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Vasculitic neuropathies usually present acutely to subacutely, with an asymmetric pattern, involving multiple peripheral nerve territories. Drug-induced vasculitis is an often overlooked etiology of vasculitic neuropathy.We present the first reported case of nitrofurantoin-associated and an illustrative case of minocycline-associated vasculitic neuropathy, with a review of the literature.The first patient is a 60-year-old woman who developed axonal sensorimotor peripheral neuropathy after nitrofurantoin use, with a superficial radial nerve biopsy confirming vasculitis. The second patient is a 23-year-old woman, with a history of acne vulgaris treated with minocycline, who presented with a subacute right common peroneal mononeuropathy followed by a left deep peroneal mononeuropathy, with elevated antinuclear, perinuclear-antineutrophil cytoplasmic, and myleoperoxidase antibodies, and MPO titers, and a sural nerve biopsy showing large arteriole vasculitis. Finally, we provide a comprehensive review of previously published cases.Medications should be considered as a trigger for medication-induced vasculitic neuropathy. Accurate diagnosis would ensure timely treatment.

This study investigated the prevalence and antimicrobial susceptibility of enterococci isolated from dogs and cats with urinary tract infections in northwestern Croatia. During this study, the laboratory received 787 urine samples, 651 from dogs and 136 from cats. A total of 260 urine samples (211 from dogs and 49 from cats) were bacteriologically positive. Of these, 29 isolates belonged to Enterococcus spp. ; 22 from dogs and seven from cats. Enterococci isolates were identified by PCR method, 12 of which were Enterococcus faecium and 17 were Enterococcus faecalis species. In dogs, 16 E. faecalis and six E. faecium strains were identified, whereas in cats, six E. faecium and only one E. faecalis strain were identified. Antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion method for nine antimicrobials: penicillin, ampicillin, vancomycin, nitrofurantoin, rifampicin, tetracycline, chloramphenicol, enrofloxacin, ciprofloxacin. The isolates were tested for high-level resistance to streptomycin and gentamicin. The highest resistance of Enterococcus spp. was observed to rifampicin (86%) and enrofloxacin (83%), followed by tetracycline and ciprofloxacin (69%). Resistance to vancomycin was 28%, and the lowest resistance was to chloramphenicol (17%). Multidrug resistance was found in 76% of enterococci isolates. High-level streptomycin resistance was detected in 17% and high-level gentamicin resistance in 10% of the isolated enterococci. When comparing species susceptibility, E. faecium isolates were significantly more resistant to penicillin, ampicillin, nitrofurantoin, and ciprofloxacin (p < 0.05). Eleven E. faecium isolates (92%) and 12 E. faecalis isolates (76%) were multidrug resistant.

Nowadays, in the clinical, pharmaceutical, and environmental sectors, the development of facile and sensitive analytical methods and/or innovative devices for the follow-up and detection of antibiotics and pharmaceutical formulations, in general, are urgently needed and still challenging. This work declared three vital applications for broad-spectrum nitrofurantoin (macrofuran) antibiotic detection and quantification: A colorimetric method, a coated paper strip-based nano-lanthanum complex prototype and fabrication of smart electronic color sensor device-based coated paper strips. The colorimetric method showed a significant response upon increasing the concentration of the nitrofurantoin in a range between (1.0–100.0 ng/mL) via a visual color change from orange-yellow to red colors degree with detection and quantification limits of 0.175 and 0.53 ng/mL, respectively, whereas the nano-lanthanum complex coated paper strip prototype showed qualitative on-site sensing for nitrofurantoin via naked eye color changes which can be detected anywhere. Moreover, a smart prototype for detecting macrofuran in the means of paper color change in the RGB color component extraction algorithm and the grayscale projection value processing algorithm was fabricated. The change in RGB color on the coated paper strip was detected using an electronic color sensor device. The developed colorimetric method, coated paper strip, and the electronic color sensor device prototype exhibited fast, simple, costless, and selective towards macrofuran over the competing analyzed. As well as, showed good applicability in the different real samples spiked with different concentrations of macrofuran. Graphical abstract

Infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) remain a public health challenge.We traced the evolution of antibiotics prescribed for patients with ESBLE-healthcare associated infections (ESBLE-HAI) between 2012 and 2017, with a specific focus on treatments for lower urinary tract infections (LUTI).We used the 2012 and 2017 French point prevalence survey data. Patients with ESBLE-HAI were defined as those diagnosed with at least one Enterobacteriaceae with ESBL production. Patients with LUTI caused by ESBLE (ESBLE-LUTI) were defined as those with LUTI as the reported infection site and diagnosed with ESBLE. We only analysed treatments intended for HAI.In 2017, more than half of treatments for ESBLE-HAIs were β-lactams. While from 2012 to 2017 the proportion of carbapenem treatments decreased from 30% to 25%, penicillin treatments doubled. Among patients treated for ESBLE-LUTI, a larger proportion received a single antibiotic in 2017. The most frequently prescribed antibiotics for these infections were amoxicillin/clavulanic acid, nitrofurantoin and ofloxacin. More than one out of six treatments lasted for more than 7 days. Carbapenem use was halved between 2012 and 2017, and decreases were likewise observed for aminoglycosides.In accordance with French recommendations, comparison of the two most recent French point prevalence surveys showed an evolution in ESBLE-HAI treatment, especially for ESBLE-LUTI. However, treatment durations remained longer than recommended. Data from the 2022 survey should provide insights on the future evolution of prescription trends.

© 2022 The Authors. Liver International published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited., Background & aims: No multi-national prospective study of drug-induced liver injury (DILI) has originated in Europe. The design of a prospective European DILI registry, clinical features and short-term outcomes of the cases and controls is reported. Methods: Patients with suspected DILI were prospectively enrolled in the United Kingdom, Spain, Germany, Switzerland, Portugal and Iceland, 2016-2021. DILI cases or non-DILI acute liver injury controls following causality assessment were enrolled. Results: Of 446 adjudicated patients, 246 DILI patients and 100 had acute liver injury due to other aetiologies, mostly autoimmune hepatitis (n = 42) and viral hepatitis (n = 34). DILI patients (mean age 56 years), 57% women, 60% with jaundice and 3.6% had pre-existing liver disease. DILI cases and non-DILI acute liver injury controls had similar demographics, clinical features and outcomes. A single agent was implicated in 199 (81%) DILI cases. Amoxicillin-clavulanate, flucloxacillin, atorvastatin, nivolumab/ipilimumab, infliximab and nitrofurantoin were the most commonly implicated drugs. Multiple conventional medications were implicated in 37 (15%) and 18 cases were caused by herbal and dietary supplements. The most common single causative drug classes were antibacterials (40%) and antineoplastic/immunomodulating agents (27%). Overall, 13 (5.3%) had drug-induced autoimmune-like hepatitis due to nitrofurantoin, methyldopa, infliximab, methylprednisolone and minocycline. Only six (2.4%) DILI patients died (50% had liver-related death), and another six received liver transplantation. Conclusions: In this first multi-national European prospective DILI Registry study, antibacterials were the most commonly implicated medications, whereas antineoplastic and immunomodulating agents accounted for higher proportion of DILI than previously described. This European initiative provides an important opportunity to advance the study on DILI., Set up of the Prospective European Drug-Induced Liver Injury Registry (Pro-Euro-DILI Registry) was supported by an award to RJA and GPA from the EASL Registry Research Grants Programme. JIG and GPA are supported by National Institute of Health Research Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Biomedical Research Centre [BRC-1215-20003]. RJA and MIL receive support from AEMPS. IAA holds a Sara Borrell contract (CD20/00083) funded by ISCiii. CIBERehd is funded by ISCiii. This article is based upon work from COST Action “CA17112 - Prospective European Drug-Induced Liver Injury Network” supported by COST (European Cooperation in Science and Technology). www.cost.eu. All authors of this manuscript are members of COST Action CA17112. The Pro-Euro-DILI is a part of the Transbioline Consortium. The TransBioLine project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 821283. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.

To assess the effectiveness of a brief educational intervention on prescribing first-line antibiotics in acute cystitis.This quasi-experimental before-after study was conducted over a period of eight months. We collected prescribing data related to urinary tract infections four months before the educational intervention and four months after it. Aggregate data on office visits, diagnoses, and issued prescriptions were collected from each practice's electronic medical records based on monthly reports.Overall, 3581 prescriptions were issued: 1717 before and 1864 after the intervention. The total number of prescriptions increased by 8.5%. The use of first-line antibiotics increased by 21.2%, the use of fluoroquinolones decreased by 6.6%, while the use of beta-lactams remained unchanged. After the intervention, nitrofurantoin was the most prescribed first-line antibiotic. The proportion of women who were prescribed first-line antibiotic did not reach the acceptable range (80%-100%) according to the European Surveillance of Antimicrobial Consumption quality indicators. The proportion of fluoroquinolones (17.9%) use was well above the acceptable range (0%-5%).A brief educational intervention proved to be a useful method in adopting better prescribing habits. Of particular importance is the considerable increase in the use of nitrofurantoin due to its reliable efficacy against multidrug-resistant urinary pathogens.

