 and bla_CMY-2, as well as mutations in the quinolone-resistance-determining region. Virulence factors associated with ExPEC pathogenesis, including adhesion, iron acquisition, immune evasion, and toxin, were detected. Plasmid sequences were identified as carrying antimicrobial resistance and virulence genes, highlighting the potential for horizontal gene transfer. Conclusions: Our findings underscore the importance of genomic surveillance in companion animals to better understand the epidemiology of ExPEC strains and monitor the spread of MDR strains. Full article

Antimicrobial resistance (AMR) has reached a critical situation globally, prompting urgent national responses to this escalating crisis, including the prioritization of novel antibiotic research. In 2016, Japan initiated a national AMR action plan that promoted appropriate antibiotic use in the country and encouraged a national environment conducive to mitigation measures. However, tackling AMR remains difficult. From an epidemiological perspective, this challenge now extends beyond severe infections, impacting common community-acquired infections, including uncomplicated urinary tract infections (uUTls) and gonorrhea. In uUTIs, the rising prevalence of extended-spectrum β-lactamase-producing and fluoroquinolone-resistant Escherichia coli diminishes the effectiveness of current, routinely used oral antibiotics, necessitating an exploration into innovative solutions. Similarly, the growing resistance of Neisseria gonorrhoeae to antibiotics such as azithromycin raises concerns about the efficacy of current therapeutic options for gonorrhea, which is a highly prevalent sexually transmitted infection. In Japan, since the removal of azithromycin as the recommended first-line treatment, there are no oral first-line antibiotics available to treat gonorrhea. Therefore, novel oral antibiotics are urgently needed for both serious and commonly occurring community-acquired infections. This narrative review discusses the limited availability of novel antibiotics in Japan, the distinctive features of the Japanese antibiotic repertoire and AMR epidemiology, and potential alternative oral treatments for community-acquired infections, including uUTIs and gonorrhea. Japan has been making significant advances toward tackling the AMR crisis through an updated national action plan, AMR policy changes, and innovative approaches to developing novel antibiotics. Substantial international cooperation and the engagement of diverse industry sectors are essential to address the pressing issue of AMR. Full article

Background: Urinary tract infections (UTIs) are among the most common types of infections during childhood. Limited data are available on the prevalence of UTI in children from Romania, with most being available for hospitalized children. For this reason, we conducted a retrospective observational study in consecutive non-hospitalized children to assess the number of positive UTI samples and the antibacterial resistance of causative pathogens. Methods: This study included 7222 consecutive urine cultures collected from children aged 1 to 18 years who are residents of Arad County, Western Romania. Urine samples were analyzed for leukocyturia and cultures for the presence of monomorphic bacteria. Results: The overall number of positive UTI samples was 10.44%. A higher number of positive UTI samples was observed in females when compared to males and in children aged 6–12 and 12 to 18 years when compared to those aged 1–5 years. The antibiotic susceptibility testing of E. coli isolates revealed high sensitivity to most tested antibacterials. Near-complete susceptibility was observed for fosfomycin (99.71%) and nitrofurantoin (96.01%), while high susceptibility rates were also observed for ciprofloxacin (85.43%) and amoxicillin–clavulanic acid (75.05%). In contrast, high resistance was found for ampicillin (62.28% resistant) and trimethoprim–sulfamethoxazole (36.53% resistant). Conclusions: Given the clinical risks associated with UTI in children, our findings underscore the urgent need for the continued monitoring of multidrug-resistant strains. Our study provides important epidemiological and resistance data to guide empirical treatment and strengthen pediatric antimicrobial resistance surveillance. Future studies should focus on different regions and regularly update resistance patterns to keep treatment and prevention strategies aligned with local conditions. Full article

Background/Objective: Urinary tract infections (UTIs) are a significant public health concern worldwide, yet longitudinal data from Portuguese hospital settings remain limited. This study aimed to characterize epidemiological trends, microbial etiology, antimicrobial resistance patterns, and associated risk factors of UTIs over a five-year period (2018–2022) in a central Portuguese hospital. Methods: In this retrospective observational study, 23,682 positive urine cultures were analyzed from specimens collected between January 2018 and December 2022. Data were extracted from the laboratory information system and included patient demographics, clinical service of origin, isolated microorganisms, resistance profiles, and annual antibiotic consumption (Defined Daily Dose (DDD) per 1000 patient-days). UTI prevalence was calculated as the proportion of positive cultures among all urine samples processed annually. Results: The positivity rate increased from 18.7% in 2018 to 22.7% in 2022, with a peak in 2019. Women represented around 70% of cases throughout the study period. Most infections originated from inpatient wards, followed by emergency services. Escherichia coli remained the leading pathogen (≈62%), followed by Klebsiella pneumoniae (≈14%) and Enterococcus faecalis (≈8%). Risk factors included catheterization (37.2%), prior UTI history (22.1%), and diabetes mellitus (18.5%). Longer hospital stays (>7 days) were associated with increased positivity. For E. coli, resistance ranged from 2% (amikacin) to 41% (ampicillin), with increasing resistance to ertapenem and fosfomycin and decreasing resistance to several key antibiotics. K. pneumoniae showed 4–36% resistance across antimicrobials, with notable increases for fosfomycin, meropenem, and cefuroxime axetil. Antibiotic usage trends reflected these patterns, with declining use of amikacin and rising use of cefuroxime axetil and meropenem. Conclusions: Over the five-year period, both UTI prevalence and resistance to critical antimicrobials increased, reinforcing the need to update empirical treatment guidelines. Identified risk factors may inform targeted prevention strategies. Ongoing surveillance and antimicrobial stewardship are crucial to mitigate the rising burden of UTIs and resistance Full article

