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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 10756

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Special Issue Editors

Dr. Majid Mirzazadeh

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Guest Editor

Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
Interests: urinary microbiome; UTI; UTI in kidney stone patients; improvement of devices used in urinary tract; antibiotic stewardship in UTI

Dr. John W. Sanders

E-Mail Website
Guest Editor

Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
Interests: emerging infections; vaccines; tropical and travel medicine; infections of military importance

Special Issue Information

Dear Colleagues,

Urinary tract infections (UTIs) are some of the most common infectious diseases in humans. Despite significant progress in the invention of more powerful and wider-spectrum antibiotics, mortality and morbidity of UTIs in patients have not significantly decreased. This is partly because of the overuse of antibiotics, resulting in the resurgence of more resistant strains, and also because of the lack of a complete understanding of microbial flora of the urinary tract.

Until recently, the urinary tract was assumed to be a sterile environment, and any microbial growth was considered abnormal and requiring treatment.

The urinary tract microbiome is currently being defined, with recent advances in microbial culture (enhanced quantitative microbial cultures) and tests focusing on the genetic detection of bacteria such as PCR and next-generation sequencing. Therefore, the protective role of the urinary microbiome and its changes alongside patients’ unusual conditions, including external catheters, internal stents, consumption of antibiotics, and underlying diseases, have become important research topics not only in UTIs, but also in other conditions, such as interstitial cystitis, prostatitis, kidney stones and pelvic pain.

With the new knowledge that the urinary tract is not sterile, the dilemma regarding how and when to treat bacterial invasion into the urinary tract has become more pronounced.

This Special Issue seeks manuscripts that increase our understanding of the urinary microbiome and the relationship of the microbiome with different disease conditions, clarifying the indication for treatment of UTIs with different levels of symptoms, the overuse of antibiotics and its detrimental effects, superbugs, and antibiotic stewardship in UTIs.

Dr. Majid Mirzazadeh
Dr. John W. Sanders
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

UTI
antibiotic
microbiome
PCR
next-generation sequencing
urine culture
enhanced quantitative urine cultures
urinary sepsis

Published Papers (7 papers)

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Research

12 pages, 2681 KiB

Open AccessArticle

A Five-Year Analysis of Antibiotic Resistance Trends among Bacteria Identified in Positive Urine Samples in a Tertiary Care Hospital from Bucharest, Romania

by Alina Maria Borcan, Georgiana Radu, Mădălina Simoiu, Elena Liliana Costea and Alexandru Rafila

Antibiotics 2024, 13(2), 160; https://doi.org/10.3390/antibiotics13020160 - 6 Feb 2024

Viewed by 1295

Abstract

The rise of multidrug-resistant bacteria (MDR) has resulted in limited treatment options and poorer outcomes for patients. The objective of this study was to analyze the overall antibiotic resistance trends and distribution for pathogens identified in urine samples at the National Institute of Infectious Diseases “Prof. Dr. Matei Balș” from Bucharest, Romania, over a 5-year period. Antibiotic susceptibility testing was performed using automatic systems and the disk diffusion method. ESBL- and carbapenemases-producing strains were identified using immunochromatography tests, and ROSCO Diagnostica kits were used for definitive confirmation. All results were interpreted according to EUCAST clinical breakpoints. Gram-negative rods (GNR) had overall resistance rates higher than 50% for penicillin and 40% for 3rd- and 4th-generation cephalosporins. Escherichia coli resistance to fosfomycin (3%) and nitrofurantoin (2%) remains low, and 33.30% of E. coli, 48% of Klebsiella spp., and 37% of Pseudomonas aeruginosa isolates were multidrug-resistant (MDR). All Acinetobacter baumannii isolates were MDR by the last year of the study. For Gram-positive cocci (GPC), 37% of all Enterococcus faecium strains and 2% of Enterococcus faecalis were vancomycin-resistant (VRE). E. coli’s incidence in UTIs’ etiology is on a downward trend. The incidence of Klebsiella spp. and GPCs is rising. Antibiotic stewardship strategies should be implemented after carefully considering regional variations in etiology and resistance trends. Full article

(This article belongs to the Special Issue Urinary Tract Infections and Antibiotic Intervention)