Urinary tract infections (UTIs) maintained a serious public health concern, as did the growth in antibiotic resistance both between uropathogenic microorganisms. A regular assessment of the microbiological agents that cause UTIs, as well as their antimicrobial resistance, is essential for a tailored empirical antibiotic response. Knowing the variables that cause UTIs can help you intervene quickly and simply to get the condition under control. The most common infecting species in acute infection is Escherichia coli (E. coli). To strengthen infection control strategies, it is necessary to know the prevalence and location of UTI. The goal of this research is to measure the frequency of microorganisms isolated from patients with UTIs as well as the antimicrobial sensitivity characteristics of Gram-negative bacteria. The purpose of this research has been to evaluate the frequency of UTIs by extracting and characterizing the various bacterial etiological organisms, as well as to assess the factors linked to UTIs. The goal of this research is to identify, characterize, and establish the antibiotic susceptibility patterns of bacteria linked to urinary tract infections. Fresh collected urine specimen was taken from inpatients or outpatients in UTI cases and bacteriologically tested using conventional microbiological methods. The Kirby-Bauer disc diffusion method was used to create the antibiogram. Staphylococcus saprophyticus, Staphylococcus aureus (28%), and Escherichia coli (24.6%) were the most common isolates (20%). The evaluated agents’ antibacterial activity was all in the following order: cefixime, ciprofloxacin, augmentin, gentamicin, ceftazidime, nitrofurantoin, ofloxacin, and cefuroxime. It was discovered that each and every one of the microbes exhibited varied degrees of resistance to the antibiotics nitrofurantoin, ciprofloxacin, and ofloxacin. Every type of bacteria, with the exception of those belonging to the genus Streptococcus, has a Multiple Antibiotic Resistance Index (MARI) that is more than 0.2. The first-line therapies for urinary tract infections (UTIs) in the region would consist of ciprofloxacin, ofloxacin, and nitrofurantoin. Lower urinary tract infections almost never result in problems if they are diagnosed and treated as soon as possible and in the correct manner. However, if treatment is not sought, a urinary tract infection can lead to serious complications.

OBJECTIVE To describe geographic and sociodemographic variations in operating hours and availability of medications commonly prescribed by pediatric urologists at Washington State retail pharmacies. METHODS We identified all retail pharmacies in the state. We stratified counties by population density and household income (HI) and compared differences in pharmacy operating hours and availability of 10 commonly prescribed medications. RESULTS 1057/1058 pharmacies were contacted. All pharmacies had liquid formulations of oxycodone, hydrocodone, ibuprofen, acetaminophen, amoxicillin, and trimethoprim-sulfamethoxazole in stock. Liquid formulations of ciprofloxacin (10%) and oxybutynin (14.3%) were uncommonly stocked, while 92.5% of pharmacies stocked nitrofurantoin suspension and 80.9% nitrofurantoin capsules. Statewide, 108 (10.2%) of pharmacies were closed on Saturdays and 297 (28.1%) closed on Sunday. More high (HPDC) than low population density (LPDC) (62.5% vs 0%, p

Residues of veterinary antibiotics in honey may be damaging to human health. Surface-enhanced Raman scattering spectroscopy (SERS) is an emerging technology widely applied in food safety. SERS has advantages of enabling fingerprint identification and fast detection, as well as does not require complex pretreatment. Considering the overuse of nitrofurans in honeybee breeding, SERS combined with spectral preprocessing was used to detect nitrofurantoin in honey. By using standardized experimental procedures and improved spectral correction methods, the lowest detection limit of nitrofurantoin was 0.1321 mg/kg. A good linear relationship in the partial least squares regression model was found among spiked samples, which allowed prediction of nitrofurantoin content in honey sample (

The aim of the study was to examine the severity of clinical symptoms of acute cystitis and the level bacteriuria in female patients who underwent to laparoscopic surgery followed by a postoperative administration of dienogest 2 mg and combined oral contraceptives pills (COCP). One hundred and forty five women who had a laparoscopic surgery prospectively were enrolled. Criteria inclusions were the age from 30 to 45 years old; body mass index (BMI) absence of previous hormonal therapy at least 6 month and recent performed a laparoscopy surgery for endometriosis. The women (

Objective To devise a residential empiric treatment algorithm, describe common uropathogens associated with urinary tract infections (UTIs) in residential care, assess all-pathogen and non-ESBL (extended-spectrum beta-lactamase) Escherichia coli antibiotic susceptibilities, and report the percentage of antibiotic use. Design A retrospective chart review of 198 residents with positive urine cultures from September 2019 to September 2020. Setting Institutional long-term care facility. Participants The exclusion criteria were negative urine culture, mixed organisms on urine culture, no antibiotic treatment, signs and symptoms of systemic infection, hospitalization because of systemic infection, and intravenous antibiotic treatment. The entire population was screened. Results The most prevalent pathogens were non-ESBL E. coli (29%), Proteus mirabilis (12%), Klebsiella pneumoniae (8%), and ESBL E. coli (8%). All-pathogen susceptibilities were 79.6% (amoxicillin/clavulanate), 64.1% (nitrofurantoin), 50.5% (sulfamethoxazole/trimethoprim), 43.7% (cephalexin), 42.7% (amoxicillin), and 41.8% (ciprofloxacin). Amoxicillin/clavulanate (96.7%), nitrofurantoin (90.0%) and sulfamethoxazole/trimethoprim (83.3%) demonstrated the highest non-ESBL E. coli susceptibilities. Nitrofurantoin was the most prescribed antibiotic (21%), followed by amoxicillin/clavulanate (19%) and ciprofloxacin (17%). Conclusion Based on the data, amoxicillin/clavulanate and nitrofurantoin are appropriate first-line options for empiric treatment of symptomatic cystitis in this long-term care facility, with sulfamethoxazole/trimethoprim as an alternative. Ciprofloxacin was overprescribed despite its low susceptibilities to commonly encountered pathogens, which emphasizes the need for a UTI empiric treatment algorithm tailored towards residential care.

Fosfomycin tromethamol (FT) was reintroduced as an option for the treatment of low urinary tract infection (UTI) in children. In this study, we described the antibiotic sensitivity and mechanisms of resistance to fosfomycin in isolates from children older than 6 years with UTI. Urine culture and antibiotic susceptibility study were performed. In fosfomycin resistant strains, PCR for fos, blaCTX-M was performed followed by classification by phylogenetic group and sequencetyping. Escherichia coli was the most frequent etiological agent (89.2%). The susceptibility percentages were: fosfomycin 97.9%; amoxicillin-clavulanate 92.7%; cefuroxime and ceftriaxone 99%; nitrofurantoin 94.4%. An E. coli strain (ST69, phylogenetic group D) was resistant to fosfomycin (MIC 256mg/l) and carried the blaCTX-M-14 and fosA3 genes in a 45kb IncN-type plasmid. Resumen La fosfomicina-trometamol (FT) se reintrodujo como una opción para el tratamiento de la infección del tracto urinario (ITU) baja en niños. En este estudio describimos la sensibilidad antibiótica y los mecanismos de resistencia a FT en aislamientos de niños mayores de 6 anos con ITU. Se realizaron urocultivos y estudios de sensibilidad antibiótica. En las cepas resistentes a fosfomicina se realizó la técnica de PCR para fos, blaCTX-M, y su identificación según su grupo filogenéticoy secuenciotipo. Escherichiacoli fue el agente etiológico más frecuente (89,2%). Los porcentajes de sensibilidad fueron: fosfomicina 97,9%; amoxicilina-clavulánico 92,7%; cefurox-ima y ceftriaxona 99%; nitrofurantoína 94,9%. Una cepa de E. coli (ST69, grupo filogenético D) fue resistente a fosfomicina (CIM 256mg/l) y portaba los genes blaCTX-M-14 y fosA3 en un plás-mido de 45 kb del tipo IncN. Este es el primer reporte de E. coli ST69 con blaCTX-M-14/fosA3 de origen humano.

Objective To compare the effectiveness of five versus seven days of nitrofurantoin treatment for urinary tract infection (UTI) in diabetic women. Methods Data were collected retrospectively from Dutch general practitioners between 2013 and 2020. Nitrofurantoin prescriptions with a duration of five (5DN) or seven days (7DN) in women with diabetes were included. Inverse propensity weighting (IPW) was performed to calculate adjusted risk differences (RD) for treatment failure within 28 days. Secondary outcomes were 14-day treatment failure, severe treatment failure, and 28-day treatment failure in defined risk groups. Results Nitrofurantoin was prescribed in 6866 episodes, 3247 (47,3%) episodes with 5DN and 3619 (52,7%) episodes with 7DN. Patients in the 7DN group had more co-morbidities, more diabetes-related complications and were more insulin-dependent. There were 517/3247 (15.9%) failures in the 5DN group versus 520/3619 (14.4%) in the 7DN group. The adjusted RD for failure within 28 days was 1.4% (95% CI -0.6 to 3.4). Conclusion We found no clinically significant difference in treatment failure in diabetic women with UTI treated either five or seven days with nitrofurantoin within 28 days. A 5-day treatment should be considered to reduce cumulative nitrofurantoin exposure in DM patients.

