Microbiological profile and antimicrobial susceptibility of bacteria associated with urinary tract infections in Ukrainian adults

K.S. Barannik; O.V. Ishchenko; R.V. Duka; R.M. Molchanov; D.O. Stepanskyi

doi:10.26641/2307-0404.2024.2.307596

Автор(и)

K.S. Barannik Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Україна https://orcid.org/0000-0002-1009-4990
O.V. Ishchenko Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Україна https://orcid.org/0000-0001-7677-5062
R.V. Duka Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Україна https://orcid.org/0000-0003-3962-8746
R.M. Molchanov Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Україна https://orcid.org/0000-0002-9589-8364
D.O. Stepanskyi Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Україна https://orcid.org/0000-0001-6350-8176

DOI:

https://doi.org/10.26641/2307-0404.2024.2.307596

Ключові слова:

urinary tract infections, urolithiasis, antimicrobial resistance, bacteria, local susceptibility profile

Анотація

The aim of the study was to analyse the microbial profile of the urinary tract infections (UTIs) due to urolithiases and to study susceptibility to antibiotics in its causative agents. The main method of the research was bacteriological. Antimicrobial susceptibility testing was conducted by serial microdilution assay in accordance with recommendations of the European committee on antimicrobial susceptibility testing (EUCAST). For present study 128 unique urine samples were collected from patients with UTIs associated with urolithiasis. Among all collected specimens, 78% (n=100) gave clinically significant growth. Among all examined participants, 88.9% of women (64/72) and 64.3% of men (36/56) had confirmed UTI; in the study, female/male ratio was 1.4 (χ2=9.76; p<0.05). Microorganisms identified in our study predominantly belonged to Bacteria (93.4%), and yeasts of Candida genus comprised only 6.6%. Among all, 66.1% were representatives of Enterobacterales (n=80), particularly, Escherichia coli (38.0%), Klebsiella oxytoca (15.7%), Klebsiella pneumoniae (2.5%), Enterobacter cloacae (5.8%), Proteus mirabilis (4.1%). Isolates of Pseudomonas aeruginosa comprised 3.3%. Among gram-positive isolates, Staphylococcus spp. (14.1%) and Enterococcus spp. (9.9%) were identified. Regarding female/male distribution, the biggest proportion of gram-positive bacteria were isolated from women, statistically significant results were obtained for sex distribution of S. saprophyticus (p<0.05). Antimicrobial susceptibility of Enterobacterales was variable, and the best results were obtained for carbapenems, novel antibiotics (cefiderocol, ceftolozane-tazobactam and ceftazidime-avibactam), aminoglycosides and tigecycline. There were 9 isolates with production of carbapenemases and resistant to all relevant β-lactam antibiotics. All isolated Staphylococcus spp. were β-lactamase producers, one isolate of S. saprophyticus demonstrated methicillin-resistance. To summarise, there is an ongoing outbreak of multidrug-resistant infections in Ukraine and causative agents of UTIs are among the most important contributors. Availability of data on the local antimicrobial susceptibility profile may guide the informed decision making in etiotropic treatment, therefore, contribute to global efforts in rational drug use and fight the resistance escalation.

Посилання

Saidakova N, Stus V, Havva N, Grodzinsky V. Peculiarities of the disease and prevalence of chronic cystitis among the female population of Ukraine in the regional aspect. Med. perspekt. 2021;26(4):212-9. doi: https://doi.org/10.26641/2307-0404.2021.4.248236

Mlugu EM, Mohamedi JA, Sangeda RZ, Mwambete KD. Prevalence of urinary tract infection and anti-microbial resistance patterns of uropathogens with biofilm forming capacity among outpatients in morogoro, Tanzania: a cross-sectional study. BMC Infect Dis. 2023;23(1):660. doi: https://doi.org/10.1186/s12879-023-08641-x

Sabih A, Leslie SW. Complicated Urinary Tract Infections. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. [cited 2024 Feb 01]. Available from: https://pubmed.ncbi.nlm.nih.gov/28613784/

O’Neill J. Tackling drug-resistant infections globally: final report and recommendations [Internet]. United Kingdom; 2016 [cited 2024 Jan 25]. Available from: https://amr-review.org/sites/default/files/160518_Final%20-paper_with%20cover.pdf

Lila ASA, Rajab AAH, Abdallah MH, Rizvi SMD, Moin A, Khafagy ES, et al. Biofilm Lifestyle in Recurrent Urinary Tract Infections. Life (Basel). 2023;13(1):148. doi: https:// doi.org/10.3390/life13010148

6.Ait-Mimoune N, Hassaine H, Boulanoir M. Bacteriological profile of urinary tract infections and antibiotic susceptibility of Escherichia coli in Algeria. Iranian Journal of Microbiology [Internet]. 2022Apr.13;. Available from: https://publish.kne-publishing.com/index.php/IJM/article/view/9180

Carroll CK, Pfaller AM. Manual of Clinical Microbiology, 4 Volume Set. 13-st ed. ASM Books; 2023. 3456 p.