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11 pages, 1126 KiB

Open AccessArticle

Evaluation of Two Tests for the Rapid Detection of CTX-M Producers Directly in Urine Samples

by Forrest Tang, Chung-Ho Lee, Xin Li, Shuo Jiang, Kin-Hung Chow, Cindy Wing-Sze Tse and Pak-Leung Ho

Antibiotics 2023, 12(11), 1585; https://doi.org/10.3390/antibiotics12111585 - 2 Nov 2023

Viewed by 1295

Abstract

Infections caused by extended-spectrum β-lactamase-producing Enterobacterales have increased rapidly and are mainly attributed to the production of CTX-M enzymes. This study evaluated the NG-Test^® CTX-M MULTI lateral flow assay (CTX-M LFA) and the Rapid ESBL NP^® test (ESBL NP test) for rapid detection of CTX-M-producing Enterobacterales directly in midstream urine (MSU) samples. Testing was performed on 277 clinical MSU samples in a hospital microbiology laboratory from November 2022 to January 2023; 60 of these samples (30 positive for ESBL producers and 30 positive for non-ESBL producers) were tested retrospectively after the identification and susceptibility results were obtained, and 217 samples were tested prospectively immediately after a Gram stain showing the presence of Gram-negative bacilli. The results were compared against phenotypic detection of ESBL and molecular testing as the reference methods. Overall, 67 of the 277 samples were culture-positive for ESBL-producing Enterobacterales. PCR for the bla_CTX-M gene was positive for all ESBL-producing Enterobacterales isolates. All CTX-M LFA results were interpretable, while three of the ESBL NP test results were noninterpretable. The sensitivity of the CTX-M LFA (100%, 95% CI 94.6–100%) was higher than that of the ESBL NP test (86.6%, 95% CI 76.0–93.7%). Both tests had high specificities (CTX-M LFA, 99.1%, 95% CI 96.6–99.9% and ESBL NP test, 100%, 95% CI 98.2–100%). In conclusion, both the CTX-M LFA and the ESBL NP test can deliver rapid results that could improve antimicrobial stewardship for urinary tract infections. Full article

(This article belongs to the Special Issue Urinary Tract Infections and Antibiotic Intervention)

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13 pages, 1780 KiB

Open AccessArticle

Urinary Tract Infection and Antimicrobial Resistance Patterns: 5-Year Experience in a Tertiary Pediatric Nephrology Center in the Southwestern Region of Poland

by Anna Kawalec, Justyna Józefiak and Katarzyna Kiliś-Pstrusińska

Antibiotics 2023, 12(9), 1454; https://doi.org/10.3390/antibiotics12091454 - 19 Sep 2023

Cited by 1 | Viewed by 1593

Abstract

(1) Background: Urinary tract infections (UTIs) are among the most common infections in the pediatric population. This study aimed to analyze the urine culture results and antimicrobial patterns over the last 5 years in children diagnosed with UTI. (2) Methods: Retrospective analysis of medical records of 242 patients hospitalized in the Pediatric Nephrology Department diagnosed with a UTI in the years 2018–2022. (3) Results: The most common causative agent was E. coli, responsible for 64% of UTIs, followed by Klebsiella spp. (16%), Pseudomonas spp. (6%), Enterobacter spp. (4%), Proteus spp. (4%), and Enterococcus spp. (3%). Non-E. coli UTIs were significantly more frequently observed in patients with congenital anomalies of the kidney and urinary tract or neurogenic bladder and patients receiving antibiotic prophylaxis. For the whole study period, 32% of E. coli were resistant to amoxicillin/clavulanic acid, 23.3% to trimethoprim/sulfamethoxazole, 12.2% to ciprofloxacin, and 4.4% to nitrofurantoin. During 2018–2022, the prevalence of E. coli resistant to amoxicillin/clavulanic acid varied from 16.7% to 41.2%, and resistance to cefuroxime increased four times (from 4% in 2018 to 16.7% in 2022). Starting in 2021, all isolated E. coli strains were classified as susceptible-increased exposure or resistant to cefuroxime. (4) Conclusion: Managing pediatric UTIs remains challenging in clinical practice. The choice of optimal empiric treatment should be considered following local recommendations and individual risk factors assessment and require careful dosage adjustment. Observed changes in antimicrobial resistance indicated the need for frequent updating of local recommendations for the management of pediatric patients with UTIs. Full article

