Received: 30-May-2022, Manuscript No. DPL-22-69614; Editor assigned: 02-Jun-2022, Pre QC No. DPL-22-69614(PQ); Reviewed: 17-Jun-2022, QC No. DPL-22-69614; Revised: 23-Jun-2022, Manuscript No. DPL-22-69614(R); Published: 30-Jun-2022 , DOI: 10.37532/dpl.2022.14.12
Since the last few decades, there has been an increase in antimicrobial resistance among community-acquired uropathogens, which calls for ongoing reevaluation of the efficacy of suggested empiric antibiotic regimens for treating Urinary Tract Infections (UTIs). To outline the microbiological range, resistance pattern, and indicators for the isolation of resistant strains in community-acquired uropathogens. Individuals who visited the outpatient clinics between October and June for the diagnosis of UTIs or the screening of asymptomatic bacteriuria were included in the study if they had a urine culture performed in one of Mashhad, Iran's three primary medical diagnostic laboratories. The Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens were employed in conjunction with the conventional disc diffusion antimicrobial susceptibility tests [1,2].
A total of 330 patients with a median age of 47 years were included. 275 people, or 83.6 percent, were female. Escherichia coli and Klebsiella species were the most frequently isolated uropathogens, accounting for 201 (60.9%) and 46 (13.9%) of the cases, respectively. The three antibiotics with the highest rates of susceptibility in E. coli isolates were gentamicin (75%) and cefixime (89.3%) (72.4 percent). In E. coli isolates, recent antibiotic exposure was a predictor of ciprofloxacin resistance (OR: 2.8, 95 percent CI: 1.33-6.28), while older age was a predictor of TMP-SMX resistance (OR: 2.1, 95 percent CI: 1.07-3.97). About two thirds of community-acquired uropathogens were E. coli and Klebsiella species .
The first-choice agent for the empiric therapy of community-acquired cystitis was determined to be nitrofurantoin because to the high Susceptibility rates, while cefixime and gentamicin may be the second-best options. However, especially in elderly patients and those who have recently taken antibiotics, Ciprofloxacin and TMP-SMX should not be utilised as first-line therapies for community-acquired UTIs.
The most typical bacterial infection seen in an outpatient setting is a Urinary Tract Infection (UTI), which affects adult women at a lifetime incidence of 50%-60%. With numerous medical visits more absenteeism, and detrimental effects on quality of life it places a heavy societal and personal burden on those affected. One of the most significant issues affecting the therapy of UTIs over the past few decades is the emergence of antibiotic resistance among uropathogens, particularly those responsible for community-acquired UTIs.
Urinalysis and urine culture with susceptibility testing are commonly used in the appropriate clinical setting to diagnose UTIs. The development of bacteria on urine cultures helps to confirm the diagnosis of UTIs, and susceptibility testing is thought to be crucial for ensuring that the right antimicrobial treatment is administered. However the typical care strategy for acute, simple cystitis obtained in the community is regarded to be empiric therapy. Two key elements serve as the foundation for the management suggestion for uncomplicated cystitis. Both the microbiological spectrum and susceptibility pattern of the organisms that cause acute simple UTIs are extremely predictable [4,5].
Based on the local uropathogen resistance rates, the suitability of the first-line medicines for empiric therapy of UTIs is determined. In this regard, thresholds for the prevalence of antibiotic resistance among uropathogens in a community have been proposed, above which some are not advised; for an antibiotic to be considered a first-line empirical treatment for urinary tract infections, resistance should not exceed 10%-20% in the most likely infecting strains. In order to make informed decisions about the use of empirical antibiotics, local uropathogen resistance surveillance and ongoing reevaluation of the appropriateness of the suggested empiric antimicrobial regimens are essential . Iran sadly lacks a surveillance system for antibiotic resistance to track community-acquired uropathogens. Due to this, there is no regional protocol for the effective handling of occurrence of community-acquired UTIs nationwide. In this work, we discuss the community-acquired uropathogens' microbial diversity and resistance profile as well as the factors that influence the isolation of resistant uropathogens in Mashhad, Iran.
The census sampling approach was used to carry out the sampling for this cross-sectional investigation. The investigation was carried out between October and June in Mashhad, Iran's three major governmental medical diagnostic laboratories. The northeastern Iranian city of Mashhad is the second-largest in the nation. If the urine samples from patients who visited the outpatient clinics for the diagnosis of symptomatic UTIs or the screening of asymptomatic bacteriuria were examined in one of the aforementioned laboratories, they were included sequentially. Those with minimal bacteriuria were disqualified.
Midstream urine samples from every patient were sent to the three clinical laboratories in sterile containers. The samples were examined two hours after they were collected. For this, a typical loop was used to inoculate each pee sample onto common culture media, such as blood agar and MacConkey agar. The cultures were examined for bacterial growth following an overnight incubation at 35°C. Any mixed bacterial colony growth that would indicate contamination was disqualified from further examination. Last but not least, bacterial isolates were identified by customary biochemical tests, and antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method (AST). The AST levels were then interpreted in accordance with the uropathogen breakpoints established by the Clinical and Laboratory Standards Institute (CLSI).