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Abstract Background and Objective: Escherichia coli, one of the most common causative agents of urinary tract infections (UTIs) acquired from community and hospital, has developed multiple resistances to various antibiotics such as aminoglycosides. The main resistance mechanism to aminoglycosides is inactivation of these drugs by a variety of acetyltransferase, nucleotidyltransferase, and phosphotransferase enzymes. this study aimed to assess the prevalence of resistance to some important aminoglycosides as well as the distribution of aph(3)-Ia, aac(3)-IIa and ant(2)-Ia genes among uropathogenic Escherichia coli isolates obtained from patients suffering UTIs. Material and Methods: Using the disk diffusion method, the antimicrobial susceptibility of 200 uropathogenic E. coli isolates collected from outpatients and inpatients was investigated to nine antibiotics. Then, the distribution of aac (3)-IIa, aph (3)-IA and ant (2)-IA genes was determined by PCR method. Results: Thirty-nine percent of E.coli isolates obtained from inpatients (n=100) and 19% of those from outpatient (n=100) demonstrated resistance to at least one of the tested aminoglycosides ‌ (i.e. 58 isolates). Among the isolates examined (n=200), 19.5%, 13%, 7.5% and 4.5% were resistant to gentamicin, kanamycin, neomycin and amikacin, respectively. The most prevalent gene among the strains resistance to at least one of the aminoglycosides (n=58) was aac (3)-IIa (65.5%), followed by aph (3)-IA (25.8%). Also, the ant (2)-IA gene was not seen in any isolates. Conclusion: The presence of aac (3)-IIa gene is significantly associated with gentamicin resistance (100%, p<0.05). Because of relatively high distribution of the aac (3)-IIa gene among uropathogenic E.coli, the use of aminoglycosides such as amikacin to treat UTI in clinical setting is recommended. Keywords: Escherichia Coli, Urinary Tract Infections, Aminoglycoside-Modifying Enzymes (AMEs)

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Background: Urinary tract infection (UTI) is one of the most common bacterial infections of all ages and sexes. Escherichia coli is reported as the most common predominant pathogen. Urinary tract infection treatment leads to abundant antibiotic application in hospitals and communities, continuously developing multidrug resistance (MDR). This study aimed to determine the sensitivity and resistance pattern to common antibiotics among E. coli isolates from patients with UTIs at Nemazee Hospital in Shiraz.
Methods: This retrospective cross-sectional survey studied 1910 positive urine samples with E. coli bacteria from patients referred to Nemazee Hospital from 2018 to 2019. Antimicrobial susceptibility testing was performed on 12 commonly used antibiotics for UTIs.
Results: A total of 1910 E. coli isolates were gathered during these 2 years. The most highlighted resistance was observed against quinolones and cephalosporins at 86.9% and 89.7%, respectively. Cephalexin (87.9%) and nalidixic acid (86.1%) have shown the lowest activity against E. coli isolates. Also, the highest susceptibility was determined for amikacin (88.3%), nitrofurantoin (76.8%), and gentamicin (70.6%). In addition, 1624 (85%) isolates were MDR.
Conclusion: In conclusion, resistance to antibiotics (such as ciprofloxacin, norfloxacin, tetracycline, cefotaxime, and nitrofurantoin) is increasing. Therefore, it is vital to follow an appropriate antimicrobial stewardship program.
 

