Antimicrobial resistance development – prevalence and antibiotic resistance patterns of bacterial strains in urine.
Authors:
Vít Paldus 1; Vladimír Šámal 1,2; Daniela Fáčková 3; Jan Mečl 1
Authors‘ workplace:
Urologické oddělení Krajské nemocnice Liberec, a. s., Liberec
1; Urologická klinika Fakultní nemocnice a Lékařské fakulty UK, Hradec Králové
2; Oddělení klinické mikrobiologie Krajské nemocnice Liberec, a. s., Liberec
3
Published in:
Ces Urol 2022; 26(1): 38-48
Category:
Original Articles
Overview
Objective: Antimicrobial resistance (AMR) has become a global concern. However there are significant differences with regard to local epidemiological factors across continents, countries and even medical facilities. Local assessment of antimicrobial resistance development is one of the essential tools in the fight against the AMR spread. The aim of our work is to evaluate the occurrence of resistant urinary strains, analyze the development of resistance and compare AMR in intensive care units (ICU) with standard department of urology.
Materials and methods: We analysed bacterial antibiotic resistance patterns of urinary tract strains in our medical facility between the years 2013–2020. We assessed the susceptibility of bacterial strains to the different antibiotics and compared the resistance patterns in ICU-s with our department of urology. We assessed the increase in number of resistant strains acting via enzymatic modification of antibiotics during this period. Namely the Extented Spectrum Beta-lactamase strains (ESBL), Beta-lactamase AmpC strains, carbapenemase producing Enterobacteriaceae (CPE), Vancomycinresistant Enterococci (VRE) and Methicillin-resistant Staphylococcus aureus (MRSA).
Results: Overall 35 831 positive bacterial cultures were assessed. We detected 4114 resistant strains altogether (11.5 %). Among them ESBL strains were the most frequent (7.8 %), with the resistance nearly doubled between 2013 and 2015 (5.6 % and 10.3 %, respectively). The adopted preventive measures have led to reduction of sustained growth of resistance, however the odds for the occurrence of resistance remain higher in the following years in comparison with 2013 (maxOR: 1.93, 95 % CI; 1.64-2.27). The increase in VRE strains during the last 3 years and in CPE strains in the last year (0.3 %) may jeopardize the efficacy of one of the last groups of antibiotics. Antimicrobial resistance namely to beta-lactam antibiotics was significantly higher in ICU-s compared to standard wards (p < 0.00).
Conclusion: Our data demonstrate the development of AMR. At least one out of ten patients treated for urinary tract infection (UTI) in our medical facility suffers from UTI caused by resistant strains. Occurrence of new types of antimicrobial resistance previously not observed in our medical facility is a serious threat.
Keywords:
Antimicrobial resistance – MRSA – ESBL – AmpC – CPE – VRE
Sources
1. Nicasio AM, Kuti JL, Nicolau DP. The current state of multidrug‑resistant gram‑negative bacilli in North America. Pharmacotherapy. 2008; 28 (2): 235–249.
2. Pallett A, Hand K. Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram‑negative bacteria. J Antimicrob Chemother. 2010; 65 Suppl 3: iii25–33.
3. Walther‑Rasmussen J, Høiby N. Class A carbapenemases. J Antimicrob Chemother. 2007; 60: 470–482.
4. Yong D, Toleman MA, Giske CG, et al. Characterization of a new metallo‑beta‑lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009; 53: 5046–5054.
5. Chan‑Tompkins NH. Multidrug‑resistant gram‑negative infections. Bringing back the old. Crit Care Nurs Q. 2011; 34(2): 87-100.
6. LIU Yi‑Yun, Wang Y, Walsh T, et al. Emergence of plasmid‑mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. The Lancet Infectious Diseases. 2016; 16(2): 161–168.
7. Watanabe T, Fukasawa T. Episome‑mediated transfger of drug resistence in enterobacteriaceae II. J Bacteriol. 1961; 81(5): 679–683.
8. van Duin D, Bonomo RA. Ceftazidime/avibactam and ceftolozane/tazobactam: second‑generation ß‑lactam/ ß‑lactamase inhibitor combinations. Clin Infect Dis. 2016; 63: 234–241.
9. Rottier WC, Ammerlaan HSM, Bonten MJM. Effects of confounders and intermediates on the association of bacteraemia caused by extendedspectrum βlactamaseproducing Enterobacteriaceae and patient outcome: a metaanalysis. J Antimicrob Chemother. 2012; 67(6): 1311–1320.
10. Bradford PA. Extended‑spectrum beta‑lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 2001; 14: 933–951.
11. Centers for Disease Control and Prevention (CDC). Guidance for control of infections with carbapenem‑resistant or carbapenemase‑producing Enterobacteriacae in acute care facilities. MMWR Morb Mortal Wkly Rep. 2009; 58: 256–260.
12. Walker E, Lyman A, Gupta K, et al. Clinical management of an increasing threat: outpatient urinary tract infections due to multidrug‑resistant uropathogens. Clin Infect Dis. 2016; 63: 960–965.
