Multidrug resistance of uropathogens as a risk factor in providing medical care to patients from central Bulgaria

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UDC: 
616.08; 616.6
Authors: 

S. Alekova, R. Koycheva

Organization: 

Trakia University, 11 Armeiska St., Stara Zagora, 6000, Bulgaria

Abstract: 

The emergence of resistance to multiple antimicrobial agents in uropathogenic bacteria has become a significant public health problem. These microorganisms are the cause of urinary tract infections, which are among the most frequently treated diseases in the outpatient medical care.

A cross-sectional study was conducted among 353 outpatients over 18 years of age with positive urine sample culture. It involved measuring the index of multiple antibiotic resistance of uropathogens causing infections among individuals. The research was conducted in the period January – June 2023 at a private clinical laboratory center located in Stara Zagora, Bulgaria.

One third of the isolates of E. coli and more than a half of those of Klebsiella pneumoniae had a measured MAR index greater than 0.2, with confirmatory high rates of resistance to aminopenicillins and cephalosporins. Alarmingly high MARI values were measured in all representatives of Enterococcus faecalis, Enterobacter species and Pseudomonas aeruginosa. These strains were also established to have high levels of resistance (varying from 58.3 to 100 %) to some of antimicrobial medicines most commonly prescribed in the outpatient healthcare.

Findings of this study emphasize the importance and seriousness of the existing problem with the increasing prevalence of uropathogenic microorganisms with multiple resistance to oral antibiotics. This creates elevated risks of failure to provide effective treatment for patients.