The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to nitrofurantoin. Proteeae species can produce urease, which can increase urine pH.Our aim was to determine whether higher urine pH in the emergency department is associated with nitrofurantoin resistance.A single health system database of emergency department patients aged 18 years and older who received urinalysis between April 18, 2014, and March 7, 2017, was examined using χOf 67,271 urine samples analyzed, 13,456 samples grew a single bacterial species. Urine cultures growing the Proteeae group were associated with significantly more alkaline urine than other bacteriuria cultures (odds ratio [OR] 2.20, 95% confidence interval [CI] 2.06-2.36; p0.001). The Proteeae species represented 4.4% of urine samples at pH 5-7, 24.4% at pH 8-9, and 40.0% at pH 9. At urine pH 5-7, 80.4% of urine samples were sensitive to nitrofurantoin; however, this percentage decreased to 66.1% for urine pH 8-9 and 54.6% for urine pH 9. Nitrofurantoin had the highest OR (2.10, 95% CI 1.85-2.39) among cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole for bacteriuria sensitive to those antibiotics at urine pH 5-7. At urine pH 8-9 and 9, nitrofurantoin had the lowest OR among the antibiotics: 0.48 (95% CI 0.42-0.54) and 0.31 (95% CI 0.24-0.40), respectively (p0.001 for both).Urine pH of 8 or higher is associated with high rates of nitrofurantoin resistance.

Purpose: With the emergence of multidrug-resistant and pan-resistant strains, Klebsiella pneumoniae (K. pneumoniae) shows higher treatment failure rates and mortality in clinics. It is more important to develop an effective method for treating K. pneumonia infections. The main objectives of this study were to determine the minimal inhibitory concentration (MIC) and the mutant prevention concentration (MPC) for eight antimicrobial agents against K. pneumoniae isolated from different hosts and compare the emergence of resistant mutants between animal strains and human strains. Materials and Methods: A total of 72 nonduplicate K. pneumoniae isolates and 8 antimicrobial agents (amikacin, azithromycin, levofloxacin, doxycycline, nitrofurantoin, colistin, tigecycline, and imipenem) were used. The MIC and MPC values were determined using agar plate assays. The values of the selection index (SI) were calculated with MPC90/MIC90. Pharmacodynamic parameters were calculated using published plasma pharmacokinetic variables. Results: For human isolate strains, the MPC50/90 (μg/mL) values were as follows: amikacin, 32/128; azithromycin, 64/128; levofloxacin, 4/16; doxycycline, 32/32; nitrofurantoin, 128/512; colistin, 4/8; tigecycline, 8/16; and imipenem, 4/8. The value of SI was 8 for azithromycin, doxycycline, and tigecycline; 16 for amikacin, levofloxacin, and nitrofurantoin; 4 for imipenem; and 2 for colistin. For animal isolate strains, the MPC90 values were 128 μg/mL for azithromycin and doxycycline, 64 μg/mL for amikacin, 32 μg/mL for levofloxacin, 512 μg/mL for nitrofurantoin, 8 μg/mL for colistin and tigecycline, 4 μg/mL for imipenem. The value of SI was 2 for colistin and imipenem, 8 for tigecycline, 16 for amikacin, and 32 for the other four agents. In combination with pharmacokinetic parameters, these findings indicated that the plasma concentrations of the seven antibiotics except imipenem were below the MPC for the entire dosing interval. Conclusion: The ability of eight antibiotics to prevent resistant mutants of K. pneumoniae was different between animal strains and human strains. Higher doses than those currently approved should be required to prevent the enrichment of mutants of drug-resistant bacteria in the clinics.

Objective: The aim of this study was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as to evaluate the problem with extended-spectrum β-lactamases (ESBLs)-producing isolates, causing urinary tract infections (UTIs) in children in Al-Amiri Hospital, Kuwait, over a 5-year period. Materials and Methods: Significant isolates from symptomatic pediatric patients with UTIs from January 2017 to December 2021 were identified by conventional methods and by the VITEK 2 identification card system. Antimicrobial susceptibility testing was performed by the disk diffusion method for Gram-positive organisms and an automated VITEK 2 system for Gram-negative organisms. ESBL-producing Enterobacterales were detected by the double-disk diffusion method and VITEK 2 system. Results: Significant bacteriuria was detected in 13.7% of the 9,742 urine samples. Escherichia coli accounted for 67.3% of these, followed by Klebsiella pneumoniae (8.9%), Proteus spp. (5.7%), and Enterococcus spp. (7.4%), respectively. High resistance rates were observed among the Enterobacterales against ampicillin, cephalothin, nitrofurantoin, amoxicillin/clavulanic acid, and trimethoprim-sulfamethoxazole. The prevalence of ESBL-producing E. coli and K. pneumoniae was 26% and 55%, respectively. The most sensitive among the antibiotics tested for Gram-negative organisms were meropenem, amikacin, gentamicin, and piperacillin/tazobactam, while the antibiotics tested for Gram-positive organisms were vancomycin, ampicillin, linezolid, and nitrofurantoin. Conclusion: E. coli remains the most common uropathogen. A high percentage of uropathogens causing UTI in children were highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria were highly prevalent in children in our hospital. Local antibiograms should be used to assist with empirical UTI treatment.

Antimicrobial resistance (AMR) by bacteria is a serious global threat, and a rapid, high-throughput, and easy-to-use phenotypic antimicrobial susceptibility testing (AST) method is essential for making timely treatment decisions and controlling the spread of antibiotic resistant micro-organisms. Traditional culture-based methods are time-consuming, and their capability to screen against a large number of different conditions is limited; meanwhile genotypic based methods, including sequencing and PCR based methods, are constrained by rarely identified resistance genes and complicated resistance mechanisms. Here, a combinatorial-screening SlipChip (cs-SlipChip) containing 192 nanoliter-sized compartments is developed which can perform high-throughput phenotypic AST within three hours by monitoring the bacterial growth within nanoliter-sized droplets with bright-field imaging and analyzing the changes in bacterial number and morphology. The minimum inhibitory concentration (MIC) of

Nitrofurantoin (NT) used for the treatment of urinary tract infections may have antiplasmodial activity. Dihydroartemisinin-piperaquine (DP) is an artemisinin based combination therapy used for the treatment of malaria. This study evaluated the antiplasmodial effect of dihydroartemisinin-piperaquine-nitrofurantoin (DP-NT) on mice infected with Plasmodium berghei. Adult Swiss albino mice (30-35 g) of both sexes were used. The mice were randomly grouped, inoculated with Plasmodium berghei, and treated orally with DP (1.7/13.7 mg/kg), NT (57.1 mg/kg) and DP-NT (1.71/13.7/ 57.1 mg/kg), respectively using curative, prophylactic and suppressive tests. The negative control was orally treated with normal saline (0.3 mL), while the positive control was orally treated with chloroquine CQ (10mg/kg). After treatment, blood samples were collected and evaluated for percentage parasitemia, inhibitions and hematological parameters. Liver samples were evaluated for histological changes. The mice were observed for mean survival time (MST). Treatment with DP-NT decreased parasitemia levels when compared to individual doses of DP and NT with significant difference observed at p

O índice da resistência antimicrobiana (RAM) cresce progressivamente no mundo e acaba limitando a eficácia de tratamento de doenças comuns, como a infecção do trato urinário (ITU). Além disso, na atualidade, a RAM é apontada como um dos principais problemas de saúde pública. Diante do exposto, o objetivo do presente estudo foi avaliar a resistência bacteriana frente aos antibióticos orais mais comumente utilizados para o tratamento das ITU em pacientes ambulatoriais, bem como a identificação das bactérias isoladas. Foi realizado um estudo observacional experimental com abordagem quantitativa no período de janeiro a maio de 2019, desenvolvido em um hospital privado de alta complexidade localizado na cidade do Recife, PE. Foram incluídas no estudo todas as uroculturas positivas de pacientes adultos atendidos no ambulatório do referido hospital, onde foi utilizado, para a identificação bacteriana, o equipamento MALDI – TOF (Matrix Associated Laser Desorption-Ionization – Time of Flight). Foram analisadas um total de 379 amostras positivas de uroculturas, das quais 16 (4,2%) representavam espécies sem interesse clínico, pois obtiveram uma porcentagem de frequência muito baixa, bem como 327 (86,3%) pertenciam a três espécies de bactérias Gram-negativas: Escherichia coli (72,8%), Klebsiella pneumoniae (16,2%) e Proteus mirabilis (11%). Enquanto nas 36 (9,5%) amostras foram identificadas duas espécies Gram-positivas: Staphylococcus saprophyticus (66,7%) e Enterococcus faecalis (33,3%). Foi possível observar que o antibiótico oral com maior percentual de resistência foi o sulfametoxazol + trimetoprima com 24,5% seguido da ciprofloxacina com 22,1%, cefuroxima (16,7%), amoxicilina + clavulanato (13,0%) e nitrofurantoína (8,1%). De acordo com recomendação, é excluído o uso de antibióticos que apresentarem resistência acima de 20%, desta forma os únicos antibióticos por via oral que possui perfil terapêutico adequado para o tratamento empírico dos pacientes adultos com ITU na região do presente estudo são cefuroxima, amoxicilina + clavulanato e nitrofurantoína.

