Urinary tract infection in urolithiasis: Antimicrobial resistance and clinico-microbiological association between risk factors and positive stone culture from a tertiary care hospital in south India

Shanmugam Kaliappan, L. Vajravelu, T. Ravinder, R. Katragadda, A. Jayachandran
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Abstract

Urinary tract infections and urolithiasis are common conditions encountered in the healthcare setup. Urinary calculi with infection can lead to recurrence. Isolation of multidrug-resistant (MDR) bacteria is rising and seriously threatens public health. In the present study, a total of 221 urinary calculi and midstream urine samples were collected and processed. Antibiotic susceptibility testing (AST) was performed for all the isolates along with the detection of drug-resistant bacteria like extended-spectrum beta-lactamase (ESBL) producers and methicillin-resistant Staphylococcus aureus (MRSA). ESBL genes, i.e., blaSHV, blaCTX-M, and blaTEM, were identified by Polymerase Chain Reaction (PCR). The significance of the association between age group, gender, risk factors, and positive stone culture was analyzed by the chi-square test. Escherichia coli was the predominant bacteria isolated from 21 (30.88%) of both the midstream urine and urolithiasis samples, followed by Klebsiella pneumoniae 13 (19.11%). High susceptibility was observed for amikacin, nitrofurantoin, and ofloxacin. ESBL-producing bacteria were identified in 25 (36.76%) isolates from urinary calculi and from 46 (39.31%) midstream urine samples. The blaSHV and blaTEM genes were detected among them. MRSA was detected in 9.09% (2 out of 7) of S. aureus isolates recovered from midstream urine samples and 9.09% (1 out of 11) of isolates recovered from urinary calculi. A significant association was observed among cases of diabetes mellitus, hypertension, obesity, and a family history of renal stones (p-value < 0.05). Isolation of MDR bacteria from the calculi is alarming and can lead to treatment failure if not treated appropriately. Performing the culture of the urinary calculi and detecting drug resistance will be of immense value for adequately treating the infection.
尿石症的尿路感染:抗微生物药物耐药性和临床微生物学风险因素与印度南部三级医院阳性结石培养之间的关联
尿路感染和尿石症是医疗机构中常见的情况。尿路结石伴感染可导致复发。耐多药细菌的分离越来越多,严重威胁着公众健康。本研究共收集和处理了221例尿结石和中游尿样本。对所有分离株进行抗生素药敏试验(AST),并检测出广谱β -内酰胺酶(ESBL)产生菌和耐甲氧西林金黄色葡萄球菌(MRSA)等耐药菌。采用聚合酶链反应(Polymerase Chain Reaction, PCR)鉴定ESBL基因blaSHV、blaCTX-M和blaTEM。采用卡方检验分析年龄、性别、危险因素与石培养阳性之间的相关性。中游尿和尿石症标本中检出的优势菌为大肠杆菌21株(30.88%),其次为肺炎克雷伯菌13株(19.11%)。对阿米卡星、呋喃妥因和氧氟沙星有较高的敏感性。从尿路结石中分离出25株(36.76%)产esbl细菌,从中游尿液中分离出46株(39.31%)产esbl细菌。其中检测到blaSHV和blaTEM基因。从中游尿液中分离出的金黄色葡萄球菌7株中检出2株,检出9.09%;从尿路结石中分离出的金黄色葡萄球菌11株中检出1株,检出MRSA。糖尿病、高血压、肥胖和肾结石家族史之间存在显著相关性(p值< 0.05)。从结石中分离出耐多药细菌是令人担忧的,如果治疗不当,可能导致治疗失败。进行尿路结石培养和检测耐药性对充分治疗感染具有重要价值。
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