Keywords: 
urinary tract infections, bacterial microorganisms, multiple antibiotic resistance index, uropathogens, antimicrobial medicines, risk factor
Alekova S., Koycheva R. Multidrug resistance of uropathogens as a risk factor in providing medical care to patients from Central Bulgaria. Health Risk Analysis, 2024, no. 2, pp. 132–140. DOI: 10.21668/health.risk/2024.2.12.eng
References: 
  1. WHO report on surveillance of antibiotic consumption: 2016–2018 early implementation. WHO, 2019. Available at: https://www.who.int/publications/i/item/who-report-on-surveillance-of-an... (June 20, 2023).
  2. Sachdev C., Anjankar A., Agrawal J. Self-Medication With Antibiotics: An Element Increasing Resistance. Cureus, 2022, vol. 14, no. 10, pp. e30844. DOI: 10.7759/cureus.30844
  3. Salam M.A., Al-Amin M.Y., Salam M.T., Pawar J.S., Akhter N., Rabaan A.A., Alqumber M.A.A. Antimicrobial Re-sistance: A Growing Serious Threat for Global Public Health. Healthcare (Basel), 2023, vol. 11, no. 13, pp. 1946. DOI: 10.3390/healthcare11131946
  4. Baran A., Kwiatkowska A., Potocki L. Antibiotics and Bacterial Resistance – A Short Story of an Endless Arms Race. Int. J. Mol. Sci., 2023, vol. 24, no. 6, pp. 5777. DOI: 10.3390/ijms24065777
  5. Munita J.M., Arias C.A. Mechanisms of Antibiotic Resistance. Microbiol. Spectr., 2016, vol. 4, no. 2. DOI: 10.1128/microbiolspec.VMBF-0016-2015
  6. Chinemerem Nwobodo D., Ugwu M.C., Oliseloke Anie C., Al-Ouqaili M.T.S., Chinedu Ikem J., Chigozie U.V., Saki M. Antibiotic resistance: The challenges and some emerging strategies for tackling a global menace. J. Clin. Lab. Anal., 2022, vol. 36, no. 9, pp. e24655. DOI: 10.1002/jcla.24655
  7. Magiorakos A.-P., Srinivasan A., Carey R.B., Carmeli Y., Falagas M.E., Giske C.G., Harbarth S., Hindler J.F. [et al.]. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect., 2012, vol. 18, no. 3, pp. 268–281. DOI: 10.1111/j.1469-0691.2011.03570.x
  8. Sandhu R., Dahiya S., Sayal P. Evaluation of multiple antibiotic resistance (MAR) index and Doxycycline susceptibility of Acinetobacter species among inpatients. Indian J. Microbiol. Res., 2016, vol. 3, no. 3, pp. 299–304. DOI: 10.5958/2394-5478.2016.00064.9
  9. Osundiya O.O., Oladele R.O., Oduyebo O.O. Multiple Antibiotic Resistance (MAR) Indices of Pseudomonas and Klebsiella species isolates in Lagos University Teaching Hospital. Afr. J. Clin. Exper. Microbiol., 2013, vol. 14, no. 3, pp. 164–168. DOI: 10.4314/ajcem.v14i3.8
  10. Prasada Rao C.M.M., Vennila T., Kosanam S., Ponsudha P., Suriyakrishnaan K., Alarfaj A.A., Hirad A.H., Sundaram S.R. [et al.]. Assessment of Bacterial Isolates from the Urine Specimens of Urinary Tract Infected Patient. Biomed. Res. Int., 2022, vol. 2022, pp. 4088187. DOI: 10.1155/2022/4088187
  11. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, vol. 399, no. 10325, pp. 629–655. DOI: 10.1016/S0140-6736(21)02724-0
  12. Sabih A., Leslie S.W. Complicated Urinary Tract Infections. In book: StatPearls. Treasure Island (FL), StatPearls Publ., 2023.
  13. Klein R.D., Hultgren S.J. Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies. Nat. Rev. Microbiol., 2020, vol. 18, no. 4, pp. 211–226. DOI: 10.1038/s41579-020-0324-0
  14. The selection and use of essential medicines (2017): report of the WHO Expert Committee (including the 20th WHO Model List of Essential Medicines and the 6th WHO Model List of Essential Medicines for Children). Geneva, World Health Organization, 2017.
  15. Czajkowski K., Broś-Konopielko M., Teliga-Czajkowska J. Urinary tract infection in women. Prz. Menopauzalny, 2021, vol. 20, no. 1, pp. 40–47. DOI: 10.5114/pm.2021.105382
  16. Kebbeh A., Dsane-Aidoo P., Sanyang K., Darboe S.M.K., Fofana N., Ameme D., Sanyang A.M., Darboe K.S. [et al.]. Antibiotics susceptibility patterns of uropathogenic bacteria: a cross-sectional analytic study at Kanifing General Hospital, The Gambia. BMC Infect. Dis., 2023, vol. 23, no. 1, pp. 723. DOI: 10.1186/s12879-023-08373-y
  17. Miftode I.L., Nastase E.V., Miftode R.-Ș., Miftode E.G., Iancu L.S., Luncă C., Anton Păduraru D.-T., Costache I.-I. [et al.]. Insights into multidrug-resistant K. pneumoniae urinary tract infections: From susceptibility to mortality. Exp. Ther. Med., 2021, vol. 22, no. 4, pp. 1086. DOI: 10.3892/etm.2021.10520
  18. Mazzariol A., Bazaj A., Cornaglia G. Multi-drug-resistant gram-negative bacteria causing urinary tract infections: a review. J. Chemother., 2017, vol. 29, suppl. 1, pp. 2–9. DOI: 10.1080/1120009X.2017.1380395
  19. Farman M., Yasir M., Al-Hindi R.R., Farraj S.A., Jiman-Fatani A.A., Alawi M., Azhar E.I. Genomic analysis of mul-tidrug-resistant clinical Enterococcus faecalis isolates for antimicrobial resistance genes and virulence factors from the western region of Saudi Arabia. Antimicrob. Resist. Infect. Control, 2019, vol. 8, pp. 55. DOI: 10.1186/s13756-019-0508-4
  20. Saad D., Gameel S., Ahmed S., Basha E., Osman M., Khalil E. Etiological Agents of Urinary Tract Infection and 7 Years Trend of Antibiotic Resistance of Bacterial Uropathogens in Sudan. The Open Microbiology Journal, 2020, vol. 14, pp. 312–320. DOI: 10.2174/1874434602014010312
Received: 
23.04.2024
Approved: 
31.05.2024
Accepted for publication: 
20.06.2024

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