Urinary tract infections (UTIs) are among the most prevalent infectious diseases in older women, especially those over 65 years of age. Physiological changes related to aging, comorbidities, and frequent use of medical devices such as urinary catheters increase susceptibility. Increasing antimicrobial resistance further complicates treatment strategies. This study aims to describe the epidemiological profile of UTI in women over 65 years of age, focusing on the characterization of etiological agents, observed antimicrobial resistance patterns, and commonly reported risk factors. We conducted a retrospective analysis of microbiological and clinical data from elderly women diagnosed with UTIs. Bacterial isolates were identified and antimicrobial susceptibility profiles were evaluated over a specified period. A statistical analysis was performed to determine the prevalence of different pathogens and antibiotic resistance trends. Escherichia coli was the predominant uropathogen, consistent across different clinical scenarios and patient conditions. The four most common bacterial strains—E. coli, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis—aligned with global epidemiological data. In Escherichia coli a significant increase in resistance to nitrofurantoin was observed, possibly indicating excessive empirical use, while resistance to other antibiotics, such as amoxicillin/clavulanic acid and ertapenem, remained stable or decreased. Institutional antibiotic stewardship programs likely contributed to this trend. The study highlights E. coli as the main etiological agent in elderly women with UTIs. The observed resistance patterns emphasize the need for localized antimicrobial surveillance and personalized therapeutic approaches. Continuous microbiological monitoring and rational use of antibiotics are crucial to optimize treatment outcomes and control the development of resistance. Full article

Background: Urinary tract infections (UTIs) are among the most prevalent bacterial infections affecting millions of people worldwide each year. They are characterized by the presence of pathogenic microorganisms in the urinary system, leading to symptoms such as frequent urination, burning sensations during urination, and lower abdominal pain. While UTIs can affect individuals of all ages and genders, they are particularly common in women due to anatomical factors. A significant concern regarding UTIs is their tendency to recur, with some patients experiencing multiple episodes within a year. Methods: This study included 674 female patients that were admitted into “Dr. Carol Davila” Central Military Emergency University Hospital in Bucharest over a period of 3 years. Results: Of the 674 women with urinary tract infection, 435 (79.3%) had more than one positive culture, and 239 (35.4%) experienced at least one recurrent urinary tract infection 6–12 months after the initial diagnosis. The mean age of women with urinary tract infection was 63 (±15.61 years). Recurrent urinary tract infections were most prevalent in those aged 65–80 years (52%). Escherichia coli was detected in 71% of the positive cultures. Conclusions: The high prevalence of UTIs among women is a significant public health concern that warrants attention. Women are particularly susceptible to UTIs due to various anatomical and physiological factors. This increased vulnerability underscores the importance of understanding the current epidemiological landscape of UTIs to develop effective preventive strategies. Full article

Urinary tract infections (UTIs) are common and are typically treated empirically, based on local antimicrobial resistance (AMR) data, which are often scarce in low- and middle-income countries. This study examines the AMR patterns of pathogens causing community-onset (CO) UTIs in the Bolivian Chaco. Urine samples were collected from subjects with suspected CO-UTIs and analyzed by culture techniques. Significant isolates were tested for their antimicrobial susceptibility. Additionally, bla_CTX-M and mcr genes were searched for using real-time PCR. A total of 361 CO-UTI episodes were diagnosed among 731 subjects from February 2020 to November 2021. The cases included uncomplicated and complicated UTIs (58.2% and 41.8%, respectively), with females accounting for the majority (85.3%) of cases. Escherichia coli was the most prevalent pathogen (86.6%), followed by Klebsiella pneumoniae (5.4%) and Proteus spp. (2.2%). Very high resistance rates (>50%) were observed for ampicillin, trimethoprim–sulfamethoxazole and fluoroquinolones, high resistance rates (>20%) for amoxicillin–clavulanate, third-generation cephalosporins and gentamicin, while lower resistance rates (<10%) were observed for nitrofurantoin and fosfomycin. The prevalence of bla_CTX-M among E. coli was high (26.7%). Colistin resistance was detected in 3.4% of E. coli, mostly associated with mcr genes. CO-UTIs from this area were characterized by high resistance rates to commonly used antibiotics (trimethoprim–sulfamethoxazole, amoxicillin–clavulanic acid and ciprofloxacin), highlighting the importance of knowledge of the local epidemiology to inform the selection of appropriate empirical antibiotic regimens. Full article