Introduction: Asymptomatic bacteriuria (ASB) in pregnancy can flare into frank pyelonephritis and sepsis if untreated due to the low immunity. Apart from causing morbidity in mothers it affects the foetus by increasing the incidence of prematurity and IUGR. The present study was undertaken to determine the prevalence of ASB in the pregnant women attending Ante natal clinic and the significance of routine urine culture. Materials and Methods : Total 310 pregnant women attending the antenatal OPD were enrolled in the study over a period of 10 months. Inclusion criteria included all pregnant women attending antenatal OPD without any urinary symptoms or history of fever. Exclusion criteria included frank UTI symptoms like fever, dysuria, increased frequency of urine, any history of intake of antibiotics, any urinary tract anomaly or renal calculi. Their midstream urine sampling was collected and subjected to both microscopy and culture sensitivity; standard microbiological method was used. Results: The prevalence of ASB was found to be 11.29% and was maximum in second trimester (54.2%). The study revealed routine urine culture is a sensitive test to diagnose ASB. The commonest bacterium isolated was Escherichia coli (51.4% cases) and the most effective antibiotic was Nitrofurantoin. The neonatal outcomes are discussed in the text while no perinatal deaths were recorded during the period of study. No direct association of asymptomatic bacteriuria with anaemia and preeclampsia was found, but odds ratio was more than one. Conclusion: The study highlights that asymptomatic bacteriuria is a common occurrence in pregnant women, including urine culture as a part of routine investigation in antenatal patients can help diagnose this condition. Prompt treatment of ASB can prevent any obstetric complication arising from the flareup of asymptomatic bacteriuria in pregnancy and thus reduce maternal and foetal morbidity. Keywords: Asymptomatic bacteriuria, Trimester, Pyeloneph

In the present study, we aimed to compare the efficacy and safety of quinolones with trimethoprim-sulfamethoxazole (TMP/SMX), nitrofurantoin, fosfomycin, and β-lactams for the treatment of uncomplicated urinary tract infections (UTIs) in adults. All controlled clinical trials assessing quinolones for uncomplicated UTIs in adults were searched from PubMed, Embase, and Cochrane Library databases. Meta-analyses were used to evaluate the efficacy and safety in randomized controlled trials (RCTs). A total of 47 RCTs consisting of 8992 patients were included in the present analysis. The clinical and bacteriological remission rates of quinolones were significantly higher (P

Aims: This study aims to compare the efficacy in alleviating pain between intracanal medicaments, namely Nitrofurantoin and Calcium Hydroxide Paste. Study Design: Randomized Controlled Trial. Place and Duration of Study: Sample: Department of Operative Dentistry, Sir Syed College of Medical Sciences, Pakistan, between January 2021 and May 2021. Methodology: 60 patients were randomly divided into 3 groups, each group having 20 patients as following: Group 1: Nitrofurantoin, Group 2: Calcium Hydroxide and Group 3: Control. Preoperative pain was recorded using a numerical pain scale. After access preparation, chemomechanical preparation was performed with subsequent placement of intracanal medicaments. Pre-operative pain score was initially recorded, followed by post-operative pain at 12, 24, 48, and 72 hours, respectively. Root canal treatment was performed in single rooted teeth with patients suffering from symptomatic irreversible pulpitis Results: Majority of the patients in all 3 groups were initially presented with moderate to severe pre-operative pain. After 72 hours post-operatively, 50% patients in Group 1 reported no pain, while 5% patients in both Group 2 and 3 had no pain. Pain significantly subsided in Group 1 as compared to Group 2 and 3. Regarding age and gender, both had no significant relationship with the pain scores in all of the 3 groups Conclusion: Nitrofurantoin has been proven to be an effective intracanal medicament in alleviating immediate post-operative pain in patients with symptomatic irreversible pulpitis as compared to calcium hydroxide. While the control group with no intracanal medicament showed little reduction in pain scores. So, nitrofurantoin can be used as a substitute to currently available standard intracanal medicaments.

Introduction. The emergence of multiresistant enterobacteria producing extendedspectrum beta-lactamase (ESBL) in outpatients with urinary tract infections represents a public health problem in Perú. Objectives. To characterize multiresistant enterobacteria isolated from patients diagnosed with urinary tract infection in two Peruvian jungle departments using molecular techniques. Materials and methods. We conducted a descriptive, observational, and retrospective study of 61 urine culture isolates from two departments in the Peruvian jungle during 2017-2018. Resistance profiles were identified using the MicroScan™ automated system and a conventional polymerase chain reaction (PCR) was used for the detection of blaCTX-M, blaTEM and blaSHV genes. Results. The most common positive ESBL enterobacteria for each department were Escherichia coli in Madre de Dios (10/40; 25%) and Ucayali (16/21; 76.2%). Gene blaCTX-M was the most prevalent in both departments (25/61; 41%), followed by blaTEM (15/61; 24.6%), and blaSHV (10/61; 16.4%). As for the antimicrobial susceptibility profile, we detected resistance levels of 72.6% for ampicillin, 82.3% for cephalothin, and 88.7% for nitrofurantoin. Conclusions. BLEE-producing multi-resistant enterobacteria strains in both departments were 57.4% and blaCTX-M was the most common gene.Introducción. La aparición de enterobacterias multirresistentes y productoras de betalactamasas de espectro extendido (BLEE) en pacientes de consulta externa con infecciones urinarias, representa un problema de salud pública en Perú. Objetivos. Caracterizar molecularmente enterobacterias multirresistentes aisladas de pacientes con diagnóstico de infección urinaria y procedentes de dos departamentos de la selva peruana. Materiales y métodos. Se hizo un estudio descriptivo, observacional y retrospectivo de 61 aislamientos de urocultivo procedentes de la selva peruana durante 2017 y 2018. Los perfiles de resistencia se identificaron utilizando el sistema automatizado MicroScan™ y para la detección de los genes blaTEM, blaCTX-M, blaSHV se empleó una reacción en cadena de la polimerasa (PCR) convencional. Resultados. Las enterobacterias positivas para BLEE más frecuentes por departamento fueron Escherichia coli en Madre de Dios (25 %, 10/40) y Ucayali (76,2 %, 16/21). En ambos departamentos, el gen blaCTX-M fue el más frecuente (25/61; 41 %), seguido por blaTEM (15/61; 24,6 %) y blaSHV (10/61; 16,4 %). En el perfil de sensibilidad antimicrobiana, se detectó 72,6 % de resistencia contra ampicilina, 82,3 % contra cefalotina y 88,7 % contra nitrofurantoína. Conclusiones. El porcentaje de cepas de enterobacterias multirresistentes productoras de BLEE en ambos departamentos fue del 57,4 % y el gen bla CTX-M fue el más frecuente.

Background Studies have suggested increased risks of childhood leukaemia after prenatal exposure to antibiotics, particularly nitrofurantoin. However, these findings may be related to the underlying maternal infection. This multinational study aimed to investigate the association between prenatal nitrofurantoin exposure and childhood leukaemia while accounting for maternal infection. Methods In a population-based cohort study of children born in Denmark, Finland, Norway or Sweden from 1997 to 2013, prenatal exposure to nitrofurantoin or pivmecillinam (active comparator) was ascertained from national Prescription Registries. Childhood leukaemia was identified by linkage to national Cancer Registries. Poisson regression was used to estimate incidence rate ratios (IRRs) and incidence rate differences (IRDs) with inverse probability of treatment weights applied to account for confounding. Results We included 44 091 children prenatally exposed to nitrofurantoin and 247 306 children prenatally exposed to pivmecillinam. The children were followed for 9.3 years on average (standard deviation 4.1). There were 161 cases of childhood leukaemia. The weighted IRR for prenatal nitrofurantoin exposure when compared with pivmecillinam was 1.34 (95% confidence interval 0.88, 2.06), corresponding to an IRD of 15 per million person-years. Higher point estimates were seen for first- and third-trimester exposure. There was no evidence of a dose–response relationship. Conclusions Prenatal exposure to nitrofurantoin was not substantially associated with childhood leukaemia, although a slightly elevated IRR with confidence intervals including the null was observed, corresponding to a small absolute risk. The lack of a dose–response relationship and a clear biological mechanism to explain the findings suggests against a causal association.

Background: Urinary tract infections are most common bacterial infection in routine clinical practice. It is also most common nosocomial infection in many hospitals. Antibiotics are usually given empirically before urine culture reports available and treatment failure rate used to be significantly high. Study of causative agents and their antimicrobial sensitivity pattern are important factors helping formulating antibiotic policy. Generally, most common uropathogene is Escherichia Coli. Tertiary care hospitals, catering of already partially treated or mal treated patients as major chunk, may have varying etiologies and different sensitivity patterns. Objective: To study the culture and sensitivity patterns of urinary tract infections in patients presenting with urinary symptoms in local hospitals. Study design: A cross sectional study Materials and methods: Study was conducted at Madanta Research Clinic Private Limited from 12th march 021 to 12th September 021. Urine from cases suspected to have symptoms suggestive of UTI were send for bacteriological culture and sensitivity. Demographic profiles of each participant along with pathogen isolated, culture sensitivity pattern was documented. Data analysis was done in IBM spss 25. Results: A total 200 samples were selected for bacteriological culture and sensitivity out of which 32% were male and 68% were female. Around 50% of participants were in age group 20-40. There was no growth in 64% sample. Among positive samples (36%), E. coli (most common) was detected in 91.66%, Klebsiella was detected in 6.94%. Gentamicin, Amikacin and Nitrofurantoin were most common antibiotics sensitive to organisms in culture and Cephalosporins group of antibiotics are commonly resistant. Conclusions: coli is the most common organism isolated in urine culture in our region Janakpur. Cephalosporins are resistant in majority of cases where as Aminoglycosides like Amikacin, Gentamicin and Nitrofurantoin are found to be highly sensitive in most of positive cases.

