Outcome of acute urinary tract infections caused by uropathogenic Escherichia coli with phenotypically demonstrable virulence factors.

Background: Urinary tract infection (UTI) caused by uropathogenic Escherichia coli (UPEC) strains is one of the most important community-acquired infections in the world. The presence of virulence factors is closely related with the pathogenesis of UTI. Methods: The present study was conducted on 150 isolates of UPEC obtained from symptomatic and asymptomatic cases of UTIs with significant counts (≥105 CFU/ml) during 1 year. UPEC isolates were studied for hemolysis on 5% sheep blood agar, mannose-sensitive hemagglutination (MSHA), mannose-resistant hemagglutination (MRHA), and biofilm formation by recommended methods. Patients with UTI due to UPEC showing virulence factors were evaluated for the treatment received and the outcome of treatment. These were compared with the outcomes of patients whose culture samples grew UPEC without demonstrable virulence factors. Results: The study showed hemolysin production in 40% of the isolates. Forty percent of the isolates showed the presence of P fimbriae (MRHA) and 60% showed Type 1 fimbriae (MSHA). Biofilm formation capacity of all UPEC isolates was classified into three categories, strong biofilm producers (4%), moderate biofilm producers (88%), and nonbiofilm producers (8%). Patients harboring all three virulence factors showed 76% recovery compared to patients harboring strains with no demonstrable virulence factors, who showed 100% recovery. Conclusion: The present study has shown the production of various virulent factors and developing drug resistance in UPEC. Treatment outcomes of patients harboring strains with no virulence factors seem to be better than the ones which contain multiple virulence factors. UPEC occurs because of multiple virulence factors. Biofilm formation and MRHA are more likely to be seen in catheterized patients. The drug resistance among UPEC is on rise; therefore, the selection of appropriate antibiotics (after antibiotic susceptibility testing) is must for proper treatment of patients and to avoid emergence of drug resistance. Significant number of the UPEC isolates was sensitive to nitrofurantoin, and half of the isolates were sensitive to cotrimoxazole, so treatment is by giving these drugs orally.

RésuméFond: L'infection urinaire (UTI) provoquée par des tensions uropathogenic d'Escherichia coli (UPEC) est l'une des infections acquises par - le plus important de la communauté dans le monde. La présence des facteurs de virulence est étroitement liée avec la pathogénie d'UTI. Méthodes: La présente étude a été conduite sur 150 isolats d'UPEC obtenu à partir des cas symptomatiques et asymptomatiques d'UTIs avec les comptes significatifs (≥105CFU/ml) pendant 1 an. Des isolats d'UPEC ont été étudiés pour le hemolysis sur l'agar de sang de moutons de 5%, l'hémagglutination sensible de - de mannose (MSHA), l'hémagglutination résistante de - de mannose (MRHA), et la formation de biofilm par des méthodes recommandées. Des patients avec UTI dû à UPEC montrant des facteurs de virulence ont été évalués pour le traitement reçu et les résultats du traitement. Ceux-ci ont été comparés aux résultats des patients dont les échantillons de culture ont élevé UPEC sans facteurs démontrables de virulence. Résultats: L'étude a montré la production d'hémolysine dans 40% des isolats. Quarante pour cent des isolats ont montré que la présence des fimbriae de P (MRHA) et de 60% a montré les fimbriae de type 1 (MSHA). La capacité de formation de Biofilm de tous les isolats d'UPEC a été classifiée dans trois catégories, producteurs forts de biofilm (4%), producteurs modérés de biofilm (88%), et producteurs de nonbiofilm (8%). Les patients hébergeant chacun des trois facteurs de virulence ont montré la récupération de 76% comparée aux patients hébergeant des tensions sans les facteurs démontrables de virulence, qui ont montré la récupération 100%. Conclusion: La présente étude a montré la production de divers facteurs virulents et de résistance au médicament se développante dans UPEC. Les résultats de traitement des patients hébergeant des tensions sans des facteurs de virulence semblent être meilleurs que ceux qui contiennent des facteurs multiples de virulence. UPEC se produit en raison des facteurs multiples de virulence. La formation de Biofilm et les MRHA sont pour être vus dans les patients cathétérisés. La résistance au médicament parmi UPEC est sur la hausse ; donc, la sélection des antibiotiques appropriés (après qu'essai antibiotique de susceptibilité) est nécessité pour le traitement approprié des patients et pour éviter l'émergence de la résistance au médicament. Le nombre significatif des isolats d'UPEC était sensible au nitrofurantoin, et la moitié des isolats étaient sensible au cotrimoxazole, ainsi le traitement est en donnant ces drogues oralement.

Outcome of acute urinary tract infections caused by uropathogenic Escherichia coli with phenotypically demonstrable virulence factors

