Dr Benjamin A H Jensen Dr Aarabi Dr Mera A Ababneh Dr Albert Abaka-Yawson Dr Mohamed Salah Abassi Dr Getahun Abate Dr Tarek Mohamed Abd ElAziz Dr Rehab M Abd El-Baky Dr Amir Abdoli Dr Akebe Luther King Abia Dr Fatma Ben Abid Prof Dr Khaled M Aboshanab Mr Ashenafi Abossie Dr Abouelfetouh Dr Maja Abram Dr Sawsan Abuhammad Dr Abulebda Professor Ali Acar Mr Oliver Okoth Achila Dr Stefan Acosta Dr Azeez Adeboye Dr Sanjib Adhikari Prof Dr Muhammad Sohail Afzal Dr Fabio Aguiar-Alves Dr Thomas Agyarko-Poku Dr Irfan Ahmad Dr Suhail Ahmad Dr Hafiz Ahmad Dr Elham Ahmadi Dr Zahra Ahmadinejad Dr Ehsan Ahmadpour Dr Haroon Ahmed Dr Firoz Ahmed Dr Wan M Aizat Dr Abraham Ajayi Dr Ali Akbar Dr Sami Akbulut Dr Hashaam Akhtar Professor Ala-Eddin Al Moustafa Dr Al-Hasan Dr Ali Al-Jumaili Dr Alexandre Alanio Dr Eliana Alcaraz Dr Maria D Alcantar Curiel Dr Gaetano Alfano Prof Dr Abdelazeem Algammal Dr Iftikhar Ali Dr Musa Mohammed Ali Dr Ihsan Ali Dr Mohammad Javed Ali Dr Ali Muhsin Ali Dr Shahzad Ali Dr Sheikh Alif Professor Michael Alifrangis Dr Reem Aljindan Prof Dr Karel Allegaert Dr Rosalie Allison Dr Ammar Almaaytah Dr Dhary Alewy Almashhadany Dr Tarig Alnour Dr Bandar Alosaimi Mr Abdullah Alqarihi Dr Alian A Alrasheedy Dr Eduardo Amaral Dr Gul Ambreen Professor Gobena Ameni Dr Ahmed Ammar Dr Linda Amoah Professor Luca Ampollini Dr Edina Amponsah-Dacosta Dr Mirko Ancillotti Ms Motswedi Anderson Dr Angel Andrade Dr Sergio Angel Dr Angkasekwinai Dr Archana Angrup Dr Enoch Aninagyei Dr Shamshul Ansari Dr Beena Antony Dr Nopporn Apiwattanakul Dr Amjad Islam Aqib Professor Mohammad Arabestani Dr Sheila Araujo Teles Dr Balew Arega Dr Gunjan Arora Dr Muhammad Imran Arshad Dr Yasir Arshad Dr Kovy Arteaga-Livias Dr Mohd Hafiz Arzmi Dr Mohammad Reza Asadi Karam Dr Takanori Asakura Dr Prince Asare Dr Mohammad Asgharzadeh Dr Hossam Ashour Dr Abdullah Tarik Aslan Dr Alaa Atamna Dr Nur Atik Dr Meiji Soe Aung Dr Wah Wah Aung Professor Sergey Avdeev Dr Akshay Avula Dr Babafela Awosile Dr Gajendra Kumar Azad Dr Davood Azadi Mr Zelalem Nigussie Azene Dr Afzal Azim Mr Muhammad Majid Aziz Dr Martin Sima Dr Azer Ozad Duzgun Dr Kenan Cetin Dr Aysegul Copur Cicek Dr Ines Bado Dr Fang Bai Dr J Kevin Baird Dr Andrea Ballini Prof Dr Zulqarnain Baloch Dr Joseph Baruch Baluku Dr Banaei Prof Dr Tuhina Banerjee Dr Tuhina Banerjee Mr Agegnehu Bante Dr Humberto Barrios Camacho Dr Mazin Barry Dr Bruno Barsic Dr Christopher S von Bartheld Dr Dariusz Bartosik Dr Joseph Baruch Baluku Dr Rasha Barwa Dr Saurav Basu Dr George Bayliss

Infection and Drug Resistance

Background
Urinary tract infections are the most commonly acquired bacterial infections and they account for an estimated 25-40% of the nosocomial infections. The microbial biofilms pose a public health problem for the persons who require indwelling medical devices, as the microorganisms in the biofilms are difficult to treat with antimicrobial agents.

The Isolation and the Biofilm Formation of Uropathogens in the Patients with Catheter Associated Urinary Tract Infections (UTIs).

Bacterial biofilm-based catheter-associated urinary tract infections: Causative pathogens and antibiotic resistance.

