Evaluation of Resistant Urinary Tract Infections by Gram-positive Bacteria in Medina, Saudi Arabia

Background: Gram-positive uropathogens have become common, associated with serious underlying illnesses and increasingly resistant to available antibiotics. Objectives: The goal of this study was to investigate the incidence and risk factors of gram-positive cocci UTIs in hospitalized patients in Medina, KSA and their susceptibility patterns to widely used antimicrobial agents. Methods: During a 12-month study, 165 clinical isolates of gram-positive cocci were recovered from 1137 culture-positive urine specimens at a tertiary hospital. Antimicrobial susceptibility of gram-positive cocci isolates was tested with the disk diffusion and E test methods. Molecular typing of some VRE isolates was done to detect the predominant Van genotypes. Results: Out of 8600 reviewed cases, 1137 (13.2%) were culture positive, 165 cases (14.5%) were gram positive cocci. E.faecalis formed 53.3% (88/165) of isolated gram-positive cocci, followed by E faecium (17.6%), S.agalactiae (23.6%) and S. aureus (5.5%). Multidrug resistant positive cocci formed 9.7% of gram-positive isolates including VRE (8.5%) and MRSA (1.2%). 75% of E. faecalis and 50% of E. faecium isolates were sensitive to nitrofurantoin, all VRE strains were sensitive to linezolid. All S. aureus isolates were sensitive to cefazolin, nirtofurantoin, sulfamethoxazole and vancomycin. 75% of MRSA strains were sensitive to sulfamethoxazole and all were sensitive to vancomycin. All isolates of S. agalactiae were sensitive to cefazolin and nitrofurantoin, and all were resistant to Trimethoprim-sulfamethoxazole. Van B genotype was detected. Conclusion: Vancomycin and nitrofurantoin seem to be effective drugs for treatment of gram positive UTIs. vanB genotype was detected.