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Objective: To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system., Methods: Design : Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data . Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals . Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011-2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical characteristics, frequencies and means were calculated among CRE HAI cases and compared with carbapenem-susceptible Enterobacteriaceae HAI cases through univariate and multivariate logistic regression using STATA 13., Results: There were 1598 Enterobacteriaceae HAI cases, of which 871 (54.1%) were carbapenem resistant. The multivariate regression analysis demonstrated that carbapenem resistance was associated with specimen type, pathogen, location prior to admission, and length of ICU stay. Between 2011 and 2017, there was an increase in the proportion of Enterobacteriaceae HAI cases due to CRE ( p -value = 0.003) and the incidence of CRE HAIs ( p -value = 0.09)., Conclusions: This analysis demonstrated a high and increasing burden of CRE in Egyptian hospitals, highlighting the importance of enhancing infection prevention and control (IPC) programs and antimicrobial stewardship activities and guiding the implementation of targeted IPC measures to contain CRE in Egyptian ICU's ., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

Background: Resistance among bacterial infections is increasingly well-documented in high-income countries; however, relatively little is known about bacterial antimicrobial resistance in low-income countries, where the burden of infections is high., Methods: We prospectively screened all adult inpatients at a referral hospital in Rwanda for suspected infection for seven months. Blood, urine, wound and sputum samples were cultured and tested for antibiotic susceptibility. We examined factors associated with resistance and compared hospital outcomes for participants with and without resistant isolates., Results: We screened 19,178 patient-days, and enrolled 647 unique participants with suspected infection. We obtained 942 culture specimens, of which 357 were culture-positive specimens. Of these positive specimens, 155 (43.4%) were wound, 83 (23.2%) urine, 64 (17.9%) blood, and 55 (15.4%) sputum. Gram-negative bacteria comprised 323 (88.7%) of all isolates. Of 241 Gram-negative isolates tested for ceftriaxone, 183 (75.9%) were resistant. Of 92 Gram-negative isolates tested for the extended spectrum beta-lactamase (ESBL) positive phenotype, 66 (71.7%) were ESBL positive phenotype. Transfer from another facility, recent surgery or antibiotic exposure, and hospital-acquired infection were each associated with resistance. Mortality was 19.6% for all enrolled participants., Conclusions: This is the first published prospective hospital-wide antibiogram of multiple specimen types from East Africa with ESBL testing. Our study suggests that low-resource settings with limited and inconsistent access to the full range of antibiotic classes may bear the highest burden of resistant infections. Hospital-acquired infections and recent antibiotic exposure are associated with a high proportion of resistant infections. Efforts to slow the development of resistance and supply effective antibiotics are urgently needed., Competing Interests: The authors have declared that no competing interests exist.

Background: Because of the unknown situation of antibiotic resistance pattern in the main hospital in Ilam, Iran, we aimed to evaluate the antibiotic resistance pattern of uropathogenic bacteria obtained from referred patients to Imam Khomaini Hospital, Ilam, Iran. So, 114 bacteria were collected during 9-month period and evaluated for their antibiotic resistance patterns., Results: Our results demonstrated that Escherichia coli as the dominant responsible for urinary tract infection. Our results demonstrated that 61.4 % (n = 70) of isolates were positive for E.coli, while lowest prevalence was observed for Staphylococcus aureus and Acinetobacter baumannii. The results also showed that 6.4% (n = 7) were metallo beta lactamase (MBL) producers. Our findings showed only 4 gram positive bacteria were obtained from patients with urinary tract infections including one methicillin resistant S. aureus (MRSA) and 2 vancomycin resistant Enterococcus faecalis (VRE)., Conclusion: In conclusion, we strongly recommended to perform a perfect study among all hospitals in Iran to evaluate the situation of antibiotic resistance and make a real panel to control this issue., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Ethnopharmacological Relevance: Piper betle, a tropical creeper plant belongs to the family Piperaceae. The leaves of this plant have been well known for their therapeutic, religious and ceremonial value in South and Southeast Asia. It has also been reported to possess several biological activities including antimicrobial, antioxidant, antinociceptive, antidiabetic, insecticidal and gastroprotective activities and used as a common ingredient in indigenous medicines. In Indian system of ayurvedic medicine, P. betle has been well recognized for its antiseptic properties and is commonly applied on wounds and lesions for its healing effects., Aim of the Study: To evaluate the anti-quorum sensing (anti-QS) and antibiofilm efficacy of P. betle and its bioactive metabolite phytol against Serratia marcescens., Materials and Methods: The P. betle ethyl acetate extract (PBE) was evaluated for its anti-QS efficacy against S. marcescens by assessing the prodigiosin and lipase production at 400 and 500µgml -1 concentrations. In addition, the biofilm biomass quantification assay was performed to evaluate the antibiofilm activity of PBE against S. marcescens. Besides, the influence of PBE on bacterial biofilm formation was assessed through microscopic techniques. The biofilm related phenomenons like exopolysaccharides (EPS) production, hydrophobicity and swarming motility were also examined to support the antibiofilm activity of PBE. Transcriptional analysis of QS regulated genes in S. marcescens was also done. Characterization of PBE was done by separation through column chromatography and identification of active metabolites by gas chromatography -mass spectrometry. The major compounds of active fractions such as hexadecanoic acid, eugenol and phytol were assessed for their anti-QS activity against S. marcescens. Further, the in vitro bioassays such as protease, biofilm and HI quantification were also carried out to confirm the anti-QS and antibiofilm potential of phytol in PBE., Results: PBE inhibits QS mediated prodigiosin pigment production in S. marcescens, which confirmed its anti-QS potential against S. marcescens. At 500µgml -1 concentration, PBE significantly inhibited the production of protease, lipase, biofilm and EPS to the level of 71%, 68%, 65% and 43% in S. marcescens, respectively. Further, their antibiofilm efficacy was confirmed through microscopic techniques. In addition, PBE effectively inhibited the hydrophobicity and swarming motility. Additionally, the results of qPCR analysis validated the downregulation of QS genes. Chromatographic techniques the presence of hexadecanoic acid, eugenol and phytol in PBE and the potential bioactive compound with anti-QS activity was identified as phytol. In vitro assays with phytol evidenced the potent inhibition of QS-controlled prodigiosin, protease, biofilm and hydrophobicity in S. marcescens, without exerting any deleterious effect on its growth., Conclusion: This study demonstrates the promising anti-QS and antibiofilm activities of PBE and its active metabolite phytol, and confirms the ethnopharmacological applications of these leaves against S. marcescens infections., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are an increasing concern regarding antibiotic resistance and their potential to cause serious infections which are difficult to treat. The purpose of this surveillance programme was to assess the incidence of ESBL in adults amongst urinary isolates, identify risk factors, and detail the antibiotic susceptibility profile in order to guide empirical treatment., Methods: From 2006 to 2014, we reviewed 21,414 positive urine cultures for E. coli and Klebsiella sp. from a University hospital in the UK and found 1420 ESBL-positive specimens. Susceptibility testing was performed by British Society of Antimicrobial Chemotherapy disc diffusion testing. ESBL screening was performed on samples resistant to cefpodoxime and confirmed by double disc diffusion (Oxoid Ltd, Basingstoke, UK). Patient gender, age, inpatient status, and catheterisation were assessed as risk factors., Results: ESBL production amongst E. coli urine cultures increased 44 %, from 4.6 to 6.6 % of all E. coli isolates. ESBL-positive organisms were associated with increases in drug resistance, particularly amongst fluoroquinolones, trimethoprim, and cephalexin. Multidrug resistance was a feature with 75 % of ESBL+ Klebsiella sp.-resistant ≥6 antibiotic classes. ESBL producers remained largely susceptible to carbapenems. Male gender, urinary catheterisation, inpatient status, and increasing age were identified as risk factors for ESBL infection or colonisation., Conclusion: We demonstrate that the incidence of ESBL-producing E. coli in urine cultures is increasing and that such isolates are multidrug resistant. Carbapenems and nitrofurantoin for E. coli infections remain effective, which may guide empirical antibiotic therapy.