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Background: Urinary tract infections (UTIs) are among the most common types of infections affecting people in community and hospital settings. Bacteria are the leading cause of UTIs, followed by fungi. 39% of all healthcare-associated infections (HAIs) affecting all age groups are UTIs, causing high morbidity and mortality rates. The antibiotic susceptibility pattern of causative organisms is changing due to improper antibiotic use. The study was conducted to determine the microbiological profile of both community and HAIs and their antimicrobial susceptibility pattern.
Methods: Clean-catch, mid-stream urine samples collected in the universal wide-mouthed sterile containers were transported to the laboratory. Samples were processed by standard conventional microbiological procedures. Antimicrobial susceptibility was done using the Kirby-Bauer disc diffusion method on Mueller-Hinton agar plates.
Results: The most common causative organisms among gram-negative bacteria were E coli (26.05%), followed by Klebsiella spp (20.37%), and Enterococcus spp (12.81%) was more common among the gram-positive bacteria. Non-albicans Candida (64.10%) were more commonly isolated than Candida albicans (35.90%). E coli was highly susceptible to nitrofurantoin and fosfomycin, and Klebsiella spp and Enterococcus spp were similarly highly susceptible.  Antibiotic resistance was more common among bacteria isolated in HAIs.
Conclusion: In both settings, E coli was the most common causative organism. The incidence of non-albicans Candida species has increased in comparison to Candida albicans. Antimicrobial susceptibility to empirical 3rd-generation cephalosporins and fluoroquinolones has drastically decreased. Hospital-acquired UTIs are a rising threat to the healthcare system and community. Based on hospitals’ antimicrobial policy formulated by studying antimicrobial susceptibility patterns, empirical treatment should be chosen.
 

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Background: Vancomycin-resistant enterococci (VRE) has become a growing concern in healthcare settings as a major cause of many nosocomial infections worldwide.  Risk factors associated with VRE are important to study. High-risk patients need to be screened and isolated to prevent the spread of infection and colonization. The present study aims to investigate the clinical spectrum, risk factors, and source of transmission of VRE in infected and colonized patients.
Methods: A prospective observational study was carried out for 1 year. A total of 200 Enterococcus species isolated from clinical samples such as urine, pus, blood, sterile body fluids, and stool from 200 patients without infection were included in the study. Stool samples were screened to measure the prevalence of VRE colonization. All samples were screened for vancomycin resistance using the Kirby-Bauer disc diffusion method. Vancomycin MIC was detected using the macrobroth dilution method. Demographic and clinical history of the patients were recorded.
Results: Vancomycin resistance was detected in 7 (3.5%) of 200 enterococci isolates from clinical samples. Urinary tract infection (n = 5, 71.4%) was the most common clinical illness caused by VRE. Gut colonization was found in 12 (6%) out of 200 patients screened for VRE. A history of previous antibiotic exposure was a significant risk factor in the current study and was associated with VRE infection and colonization. Endogenous bloodstream infection caused by VRE was found in one patient with VRE colonization.
Conclusion: The findings of this study highlight the significant burden of VRE on patients, both those infected and colonized. The emergence of multidrug-resistant bacteria in healthcare settings, a consequence of inappropriate antibiotic use, is a serious concern that warrants further research and our continued attention.
 

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Background and objectives: Urinary tract infection (UTI) caused by Uropathogenic Escherichia coli (UPEC) is a worldwide health problem. Virulence factors (VFs) expressed by UPEC strains promote the pathogenicity of bacteria in the urinary tract. Treatment of the infection is often difficult due to the high antimicrobial resistance of E. coli. This study aimed to determine VFs and the antibiotic susceptibility pattern of isolated UPEC strains in the north of Iran.

Methods: 105 urine samples were collected from females with UTIs, in north of Iran, Rasht. The samples were cultured on EMB agar and MacConkey agar. The plates were incubated at 37°C for 24 h and the pure isolates were identified using Gram-stains and standard biochemical tests. The presence of six VF genes including papC, sfa/foc, fimH, afa, ibeA and neuC were identified by polymerase chain reaction (PCR) in UPEC strains and verified by direct sequencing. Antibiotic susceptibility test (AST) was performed by disk diffusion method based on the Clinical and Laboratory Standards Institute (CLSI) guidelines.
Results: 65.71% isolates were identified as E. coli. The most frequent virulence gene was fimH (100%) and the least one was afa (1.44%).  The highest and the lowest antibiotic resistance rates were observed against Cephazolin (66.66%), and Gentamicin (24.63%), respectively. Indeed, the prevalence of multiple drug resistance (MDR) was determined as 73.91%.
Conclusion: Our study highlighted the importance of local monitoring in UPEC isolates due to the high genetic mutation capacity of the pathogen, environmental and patient properties to recommend the best strategies against UTIs.