Urinary tract infections (UTIs) are one of the most common bacterial diseases both in communities and in hospitalized patients, and at the same, time they are one of the most common indications for the use of antibiotics. UTI guidelines are generally available nationally or internationally, but they do not address all aspects of UTI treatment for different patient cohorts, age, gender, or comorbidities. The aim of the study was to point out the importance of stratified cumulative antibiograms at the level of individual health care facilities and the significant differences between epidemiological data, not only at the national level, but also at the local level. Our study analyses data from 383 patients with UTIs from a hospital department, General University Hospital (GUH), and 272 patients from an outpatient medical facility, Urocentrum (UC). This analysis focuses on the most common UTI causative agent, Escherichia coli, its representation as the causative agent of UTI in patients with complicated acute cystitis (N30), and its representation in complicated acute cystitis in patients with prostate cancer (C61). In addition to the frequency of occurrence, a sub-analysis of the incidence of resistance of E. coli to commonly used antibiotics by age, gender, diagnosis, and medical facility was performed. Results: The most common causative agent of UTI was E. coli. In patients with N30, it was 70% in GUH and 54% in UC, but in oncological patients with UTI, it was only 39% and 35%, respectively. In patients with UTI in C61, there was a significant difference in susceptibility of E. coli between individual health care facilities. Lower resistance was found in UC opposite to GUH isolates in ampicillin, with 29.8% vs. 65%, p = 0.001; amoxicillin/clavulanic acid, with 8.5% vs. 30%, p = 0.01; with 2.1% vs. 17.5% in pivmecillinam, p = 0.01; with 10.6% vs. 37.5% in co-trimoxazole, p = 0.003; and ciprofloxacin, with 10.6% vs. 30%, p = 0.04. The study shows significant differences in the sensitivity of urinary E. coli isolates in patients in relation to age, gender, medical devices, and the presence of comorbidities. Full article

Introduction: This study analyzes urinary tract infections (UTIs) in a hospital in Central Portugal over a five-year period, focusing on bacterial prevalence, patient demographics, and antibiotic resistance patterns. This investigation aims to provide insights that can guide improved infection control and treatment strategies. Methods: A total of 6161 positive urine cultures collected over five years were examined, with particular emphasis on 2019 due to a peak in infection rates. The analysis explored bacterial prevalence, demographic factors such as sex and clinical service origin, and antibiotic resistance. Special attention was given to hospitalized patients, especially those undergoing invasive procedures, due to their increased vulnerability to infection. Results: This study found that UTIs were more prevalent in female patients, reflecting anatomical susceptibilities. Hospitalized individuals, particularly those requiring invasive procedures, were at greater risk. The predominant bacteria were Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, with differences in prevalence by patient sex and service origin. Resistance to Imipenem in E. coli increased, raising concerns about last-resort treatments. However, resistance to other antibiotics declined, suggesting improvements due to recent stewardship measures. During the COVID-19 pandemic, overall antibiotic consumption decreased due to changes in clinical practices. Conclusion: The findings highlight the importance of strict infection control, targeted prevention measures, and rational antibiotic use to combat resistance. Ongoing surveillance and personalized treatment approaches are essential to improve UTI management and outcomes. Full article

Background: Urinary tract infections (UTIs) are common infectious diseases in hospital settings, and they are frequently caused by uropathogenic Escherichia coli (UPEC). The emergence of carbapenem-resistant (Carb-R) E. coli strains poses a significant threat due to their multidrug resistance and virulence. This study aims to characterize the antimicrobial resistance and virulence profiles of Carb-R UPEC strains isolated from hospitalized patients. Methods: A total of 1100 urine samples were collected from patients in Lahore and Faisalabad, Pakistan, between May 2023 and April 2024. The samples were processed to isolate and identify E. coli using standard microbiological techniques and VITEK®2, followed by amplification of the uidA gene. Antimicrobial susceptibility was evaluated using the Kirby–Bauer disc diffusion method and broth microdilution. Resistance and virulence genes were detected through PCR and DNA sequencing, and sequence typing was performed using MLST. Results: Among the 118 Carb-R UPEC isolates, resistance was most frequently observed against sulfamethoxazole-trimethoprim (96.6%) and doxycycline (96.6%). All of the isolates remained sensitive to colistin and tigecycline. Sequence types ST405 (35.6%) and ST167 (21.2%) were predominant and carried the bla_CTX-M-15 and bla_NDM-5 genes. The distribution of virulence genes and a variety of antimicrobial resistance genes (ARGs), conferring resistance to aminoglycosides, fluoroquinolones, tetracyclines, and sulfonamides, were observed as specifically linked to certain sequence types. Conclusions: This study provides insights into the molecular epidemiology of carbapenem-resistant Uropathogenic E. coli (Carb-R UPEC) strains and highlights the presence of globally high-risk E. coli clones exhibiting extensive drug resistance phenotypes in Pakistani hospitals. The findings underscore the urgent need for enhanced surveillance and stringent antibiotic stewardship to manage the spread of these highly resistant and virulent strains within hospital settings. Full article