Background/aim: Because patients in intensive care units usully have an urinary catheter, the risk of urinary tract infection for these patients is higher than in other patients. The aim of this study was to identify risk factors and causative microrganisms in patients with catheter-associated urinary tract infection (CAUTI) in the Surgical Intensive Care Unit (SICU) during a 6-year period., Methods: All data were collected during prospective surveillance conducted from 2006 to 2011 in the SICU, Military Medical Academy, Belgrade, Serbia. This case control study was performed in patients with nosocomial infections recorded during surveillance. The cases with CAUTIs were identified using the definition of the Center for Disease Control and Prevention. The control group consisted of patients with other nosocomial infections who did not fulfill criteria for CAUTIs according to case definition. Results. We surveyed 1,369 patients representing 13,761 patient days. There were a total of 226 patients with nosocomial infections in the SICU. Of these patients, 64 had CAUTIs as defined in this study, and 162 met the criteria for the control group. Multivariate logistic regression analysis identified two risk factors independently associated to CAUTIs: the duration of having an indwelling catheter (OR = 1.014; 95% CI 1.005-1.024; p = 0.003) and female gender (OR = 2.377; 95% CI 1.278-4.421; p = 0.006). Overall 71 pathogens were isolated from the urine culture of 64 patients with CAUTIs. Candida spp. (28.2%), Pseudomonas aeruginosa (18.3%) and Klebsiella spp. (15.5%) were the most frequently isolated microorganisms., Conclusions: The risk factors and causative microrganisms considering CAUTIs in the SICU must be considered in of planning CAUTIs prevention in this setting.

Objectives: The use of pneumococcal antigen urinary tests is substantially increasing and is associated with a significant cost. The relevant use of this test in the intensive care unit (ICU) should be better defined. Our aim was to define the role of this test in relation to other microbiological tests. We described a series of patients admitted to the ICU for an invasive pneumococcal disease (IPD)., Patients and Methods: We conducted a retrospective and descriptive study of the microbiological tests used to diagnose IPD in patients admitted to the ICU of the University Hospital in Bordeaux. Our aim was to measure the sensitivity of these bacteriological tests and of the BinaxNOWS. pneumoniae test., Results: Between 2009 and 2013, 148 patients were admitted for an IPD. A lower respiratory tract infection was diagnosed in 96.6% of them (143 patients). The overall ICU case fatality rate was 17.6%. The sensitivity of the pneumococcal antigen urinary test, sputum bacteriological examination, and blood cultures was respectively 83%, 37.6%, and 29.7%. S. pneumoniae was isolated from at least one bacteriological sample in 48.6% of patients, but in 51.4%, the diagnosis was only based on the results of the pneumococcal antigen urinary test., Conclusion: We suggest performing a pneumococcal antigen urinary test when an IPD is suspected, only if the bacteriological tests are still negative after 48hours. This strategy would result in a substantial cost saving. Patients would not face any additional risks as the result of the pneumococcal antigen urinary test does not have any impact on the initially prescribed antibiotic therapy., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the prevalence of, and risk factors for, highly resistant microorganisms (HRMO) in urinary isolates from newly admitted patients in a rehabilitation hospital., Subjects: A total of 906 patients transferred to a rehabilitation hospital from other hospitals., Methods: A screening study was performed from June 2012 through May 2013. Urine samples were collected from transferred patients on admission day., Results: Of the total of 916 patients, 148 (16.2%) displayed growth of HRMO in urine cultures. Gram-negative species had a higher number and ratio of HRMO compared with Gram-positive species (141/325 (43.4%) vs 9/97 (9.3%)). Multivariate analysis revealed that age over 60 years, female sex, recent surgery, and use of urinary catheters were risk factors for HRMO among all admitted patients. Even among patients with bacteriuria, recent surgery and an indwelling urinary catheter were significant risk factors for HRMO colonization. The odds ratio for prevalence of HRMO in patients with 2 or more risk factors was 4.1 (95% confidence interval 2.7-6.1), compared with those with single or no risk factors., Conclusion: The prevalence of HRMO in rehabilitation patients was higher than expected. Routine screening of urine culture for HRMO is therefore recommended in rehabilitation patients with multiple risk factors.

Background and Objective: Techniques membrane antigen immunochromatographic detecting in urine the pneumococcal polysaccharide C, have developed significantly, increasing requests for antigenuria to clinical microbiology laboratories. We evaluated the impact of the application of this test in the diagnosis of infections of lower respiratory tract., Patients and Method: Six hundred and sixteen determinations were performed by antigenuria BinaxNOW(®) S. pneumoniae in as many patients over 14 years admitted to the Hospital Universitario Virgen de las Nieves (Granada) between November 2010 and March 2011., Results: In 91.1% of patients who were determined antigenuria the presence of respiratory symptoms justified the request. Only 8.4% of 616 antigenurias performed were positive. S. pneumoniae was isolated from the respiratory sample culture in 8 of these 52 patients. In 29.8% of patients the diagnosis of lower respiratory tract infection was based on clinical, radiological and/or analytical, as antigenurias were negative and did not involve any other additional microbiological test., Conclusions: We believe that this technique should be used in a complementary manner, and never to the detriment of other microbiological tests, especially in hospitalized patients.

Reducing health care-associated urinary tract infection (UTI) is a National Patient Safety Goal. The purpose of this investigation was to establish a colony count threshold to predict clinically significant UTIs that develop in hospitalized patients. A total of 185 cases were reviewed sequentially by 2 physicians. The information extracted included subjective complaints, presence of an indwelling urinary catheter, clinical signs and symptoms, WBC count, urinalysis, and urine culture results. The first reviewer recorded whether the patient was diagnosed and treated for a UTI by the clinician. The second reviewer determined if the patient met National Healthcare Safety Network guidelines for nosocomial UTI. Compared with patients with colony counts less than 100,000 colony-forming units per milliliter (CFU/mL), patients with colony counts 100,000 CFU/mL or more were 73.86 times more likely to have a clinically significant UTI (odds ratio, 73.86; 95% confidence interval, 24.23 ∼ 225.15; P < .0001; c-statistic, 0.859). Reporting positive results only for patients with 100,000 CFU/mL or more would have reduced the number of positive cultures by 38%. These data suggest that reporting colony counts less than 100,000 CFU/mL encourages treatment of non-clinically significant UTIs in hospitalized patients, causing inappropriate antibiotic use.