(This article belongs to the Special Issue Urinary Tract Infections and Antibiotic Intervention)

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11 pages, 1657 KiB

Open AccessArticle

Impact of Menopausal Status and Recurrent UTIs on Symptoms, Severity, and Daily Life: Findings from an Online Survey of Women Reporting a Recent UTI

by Leigh N. Sanyaolu, Emily Cooper, Brieze Read, Haroon Ahmed and Donna M. Lecky

Antibiotics 2023, 12(7), 1150; https://doi.org/10.3390/antibiotics12071150 - 5 Jul 2023

Cited by 1 | Viewed by 1429

Abstract

Introduction: Current UKHSA UTI diagnostic guidance advises empirical antibiotics if two of the following symptoms are present: cloudy urine, dysuria, and new onset nocturia. Hormonal changes during menopause may impact UTI symptoms, and qualitative studies suggest women with recurrent UTIs may present with different UTI symptoms. This study aims to assess whether menopausal status and the presence of recurrent UTIs impact UTI symptoms in women. Methods: An e-survey was conducted between 13 March 2021 and 13 April 2021. Women aged 16 years or older with a history of a UTI in the last year were eligible for inclusion. We defined menopause as those aged 45–64 years; pre-menopause as those less than 45 years; and post-menopause as those 65 years and older. Recurrent UTIs were defined as three or more UTIs in the last year. The data were weighted to be representative of the UK population. Crude unadjusted and adjusted odds ratios were estimated using logistic regression. Results: In total, 1096 women reported a UTI in the last year. There were significant differences in UTI symptoms based on menopausal status and the presence of recurrent UTIs. Post-menopausal women self-reported more incontinence (OR 2.76, 95% CI 1.50,5.09), whereas menopausal women reported more nocturia. Women with recurrent UTIs reported less dysuria, more severe symptoms (OR 1.93 95% CI 1.37,2.73) and a greater impact on daily life (OR 1.68, 95% CI 1.19,2.37). Conclusions: This survey provides evidence that acute UTIs present differently based on menopausal status and in women with recurrent UTIs. It is important that healthcare professionals are aware of these differences when assessing women presenting with an acute UTI and, therefore, further research in this area is needed. Full article

(This article belongs to the Special Issue Urinary Tract Infections and Antibiotic Intervention)

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8 pages, 656 KiB

Open AccessCommunication

In Vitro Activity of Omadacycline and Comparator Antibiotics against Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Urinary Isolates

by Tyler J. Stone, Abdullah Kilic, John C. Williamson and Elizabeth L. Palavecino

Antibiotics 2023, 12(6), 953; https://doi.org/10.3390/antibiotics12060953 - 24 May 2023

Cited by 1 | Viewed by 1304

Abstract

Limited oral antibiotic options exist for urinary tract infections (UTI) caused by ESBL-producing Enterobacterales. The aim of the study was to evaluate in vitro activity of omadacycline and comparator antibiotics against clinical ESBL-producing and non-ESBL-producing E. coli and K. pneumoniae urinary isolates. 102 isolates each of E. coli and K. pneumoniae were collected from clinical urine specimens in 2019. By design, an equal number of each species were included that tested positive and negative for ESBL production. Omadacycline MICs were determined using gradient test strips and compared to MICs of comparator antibiotics as determined by an automated broth microdilution system. Isolates were considered susceptible to omadacycline if the MIC was ≤4 µg/mL for each species. 54.9% of all ESBL-producing isolates were susceptible to omadacycline, but better susceptibility was observed for ESBL-producing E. coli (74.5%). Omadacycline MICs were 2–4 fold lower for E. coli and K. pneumoniae strains not producing ESBL. The omadacycline MIC 50 and 90 values were 4 and 16 µg/mL, respectively, for all isolates studied. 74.5% of all isolates were considered susceptible to omadacycline. MICs were generally lower for E. coli strains with MIC 50 and 90 values of 4 and 8 µg/mL, respectively (87.3% susceptible), compared with K. pneumoniae. Overall, the most active agents were omadacycline and nitrofurantoin, while other comparator antibiotics were less active. Omadacycline represents a promising oral antibiotic for treating UTI caused by ESBL-producing E. coli, particularly when resistance limits other oral options. Prospective, controlled clinical trials are needed to validate these in vitro results. Full article