The biological fitness cost of antibiotic resistance is a key parameter in determining the rate of appearance and spread of antibiotic-resistant bacteria in Egypt. Our study aimed to investigate the prevalence of antibiotic resistance among Escherichia coli clinical isolates from Greater Cairo area hospitals. A total of 537 clinical isolates were recovered from samples of urine, diarrheal specimen, pus, wound culture, gastric wound, blood, drain culture, sputum, high vaginal swab, abscess, amniotic fluid, ventilator, burn swab, splenic drain culture, and unknown site of infection during different seasons. All isolates were subjected to phenotypic and genotypic susceptibility testing for colistin, nitrofurantoin, fosfomycin, and trimethoprim, quinolones, and β-lactam resistance. Our results revealed that 42.7% of the isolates harbored at least one resistance encoding gene, 10% harboring 2, 0.6% harboring 3, and 0.85% harboring 4 resistance-encoding genes. PCR reported the prevalence of resistance genes as follows: bla-SHV 13.4%, mcr-1 0.6%, qnr-A 23.8%, fos-A 1.06%, nfs-A 3.6%, and dfr-A 25.5%. We reported that three isolates carried the mcr-1 gene encoding colistin resistance from three different hospitals. Upon performing sequencing and phylogenetic analysis on the three positive mcr-1 isolates (MT890587, MT890588, and MT890589), the three isolates showed 100% identity with themselves, with some strains from Egypt and Japan, and 99.9% identity with an isolate from China.

Nitrofurantoin (NFT) is mainly used in humans for the treatment of urinary tract infections. NFT is used as feed additives in animals, due to its broad antimicrobial activity. However, it shows more side effects on human health and the environment. Therefore low-cost, portable, and rapid sensors are necessary for the detection of NFT in real samples. Herein, we successfully developed an electrochemical sensor using a glassy carbon electrode (GCE) modified with gadolinium orthoferrite (GdFeO3) decorated on reduced graphene oxide (RGO) nanocomposite for the detection of NFT. The facile hydrothermal method was used to synthesis a novel GdFeO3/RGO nanocomposite, the morphological and structural characterization was confirmed by the FESEM, HRTEM, EDX, XRD, Raman, and XPS techniques. The formation mechanism of GdFeO3/RGO nanocomposite had been discussed. The effective intercalation of the nanostructured GdFeO3 to the RGO sheets leads to the significant enhancement in physicochemical properties such as electrical conductivity, electro-active surface area, structural stability, and electrochemical activity, which was observed from the EIS and CV experimental results. The electrochemical studies established that the developed GdFeO3/RGO sensor was highly sensitive and selective to NFT. Moreover, the GdFeO3/RGO sensor exhibits good sensitivity of 4.1985 μA μM−1 cm−2, a low detection limit (LOD) of 0.0153 µM and a linear range from 0.001 to 249 µM for NFT detection under optimized experimental conditions. In addition, the investigation of storage time on the CV response of the GdFeO3/RGO sensor indicates superior stability. Owing to these extraordinary analytical advantages, the as-fabricated sensor was applied to detect the NFT levels in human urine and river water samples with satisfactory results.

The urinary tract infections (UTI’s) are common infections that can affect kidneys, ureters, and urethra. About 40% of urinary tract infections are caused during hospitalization and globally an estimated 600,000 patients are affected per year. Urinary tract infections are more prevalent in women due to their short urethra and its anatomical proximity to the anal orifice. A bladder infection may cause pelvic pain, increased urge to urinate, pain with urination and blood in the urine. A kidney infection may cause back pain, nausea, vomiting and fever. Bacteriuria is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth & pyelonephritis if untreated. This study was carried out to isolate and identify bacteria involved in the first trimester of pregnancy. A cross sectional study was conducted from February, 2019 to June 2019. Structured questionnaires were used to collect data from pregnant women. UTI was diagnosed by urine culture on standard culture media. Out of 25 pregnant women included in this study, 15 (60.0%) were symptomatic and 10 (40.0%) asymptomatic. Escherichia coli(64%) was the most commonly found bacterial isolate followed by Psedomonas aeruginosa (20%), Klebsiella sp. (12%) and Proteus sp. (0.4%). Antibiotic susceptibility test by Kirby-Bayer Disc diffusion method revealed that all the bacterial isolates subjected to antibiogram test were sensitive or susceptible to Gentamycin, Nalidixic acid, Nitrofurantoin, Amikacin and Co-trimoxazole, and resistant to Amoxicillin, Norfloxacin and erythromycin were resistant to all bacterial isolates.

Hospital specific monitoring studies aims to determine the prevalence of the type of microorganisms that causes urinary infections and to assess the antimicrobial sensitivity pattern. A hospital based short term prospective cross-sectional study was conducted at Sagar Hospital, Bengaluru from August to October 2020. Antimicrobial susceptibility in MIC test was performed for the isolated pathogens by using automated VITEK compact method and stratification was done according to ICU and NON-ICU patients with over 260 urine culture tests of the suspected in-patient for urinary tract infection. All antimicrobial susceptibility data was analyzed using WHONET software 5.6. Sixty-six urine culture tests showed culture positive, 41 from non-ICU and 23 from ICU. Gram-negative bacilli E.Coli (61% in ICU, 52% IN non-ICU) was the most prevalent bacterium, followed by Klebsiella pneumoniae ss. pneumoniae (9% in ICU, 20% IN non-ICU), and Candida albicans 9% prevalence was seen only in ICU isolates. The study shows that the rate of resistance towards ampicillin (100%) was high among gram negative isolates and penicillin (100%) among gram positive isolates. The susceptibility was favorable towards polymixinB, colistin in gram negative organisms and nitrofurantoin, vancomycin in gram positive organisms. The present study revealed that E.Coli is the predominant bacterial pathogen. It also demonstrates there is an increasing resistance to ampicillin (88.2%) and ESBL (90%) among UTI pathogens. While, polymixin B (100%) and colistin was found most effective among gram negative and nitrofurantoin was most effective among gram positive organisms. Keywords: Antibiotic, antimicrobial resistance, urinary tract infection

Background: Urinary tract infections (UTI) are most common bacterial infections encountered in clinical practice and E.coli is predominant organism causing UTI. Objectives of the study: 1. To study antibiotic resistance pattern among uropathogenic E.coli (UPEC). 2. To study extended spectrum beta lactamase (ESBL) production and their correlation with antibiotic resistance among uropathogenic E.coli (UPEC). 3. To study biofilm formation and its correlation with antibiotic resistance among uropathogenic E.coli (UPEC). Materials and Methods: A prospective study was conducted on first 100 Escherichia coli isolated from urine specimens of patients suspected to be having urinary tract infection between January 2016 and December 2016 received at Department of Microbiology, SIMS Shimoga. Fresh midstream urine samples were aseptically collected in sterile containers and plated on Blood agar & MacConkey agar plates using a standard loop technique & the growth was processed by standard bacteriological technique. Biofilm detection was done by tube and microtitre plate method. ESBL detection was done according to CLSI criteria. Antimicrobial sensitivity testing was done using Kirby-Bauer methods on Mueller-Hinton agar. Results were interpreted as per the CLSI guidelines. Result: Antibiotic sensitivity of E.coli was nitrofurantoin (100%) fosfomycin (100%) imipenem (77%) cotrimoxazole (61%) amikacin (47%) aztreonam (53%) piperacillintazobactam (41%). cefotaxim (25%) ceftazidime (32%) norfloxacin (20%) ampicillin-sulbactam (12%) ciprofloxacin (15%), levofloxacin (12%), amoxiclavulanicacid (15%). ESBL positive were 83% (screening), 80% (confirmatory). Biofilm positive were 63% (tube method) 79% (Microtiterplate method). Conclusion: This study showed Fosfomycin and Nitrofurantoin were the most sensitive drug. Study shows antibiotic resistance was seen more in ESBL and Biofilm producers compared to non ESBL and non biofilm producers. Keywords: Antibiotic resistance

Objectives To evaluate the empiric therapy prescribed for acute uncomplicated cystitis in the outpatient setting (emergency department and ambulatory care clinics) and to characterize uropathogens for discordance between the therapy prescribed and susceptibility. Methods A retrospective review was conducted at an inner-city emergency department and multiple clinics to evaluate the empiric therapy prescribed and the uropathogens isolated from culture for patients with acute uncomplicated cystitis. Results A total of 144 urine cultures were included. Among the patients, 53.4% were empirically prescribed cephalexin, 20.1% ciprofloxacin, 11% nitrofurantoin, and 8.3% trimethoprim/sulfamethoxazole. The most common uropathogen was Escherichia coli (72.4%), followed by Streptococcus agalactiae (7.6%) and Klebsiella pneumoniae (4.8%). Of the 107 E. coli isolates, 9 were extended spectrum beta-lactamase–producing. E. coli antimicrobial susceptibilities were as follows: ceFAZolin (97%), nitrofurantoin (96%), cefTRIAXone (91%), ciprofloxacin (87%), and trimethoprim-sulfamethoxazole (59%). The concordance rates with the Infectious Diseases Society of America treatment guidelines for acute uncomplicated cystitis and local resistance patterns were as follows: empiric therapy prescribed (70%), dosing of empiric therapy (77%), and duration of empiric therapy (22%). For empiric therapy prescribed and susceptibility mismatch, 5.6% of the isolates were not susceptible to therapy, 76.4% were susceptible to therapy, 14% did not have susceptibilities, and 4.2% did not receive therapy. Conclusions Most of the cases of acute uncomplicated cystitis at the subject institution can be managed safely and effectively with nitrofurantoin or first-generation cephalosporins. Institutions should use national guidelines in conjunction with local resistance and prescribing patterns to improve antibiotic prescribing in the outpatient setting.