Objective: To analyse the results of positive urine cultures over a 5-year period in a large hospital and urology department (amongst both inpatients and outpatients), assess the prevalence of different organisms and the resistance profiles of a range of antibiotics, and thus provide information on which organisms are likely to cause urosepsis., Methods: The use of antibiotics should be based on knowledge of which pathogens are present and what resistance patterns are emerging, particularly relevant in surgical disciplines like urology, as antibiotics are now routinely administered peri-operatively, whereby evidence-based prescription is preferable to generic guidelines. We therefore examined almost 25,000 positive urine cultures in our hospital over a 5-year period, and focused on the infections encountered amongst urology patients during this time., Results: A significant proportion of inpatient urinary infection (40%) is caused by Gram-positive bacteria such as Streptococcus faecalis, underlining the need for including Gram-positive cover during urological prophylaxis. The commonest pathogen remains Escherichia coli among both inpatients and outpatients. The ineffectiveness of common antibiotics such as ciprofloxacin and trimethoprim was identified, as was the increase in gentamicin resistance., Conclusion: We propose using an aminoglycoside with a penicillin for high-risk cases (e.g. endoscopic stone surgery) while low-risk cases (e.g. flexible cystoscopy with no risk factors) might be managed without such prophylaxis. Pathogenic patterns and resistance rates should be monitored regularly.

We identified 1,805 gram-negative organisms in cultures of urine samples obtained over a 10-month period from residents of 63 long-term care facilities. The prevalence of fluoroquinolone resistance in Escherichia coli was 51% (446 of 874 isolates), whereas the prevalences of ceftazidime and imipenem resistance in Klebsiella species were 26% and 6% (84 and 19 of 323 isolates), respectively. The prevalence of resistance varied significantly by facility type, size, and geographic location.

We examined 834 isolates of urinary cultures (26 fungi and 808 isolates from 28 bacteria) in an academic geriatric teaching hospital for microbial spectrum and resistance analysis. Of the bacteria, 90% were associated to ten species. Detection rate of MRSA and ESBL was 1%, detection rate for pseudomonas aeruginosa, proteus species, coagulase negative staphylococci and klebsiella species were higher than in an university clinic (p < 0.001). Resistency rates were high for the 10 most frequent bacteria: 53.3% of cross-tabulations between bacterium and antibiotic agent (sulfamethoxazol-trimethoprim, amoxicillin-clavulanate, ciprofloxacin, moxifloxacin, cefuroxim, imipenem) showed resistency rate higher than 10%. We assume that specific factors of geriatric sample taking have an impact to our 2-year resistogram results. It is necessary to combine data analysis from comprehensive geriatric assessment and microbiological methods.

Background: Urinary tract is a common site of bacterial infections in children. The main etiological agents of infection are Gram negative bacteria from the Enterobacteriaceae in particular of intestinal origin. The uropathogenic strains may indicate resistance for many antibacterial drugs., Aim: The aim of this study was an analysis of urine samples from outpatient or hospitalized children treated at the Institute of Mother and Child in Warsaw, in the years 2006-2007. The frequency of individual bacterial species and antibiotic susceptibility were investigated., Materials and Methods: In all, 2096 urine samples from patients treated at the Institute of Mother and Child were investigated. Bacteriuria was examined and antibiotics susceptibility was estimated. Biochemical tests were used for the identification of uropathogenic strains. Antibiotic susceptibility was examined using standard diffusion discs methods., Results: During 2006-2007, in all 2096 urine samples were taken, of which 313 were positive (14.9%). E. coli was the most often isolated bacteria (54%) and enterococci dominated in Gram-positive bacteria., Conclusions: Enterobacteriaceae were the most frequently isolated bacteria. Most of the antibiotics used in the treatment of urinary tract infections had high antibacterial activity except for ampicillin.

Objective: To determine physician practice and perception about the management of intensive care unit (ICU)-acquired bacteriuria and funguria., Design: Cross-sectional, self-administered, Web-based survey., Setting: All provinces within Canada., Participants: Staff ICU physicians who are members of either the Canadian Critical Care Trials Group or the Canadian Critical Care Society., Interventions: Survey items were developed by four ICU clinicians, and survey sensibility was assessed by five independent intensivists. Nonrespondents received three follow-up reminders. Participants were asked questions about general perceptions and practices regarding the management of ICU-acquired bacteriuria and funguria. Clinical scenarios were used to elicit management strategies, including antimicrobial prescriptions., Measurements and Main Results: Ninety of 198 physicians (45%) responded. Bacteriuria was perceived by 63% of the respondents to be a frequent but low-morbidity problem. Most intensivists (98%) did not use a protocol for management. Traditional symptoms were rarely used to interpret the significance of bacteriuria. Presence of systemic inflammatory response syndrome (93%), presence of hemodynamic changes (91%), and urinalysis (69%) were used often. Within clinical scenarios, source control via urinary catheter change was not universal, ranging from 44% to 67% in the various scenarios, even in patients presenting with septic shock. Prescription of antimicrobials was common across scenarios despite the low-morbidity perception. In an asymptomatic patient, 19% of respondents would prescribe antimicrobials. Changing the species from fungus to bacteria and the presence of systemic inflammatory response syndrome or shock increased the likelihood of antimicrobial use up to 70% to 80%., Conclusions: ICU physicians perceive bacteriuria to have low morbidity. However, management approaches vary considerably, and systemic antimicrobials are frequently prescribed. Increased clinical instability and bacterial vs. fungal organisms isolated in urine cultures increased the use of antimicrobials. The considerable variability in practice and discordance between likelihood of urinary tract infection and antimicrobial prescription, highlights the need for additional clinical trials.

Objective: To determine the concomitant incidence, molecular diversity, management and outcome of nosocomial candidemia and candiduria in intensive care unit (ICU) patients in France., Design: A 1-year prospective observational study in 24 adult ICUs., Patients: Two hundred and sixty-two patients with nosocomial candidemia and/or candiduria., Measurements and Results: Blood and urine samples were collected when signs of sepsis were present. Antifungal susceptibility of Candida strains was determined; in addition, all blood and 72% of urine C. albicans isolates were analyzed by using multi-locus sequence type (MLST). The mean incidences of candidemia and candiduria were 6.7 and 27.4/1000 admissions, respectively. Eight percent of candiduric patients developed candidemia with the same species. The mean interval between ICU admission and candidemia was 19.0 +/- 2.9 days, and 17.2 +/- 1.1 days for candiduria. C. albicans and C. glabrata were isolated in 54.2% and 17% of blood and 66.5% and 21.6% of urine Candida-positive cultures, respectively. Fluconazole was the most frequently prescribed agent. In all candidemic patients, the prescribed curative antifungal agent was active in vitro against the responsible identified strain. Crude ICU mortality was 61.8% for candidemic and 31.3% for candiduric patients. Seventy-five percent of the patients were infected with a unique C. albicans strain; cross-transmission between seven patients was suggested in one hospital., Conclusions: Candidemia is late-onset ICU-acquired infection associated with high mortality. No difference in susceptibility and genetic background were found between blood and urine strains of Candida species.

