Background: Urinary Tract Infection (UTI)
detected in the hospital and in the community
is one of the most common reasons for consultation in everyday
practice; it represents a major source of antibiotic consumption. Thisstudy’s objectives were to outline the
microbiological profile of Tunisian patients with UTI and assess antibiotic
resistance over the course of three years at the Orthopedic Institute. Methods: All strains identified in urine samples between January 1st, 2019, and December
31st, 2021, were included. Standard laboratory procedures were used to
identify the bacterium. The Microscan Walkway 40 Plus was used to do
biochemical assays and antibiotic susceptibility testing. The EUCAST criteria
were used to interpret the findings. Results: A total of 1313 strains were isolated. The bacteriological
study showed the predominance of
enterobacteria (96.8%), especially E. coli (52.2%) and K. pneumoniae (19.3%). Overall resistance rates to
antimicrobial agents were as follows:
for hospital, E. coli strains were in descending order amoxicillin (73.05%),
trimeth/sulfamethoxazole (46.9%), ofloxacin (40.3%), amoxicillin/clavulanic acid (35.05%) and gentamicin (20.5%). Our results
showed low resistance to fosfomycin
for E. coli 2.6% in hospitals while ≥12.1% for K.pneumoniae. Amikacin resistance remains medium-low for E. coli being ≥20% and 10% for K.pneumonia. Nitrofuran resistance has affected
1.06% of E. coli strains in hospital
settings and 21.5% of K. pneumoniae. Extended Spectrum Beta-Lactamases
(ESBLs) production was present in a number
of enterobacteria (19.3% of K. pneumoniaeand 14.4% of E. coli). Conclusion: The prevalence of E. coli and K. pneumoniae producers ESBLs in UTI is
increasing.Rigorous surveillance of resistance rate is necessary to determine appropriate empirical
treatment and limit the spread of multiresistant strains.
References
[1]
Bitew, A., Molalign, T. and Chanie, M. (2017) Species Distribution and Antibiotic Susceptibility Profile of Bacterial Uropathogens among Patients Complaining Urinary Tract Infections. BMC Infectious Diseases, 17, Article No. 654.
https://doi.org/10.1186/s12879-017-2743-8
[2]
Córdoba, G., Holm, A., Hansen, F., Hammerum, A.M. and Bjerrum, L. (2017) Prevalence of Antimicrobial Resistant Escherichia coli from Patients with Suspected Urinary Tract Infection in Primary Care, Denmark. BMC Infectious Diseases, 17, Article No. 670. https://doi.org/10.1186/s12879-017-2785-y
[3]
Guermazi-Toumi, S., Boujlel, S., Assoudi, M., Issaoui, R., Tlili, S. and Hlaiem, M.E. (2018) Susceptibility Profiles of Bacteria Causing Urinary Tract Infections in Southern Tunisia. Journal of Global Antimicrobial Resistance, 12, 48-52.
https://doi.org/10.1016/j.jgar.2017.09.004
[4]
Farrell, D.J., Morrissey, I., De Rubeis, D., Robbins, M. And Felminghan, D. (2003) A UK Multicentre Study of the Antimicrobial Susceptibility of Bacterial Pathogens Causing Urinary Tract Infection. Journal of Infection, 46, 94-100.
https://doi.org/10.1053/jinf.2002.1091
[5]
Mahamat, A., Lavigne, J.-P., Bouziges, N., Daurès, J.-P. and Sotto, A. (2006) Profils de résistance des souches urinaires de Proteus mirabilis de 1999 à 2005 au CHU de Nîmes. Pathologie Biologie, 54, 456-461.
https://doi.org/10.1016/j.patbio.2006.07.015
[6]
Bouallègue, O., Saidani, M., Ben Mohamed, S. and Mzoughi, R. (2004) Particularités bactériologiques des infections urinaires chez l’enfant dans la région de sousse, Tunisie. Tunisie Médicale, 82, 742-746.