The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 13.0 [Internet]. 2023 [cited 2024 Feb 05]. Available from: http://www.eucast.org

The European Committee on Antimicrobial Susceptibility Testing. Intrinsic resistance and unusual pheno-types. Expert rules. Version 3.3 [Internet]. 2021. [cited 2024 Feb 15]. Available from: http://www.eucast.org

The European Committee on Antimicrobial Susceptibility Testing. EUCAST Guidance Documents [Internet]. [cited 2024 Feb 15]. Available from: http://www.eucast.org

Ryzhov OA, Penkin YuM. [Statistical methods of processing the results of medical and biological research]. Magnolia; 2022. 160 p. Ukrainian.

Pantha S, Parajuli H, Arjyal C, Karki ST, Shres-tha D. Phenotypic characterization of ESBL-producing urinary isolates of E. coli and Klebsiella spp. in a tertiary care children's hospital in Nepal. Trop Med Health. 2024;52(1):20. doi: https://doi.org/10.1186/s41182-024-00587-3

Keighley C, van Oijen AM, Brentnall SJ, Sander-son-Smith M, Newton P, Miyakis S. Multi-year antimicro-bial-resistance trends in urine Escherichia coli isolates from both community-based and hospital-based labora-tories of an Australian local health district. J Glob Antimicrob Resist. 2022;31:386-90. doi: https://doi.org/10.1016/j.jgar.2022.11.008

Kot B. Antibiotic Resistance Among Uropathogenic Escherichia coli. Pol J Microbiol. 2019;68(4):403-15. doi: https://doi.org/10.33073/pjm-2019-048

Yang X, Chen H, Zheng Y, Qu S, Wang H, Yi F. Disease burden and long-term trends of urinary tract infections: A worldwide report. Front Public Health. 2022;10:888205. doi: https://doi.org/10.3389/fpubh.2022.888205

Bharuka V, Meshram R, Munjewar PK. Compre-hensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies. Cureus. 2024;16(2):e53882. doi: https://doi.org/10.7759/cureus.53882

Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare (Basel). 2023;11(13):1946. doi: https://doi.org/10.3390/healthcare11131946

Salmanov AG, Artyomenko V, Susidko OM, Kor-niyenko SM, Kovalyshyn OA, Rud VO, et al. Urinary tract infections in pregnant women in Ukraine: results of a mul¬ticenter study (2020-2022). Wiad Lek. 2023;76(7):1527-35. doi: https://doi.org/10.36740/WLek202307103

Rodrigues SH, Nunes GD, Soares GG, Ferreira RL, Damas MSF, Laprega PM, et al. First report of coexistence of blaKPC-2 and blaNDM-1 in carbapenem-resistant clinical isolates of Klebsiella aerogenes in Brazil. Front Microbiol. 2024;15:1352851. doi: https://doi.org/10.3389/fmicb.2024.1352851

Bedenić B, Meštrović T. Mechanisms of Resis-tance in Gram-Negative Urinary Pathogens: From Country-Specific Molecular Insights to Global Clinical Relevance. Diagnostics (Basel). 2021;11(5):800. doi: https://doi.org/10.3390/diagnostics11050800

Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C. Urinary Tract Infections: The Current Scenario and Future Prospects. Pathogens. 2023;12(4):623. doi: https://doi.org/10.3390/pathogens12040623

Kondratiuk V, Jones BT, Kovalchuk V, Kova-lenko I, Ganiuk V, Kondratiuk O, et al. Phenotypic and genotypic characterization of antibiotic resistance in military hospital-associated bacteria from war injuries in the Eastern Ukraine conflict between 2014 and 2020. J Hosp Infect. 2021;112:69-76. doi: https://doi.org/10.1016/j.jhin.2021.03.020

Schultze T, Hogardt M, Velázquez ES, Hack D, Besier S, Wichelhaus TA, et al. Molecular surveillance of multidrug-resistant Gram-negative bacteria in Ukrainian patients, Germany, March to June 2022. Euro Surveill. 2023;28(1):2200850. doi: https://doi.org/10.2807/1560-7917.ES.2023.28.1.2200850

Stein C, Zechel M, Spott R, Pletz MW, Kipp F. Multidrug-resistant isolates from Ukrainian patients in a German health facility: a genomic surveillance study focusing on antimicrobial resistance and bacterial relatedness. Infection. 2023;51(6):1731-8. doi: https://doi.org/10.1007/s15010-023-02061-4

Ludvigsson JF, Loboda A. Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees. Acta Paediatr. 2022;111(7):1341-53. doi: https://doi.org/10.1111/apa.16370