Purple urine bag syndrome (PUBS) is a rare occurrence, in which the patient has a purple-colored urine bag following urinary catheterization for hours to days. Most of authors believe it is a mixture of indigo (blue) and indirubin (red) that becomes purple. Previous study showed that PUBS occurred predominantly in chronically catheterized, constipated women. We collected 10 elderly patients with PUBS in two nursing homes. The first two cases were identified by chart review in 1987 and 2003, and then later eight cases (42.1%) were collected among 19 urinary catheterized elderly in the period between January 2007 and June 2007. In the present report, PUBS probably can occur in any patients with the right elements, namely urinary tract infection (UTI) with bacteria possessing these enzymes, diet with enough tryptophan, and being catheterized. Associations with bed-bound state, Alzheimer's, or dementia from other causes are reflections of the state of such patients who are at higher risk for UTI, and hence PUBS occurred. Although we presented PUBS as a harmless problem, prevention and control of the nosocomial catheter-associated UTIs (CAUTIs) has become very important in the new patient-centered medical era. Thus, we should decrease the duration of catheterization, improve catheter care, and deploy technological advances designed for prevention, especially in the elderly cared for in nursing homes.

Objective: To describe the patterns of antimicrobial resistance of organisms isolated from urine cultures at a teaching oncological hospital for adult patients., Material and Methods: All strains obtained from urine cultures from 1998 to 2005 were included. Mean susceptibilities were obtained for each antimicrobial tested; nosocomial and community-acquired isolates were analyzed separately., Results: A total of 9,232 positive urine cultures were obtained (20.7%) from 44,447 samples taken. Gram negative bacteria were reported in 78.8%, Gram-positive in 13.8% and yeasts in 7.4%. Escherichia coli was the most frequently isolated bacterium (41.3%); antimicrobial resistance was higher in nosocomial isolates than in community strains (amikacin 92.4 vs. 97%, ceftazidime 83.1 vs. 95.1% and ciprofloxacin 46.2 vs. 58.6%). Pseudomonas aeruginosa showed a greater resistance to amikacin and ceftazidime in nosocomial cultures compared to community-acquired bacterial cultures (55.7 vs. 66.6% and 65.5 vs. 84.8% respectively). Vancomycin-resistant enterococci were found in only 2.5% (3 of 119 E. faecium isolates)., Conclusions: Higher bacterial resistance was observed in nosocomial cultures than in community ones. Antimicrobial resistance was found to be progressively increasing for E. coli, the most frequent pathogen isolated both in nosocomial and community infections. We consider imperative the establishment of an intense educational campaign for the use and control of antibiotics.

Background: Pseudomonas aeruginosa is a ubiquitous gram-negative pathogen with a propensity to cause opportunistic infections in humans. Different strains of the organism could colonise patients heralding a wide spectrum of P. aeruginosa infections in the environment., Objective: To analyse isolates of P. aeruginosa from clinical and environmental samples using the Polymerase Chain Reaction (PCR) to establish strain relatedness., Methods: Fifty-two strains of the organism were isolated from wound swabs, urine, sputum of patients and environmental samples from the hospital environment using standard microbiological techniques and ethical consideration. Genomic DNA of the isolates was amplified with primers AF1 (5'-AGA GTT TGA TCC TGG CTCA-3') and 1541R (5'-AAG GAG GTG ATC CAG CC-3')., Results: At least two bands were observed in all isolates typed and band sizes ranged from 0.07 - 1.5kb. The strains were genetically diverse, displaying profiles of 2 - 6 bands between 0.07 - 1.5kb., Conclusion: The study demonstrates that strain diversity could be discerned between strains of P. aeruginosa, circulating in the environment of Buea, a finding which has important epidemiological and clinical significance bearing in mind that this pathogen is highly incriminated in nosocomial infections with attendant social implications. This therefore calls for more attention in the diagnosis and management of P. aeruginosa infections in the environment of Buea, Cameroon.

Objective: To investigate the risk factors and the Candida species that cause candiduria in hospitalized patients via a case-control study., Methods: We evaluated the results of the urine analysis of the specimens sent to the laboratories of Central Microbiology and the Department of Clinical Bacteriology and Infectious Diseases of Selcuk University Medical School, Konya, Turkey between January and December 2004. The urinary specimens, sent from hospitalized patients, obtained within 72 hours were evaluated. A total of 51 patients above 17 years of age, without any bacterial growth in urine specimens, with fever above 38 degrees celcius and pyuria were included in this study. A control group of 153 patients without any bacterial growth at 72 hours after hospitalization was present. The average age of the patients, the hospitalization period, and clinics resemble each other in the 2 groups., Results: Risk for candiduria was increased by 4 folds (p=0.001; OR=4.020) in abdominal surgery, by 1.4 folds (p=0.335; OR:1.478) in corticosteroid and immune suppressive therapies and by 12 folds (p=0.000; OR=12.408) in urinary catheterization, antibiotic use increased the risk of candiduria by 6 folds (p=0.000; OR=6.00). The risk of candiduria was higher by 2 folds in diabetes mellitus patients than in the controls (p=0.044; OR=2.002)., Conclusion: Candida albicans (68.62%) was the most commonly isolated agent in candiduria patients. We should decrease the use of urinary catheters and avoid excess use of antibiotics as much as possible in hospitalized patients.

Introduction: Urinary tract infection (UTI) is the most common nosocomial infection among hospitalised patients. Area-specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for UTIs and their resistance patterns may help the clinician to choose the correct empirical treatment. Recent reports have shown increasing resistance to commonly-used antibiotics. We aimed to study the antibiotic resistance pattern of the urinary pathogens isolated from hospitalised patients., Methods: Three urine samples were collected by the mid-stream "clean catch" method from 1,680 clinically-suspected cases of urinary tract infections from inpatients of various clinical departments during one year. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility of the isolated pathogens was tested for commonly-used antibiotics by Kirby-Bauer technique according to NCCLS guidelines., Results: Significant bacteriuria was present in 71.7 percent of the samples, 17 percent were sterile, 4.8 percent showed insignificant bacteriuria, and 6.5 percent non-pathogenic bacteriuria. The most common pathogens isolated were Escherichia coli (59.4 percent), Klebsiella spp (15.7 percent) and Enterococcus faecalis (8.1 percent). The mean susceptibility was high for amikacin (87.2 percent), ciprofloxacin (74.8 percent), ceftazidime (71.5 percent) and gentamicin (70.4 percent) but low for nitrofurantoin (35 percent), cephalexin (49.7 percent) and ampicillin (50.5 percent). Escherichia coli was found to be most susceptible to amikacin (98 percent) followed by gentamicin (87.9 percent), ceftazidime (80.8 percent), norfloxacin (78.4 percent) and cotrimoxazole (77.9 percent)., Conclusion: A high isolation rate of pathogens from urine samples of clinically-suspected UTI shows a good correlation between clinical findings and microbiological methods. The antibiotics commonly used in UTIs are less effective. Since the present study was a cross-sectional study, regular monitoring is required to establish reliable information about resistance pattern of urinary pathogens for optimal empirical therapy of patients with nosocomial UTIs.