(This article belongs to the Special Issue Urinary Tract Infections and Antibiotic Intervention)

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17 pages, 2103 KiB

Open AccessArticle

Uropathogens’ Antibiotic Resistance Evolution in a Female Population: A Sequential Multi-Year Comparative Analysis

by Cristian Mareș, Răzvan-Cosmin Petca, Răzvan-Ionuț Popescu, Aida Petca, Bogdan Florin Geavlete and Viorel Jinga

Antibiotics 2023, 12(6), 948; https://doi.org/10.3390/antibiotics12060948 - 23 May 2023

Cited by 4 | Viewed by 1474

Abstract

Urinary Tract Infections (UTIs) represent a common finding among females and an important basis for antibiotic treatment. Considering the significant increase in antibiotic resistance during the last decades, this study retrospectively follows the incidence of uropathogens and the evolution of resistance rates in the short and medium term. The current study was conducted at the “Prof. Dr. Th. Burghele” Clinical Hospital, including 1124 positive urine cultures, in three periods of four months between 2018 and 2022. Escherichia coli was the most frequent uropathogen (54.53%), followed by Klebsiella spp. (16.54%), and Enterococcus spp. (14.59%). The incidence of UTIs among the female population is directly proportional to age, with few exceptions. The highest overall resistance in Gram-negative uropathogens was observed for levofloxacin 30.69%, followed by ceftazidime 13.77% and amikacin 9.86%. The highest resistance in Gram-positive uropathogens was observed for levofloxacin 2018-R = 34.34%, 2020-R = 50.0%, and 2022-R = 44.92%, and penicillin 2018-R = 36.36%, 2020-R = 41.17%, and 2022-R = 37.68%. In Gram-negative uropathogens, a linear evolution was observed for ceftazidime 2018-R = 11.08%, 2020-R = 13.58%, and 2022-R = 17.33%, and levofloxacin 2018-R = 28.45%, 2020-R = 33.33%, and 2022-R = 35.0%. The current knowledge dictates the need to continuously assess antimicrobial resistance patterns, information that is necessary for treatment recommendations. The present study aims to determine the current situation and the evolution trends according to the current locoregional situation. Full article

(This article belongs to the Special Issue Urinary Tract Infections and Antibiotic Intervention)

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12 pages, 258 KiB

Open AccessArticle

The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study

by Filip Jansåker, Xinjun Li, Ingvild Vik, Niels Frimodt-Møller, Jenny Dahl Knudsen and Kristina Sundquist

Antibiotics 2022, 11(12), 1695; https://doi.org/10.3390/antibiotics11121695 - 24 Nov 2022

Cited by 5 | Viewed by 1769

Abstract

Background: The risk of pyelonephritis following uncomplicated lower urinary tract infection (cystitis) in women has not been studied in well-powered samples. This is likely due to the previous lack of nationwide primary healthcare data. We aimed to examine the risks of pyelonephritis following cystitis in women and explore if antibiotic treatment, cervical cancer, parity, and sociodemographic factors are related to these risks. Methods: This was a nationwide cohort study (2006–2018) of 752,289 women diagnosed with uncomplicated cystitis in primary healthcare settings. Of these, 404 696 did not redeem an antibiotic prescription within five days from cystitis. Logistic regression models were used to calculate odds ratios for pyelonephritis within 30 days and 90 days following the cystitis event. Results: Around one percent (7454) of all women with cystitis were diagnosed with pyelonephritis within 30 days, of which 78.2% had not redeemed an antibiotic for their cystitis. Antibiotic treatment was inversely associated with both outpatient registration and hospitalization due to pyelonephritis, with odds ratios of 0.85 (95% CI 0.80 to 0.91) and 0.65 (95% CI 0.55 to 0.77), respectively. Sociodemographic factors, parity, and cervical cancer were, with few exceptions (e.g., age and region of residency), not associated with pyelonephritis. Conclusions: Antibiotic treatment was inversely associated with pyelonephritis, but the absolute risk reduction was low. Non-antibiotic treatment for cystitis might be a safe option for most women. Future studies identifying the women at the highest risks will help clinicians in their decision making when treating cystitis, while keeping the ecological costs of antibiotics in mind. Full article

(This article belongs to the Special Issue Urinary Tract Infections and Antibiotic Intervention)

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