13. Tinelli M, Cataldo MA, Mantengoli E, et al. Epidemiology and genetic characteristicsn of extended‑spectrum beta‑lactamases‑producing Gram‑negative bacteria causing urinary tract infections in long‑term care facilities. J Antimicrob Chemother. 2012; 67(12): 2982–2987.
14. Toner L, Papa N, Aliyu SH, et al. Extendedspectrum betalactamaseproducing Enterobacteriaceae in hospital urinary tract infections: incidence and antibiotic susceptibility profile over 9 years. World J Urol. 2016; 34(7): 1031–1037
15. Ozgur BC, Ekıcı M, Yuceturk CN, Bayrak O. Bacterial colonization of double J stents and bacteriuria frequency. Kaohsiung J Med Sci. 2013; 29(12): 658–661.
16. Kehinde EO, Rotimi VO, AlHunayan A, et al. Bacteriology of urinary tract infection associated with indwelling J ureteral stents. J Endourol. 2004; 18(9): 891–896.
17. Lojanapiwat B. Colonization of internal ureteral stent and bacteriuria. World J Urol. 2006; 24(6): 681–683.
18. LaraIsla A, MedinaPolo J, AlonsoIsa M, et al. Urinary Infections in Patients with Catheters in the Upper Urinary Tract: Microbiological Study. Urol Int. 2017; 98(4): 442–448.
19. Cai T, Mazzoli S, Lanzafame P, et al. Asymptomatic Bacteriuria in Clinical Urological Practice: Preope rative Control of Bacteriuria and Management of Recurrent UTI. Pathogens. 2016; 5(1): 4.
20. Magyar A, Köves B, Nagy K, et al. Spectrum and antibiotic resistance of uropathogens between 2004 and 2015 in a tertiary care hospital in Hungary. J Med Microbiol. 2017; 66(6): 788–797.
21. Gohel K, Jojera A, Soni S, et al. Bacteriological Profile and Drug Resistance Patterns of Blood Culture Isolates in a Tertiary Care Nephrourology Teaching Institute. BioMed Res Int. 2014; 2014: 1–5.
22. van der Donk CFM, Beisser PS, HoogkampKorstanje JAA, et al. A 12 year (1998-2009) antibiotic resistance surveillance of Klebsiella pneumoniae collected from intensive care and urology patients in 14 Dutch hospitals. J Antimicrob Chemother. 2011; 66(4): 855–858.
23. Stapleton PJ, Lundon DJ, McWade R, et al. Antibiotic resistance patterns of Escherichia coli urinary isolates and comparison with antibiotic consumption data over 10 years, 2005–2014. Ir J Med Sci. 2017; 186(3): 733–741.
24. European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS‑Net) – Annual Epidemiological Report 2019. Stockholm: ECDC; 2020.
25. European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS‑Net) – Annual Epidemiological Report for 2019 [Internet]. Stockholm: ECDC; 2020. Dostupné z: https://www.ecdc.europa.eu/en/publications‑data/ surveillance‑antimicrobial‑resistance‑europe- 2019, 18. 11. 2020.
26. Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP). 2019 AR Threats Report [Internet]. 2019. Dostupné z: https://www.cdc.gov/drugresistance/Biggest‑Threats. html, 23. 11. 2021.
27. Bonkat G, Bartoletti R, Bruyère R, et al. Panel EAU Working Group on Urological Infections. EAU Guidelines on Urological infections. Edn. presented at the EAU Annual Congress Milan 2021. 978-94- 92671-13-4. Publisher: EAU Guidelines Office. Place published: Arnhem, The Netherlands.
28. Hrbáček J, Čermák P, Hanáček V, et al. Prevalence uropatogenů v moči a spektrum jejich rezistence – analýza dat z jednoho pracoviště. Ces Urol. 2019; 23(4): 316–324.
29. Fajfr M, Louda M, Paterová P, et al. The susceptibility to fosfomycin of Gramnegative bacteria isolates from urinary tract infection in the Czech Republic: data from a unicentric study. BMC Urol. 2017; 26; 17(1): 33.
30. Heidler S, Asboth F, Mert C, Madersbacher S. Methicillinresistant Staphylococcus aureus (MRSA) in an Austrian urological department: 10 years experience covering 95161 patients. World J Urol. 2013; 31(3): 559–563.
31. Stapleton PJ, Lundon DJ, McWade R, et al. Antibiotic resistance patterns of Escherichia coli urinary isolates and comparison with antibiotic consumption data over 10 years, 2005–2014. Ir J Med Sci. 2017; 186(3): 733–741.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2022 Issue 1
Most read in this issue
- Antimicrobial resistance development – prevalence and antibiotic resistance patterns of bacterial strains in urine.
- Postpubertal teratoma with somatic‑type malignancy
- „Novinky“ v diagnostice karcinomu prostaty
- Rare case report of clear cell renal carcinoma of the right kidney with synchronous metastases in both ovaries