[7]
Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires de l’adulte.
https://www.infectiologie.com/UserFiles/File/spilf/recos/infections-urinaires-spilf.pdf
[8]
Farrell, J., Morrissey, I., Rubeis, D., Robbins, M. and Felminghan, D. (2003) A UK Multicentre Study of the Antimicrobial Susceptibility of Bacterial Pathogens Causing Urinary Tract Infection. Journal of Infection, 46, 94-100.
https://doi.org/10.1053/jinf.2002.1091
[9]
Société Française de Microbiologie (2018) Référentiel en Microbiologie Médicale (Rémic). Volume 6.2, 5ème Edition, Société Française de Microbiologie, Paris.
https://www.sfm-microbiologie.org/boutique/referentiel-en-microbiologie-medicale-remic/
[10]
MicroScan WalkAway plus System. Beckman Coulter, Brea.
https://www.beckmancoulter.com/en/products/microbiology/microscan-walkaway-plus-system
[11]
Société Française de Microbiologie (2018) Détermination de la sensibilité aux antibiotiques. CASFM/EUCAST, Société Française de Microbiologie, Paris, 7-15.
[12]
Daoud, N., Hamdoun, M., Hannachi, H., Gharsallah, C., Mallekh, W. and Bahri, O. (2020) Antimicrobial Susceptibility Patterns of Escherichia coli among Tunisian Outpatients with Community-Acquired Urinary Tract Infection (2012-2018). Current Urology, 14, 200-205. https://doi.org/10.1159/000499238
[13]
Yilmaz, N., Agus, N., Bayram, A., Samlioglu, P., Sirin, M.C., Derici, Y.K. and Hancı, S.Y. (2016) Antimicrobial Susceptibilities of Escherichia coli Isolates as Agents of Community-Acquired Urinary Tract Infection (2008-2014). Turkish Journal of Urology, 42, 32-36. https://doi.org/10.5152/tud.2016.90836
[14]
Smaoui, S., Abdelhedi, K., Marouane, C., Kammoun, S. and Messadi-Akrout, F. (2015) Antibiotic Resistance of Community-Acquired Uropathogenic Enterobacteriaceae Isolated in Sfax (Tunisia). Médecine et Maladies Infectieuses, 45, 335-337.
https://doi.org/10.1016/j.medmal.2015.07.004
[15]
Den Heijer, C.D., Donker, G.A., Maes, J. and Stobberingh, E.E. (2010) Antibiotic Susceptibility of Unselected Uropathogenic Escherichia coli from Female Dutch General Practice Patients: A Comparison of Two Surveys with a 5 Year Interval. Journal of Antimicrobial Chemotherapy, 65, 2128-2133. https://doi.org/10.1093/jac/dkq286
[16]
Shariff, V.A., Shenoy, M.S. and Yadav, T. (2013) The Antibiotic Susceptibility Patterns of Uropathogenic Escherichia coli, with Special Reference to the Fluoroquinolones. Journal of Clinical and Diagnostic Research, 7, 1027-1030.
https://doi.org/10.7860/JCDR/2013/4917.3038
[17]
Mamani, M., Nobari, N., Alikhani, M.Y. and Poorolajal, J. (2015) Antibacterial Susceptibility of Escherichia coli among Outpatients with Community-Acquired Urinary Tract Infection in Hamadan, Iran. Journal of Global Antimicrobial Resistance, 3, 40-43. https://doi.org/10.1016/j.jgar.2015.01.003
[18]
Kahlmeter, G. and Poulsen, H.O. (2012) Antimicrobial Susceptibility of Escherichia coli from Community-Acquired Urinary Tract Infections in Europe: The ECO·SENS Study Revisited. International Journal of Antimicrobial Agents, 39, 45-51.
https://doi.org/10.1016/j.ijantimicag.2011.09.013
[19]
Observatoire National de l’Epidémiologie de la Résistance Bactérienne aux Antibiotiques (ONERBA) (2017) Rapport d’activité/Annual Report.
http://onerba.org/publications/rapports-onerba/
[20]
Société Tunisienne de Pathologie Infectieuse (2016) Antibiothérapie des infections urinaires communautaires de l’adulte. Recommandations de la STPI. Société Tunisienne de Pathologie Infectieuse, Tunis.