Urinary tract infections are one of the main complications in kidney transplant patients, with a significant impact on graft function and survival. In fact, it is estimated that up to 74% of kidney transplant patients experience at least one episode of UTIs in the first year after transplantation, with an increased risk of graft loss and an increased risk of mortality. Several risk factors have been identified, such as female gender, old age, diabetes mellitus, immunosuppression, pre-transplant UTIs, urinary tract abnormalities, and prolonged dialysis. The worsening burden of antimicrobial resistance is also in itself a risk factor and a major complication in evolution and management. The management of prophylaxis, asymptomatic bacteriuria, and UTIs is still an open challenge, with some points to be clarified. Faced with such scenarios, our review aimed to evaluate the current epidemiology, examine the risk factors, and consider all the possibilities and methods of management, giving a current view and evaluation of the topic. Full article

Urinary tract infection (UTI) is a common cause of recurrent infections, especially among young women, but also in patients with infections related to the insertion of urological devices. The aim of this study was to determine the recurrent UTI readmission rate among older patients and the risk factors for recurrent UTI in a prospective cohort of patients admitted to the hospital with community-acquired UTI. We assessed the frequency of recurrent UTIs over a one-year follow-up period after discharge and compared the clinical and epidemiological characteristics between cases with and without recurrences. Out of a total of 462 patients included in this study, 35 (7.6%) had a readmission due to UTI. The patients in the overall series had a median age of 78 (69–86) years, and 50% were women. Recurrent UTIs were associated with healthcare-associated UTIs (OR 2.8, 95% CI 1.1–6.9) and Pseudomonas aeruginosa infections (OR 2.7, 95% CI 1.1–7.2) according to multivariate analysis. Patients with recurrent UTIs experienced longer hospital stays, with no significant difference in mortality rates. Half of the recurrent UTIs were caused by the same microorganisms as those in primary UTIs, but the prolonged period up to recurrence, with a median of 4 months, suggests that they were mostly reinfections. In conclusion, elderly patients admitted to the hospital with complicated UTIs had a low long-term risk of recurrent UTIs. However, this risk was higher in patients with healthcare-associated infection criteria and in those with P. aeruginosa UTIs. Identifying these risk groups may aid in the early detection of recurrent UTIs. Full article

Background: The escalating resistance of uropathogens in pediatric febrile urinary tract infection (F-UTI) is a global concern. This study examined changing trends in F-UTI epidemiology and resistance patterns among Israeli pediatric inpatients over a decade. Methods: Demographic, clinical, and laboratory data for children between 3 months and 18 years old with febrile UTI from 2010 to 2021 were retrieved from electronic medical records. Results: A total of 761 cases of F-UTI were identified (702 females, mean age 43 months). Escherichia coli was the most common pathogen (85.9%), followed by Pseudomonas aeruginosa (3.5%) and Klebsiella pneumoniae (3.4%). Compared with the non-complicated UTI group, the complicated UTI group had significantly higher rates of Pseudomonas aeruginosa (5.3% vs. 1.0%, p = 0.002) and Klebsiella pneumoniae (4.6% vs. 1.6%, p = 0.03). Antibiotic resistance analysis revealed significant differences between the groups: resistance to cephalexin was higher in the complicated UTI group (19.3%) compared with the non-complicated UTI group (13.4%, p = 0.03). Notably, relatively low resistance rates were observed for ceftriaxone (4.4%) and gentamicin (6.0%). Over time, a significant decreasing trend in resistance to ampicillin was observed (slope = −0.0193, p = 0.011). No significant trends were found for trimethoprim–sulfamethoxazole, cephalexin, amoxicillin–clavulanic acid, ceftriaxone, and cefuroxime. Conclusions: Significant differences in pathogen distribution and resistance patterns between complicated UTI and non-complicated UTI groups highlight the need for continuous resistance monitoring and adherence to local guidelines. For the treatment of severe community F-UTI, ceftriaxone could be a reasonable option for first-onset F-UTI. Further studies are needed to implement antibiotic stewardship and optimize usage. Full article