Objective. To characterize the profiles and genetic determinants of antibiotic resistance in pathogens of community-acquired urinary tract infections (UTI) in women of reproductive age in St. Petersburg (Russia).Materials and methods. The study included strains of microorganisms obtained from 145 women of reproductive age with diagnosed with a UTI. Antibiotic susceptibility was evaluated by disk diffusion method; the interpretation of the results was carried out in accordance with the EUCAST criteria. Strains of uropathogenic enterobacteria were tested by PCR for the presence of beta-lactamase genes: beta-lactamase genes encoding enzymes of the AmpC group (MOX, CMY, LAT, BIL, DHA, ACC, MIR, ACT, FOX), TEM, SHV, OXA‑1, ESBL genes of the CTX–M group, genes of carbapenemases (KPC, OXA‑48) and metal-beta-lactamases (VIM, IMP, NDM).Results. Most cases (81 %) of UTIs in women in St. Petersburg were due to enterobacteria, with Escherichia coli highly prevailing (66 %). Fosfomycin, meropenem and nitrofurantoin had the highest in vitro activity against uropathogenic Enterobacteriaceae. High rates of resistance to betalactam antibiotics were found (from 16 % to cefotaxime to 28 % to amoxicillin/clavulanic acid). The genes of TEM-beta-lactamases were found in 31 isolates (26.7 %), SHV – in 17 (14.6 %), CTX–M type – in 15 (12.9 %), DHA – in 2 (1.7 %). The other beta-lactam resistance genes (MOX, CMY, LAT, BIL, ACC, MIR, ACT, FOX, KPC group, OXA-like group, VIM, IMP, NDM) were not detected.Conclusion. Microbiological and molecular analysis of the structure of beta-lactam resistance is important for the effective of epidemiological control of antimicrobial resistance in pathogens causing urinary tract infections.

Infection with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae is emerging as an important challenge in health-care.50 swabs were collected from inanimate origins located in Chennai and the organisms isolated were identified by performing various preliminary tests like gram staining, capsule staining, motility, catalase, oxidase and biochemicals. antibiotic sensitivity testing was done for all the isolates using Ampicillin (AMP), Tetracycline (TE), Nitrofurantoin (NIT), Colistin (CL), Piperacillin (PIT), Noroxin (NX), Cefepime (CPM), Cefeparazone (CPZ), Ceftazidime (CFZ), Ciprofloxacin (CIP), Cotrimazole (COT), Ceftriaxone (CFX), Tigecycline (TGC), Tobramycin (TOB), Gentamicin (GEN), Amikacin (AK) and Imipenem (IMP) drugs and highest resistant against all the gram negative drugs was shown by Klebsiella which was further confirmed by MIC. The isolate was analysed for species by 16S rRNA sequencing which was reported as Klebsiella pneumoniae. The main objective of the present study is to identify the genes responsible for showing MDR and given for PCR reported as NDM, OXA-48 and K2A are the genes. Molecular docking was done by retrieving the gene structures of OXA-48 NDM and K2A of K.pneumoniae from protein data bank with proteins present in the leaf part of Cassia auriculata in patchdock and the binding interactions were interpreted and visualized using pyMOL to give a breakpoint by designing a drug for MDR bacterial strains.

The aim of this study was to analyze the extended spectrum β-lactamases (ESBLs) production and antibiotic susceptibility profile of urinary tract infected bacterial pathogens such as Escherichia coli and Klebsiella spp. A total of 143 Gram-negative bacteria were isolated from people suffering from urinary tract infections (UTIs) were included in this study. Among them, Escherichia coli (75%) were the predominantly isolated bacterial pathogen followed by Klebsiella oxytoca (14.6%) and K. pneumoniae (10.4%). Approximately 65% (n=93) of isolates were positive for ESBL production and E.coli was found to be the highest ESBL producer (67.6%) followed by K. oxytoca (57.1%) and K. pneumoniae (53.3%). E. coli showed high level of 86.1% resistance to cefotaxime and cefuroxime and 100% sensitive to imipenem and meropenem, whereas, K. oxytoca showed high level of 90.5% resistance to cefuroxime and 100% sensitive to amikacin, imipenem and meropenem. Similarly, K. pneumoniae showed high level of 73.3% resistance to nitrofurantoin and 93.3% sensitive to imipenem. This study reveals that majority of UTIs caused bacteria are ESBL producing multidrug-resistant bacteria and showing broad spectrum antibiotic resistance profile.

Background: Urinary tract infections are common during childhood. The etiologic agents and empirical antibiotics may vary due to age and geographic area. Objectives: This study was designed to investigate the urinary tract infection pathogens, their antibiotic resistance profile and risk factors in a sample of well-child population. Materials and Methods: This retrospective study was conducted in the pediatric clinics of a secondary health-care centre in a one-year period. The source of data was hospital and laboratory records. Toilet trained children and adolescents aged between 5-17 years old with positive urine culture were enrolled into the study. Microbiological studies were conducted ac- cording to international guidelines. Results: During the study 3640 urine samples were analyzed and 342(9.4%) had significant growth. Gram negative en- terobacteria were the most common infectious agents. Antibiotic susceptibility tests showed low cephalosporine resistance unless ESBL was positive. Multi drug resistance was remarkable. Extended beta lactamase resistance rate was 17%. Previous history of antibiotic use before the present administration was the only significant risk factor for ESBL positivity. Conclusion: Treating urinary tract infections may become an emerging problem soon. Unless there are risk factors, cepha- losporines are good options, but if so nitrofurantoin or carbapanems should be preferred for treatment in this population. Keywords: Urinary tract infections; antibiotics; susceptibility.

الملخص: أهداف البحث: تتزايد التهابات المسالك البولية في الأطفال بسرعة في جميع أنحاء العالم، وعادة ما تكون ناجمة عن البكتيريا المقاومة للأدوية. هذه الدراسة تحدد انتشار التهاب المسالك البولية في الأطفال، وتقيم نمط البكتيريا المقاومة للأدوية من قبل سلالات معزولة من الإشريكية والكلبسيلة عن التهابات المسالك البولية في مرضى الأطفال. طرق البحث: تم عزل السلالات البكتيرية الممرضة للجهاز البولي من المرضى الأطفال بالتهابات المسالك البولية التي تم إدخالها في معهد صحة الطفل بلاهور، باكستان. تم تحديد السلالات من جنس الإشريكية والكلبسيلة، من خلال التوصيف الكيميائي الحيوي، وتعرضت لمقاييس الحساسية للمضادات الحيوية لتحديد البكتيريا المقاومة للأدوية ضد ٢١ من الأدوية المضادة للميكروبات. النتائج: خلال ستة أشهر، تم عزل ما مجموعه ٦٣ من الإشريكية و٣٧ من سلالات الكلبسيلة من ١٣٠ طفلا مصابين بالتهابات المسالك البولية. وأظهرت مقاييس حساسية المضادات الحيوية أن الإشريكية والكلبسيلة لها مقاومة عالية ضد كوأموكسيكلاف، وسيفروكسيم، وسيفيكسيم، وسيفوتاكسيم، وسيفتازيديم، وسيفترياكسون، وسيبروفلوكساسين، وحمض ناليديكسيك، ونورفلوكساسين، وحمض بيبيديمك، وكوتريموكسيزول. ومع ذلك، فقد وجد أن للعقاقير المضادة للميكروبات بما في ذلك بوليميكسين-ب، وكبريتات الكوليستين، والكلورامفينيكول، ونيتروفوارانتون، وفوسفومايسين فاعلية كبرى للتحكم بالسلالات الممرضة للجهاز البولي من القولونية الإشريكيشية والكلبسيلة الرئوية. وتم تحديد السلالات الخمس التي تعاني من أعلى مقاومة ضد المضادات الحيوية المختبرة على أنها سلالات من الإشريكية القولونية والكلبسيلة الرئوية. الاستنتاجات: أظهرت دراستنا أن الإشريكية القولونية والكلبسيلة الرئوية كانت البكتيريا المهيمنة لمقاومة للأدوية من التهابات المسالك البولية المكتسبة من المجتمع في مجموعتنا. وتم الوصول إلى أن هذه البكتيريا الممرضة للجهاز البولي غير مستجيبة للعقارات المستخدمة بشكل روتيني من المضادات الحيوية مثل بيتا اللاكتام، والبيريدوبيريميدين، والكينولون، والفلوروكينولون. قد تكون هذه النتائج مفيدة للأطباء لتعزيز العلاج التجريبي لالتهابات المسالك البولية في الأطفال. Abstract: Objectives: Urinary tract infections (UTIs) in children are rapidly increasing worldwide and are commonly caused by extensively drug-resistant bacteria. This study determines the prevalence of UTIs in paediatric patients and evaluates the pattern of extensively drug-resistance in Escherichia coli and Klebsiella pneumoniae strains isolated from paediatric UTI patients. Methods: Uropathogenic bacterial strains were isolated from paediatric patients with UTIs admitted to the Institute of Child Health, Lahore, Pakistan. Strains of both E. coli and K. pneumoniae were identified using biochemical characterisation and subjected to antibiotic susceptibility assays for 21 common antimicrobial drugs in order to determine their extensively drug-resistant profile. Results: We isolated 63 E. coli and 37 K. pneumoniae strains from 130 paediatric patients with UTIs over a period of six months. The antibiotic susceptibility assays showed that both the E. coli and K. pneumoniae strains exhibited a high degree of resistance against co-amoxiclav, cefuroxime, cefixime, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, nalidixic acid, norfloxacin, pepedemic acid, and co-trimoxazole. However, several of the antimicrobial agents, including polymyxin B, colistin sulphate, chloramphenicol, nitrofurantoin, and fosfomycin, were found to retain their antimicrobial activities against both pathogens. The five highest antibiotic resistant strains were identified as E. coli strains ZK9, ZK40, and ZK60 and K. pneumoniae ZK32 and ZK89 using 16S rRNA gene sequencing. Conclusion: Our study demonstrates that E. coli and K. pneumonia are the dominant extensively drug-resistant uropathogenic bacteria in community-acquired UTIs in our cohort. These uropathogens were found to be resistant to the majority of the routinely-used classes of β-lactams, pyridopyrimidines, quinolones, and fluoroquinolone antibiotics, and these findings may be useful for clinicians in their treatment of paediatric UTIs.