[21]
Bonacorsi, S., Bruyère F., Cariou G., Clouqueur E., Cohen R., Doco-Lecompte T., Elefant E., Faure K., Gauzit R., Gavazzi G., Lemaitre L., Raymond J., Senneville E., Sotto A., Subtil D., Trivalle C., Merens A. and Etienne M. (2018) Practice Guidelines for the Management of Adultcommunity-Acquired Urinary Tract Infections. Médecine et Maladies Infectieuses, 48, 327-358.
https://doi.org/10.1016/j.medmal.2018.03.005
[22]
Marzouk, M., Ferjani, A., Haj Ali, M. and Boukadida, J. (2015) Profile and Susceptibility to Antibiotics in Urinary Tract Infections in Children and Newborns from 2012 to 2013: Data from 1879 Urine Cultures. Archives de Pédiatrie, 22, 505-509.
https://doi.org/10.1016/j.arcped.2015.02.015
[23]
El Bouamri, M.C., Arsalane, L., Kamouni, Y., Yahyaoui, H., Bennouar, N., Berraha, M. and Zouhair, S. (2014) Current Antibiotic Resistance Profile of Uropathogenic Escherichia coli Strains and Therapeutic Consequences. Progrès en Urologie, 24, 1058-1062. https://doi.org/10.1016/j.purol.2014.09.035
[24]
Heytens, S., Boelens, J., Claeys, G., DeSutter, A. and Christiaens, T. (2017) Uropathogen Distribution and Antimicrobial Susceptibility in Uncomplicated Cystitis in Belgium, a High Antibiotics Prescribing Country: 20-Year Surveillance. European Journal of Clinical Microbiology & Infectious Diseases, 36, 105-113.
https://doi.org/10.1007/s10096-016-2776-8
[25]
Huang, L.-F., Lo, Y.-C., Su, L.-H. and Chang, C.-L (2014). Antimicrobial Susceptibility Patterns among Escherichia coli Urinary Isolates from Community-Onset Health Care-Associated Urinary Tract Infection. Journal of the Formosan Medical Association, 113, 970-973. https://doi.org/10.1016/j.jfma.2014.01.009
[26]
Honderlick, P., Cahen, P., Gravisse, J. and Vignon D. (2006) Quelle sensibilité aux antibiotiques pour les bactéries responsables d’infections urinaires? Que penser de fosfomycine et nitrofuranes. Pathologie Biologie, 54, 462-466.
https://doi.org/10.1016/j.patbio.2006.07.016
[27]
Passadouro, R., Fonseca, R., Figueiredo, F., Lopes, A. and Fernandes, C. (2014) Evaluation of the Antimicrobial Susceptibility of Community-Acquired Urinary Tract Infection. Acta Médica Portuguesa, 27, 737-742. https://doi.org/10.20344/amp.5352
[28]
Le Conte, P., Elkharrat, D. and Potel, G. (2004) Prise en charge des infections urinaires communautaires dans les Service d’Accueil et d’Urgence Français. Antibiotiques, 4, 237-239. https://doi.org/10.1016/S1294-5501(04)94270-7
[29]
Sastry, S. and Doi, Y. (2016) Fosfomycin: Resurgence of an Old Companion. Journal of Infection and Chemotherapy, 22, 273-280.
https://doi.org/10.1016/j.jiac.2016.01.010
[30]
Lemort, M.-L., Neuville, S., Medus, M., Gueudet, P., Saada, M., Aumaître, H. and Lecaillon, E. (2006) Evolution comparée de la sensibilité de souches de Escherichia coli isolées d’infections urinaires de patientsconsultants aux urgences et de patients hospitalisés en 2002 et 2004 à l’hôpital de Perpignan. Pathologie Biologie, 54, 426-430. https://doi.org/10.1016/j.patbio.2006.07.007
[31]
Muratani, T. and Matsumoto, T. (2006) Urinary Tract Infection Caused by Fluoroquinolone- and Cephem-Resistant Enterobacteriaceae. International Journal of Antimicrobial Agents, 28, 10-13.
https://doi.org/10.1016/j.ijantimicag.2006.05.009
[32]
Bergogne-Bérézin, E. (2006) Antibiothérapie des infections urinaires basses: Bases cliniques, microbiologiques et pharmacologiques. Antibiotiques, 8, 51-62.
https://doi.org/10.1016/S1294-5501(06)70797-X
[33]
Infectiologie.com. https://www.infectiologie.com
[34]
Flores-Mireles, A., Walker, J., Caparon, M. and Hultgren, S.J. (2015) Urinary Tract Infections: Epidemiology, Mechanisms of Infection and Treatment Options. Nature Reviews Microbiology, 13, 269-284. https://doi.org/10.1038/nrmicro3432
[35]
Machalinski, A. (2021) Best Ways to Help Prevent UTIs. WebMD.
https://www.webmd.com/women/guide/avoid-uti