Background: Cefdinir, an extended-spectrum cephalosporin administered orally, is approved by the U.S. Federal Drug Administration for treatment of skin and respiratory tract infections. During the last two years at the authors' institution, this agent has been used as an off-label treatment for urinary tract infections in children., Objectives: To evaluate antimicrobial susceptibility testing data in children to determine whether there is support for this prescribing practice., Methods: In this retrospective study (2003-2004), the authors compared the susceptibility patterns of urinary pathogens to cefdinir and selected antibiotics in children who were evaluated for urinary tract infections in an urban tertiary academic pediatric emergency department. Pathogens (community acquired vs. opportunistic or nosocomial) were categorized as susceptible, indeterminate, or resistant on the basis of antibiotic susceptibility breakpoints. The frequency of these categorizations for individual drugs was determined., Results: Seven hundred five isolates were recovered from urine during the study period. Pathogens isolated most frequently were Escherichia coli, Klebsiella spp, and Proteus spp. Of 431 isolates retained in the data set, 412 (95.6%) were susceptible to cefdinir. This rate was comparable or superior to rates observed for other antibiotics: 49.4% for ampicillin, 84.9% for trimethoprim-sulfamethoxazole, 88.4% for cefazolin, 93.3% for nitrofurantoin, 94.2% for ticarcillin-clavulanate potassium, 97.5% for gentamicin, and 97.7% for ceftriaxone. Cefdinir, however, had lower activity (64.7%) against 17 bacterial isolates categorized as opportunistic or nosocomial pathogens., Conclusions: Cefdinir provides good coverage against common pathogens responsible for urinary tract infections in children and compares favorably with other oral and parenteral antibiotics that are used in the empiric treatment of this infection.

Objectives: The existing therapeutic options for complicated urinary tract infections (UTI) caused by gram-positive uropathogens are not always optimal. Therefore, newer antimicrobials have to be assessed., Methods: The antimicrobial activity of daptomycin was tested versus linezolid, vancomycin, and ampicillin (enterococci on ly), against pathogens from three different collections: (1) Uropathogens from hospitalized urological patients with complicated and/or hospital-acquired UTIs of the Urologic Clinic, Hospital St. Elisabeth, Straubing. (2) Uropathogens from a multicenter study comprising 37 urological centers throughout Germany. (3) Methicillin-resistant Staphylococcus aureus (MRSA) isolates of patients and staff within the Hospital St. Elisabeth, Straubing. Genotyping of the latter isolates was performed by pulsed-field gel electrophoresis. The minimal inhibitory concentrations (MIC) of daptomycin, linezolid, vancomycin, and ampicillin (only tested against enterococci) were determined by an agar dilution method using a multipointer with an inoculum of 10(4) CFU per point., Results: For all methicillin-susceptible Staphylococcus aureus (n = 25), MRSA (n = 49), methicillin-susceptible coagulase-negative staphylococci (n = 129), methicillin-resistant coagulase-negative staphylococci (n = 33), for Enterococcus faecalis (n = 289), and for Enterococcus faecium (n = 4) the MICs ranged up to 2 mg/l (daptomycin, linezolid), up to 4 mg/l (vancomycin), and up to 8 mg/l (ampicillin, enterococci only) indicating that all strains were susceptible to the antibiotics tested., Conclusions: According to the in vitro activity daptomycin may be considered a promising antibacterial agent for the treatment of complicated UTI caused by gram-positive uropathogens. Thus, daptomycin should be evaluated in a clinical study., (Copyright 2005 S. Karger AG, Basel)

The presence of Candida species in the urine is frequent among hospitalized patients. We studied sample urine of 205 hospitalized patients during a 1-year period to determine the incidence of nosocomial candiduria. The yeasts were isolated in 22% (45/205) urine cultures and risk factors in these patients were analyzed. Candida albicans was isolated in 35.6% and C. tropicalis (22%) was the second most frequent species isolated. Most patients were women (57.8%) with a mean age of 48.7 years. The principal risk factors that were observed in patients with candiduria included antibiotics therapy (100%), urinary catheterization (84.4%), surgical procedure (66.7%), female sex and extended hospitalization. The efficacy of fluconazole therapy to eradicate Candida from urine was demonstrated (p =0.05). Of the 23 individuals who received antifungal therapy, candiduria persisted in 9 (39.2%) and of 22 patients who received no antifungal therapy, the candiduria persisted in 15 (68.2%).

Objective: To assess the change in the bacterial profile and pattern of antibiotic resistance of catheter-associated urinary tract infections (CAUTIs, the most prevalent form of nosocomial infections) between 1996 and 2001., Materials and Methods: Catheter samples of urine (CSUs) submitted in 1996, 1998 and 2001 (2451, 2460 and 3349 specimens, respectively) were analysed. The distribution of different uropathogens in bacterial CAUTIs and their in vitro antimicrobial resistance was evaluated over the study interval. The likelihood ratio test was used to assess whether there was a linear trend according to calendar year., Results: Escherichia coli was the most frequently isolated pathogen in all years, but its frequency declined over time (35.6%, 32.5% and 26.6%, respectively). Enterococcus was the second most frequent overall, with a significant increase in frequency with time (11.8%, 15.3% and 22.0%, respectively). There was also a considerable change in resistance patterns to antibiotics. As a result, in 1996, CAUTIs were least often resistant to ciprofloxacin (8.0%) followed by co-amoxiclav (18.5%) and cephalexin (25.4%). In 2001, CAUTIs were least often resistant to co-amoxiclav (22.5%), followed by ciprofloxacin (27.2%) and nitrofurantoin (28.8%)., Conclusion: The types of organisms associated with CAUTI have changed over the last 5 years in a UK institution, as have the patterns of antibiotic resistance. Currently, the most appropriate agents for the empirical management of CAUTIs seem to be co-amoxiclav, ciprofloxacin and nitrofurantoin.

Over the past 20 years, there has been a significant increase in the number of nosocomial infections. Nosocomial infections by fungal organisms, in particular Candida species, have shown the highest increase in incidence, currently being the leading pathogen in urinary tract infections and the fourth most common blood-born pathogen within hospitalized patients. This case report describes a patient with acute pancreatitis, complicated by acute renal failure, who developed nosocomial fungiuria and fungemia following bilateral ureteral stenting, and whose fungiuria persisted despite adequate antifungal treatment. Conditions resolved with removal of the intraureteral stents, which we believe, served as the nidus for her persistent fungiuria.