BackgroundUrinary tract infections are one of the most common infections in primary and secondary care, with the majority of antimicrobial therapy initiated empirically before culture results are available. In some cases, however, over 40% of the bacteria that cause UTIs are resistant to some of the antimicrobials used, yet we do not know how the patient outcome is affected in terms of relapse, treatment failure, progression to more serious illness (bacteraemia) requiring hospitalization, and ultimately death. This study analyzed the current patterns of antimicrobial use for UTI in the community in Scotland, and factors for poor outcomes.ObjectivesTo explore antimicrobial use for UTI in the community in Scotland, and the relationship with patient characteristics and antimicrobial resistance inE. colibloodstream infections and subsequent mortality.MethodsWe included all adult patients in Scotland with a positive blood culture withE. coligrowth, receiving at least one UTI-related antimicrobial (amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, trimethoprim, and nitrofurantoin) between 1st January 2009 and 31st December 2012. Univariate and multivariate logistic regression analysis was performed to understand the impact of age, gender, socioeconomic status, previous community antimicrobial exposure (including long-term use), prior treatment failure, and multi-morbidity, on the occurrence ofE. colibacteraemia, trimethoprim and nitrofurantoin resistance, and mortality.ResultsThere were 1,093,227 patients aged 16 to 100 years old identified as receiving at least one prescription for the 5 UTI-related antimicrobials during the study period. Antimicrobial use was particularly prevalent in the female elderly population, and 10% study population was on long-term antimicrobials. The greatest predictor for trimethoprim resistance inE. colibacteraemia was increasing age (OR 7.18, 95% CI 5.70 to 9.04 for the 65 years old and over group), followed by multi-morbidity (OR 5.42, 95% CI 4.82 to 6.09 for Charlson Index 3+). Prior antimicrobial use, along with prior treatment failure, male gender, and higher deprivation were also associated with a greater likelihood of a resistantE. colibacteraemia. Mortality was significantly associated with both having anE. colibloodstream infection, and those with resistant growth.ConclusionIncreasing age, increasing co-morbidity, lower socioeconomic status, and prior community antibiotic exposure were significantly associated with a resistantE. colibacteraemia, which leads to increased mortality.

Leishmaniasis is a vector-borne parasitic disease that mostly affects populations in tropical and sub-tropical countries. There is currently no protective anti-leishmanial vaccine and only a paucity of clinical drugs is available to treat this disease albeit their toxicity. Leishmaniasis is curable but its eradication and elimination have been hampered by the emergence of multidrug resistant strains of the causative pathogens. This heightens the necessity for new and effective antileishmanial drugs. In search for such agents, nitrofurantoin, a clinical antibiotic, was appended to triazole scaffold through alkylene linkers of various length, and the resulting hybrids were evaluated for in vitro antileishmanial efficacy against Leishmania (L.) parasite of two strains. The hybrid 13, harboring a n-pentylene linker was uncovered as a leishmanicidal hit with micromolar activity against antimonial-resistant L. donovani, the causative of deadly visceral Leishmaniasis.

In recent years, the harmonization of domestic and foreign clinical recommendations for the treatment of cystitis has been achieved. Nitrofurans and fosfomycin trometamol are recommended as first line therapy antibiotics, and oral 3rd generation of cephalosporins are recommended as alternative antibiotics; fluoroquinolones are excluded from the recommended medications due to an unfavorable safety profile. The main rationale for inclusion of antibiotics in the recommendations as a first line therapy of cystitis is the level of resistance of uropathogens to antibiotics, primarily Escherichia coli. Stable low level of resistance of E. coli in Russia was noted to nitrofurans and fosfomycin (5%), higher to cephalosporins. Among nitrofurans, furazidine is characterized by higher activity against E. coli compared to nitrofurantoin. The potassium salt of furazidine in dosage form with magnesium carbonate is preferred, since it is characterized by higher bioavailability and provides a therapeutic level of concentrations in urine above the MIC during the entire dosing period. Due to the global increase in the resistance of uropathogens observed in recent years, experts have begun to pay more and more attention to the ecological safety of antimicrobial therapy in order to minimize the risk of concomitant (collateral) damage, contributing to the selection of multi-drug resistant strains of microorganisms. In the latest WHO document of 2021, experts divided antibiotics into three groups (ACCESS, WATCH, RESERVE) according to the priority of choice. The ACCESS group of drugs for the treatment of cystitis includes nitrofurantoin and furazidine as agents with minimal collateral effect, while fosfomycin trometamol and cephalosporins are listed in the WATCH group. Thus, from the standpoint of ecological safety, WHO experts recommend prescribing nitrofurans in the treatment of cystitis in the first line of therapy.В последние годы достигнута гармонизация отечественных и зарубежных клинических рекомендаций по лечению цистита. В качестве средств 1-й линии рекомендованы нитрофураны и фосфомицина трометамол, в качестве альтернативных препаратов пероральные цефалоспорины III поколения. Фторхинолоны исключены из рекомендованных средств из-за неблагоприятного профиля переносимости. Основным обоснованием включения в рекомендации в качестве средств 1-й линии терапии служит уровень устойчивости уропатогенов, прежде всего ведущего Escherichia coli к антибиотикам. Стабильно низкая устойчивость E. coli в Российской Федерации отмечена к нитрофуранам и фосфомицину (5%), более высокая к цефалоспоринам. Среди нитрофуранов фуразидин характеризуется более высокой активностью против E. coli по сравнению с нитрофурантоином. Калиевая соль фуразидина в лекарственной форме с магния карбонатом основным является предпочтительной, поскольку характеризуется более высокой биодоступностью и обеспечивает терапевтический уровень концентраций в моче выше минимальной подавляющей концентрации в течение всего периода дозирования. В связи с глобальным ростом устойчивости уропатогенов, наблюдаемым в последние годы, эксперты стали обращать все больше внимания на экологическую безопасность антимикробной терапии с целью минимизации риска развития сопутствующего (параллельного) ущерба терапии, способствующего селекции полирезистентных штаммов микроорганизмов. В последнем документе Всемирной организации здравоохранения (ВОЗ) от 2021 г. эксперты разделили антибиотики на 3 группы (ACCESS, WATCH, RESERVE) по приоритету выбора. Из препаратов для лечения цистита в группу ACCESS включены нитрофурантоин и фуразидин как средства с минимальным сопутствующим эффектом, а фосфомицина трометамол и цефалоспорины указаны в группе WATCH. Таким образом, с позиции экологической безопасности при лечении цистита эксперты ВОЗ рекомендуют в 1-й линии терапии назначать нитрофураны.

