Prevalence and Antimicrobial Susceptibility Pattern of Staphylococcus species causing Urinary Tract Infections in Women of Reproductive Age: 5 Years Retrospective Study

Abstract

Background/Aim: Infections of the urinary tract are amongst the most prevalent infections in women, females at child-bearing age have a higher predisposition to urinary tract infections. Approximately 13% of health-care-associated urinary tract infections occur due to Coagulase Negative Staphylococci (CNS); this species’ resistance rate is alarming. The study aims to describe urinary tract infections of women of reproductive age through 5 years of results, emphasizing Staphylococcus species as an etiological agent and their antimicrobial susceptibility patterns. Material and Methods: In the study, 4562 urine samples sent between November 2017 and November 2022 were retrospectively analyzed. Routine culture methods were used to isolate bacteria from urine specimens. According to the European Committee on Antimicrobial Susceptibility Testing (version 8.0-12.0) recommendations, an antimicrobial susceptibility test was performed using the disc diffusion technique. Obtained data analysis was achieved by Statistical Package for Social Sciences (SPSS 20.0), Categorical variables were presented as frequency and percentage however continuous variable was described as mean ± Standard deviation (SD), and binary logistic regression test was done to determine the association with statistical significance of (p<0.05). Results: Of the 4562 urine samples taken from women of reproductive age, 166 (3.6%) had a UTI due to Staphylococcus species. The most common species was CNS 110 (66.2%). Followed by, Staphylococcus aureus which was 42 (25.3%), and Staphylococcus saprophyticus 14 (8.4%). All isolate species showed susceptibility to tigecycline and linezolid (100%). The highest level of antibiotic resistance was showed by S. aureus and CNS against penicillin-G which was (83.30%) and (58.1%) respectively, while the majority of S. saprophyticus showed resistance against Erythromycin (64.2%). CNS displayed the highest oxacillin resistance (20.90%) among Staphylococcus species. Conclusion: The study illustrates the significance of Staphylococcus species as a pathogen of the urinary tract, especially in women of reproductive age. There is clear evidence of the resistance of isolates to penicillin-G which may suggest the production of penicillin-binding protein 2a. Regular surveillance of the frequency and resistance pattern of Staphylococcus species causing urinary tract infections in local regions, especially keeping in mind the high-risk patients mentioned in our study should be monitored.

Keywords

• Reproductive age
• Staphylococcus species
• Urinary tract infection
• women

Üreme Çağındaki Kadınlarda İdrar Yolu Enfeksiyonlarına Neden Olan Stafilokok Suşlarının Prevalansı ve Antimikrobiyal Duyarlılık Paterni: 5 Yıl Retrospektif Çalışma

Abstract

Giriş/Amaç: İdrar yolu enfeksiyonları kadınlarda en sık görülen enfeksiyonların arasındadır. Doğurganlık çağındaki kadınların idrar yolu enfeksiyonlarına yatkınlığı daha fazladır. Koagülaz Negatif Stafilokoklar (KNS), yatan hastalarda idrar yolu enfeksiyonlarının (İYE) yaklaşık %13’ünden sorumludur. Bu patojen grubunun antimikrobiyallerine karşı direncin artması da endişe vericidir. Bu çalışmada, üreme çağındaki kadınların idrar yolu enfeksiyonlarının etiyolojik bir ajanı olan Stafilokok türlerini ve bunların antimikrobiyal duyarlılık paternlerinin araştırması amaçlanmıştır. Materyal ve Metod: Bu çalışmada, Kasım 2017-Kasım 2022 tarihleri arasında toplanan 4562 adet idrar örneği retrospektif olarak incelenmiştir. Bakterileri idrar örneklerinden izole etmek için rutin kültür yöntemleri kullanıldı. European Committee on Antimicrobial Susceptibility Testing (versiyon 8.0-12.0) önerilerine göre disk difüzyon tekniği kullanılarak antimikrobiyal duyarlılık testi yapıldı Veriler Statistical Package for Social Sciences (SPSS 20.0) programıyla analiz edildi. Kategorik değişkenler frekans ve yüzde olarak ifade edildi, sürekli değişkenler ise ortalama ± Standart sapma (SS) şeklinde verildi. Tüm karşılaştırmalarda P<0,05 istatistiksel anlamlılık düzeyi olarak kabul edildi. Bulgular: Doğurgan çağındaki kadınlardan elde edilen 4562 idrar örneğinin 166'sında (%3,6) stafilokok türlerine bağlı İYE saptandı. En sık karşılaşılan Stafilokok türü KNS olup, 110 adet (% 66.2) idrar örneğinde etken olarak tespit edildi. Bunu takiben, 42 adet Staphylococcus aureus (%25.3) ve 14 adet (%8.4) Staphylococcus saprophyticus etken olarak saptandı. Tüm izolatlar tigesiklin ve linezolide karşı (%100) duyarlıydı. En yüksek antibiyotik direnci, penisilin-G'ye karşı Staphylococcus aureus (%83,30) ve KNS (%58,1) tarafından gelişirken, Staphylococcus saprophyticus'un büyük çoğunluğu eritromisin'e (%64,2) karşı direnç göstermiştir. KNS, Stafilokok türleri arasında en yüksek oksasilin direncini (%20,90) göstermiştir. Sonuç: Stafilokok türleri, özellikle üreme çağındaki kadınlarda idrar yolu patojeni olarak önemini göstermektedir. İzolatların penisilin-G'ye karşı direncine açık kanıtlar vardır. Bu direncin gelişmesine penisilin bağlayıcı protein 2a üretimi yol açmış olabilir. İdrar yolu enfeksiyonlarına neden olan Stafilokok türlerinin sık görülen prevalansı ve duyarlılık paternleri, özellikle çalışmamızda ele alınan yüksek riskli hastaları tedavi ederken göz önünde bulundurulmalıdır.