Acinetobacter baumannii 65FFC, an imipenem-resistant clinical strain, isolated from the urine of a patient at the Coimbra University Hospital, Portugal, in 1998, produced a metallo-beta-lactamase with a calculated pI 9.3. The isolate was highly resistant to penicillins, broad-spectrum cephalosporins, including ceftazidime, ceftriaxone, cefepime, cefpirome, and to aztreonam, but it remained susceptible to ampicillin/sulbactam, aminoglycosides and quinolones. Nucleotide sequence revealed a new allelic variant of other bla(IMP) genes, named bla(IMP-5). IMP-5 beta-lactamase showed a greater homology with IMP-1, IMP-3 and IMP-4 (identified in Southeast Asia), than with IMP-2, found in Italy (93%, 92%, 91% and 87% of amino acid identity, respectively). bla(IMP-5) was the only gene cassette inserted into a class 1 integron, named In76. This is the first IMP-enzyme reported in Portugal and the second in Europe, indicating a wider dissemination in the environment of bla(IMP) alleles.

Patients in intensive care units (ICU) are at risk of nosocomial infections. The incidence of nosocomial fungal infections has increased in parallel with the increase of nosocomial infections. Candida albicans is the most frequent pathogenic species among the fungi. The aim of this study was to make an epidemiological surveillance of C. albicans urine isolates which were isolated from patients who were hospitalized in ICU between June 2000 and October 2001 by antifungal susceptibility testing and Randomly Amplified Polymorphic DNA (RAPD) analysis. For this purpose, 38 C. albicans which were isolated from 29 patients were investigated for amphotericin B and fluconazole susceptibility with the microdilution method. The range of minimal inhibitory concentration (MIC) of amphotericin B was between 0.25-1 microgram/ml and MIC50 value was 0.5 microgram/ml and none of the isolates had high (MIC > 1 microgram/ml) MIC values. The MIC values for fluconazole varied between 0.25-16 micrograms/ml and MIC50 value was 1 microgram/ml. While none of the isolates was resistant to fluconazole, two isolates were detected as dose dependent susceptible. RAPD analysis was performed with two different primers in order to investigate clonal relationship, and 22 patterns were detected with one of the primers and 24 patterns were detected with the other. In conclusion, it is thought that the origin of the C. albicans urine isolates were mostly endogenous but exogenous spread might also be considered as isolates that were clonally related were isolated from different patients at the same time interval.

Background: A quick and reliable method for detecting bacteriuria would allow to exclude the presence of microorganisms in the urine on the same day the sample is obtained.Objectives. Two semiautomatic methods have been evaluated for bacteriuria screening, taking the semiquantitative culture as reference method., Material and Method: A prospective study of urine samples from patients suspected of having a urinary infection was designed. One method is based on bioluminescence that detects the presence of ATP liberated by the bacterial cell (Utiscreen-Coral Biomedical). The other semiautomatic method uses a nephelometry technique (Uro-quick). The results of each semiautomatic method were compared with the semiquantitative culture. Samples presenting counts > 104 UFC/ml of one or two microorganisms were considered as having urinary-tract infection (equivalent to significative bacteriuria). Cultures with counts < 5,000 UFC/ml or containing three or more microorganisms were classified as non-representative of significant bacteriuria. The nephelometric system allows to obtain results at two different times. Samples were divided into two groups to compare both situations., Results: 1,090 urine samples, received consecutively, were considered. In the case of the bioluminescence system, the study was prolonged to 1,565 samples. The values obtained were: a) bioluminescence: general data, sensibilitiy (S) 5 94.4%; especificity (E) 5 72.8%; positive predictive value (PPV) 5 46.2% and negative predictive value (NPV) 5 98.2%; hospitalized patients only, S 5 97.5%; E 5 77.3%; PPV 5 61.2% and NPV 5 98.8%; and b) nephelometry: 195 min, S 5 96.7%; E 5 88.8%; PPV 5 67.9% and NPV 5 99.1%; 235 min, S 5 95.5%; E 5 81.0%; PPV 5 58.7% and NPV 5 98.4%., Conclusion: A negative predictive value from both methods under these conditions would allow them to be used in medical centers for the exclusion of bacteriuria.

Objective: To assess the cost-effectiveness of urinary dipsticks (UDs) to screen asymptomatic catheterized patients for quantitative urine., Design: Prospective comparison of UD with quantitative urine culture (QUC) (reference technique) and cost-effectiveness analysis performed from the hospital's perspective., Setting: Medical intensive care unit (ICU) of the Besançon University Hospital (France)., Patients and Participants: All consecutive, asymptomatic, catheterized patients., Interventions: Urinary dipsticks (Multistix 8-SG) were analyzed by the reflectance spectrophotometric method (Clinitek 50). Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of four combinations of the leukocyte (L) test pad and the nitrite (N) test pad were calculated: L and N, L or N, L alone and N alone. A micro-costing technique was used to determine the direct medical cost of each strategy. The calculated cost-effectiveness ratio was the incremental cost-effectiveness (ICE) ratio., Measurements and Results: Three hundred thirty-nine urine samples taken from 144 patients were analyzed. The incidence of asymptomatic catheter-associated urinary tract infections (CAUTIs) was 31.3% (> or =10(5) organisms/ml). The L or N combination was the best detector of asymptomatic CAUTI: Se=87.2%, Sp=61.6%, PPV=30.6% and NPV=96.1%. The cost of QUC strategy and UD strategy was EUR 21.5 and EUR 12.6 per test, respectively. The ICE ratio of QUCs was EUR 69.5 per case of detected CAUTI., Conclusion: The UD is a cost-effective test for screening asymptomatic catheterized patients for quantitative urine culture in a medical ICU.

Objectives: To obtain information on the microbiology workload, etiology and antimicrobial susceptibility of urinary tract infection (UTI) pathogens isolated in European hospitals., Materials and Methods: We collected data available in the microbiology units of a large sample of European hospitals regarding the laboratory workload, diagnostic criteria, and etiology and antimicrobial resistance of the urinary isolates collected on one day (the study day)., Results: Data were received from a total of 228 hospitals from 29 European countries. The average rate of urine samples cultured per 1000 admissions in 1999 was 324. The criteria to consider a positive urine culture as significant were quite variable; > or =10(4) colony-forming units (CFU)/mL for bacteria or > or =10(3) CFU/mL in the case of yeasts were the most used cut-off points. On the study day, a total of 607 micro-organisms from 522 patients with nosocomial UTI were isolated. The six most commonly isolated micro-organisms were, in decreasing order: Escherichia coli (35.6%), Enterococci (15.8%), Candida (9.4%), Klebsiella (8.3%), Proteus (7.9%) and Pseudomonas aeruginosa (6.9%). Pseudomonas was isolated more frequently in non-EU countries. The study data reveal high rates of antimicrobial resistance in UTI pathogens, especially in non-EU countries, where Pseudomonas aeruginosa presented rates of aminoglycoside resistance as high as 72% to gentamicin, 69.2% to tobramycin and 40% to amikacin., Conclusions: Nosocomial UTI accounts for an important proportion of the workload in microbiology laboratories. A consensus on the practice and interpretation of urine cultures in Europe is needed. The levels and patterns of resistance of UTI pathogens must be a serious cause for concern and a clear reason for stricter guidelines and regulations in antimicrobial policy.