Introduction: Urinary tract infections (UTI) are one of the most common infections encountered in the emergency department (ED) with an estimated 2-3 million annual visits. Commonly prescribed antibiotics for UTIs have shown growing rates of resistance. Previous studies lack direction on improving UTI treatment based on the labs available to the bedside clinician. Methods: We sought to determine if antibiotic resistance in UTIs was related to demographics, urinalysis, and history of renal failure or kidney stones. We conducted an analysis of 892 women ≥18 years of age discharged from the ED with a UTI diagnosis. We assessed predictors of nitrofurantoin resistance, cefazolin resistance, ciprofloxacin resistance, and trimethoprim-sulfamethoxazole resistance using unadjusted and multivariable logistic regression models. Results: Antibiotic resistance was 13.6% for nitrofurantoin, 11.9% for cefazolin, 12.8% for ciprofloxacin, and 17.1% for trimethoprim-sulfamethoxazole. In multivariable analysis, significant independent associations with an increased likelihood of resistance to nitrofurantoin were observed for less urine blood (OR [per 1 category increase of score] 0.81; P = 0.02); greater mucous (OR [per 1 category increase of score] 1.22; P = 0.02); less specific gravity urine (OR [per 1 category increase] 0.87; P = 0.04), and presence of any history of kidney stones (OR 3.24; P = 0.01). There were no significant predictors for cefazolin resistance (all P ≥0.06); age was the only significant predictor of ciprofloxacin resistance (OR per 10 year increase] 1.10, P = 0.05), and lower specific gravity urine was significantly associated with an increased risk of resistance to trimethoprim- sulfamethoxazole (OR [per 1 category increase] 0.88, P = 0.04). Conclusion: Women with any history of kidney stones may have bacteriuria resistant to nitrofurantoin, suggesting that providers might consider alternative antibiotic therapies in this scenario.

Human carbonic anhydrase VII (hCA VII) constitutes a promising molecular target for the treatment of epileptic seizures and other central nervous system disorders due to its almost exclusive expression in neurons. Achieving isoform selectivity is one of the main challenges for the discovery of new hCA inhibitors, since nonspecific inhibition may lead to tolerance and side effects. In the present work, we report the development of a molecular docking protocol based on AutoDock4

To evaluate whether there were any changes in the rates of urinary tract infection (UTI) and antibiotic resistance in pediatric patients during the pandemic period.Urine culture samples collected due to suspected UTI were searched retrospectively from our hospital database, and the patients with growth in urine culture were identified. They were divided into 2 groups as Group A (before COVID-19, March 11, 2019- March 11, 2020) and Group B (COVID-19 period, March 11, 2020- March 11, 2021). Also, COVID-19 period was divided into 3 subgroups (March 2020- June 2020: first epidemic peak, July 2020 - November 2020: normalization process, December 2020- March 2021: second epidemic peak). We adjusted the patient age as1, 1-6 and 7-18 years. Age, gender, microorganism strain types, and their antibiotic resistance patterns were compared between the 2 groups Results: This cross-sectional study included 250 eligible patients (Group A, n=182 and Group B, n=68) with a mean age of 10.91 ± 5.58 years. The male/female ratio was higher in Group B than in Group A (p = .004). Incidence of UTIs was lower in the curfew and restriction periods due to epidemic peaks than normalization process (p = .001). The proportion of E.coli decreased from 80.2% to 61.8% during the pandemic period when compared to pre-pandemic period (p = .001). Group B had lower rates of resistance to ampicillin, fosfomycin and nitrofurantoin for E.coli than Group A (p = .001, p = .012 and p = .001, respectively). Also, Group B had higher rate of uncommon microorganisms and lower rate of resistance to nitrofurantoin for E.coli than Group A in patients aged 7-18 years (p = .003 and p = .023, respectively).Our study demonstrates that the ongoing COVID-19 pandemic process has caused alterations in community-acquired UTIs in children. More hygienic lifestyle may be considered as the main factor in this change.

Antibiotic resistance is becoming increasingly prevalent amongst bacterial pathogens and there is an urgent need to develop new types of antibiotics with novel modes of action. One promising strategy is to develop resistance-breaker compounds, which inhibit resistance mechanisms and thus resensitize bacteria to existing antibiotics. In the current study, we identify bacterial DNA double-strand break repair as a promising target for the development of resistance-breaking co-therapies. We examined genetic variants of Escherichia coli that combined antibiotic-resistance determinants with DNA repair defects. We observed that defects in the double-strand break repair pathway led to significant resensitization toward five bactericidal antibiotics representing different functional classes. Effects ranged from partial to full resensitization. For ciprofloxacin and nitrofurantoin, sensitization manifested as a reduction in the minimum inhibitory concentration. For kanamycin and trimethoprim, sensitivity manifested through increased rates of killing at high antibiotic concentrations. For ampicillin, repair defects dramatically reduced antibiotic tolerance. Ciprofloxacin, nitrofurantoin, and trimethoprim induce the promutagenic SOS response. Disruption of double-strand break repair strongly dampened the induction of SOS by these antibiotics. Our findings suggest that if break-repair inhibitors can be developed they could resensitize antibiotic-resistant bacteria to multiple classes of existing antibiotics and may suppress the development of de novo antibiotic-resistance mutations.

Background: Urinary tract infections (UTI) are one of the most common infections in the community and hospitals. Uropathogens colonize the urinary tract and may ascend to bladder causing cystitis, if left untreated reach kidneys through ureters can be responsible for acute pyelonephritis and cause renal damage. Aims: The aim of the present study is to determine the prevalence of urinary tract infections and antibiotic susceptibility pattern in a tertiary care hospital. Settings & Design: This is an observational study conducted in Microbiology department, Hind Institute of Medical Sciences, Barabanki. Materials and Methods: A total of 623 urine(mid-stream) samples were collected from indoor and outdoor departments of hospital and culture was done on UTI chromogenic agar using semiquantitative method. Antibiotic sensitivity test was performed using Kirby Bauer disc diffusion method. Results: Prevalence of urinary tract infections is 29% in the study. (43%) is the most common micro-organism isolated followed by (13%), (11%), (10.4%), (8.8%), (3.3%), (1.6%), CONS & (1.1%) and (6.6%). The females(56.6%) are more commonly affected than males. Conclusion: In the present study, beta-lactamase inhibitors and aminoglycosides were effective drugs against gram negative bacteria. Vancomycin and linezolid were sensitive in gram positive bacteria. Nitrofurantoin is the promising drug in cases of uncomplicated UTI, and safe to use in pregnancy. High recurrence rates and antimicrobial resistance are responsible for increasing the burden of disease. It is advised to use the antibiotics judiciously as per the hospital antibiotic policy which will help prevent multidrug resistance micro-organism further reducing morbidity and mortality. Keywords: Escherichia coli, Urinary tract infections, Uropathogens.

NfsA is a dimeric flavoprotein that catalyses the reduction in nitroaromatics and quinones by NADPH. This reduction is required for the activity of nitrofuran antibiotics. The crystal structure of free Escherichia coli NfsA and several homologues have been determined previously, but there is no structure of the enzyme with ligands. We present here crystal structures of oxidised E. coli NfsA in the presence of several ligands, including the antibiotic nitrofurantoin. Nitrofurantoin binds with the furan ring, rather than the nitro group that is reduced, near the N5 of the FMN. Molecular dynamics simulations show that this orientation is only favourable in the oxidised enzyme, while potentiometry suggests that little semiquinone is formed in the free protein. This suggests that the reduction occurs by direct hydride transfer from FMNH− to nitrofurantoin bound in the reverse orientation to that in the crystal structure. We present a model of nitrofurantoin bound to reduced NfsA in a viable hydride transfer orientation. The substrate 1,4-benzoquinone and the product hydroquinone are positioned close to the FMN N5 in the respective crystal structures with NfsA, suitable for reaction, but are mobile within the active site. The structure with a second FMN, bound as a ligand, shows that a mobile loop in the free protein forms a phosphate-binding pocket. NfsA is specific for NADPH and a similar conformational change, forming a phosphate-binding pocket, is likely to also occur with the natural cofactor.

Antibiotics are essential molecules for the treatment and prophylaxis of many infectious diseases. However, drugs that combat microbial infections can become a human health threat due to their high and often indiscriminate consumption, considered one of the factors of antimicrobial resistance (AMR) emergence. The AMR crisis, the decrease in new drug development by the pharmaceutical industry, and reduced economic incentives for research have all reduced the options for treating infections, and new strategies are necessary, including the return of some traditional but “forgotten” antibiotics. However, prescriptions for these older drugs including nitrofurantoin and oral fosfomycin, have been based on the results of pioneer studies, and the limited knowledge generated 50–70 years ago may not be enough. To avoid harming patients and further increasing multidrug resistance, systematic evaluation is required, mainly for the drugs prescribed for community-acquired infections, such as urinary tract infections (UTI). Therefore, this review has the objective of reporting the use of two classic drugs from the nitrofuran and phosphonic acid classes for UTI control nowadays. Furthermore, we also explore new approaches used for these antibiotics, including new combination regimes for spectral amplification, and the prospects for reducing bacterial resistance in the fight against bacteria responsible for UTI.

The present study was designed to reintroduce an older antimicrobial nitrofurantoin to treat uncomplicated urinary tract infection and to explore the relationship between the reintroduction and corresponding shift in sensitivity pattern of the microbes. The microbial sensitivity against ciprofloxacin before intervention was 46.6%, which significantly increased after intervention (51.8%). Treatment with nitrofurantoin resulted in a total clinical cure rate of 80.6%, of which rate of clinical cure achieved in expected time was 66.1% and delayed was 14.5%. The rate of total clinical cure with nitrofurantoin corresponded closely with the proportion of urinary isolates sensitive to nitrofurantoin. i.e., 86.3%. This preliminary study revealed that revival might be an effective strategy to increase the sensitivity and to delay the emergence of resistance.