Keywords

• Doğurgan çağ
• idrar yolu enfeksiyonu
• kadınlar
• Stafilokok Suşları

References

1. Abate D, Marami D, Letta S. Prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among pregnant and nonpregnant women at public health facilities, harar, eastern ethiopia: A comparative cross-sectional study. Canadian Journal of Infectious Diseases and Medical Microbiology. 2020;2020.
2. Kabir A, Sayeed S, Biswas P, et al. Antimicrobial sensitivity pattern of the common uropathogens among patients admitted in a tertiary care hospital in Bangladesh. Journal of Medicine (Bangladesh). 2020;21(2):93–7.
3. Ali S, Perdawood D, Abdulrahman R, et al. Vitamin D deficiency as a risk factor for urinary tract infection in women at reproductive age. Saudi J Biol Sci. 2020 Nov 1;27(11):2942–7.
4. Karamanoğlu A, Yavuz M. Evidence and practice recommendations for the prevention of healthcare-associated urinary tract infection. Gümüşhane University Journal of Health Sciences. 2023;12(2):809–19.
5. Hashemzadeh M, Dezfuli A, Nashibi R, et al. Study of biofilm formation, structure and antibiotic resistance in staphylococcus saprophyticus strains causing urinary tract infection in women in Ahvaz, Iran. New Microbes New Infect. 2021 Jan 1:39:100831.
6. Jagtap S, Harikumar S, Vinayagamoorthy V, et al. Comprehensive assessment of holding urine as a behavioral risk factor for UTI in women and reasons for delayed voiding. BMC Infect Dis. 2022 Dec 1;22(1).
7. Simon-Oke I, Odeyemi O, Afolabi OJ. Incidence of urinary tract infections and antimicrobial susceptibility pattern among pregnant women in Akure. Nigeria. Sci Afr. 2019 Nov 1;6.
8. Krishnaswamy PH, Basu M. Urinary tract infection in gynaecology and obstetrics. Obstetrics, Gynecology and Reproductive Medicine. 2020;30(9):276–82.

9. Storme O, Saucedo JT, Garcia-Mora A, et al. Risk factors and predisposing conditions for urinary tract infection. Vol. 11, Therapeutic Advances in Urology. SAGE Publications Inc.; 2019. p. 19–28.
10. Girma A, Aemiro A. The Bacterial Profile and Antimicrobial Susceptibility Patterns of Urinary Tract Infection Patients at Pawe General Hospital, Northwest Ethiopia. Scientifica (Cairo). 2022 Apr 25;2022:1–8.
11. Mitiku A, Aklilu A, Biresaw G, et al. Prevalence and associated factors of methicillin-resistant Staphylococcus aureus (MRSA) among urinary tract infection suspected patients attending arba minch general hospital, Southern Ethiopia. Infect Drug Resist. 2021;14:2133–42.
12. Alao F, Smith S, Omonigbehin E, et al. Prevalence of virulence genes in Staphylococcus saprophyticus isolated from women with urinary tract infections in Lagos State. Sci Afr. 2020 Nov 1;10.
13. Szemraj M, Grazul M, Balcerczak E, et al. Staphylococcal species less frequently isolated from human clinical specimens - Are they a threat for hospital patients? BMC Infect Dis. 2020 Feb 11;20(1).
14. Mondal S, Noori M, Pal D. Sexual dysfunction in female patients of reproductive age group with recurrent urinary tract infection: a cross-sectional study. AJOG Global Reports. 2022 Nov 1;2(4):1–8.
15. Akca D, Türk R. Determination of genital hygiene behaviors of women. Kafkas Journal of Medical Sciences. 2021;11(1):1–9.
16. Omidifar N, Taghi E, Mohebi S, et al. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in pregnant women in Shiraz, Southwest Iran. Gene Rep. 2020 Sep 1;20.
17. Çilburunoglu M, Kirisci Ö, Yerlikaya H, ve ark. Bir üniversite hastanesine gönderilen idrar kültürlerinde üreyen izolatların dağılımı ve antimikrobiyal duyarlılık profilinin incelenmesi. Sakarya Medical Journal. 2020 Nov 21;
18. Saleha S, Ratna kumari P. Bacteriological profile of urinary tract infections (UTI) and their antibiotic susceptibility pattern in women of reproductive age group. Indian J Med Microbiol. 2021 Sep;39.
19. Quaiser S, Khan R, Khan F, et al. Clinical and bacteriological profile of UTI patients attending a North Indian tertiary care center. Ann Trop Med Public Health. 2015 Nov 1;8(6):246–52.
20. Nahab H, Akeel Hamed, Aqeel Abdul Munem. Bacteriological study of urinary tract infections among pregnant women in Al-Samawa city of Iraq. Arch Razi Inst. 2022 Jan 1;77(1):107–12.
21. Mohydin M, Haroon M, Rasheed UR, et al. Culture and sensitivity pattern of urinary tract infections among women of reproductive age group. Pakistan Journal of Medical and Health Sciences. 2019;13(2):263–6.
22. Osman O, İbrahim S, Nazan Ç, ve ark. Yatan hastaların kan örneklerinden izole edilen Staphylococcus spp. bakterilerin antibiyotik dirençliliği. Van Sag Bil Derg. 2021;14(2):144–52.