Urinary tract infection (UTI) represents one of the most common diseases encountered in community medical practice. In resource poor settings, treatment is usually empiric due to the high cost and long duration required for reporting diagnosis by culture and antibiotic susceptibility testing. With the growing problem of drug resistance knowledge of antibiotic susceptibility pattern is pertinent for successful eradication of invading pathogens. Our study, the first of its kind in Cameroon, analyzed the distribution and antibiotic susceptibility of bacteria causing community-acquired urinary tract infection (CAUTI) in two towns (Bamenda and Buea) with a large number of young and middle aged persons, to provide data that could guide empiric treatment. We cultured 235 urine specimens and analyzed the antibiotic susceptibility of isolates by the disc diffusion technique. Uropathogens were recovered from 137 (58.3%), with prevalence rates in Buea and Bamenda being 65.9% and 54% respectively. Predominant pathogens were Escherichia coli (31.4%), Klebsiella oxytoca (25.5%) and Staphylococcus spp (24.1%). Geographic variation in uropathogen distribution and antibiotic susceptibility was observed, and a significant difference in pathogen distribution with respect to gender. The 20–39 years age group had the highest prevalence of infection. All pathogens isolated were detected in this group. Isolates exhibited low susceptibility to antibiotics tested. Bamenda isolates generally exhibited lower susceptibility compared to those from Buea. Regional variation in etiology of CAUTI and antibiotic susceptibility observed in our study emphasizes the need to establish local and national antimicrobial resistance monitoring systems in Cameroon to provide information for the development of CAUTI treatment guidelines.

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Etiologic profile and antimicrobial susceptibility of community-acquired urinary tract infection in two Cameroonian towns

Background: There are sporadic reports on detection of extended-spectrum beta-lactamases (ESBL) producers from Karnataka; hence, this is a first multicentric study across Karnataka state to determine the prevalence of ESBL production among clinical isolates of Escherichia coli and Klebsiella pneumoniae .
 Aims and objectives: To determine the prevalence of ESBL producing clinical isolates of E. coli and K. pneumoniae from five geographically distributed centers across Karnataka, to study the susceptibility of ESBL producing isolates to other beta-lactam and beta-lactam-beta-lactamase inhibitors and to demonstrate transferability of plasmids coding for ESBL phenotype.
 Materials and Methods: Two hundred isolates of E. coli and K. pneumoniae each were collected from each of the five centers (Bellary, Dharwad, Davangere, Kolar and Mangalore). They were screened for resistance to screening agents (ceftazidime, cefotaxime, ceftriaxone, aztreonam) and positive isolates were confirmed for ESBL production by test described by Clinical and Laboratory Standards Institute . Co-production of ESBL and AmpC beta-lactamase was identified by using amino-phenylboronic acid disk method. Susceptibility of ESBL producers to beta-lactam antibiotics and beta-lactamase inhibitors was performed. Transferability of plasmids was performed by conjugation experiment.
 Results: Overall prevalence of ESBL production among E. coli and K. pneumoniae across five centers of the state was 57.5%. ESBL production was found to be 61.4% among E. coli and 46.2% among K. pneumoniae . ESBL production was significantly more among E. coli than K. pneumoniae . Significant variations in distribution of ESBL across the state was observed among E. coli isolates, but not among K. pneumoniae isolates. All ESBL producers demonstrated minimum inhibitory concentration levels ≥2 μg/ml towards cefotaxime, ceftazidime and ceftriaxone.
 Conclusion: Overall prevalence of ESBL production among clinical isolates of E. coli and K. pneumoniae across Karnataka state was high. The prevalence of ESBL production was significantly higher with E. coli than K. pneumoniae isolates. Higher rates of resistance to ceftriaxone and cefotaxime than to ceftazidime suggests the possibility of presence of CTX-M type ESBLs. Of all the beta-lactam/beta-lactamase inhibitor combinations tested, cefepime-tazobactam demonstrated highest in-vitro activity against ESBL producers. There was no statistical difference in the transferability of plasmids among E. coli and K. pneumoniae.

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Extended-Spectrum Beta-Lactamases Producing Escherichia coli and Klebsiella pneumoniae: A Multi-Centric Study Across Karnataka.

The knowledge of etiology and antibiotic resistance pattern of the organisms causing urinary tract infection is essential. This study was taken up to determine the presentation and risk factors associated with community-acquired urinary tract infection (CA-UTI). The distribution of bacterial strains isolated from these patients and their resistance pattern were also studied. This multidisciplinary prospective observational study was conducted in M. S. Ramaiah Hospital, Bangalore, between January and December, 2008. Patients who had CA-UTI confirmed by positive urine culture reports were included in the study. Statistical analysis was done using the SPSS version 16. Symptomatology and others risk factors for CA-UTI were studied in these patients and the causative organisms and their resistance patterns were recorded. Of the total 510 patients included, 57% belonged to the elderly age group (50-79 years). Fever and dysuria were the most common clinical presentation, but were not specific in predicting CA-UTI. Escherichia coli (66.9%) was the most common organism causing CA-UTIs with extended spectrum beta lactamase (ESBL) resistance seen in nearly two-thirds of these cases (42.2%). The organisms recorded least resistance against carbapenems (3.9%). A high resistance rate was seen for fluoroquinolones (74.1%). In conclusion, a high rate of ESBL-positive organisms and their resistance to commonly used antibiotics brings a concern for future options in treating these conditions.

P Shiva Kumar

Papers

Clinico-microbiological profile of urinary tract infection in south India.