Candida spp. are increasingly involved in nosocomial infections in severely ill patients and the diagnosis is difficult. In this context, the significance of candiduria remains unclear. Management of this condition is still equivocal, because of the lack of information about its natural history and its predictive value for disseminated infection. Little is known about the discriminant value of colony count. After a comprehensive review of the available published data, the preliminary results of a multicentric prospective survey in critically ill patients hospitalised in intensive care units are given. The aim of the study was to search for correlations between quantitative candiduria and known risk factors for disseminated candidiasis. There is a statistically significant correlation (p = 0.003) between heavy candiduria (> 10(4) cfu.mL-1) and high Pittet colonisation index (> or = 0.5). Quantification of candiduria could be useful to select patients at high risk for disseminated candidiasis.

Postoperative urinary tract infection (UTI) is a common hospital infection after gynaecological operations. A prospective randomized study was performed to examine whether the incidence of UTI could be reduced by reversing the sequence of vaginal cleansing and urethral catheterization. Subjects were randomly allocated to: (1) urethral catheterization before vaginal cleansing; and (2) urethral catheterization after vaginal cleansing. Urine cultures were performed immediately after the procedures as the baseline, on the day of catheter removal, and two days after catheter removal. Patients were examined daily after the operation for any urinary symptoms and fever. The incidences of preoperative asymptomatic bacteriuria were similar in both groups, seven of 84 in group 1 vs. eight of 83 in group 2. Among those with negative urine culture before the operation, 77 in group 1 and 75 in group 2, there was no significant difference in postoperative bacteriuria at catheter removal (23 vs. 22) and two days later (35 vs. 42). No significant difference was noted in the incidence of UTI (5 vs. 10, P = 0.25), with a trend towards less UTI in group 1. Voiding discomfort was more common, and fever less common in group 1. There were significant associations between urine culture results at three different occasions. Bacteriuria at catheter removal is associated with a 7.2 times risk of bacteriuria two days later, 2.4 times risk of urinary symptoms and 3.2 times risk of UTI. Routine surveillance at catheter removal is not cost-effective. We conclude that postoperative bacteriuria and UTI are common. Reversing the sequence of the procedures cannot reduce the incidence. There is no evidence to change the status quo.

The presence of Candida species in the urine is frequent among hospitalized patients. It represents a major challenge to the physician because it is unclear whether candiduria represents colonization or infection, whether the bladder or the kidney is involved in infection, or whether it represents a surrogate marker for systemic infection. This picture is more complicated because there are few prospective studies addressing the issue of when and how to treat a patient with candiduria. Strategies for management are based on the presence or absence of other features such as anatomic genitourinary abnormalities, renal transplant, and fever. If treatment is considered, fluconazole is the drug of choice, provided the agent is not Candida krusei or Candida glabrata.

The presence of cytotoxic necrotizing factor 1 (CNF1), together with various associated virulence factors (alpha-haemolysin, P-, S- and A-fimbriae), was screened in 175 uropathogenic Escherichia coli strains isolated from hospitalized adult patients. The cnf1 gene was detected in 30% of the selected strains independently of the severity of the clinical urinary infection. A significant association between CNF1, haemolytic activity and the products of the pap/sfa genes was found. However, CNF1 appeared not to play a major role in nosocomial E. coli urinary tract infections.

An outbreak of 14 cases of urinary tract infections by Pseudomonas aeruginosa, including six symptomatic infections, occurred from September to November 1994 in a paediatric surgical unit. During the outbreak, urine samples from patients and multiple samples from the environment of patients were tested for the presence of P. aeruginosa. Bacterial isolates were studied by pulsed-field gel electrophoresis. Genotypic analysis showed that most of the isolates from children were different. Multiple P. aeruginosa isolates were also found in the tap water, as the only putative source of contamination. Two of these isolates were identified in two infected patients, indicating possible direct contamination of patients via tap water and this was related to the distal colonization of faucets. Bacteria were eradicated from tap water by replacement of taps. The cluster of cases of P. aeruginosa urinary infection was, therefore, related to multiple contaminations through tap water. These results illustrate an unexpected risk of nosocomial infection and emphasizes the importance of checking tap water to prevent bacterial contamination through handwashing in contaminated water.

At our community teaching hospital between August 1994 and August 1995, Candida glabrata accounted for 14% of all Candida isolates and for 31% of urinary Candida isolates. The culture site was urine for 68% of C. glabrata isolates compared to 30% of all Candida isolates (p < 0.001, chi 2). To study the association between C. glabrata and isolation from the urine, we analyzed all available C. glabrata urinary isolates over a 3-month period (23 isolates from 20 patients) using electrophoretic karyotyping, random amplified polymorphic DNA analysis, and fluconazole susceptibility testing. Random amplified polymorphic DNA generated eight types, although electrophoretic karyotyping generated 17 types. Combining the two methods resulted in 19 types indicating that urinary C. glabrata strains at our hospital are genetically diverse and the association between C. glabrata and urinary tract isolation does not appear to be due to horizontal transmission of a single or small number of strains. In vitro susceptibility tests showed that C. glabrata isolates from patients receiving fluconazole had significantly higher minimum inhibitory concentrations to fluconazole than those not receiving fluconazole (p < 0.05). Despite a limited number of patients and isolates, our data suggest that selection of less susceptible organisms by the presence of antifungal agents may be an important contributor to increased urinary isolation of C. glabrata from patients in our hospital.

Objective: To determine risk factors for patients whose cultures grew Stenotrophomonas maltophilia., Design: Retrospective case-control study of 60 patients with cultures positive for S maltophilia, matched by specimen site to 120 controls whose cultures grew other gram-negative aerobic bacteria., Setting: University medical center., Results: S maltophilia was identified from the following sites: respiratory (36), wound (13), urinary (6), blood (4), and cerebral spinal fluid (1). By univariate analysis, cases had a higher risk of exposure than controls for ampicillin (P < .001), gentamicin (P < .001), vancomycin (P = .001), metronidazole (P = .003), piperacillin (P = .007), cefotaxime (P = .014), ceftazidime (P = .017), ciprofloxacin (P = .030), tobramycin (P = .040), and chronic respiratory disease (P = .024). Length of time foreign objects were in place prior to positive culture differed significantly between cases and controls only for endotracheal tubes in patients with respiratory isolates (median number of days: 12.5 for cases, 5 for controls; P = .007). For patients with urinary tract infections, having a urinary catheter increased the odds of infection 10 times over controls. Exposures found by multivariate analysis to be significantly more prevalent in cases than controls included ampicillin, cefotaxime, erythromycin, gentamicin, metronidazole, piperacillin, tobramycin, chronic respiratory disease, and female gender. Odds ratios were > 1 indicating higher risk for cases, except for erythromycin, which had an odds ratio < 1., Conclusions: The primary risk factor associated with isolation of S maltophilia was antibiotic use. For patients with pulmonary infections, chronic respiratory disease and length of time an endotracheal tube was in place also contributed to the risk. This suggests that judicious use of antibiotics may prevent some cases of S maltophilia infection.

Objective: To describe the incidence and patterns of nosocomial fungal infection in a large teaching hospital in Taiwan., Design: Prospective, hospitalwide nosocomial surveillance data from 1981 through 1993 were analyzed to show the secular trend in nosocomial fungal infection rates and to identify the most common pathogens and sites of infection (other than skin) in this hospital., Setting and Patients: The National Taiwan University Hospital is a medical school-affiliated hospital in the city of Taipei, Taiwan, with a 1200-bed capacity before 1991 and 1500 beds since 1992. It provides both primary and tertiary medical care., Results: The overall nosocomial fungal infection rate rose from 0.9 infections per 1000 discharges in 1981 to 6.6 per 1000 discharges in 1993, with the highest rate at the medical intensive-care unit (26.5/1000 discharges in 1993). This increase in infection rate was found at four major anatomic sites of infection, particularly including the bloodstream (0.08-2.19/1000 discharges) and the urinary tract (0.36-2.95/1000 discharges). Of 256 pathogens causing nosocomial fungemia from 1981 through 1993, Candida albicans was the most commonly isolated (50.8%), followed by Candida tropicalis (17.6%). Candida parapsilosis (11.7%), and Candida glabrata (8.2%). As compared to isolates from 1981 through 1988, the proportion of C parapsilosis and C glabrata isolated between 1989 and 1993 increased more than sixfold and fourfold, respectively. The increasing importance of fungal infections was confirmed further by the increased use of amphotericin B and azoles in this hospital., Conclusions: Candida species and other yeasts have become a prominent cause of nosocomial infections in this hospital. These fungal pathogens accounted for a higher proportion of nosocomial bloodstream and urinary infections than any single bacterial species. Therefore, it is important to conduct a prospective epidemiological study and to establish in vitro antifungal susceptibility testing to enhance efforts to control nosocomial fungal infections and to minimize the risk of emergence of antifungal resistance.

Method: Eighteen hospitalized patients with candiduria were treated with oral potassium-sodium-hydrogen citrate to alkalinize the urine. The results obtained were compared with those observed in an untreated retrospective control group. Dosage was adjusted in accordance with the pH of the urine measured immediately before treatment with the aim of achieving a pH of 7 to 7.5., Results: All patients had an indwelling catheter, which is a predisposing factor for candiduria. In 16 out of 18 patients (89%) treatment with potassium-sodium-hydrogen citrate raised pH and resulted in the disappearance of candiduria. Duration of treatment varied between two days and one month (mean: seven days). In four patients the urine became completely sterile; during treatment 12 out of 18 patients developed significant bacteriuria (in eight cases of these the indwelling catheter had been left in place)., Conclusions: Alkalinization of the urine is a simple and effective method of treating candiduria in patients with an indwelling catheter. An additional advantage is the metaphylaxis and prophylaxis of renal stone formation in immobilized patients.

Study Objective: To determine the influence of treatment on the microbiologic outcome of funguria., Design: Retrospective case series., Setting: A 300-bed tertiary care teaching hospital in a large metropolitan area., Subjects: 141 hospitalized patients, 18 years of age or older, with at least one urine culture positive (> or = 10(2) cfu/ml) for fungi., Interventions: Retrospective review of medical records to determine the microbiologic outcome of funguria., Main Results: Funguria developed rapidly in individuals with known predisposing factors. Urinalysis did not routinely detect the presence of fungi or pyuria. Symptoms such as fever, dysuria, and frequency were generally absent. Funguria persisted whether it was due to Candida albicans or nonalbicans species. There were no statistical differences in the microbiologic outcomes of treated and untreated funguria., Conclusions: Funguria is a rapidly developing, often benign and persistent process. Minimizing predisposing risks, such as removing indwelling urinary catheters, is beneficial in its management. Pharmacologic treatment of funguria due to C. albicans or non-albicans species does not influence the microbiologic outcome.

Background: To evaluate the catalase test as a screening method in urinary tract infection (UTI) versus sediment, reactive strip and Gram., Methods: Two hundred forty-five's stain urine samples were prospectively analyzed in the Hospital Universitario San Ignacio de Bogotá (Colombia). The culture was used as a reference test for the evaluation of the screening parameters in UTI patients., Results: Of the 245 urine samples 45 were discarded. The remaining 200 urine samples were cultured being 100 positive and 100 negative. The former were analyzed by screening methods. The sensitivity and specificity of the catalase test was 97% and 94%, respectively with a positive predictive value of 94% and negative of 97%. The most frequently isolated microorganism was E. coli (84%), followed by Proteus sp. (6%)., Conclusions: The use of the catalase test in urinary tract infection is a safe, economic and rapid method providing advantages due to its high sensitivity and specificity values, its good correlation with the different parameters evaluated in this study (sediment, strip, Gram's stain), and offers optimum diagnosis in urinary tract infection in developing countries such as Colombia.

To determine through a prospective study the characteristics of hospital-acquired urinary tract infections (HAUTI) in children, 525 children subjected to bladder catheterization during a hospital admission were identified through surveillance of 12,316 admissions during a 24-month period. Urine culture results were available for 296 (56.4%) of the catheterized patients. In addition 12 noncatheterized children with a documented HAUTI were identified. The clinical courses of all patients with a HAUTI were followed for at least 6 months after their last HAUTI during the study period. Forty-four patients, 1 week to 17 years of age, with 1 or more HAUTI during a hospital unit admission were identified. A total of 51 HAUTI occurred. Thirty-nine (76.5%) of the infections occurred in patients subjected to catheterization. Thirty-two (10.8%) of 296 catheterized patients developed a HAUTI. Forty-three (84.3%) of the 51 infections were single organism infections. One HAUTI was associated with a wound infection with the same organism and one with a concurrent bacteremia with the same organism. Relapses were seen after 4 HAUTI. One reinfection was identified. There were no deaths directly associated with a HAUTI. Hospitalized children subjected to urinary tract catheterization are at significant risk for HAUTI. Complications are infrequent and not life-threatening.

The minimum inhibitory concentrations (MIC) of ciprofloxacin were determined for 441 uropathogens from patients with complicated and/or hospital acquired urinary tract infections (UTI). None of the Enterobacteriaceae was resistant (MIC > or = 4 mg/l), but 21.7% of enterococci, 28.3% of Pseudomonas spp. and 38.5% of staphylococci were. Subtyping of the strains revealed that with staphylococci there was no clonal spread of resistant strains. In the case of enterococci and Pseudomonas spp., however, cross infections played a major role (46% and 40% respectively). In a retrospective analysis of 370 UTI episodes caused by Pseudomonas aeruginosa (74), enterococci (185) or staphylococci (111) there was no difference between sensitive and resistant strains with respect to clinical aspects and rates of elimination by appropriate anti-bacterial therapy. The rates of spontaneous disappearance without antibacterial therapy ranged from 28% in the case of P. aeruginosa up to 63% in the case of coagulase-negative staphylococci. This implies that especially in UTI caused by gram-positive cocci an indication for antibacterial therapy should be weighted thoroughly and fluoroquinolones should only be used in accordance with sensitivity testing.