Background: Urinary tract infection (UTI) caused by uropathogenic Escherichia coli (UPEC) strains is one of the most important community-acquired infections in the world. The presence of virulence factors is closely related with the pathogenesis of UTI. Methods: The present study was conducted on 150 isolates of UPEC obtained from symptomatic and asymptomatic cases of UTIs with significant counts (≥105 CFU/ml) during 1 year. UPEC isolates were studied for hemolysis on 5% sheep blood agar, mannose-sensitive hemagglutination (MSHA), mannose-resistant hemagglutination (MRHA), and biofilm formation by recommended methods. Patients with UTI due to UPEC showing virulence factors were evaluated for the treatment received and the outcome of treatment. These were compared with the outcomes of patients whose culture samples grew UPEC without demonstrable virulence factors. Results: The study showed hemolysin production in 40% of the isolates. Forty percent of the isolates showed the presence of P fimbriae (MRHA) and 60% showed Type 1 fimbriae (MSHA). Biofilm formation capacity of all UPEC isolates was classified into three categories, strong biofilm producers (4%), moderate biofilm producers (88%), and nonbiofilm producers (8%). Patients harboring all three virulence factors showed 76% recovery compared to patients harboring strains with no demonstrable virulence factors, who showed 100% recovery. Conclusion: The present study has shown the production of various virulent factors and developing drug resistance in UPEC. Treatment outcomes of patients harboring strains with no virulence factors seem to be better than the ones which contain multiple virulence factors. UPEC occurs because of multiple virulence factors. Biofilm formation and MRHA are more likely to be seen in catheterized patients. The drug resistance among UPEC is on rise; therefore, the selection of appropriate antibiotics (after antibiotic susceptibility testing) is must for proper treatment of patients and to avoid emergence of drug resistance. Significant number of the UPEC isolates was sensitive to nitrofurantoin, and half of the isolates were sensitive to cotrimoxazole, so treatment is by giving these drugs orally

Species distribution and antifungal susceptibility among clinical isolates of Candida parapsilosis complex from India / Distribución de especies y sensibilidad antimicótica de aislamientos clínicos del complejo Candida parapsilosis en India

Background: Candida parapsilosis is recognized as a species complex: Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis are three distinct but closely related species. Aims: To determine the species and antifungal susceptibility of members of the C. parapsilosis complex, isolated from clinical samples. Methods: Isolates identified as C. parapsilosis complex by VITEK(R) 2 system were included. Antifungal susceptibility test was done using the VITEK(R) 2 semi-automated system. The distribution of the species in the complex was determined by multiplex PCR. Results: Among the seventy-seven C. parapsilosis complex isolates, C. parapsilosis sensu stricto (57.1%) was the commonest species, followed by C. orthopsilosis (40.2%) and C. metapsilosis (2.5%). All three species were susceptible to amphotericin B, caspofungin and micafungin. Among C. parapsilosis sensu stricto isolates, 16% were resistant to fluconazole while 2.2% showed dose dependent susceptibility. Also, 18.2% of C. parapsilosis sensu stricto isolates showed dose dependent susceptibility to voriconazole. Conclusions: C. parapsilosis sensu stricto was the most commonly isolated member of the C. parapsilosis complex and it showed high resistance to fluconazole. A high prevalence of C. orthopsilosis (40.2%) was also noted

Antecedentes: Candida parapsilosis se reconoce como un complejo de especies compuesto por Candida parapsilosis sensu stricto, Candida orthopsilosis y Candida metapsilosis, tres especies distintas pero estrechamente relacionadas. Objetivos: Establecer las especies y la sensibilidad antifúngica de aislamientos del complejo C. parapsilosis procedentes de muestras clínicas. Métodos: Se incluyeron los aislamientos identificados como complejo C. parapsilosis por el sistema VITEK(R) 2. El estudio de la sensibilidad antimicótica se realizó mediante el sistema semiautomático VITEK(R) 2. La distribución de las especies del complejo se estableció mediante PCR múltiple. Resultados: Entre los 77 aislamientos del complejo C. parapsilosis, C. parapsilosis sensu stricto (57,1%) fue la especie más común, seguida por C. orthopsilosis (40,2%) y C. metapsilosis (2,5%). Las tres especies fueron sensibles a anfotericina B, caspofungina y micafungina. Entre los aislamientos de C. parapsilosis sensu stricto, el 16% fue resistente al fluconazol, mientras que el 2,2% mostró sensibilidad dependiente de la dosis. Además, el 18,2% de los aislamientos de C. parapsilosis sensu stricto mostró una sensibilidad al voriconazol dependiente de la dosis. Conclusiones: C. parapsilosis sensu stricto fue la especie más aislada del complejo C. parapsilosis y mostró una elevada resistencia al fluconazol. C. orthopsilosis fue también aislada con una alta prevalencia (40,2%)

Species distribution and antifungal susceptibility among clinical isolates of Candida parapsilosis complex from India.

BACKGROUND: Candida parapsilosis is recognized as a species complex: Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis are three distinct but closely related species. AIMS: To determine the species and antifungal susceptibility of members of the C. parapsilosis complex, isolated from clinical samples. METHODS: Isolates identified as C. parapsilosis complex by VITEK® 2 system were included. Antifungal susceptibility test was done using the VITEK® 2 semi-automated system. The distribution of the species in the complex was determined by multiplex PCR. RESULTS: Among the seventy-seven C. parapsilosis complex isolates, C. parapsilosis sensu stricto (57.1%) was the commonest species, followed by C. orthopsilosis (40.2%) and C. metapsilosis (2.5%). All three species were susceptible to amphotericin B, caspofungin and micafungin. Among C. parapsilosis sensu stricto isolates, 16% were resistant to fluconazole while 2.2% showed dose dependent susceptibility. Also, 18.2% of C. parapsilosis sensu stricto isolates showed dose dependent susceptibility to voriconazole. CONCLUSIONS: C. parapsilosis sensu stricto was the most commonly isolated member of the C. parapsilosis complex and it showed high resistance to fluconazole. A high prevalence of C. orthopsilosis (40.2%) was also noted.

Simple low cost differentiation of Candida auris from Candida haemulonii complex using CHROMagar Candida medium supplemented with Pal's medium / Diferenciación sencilla y de bajo coste de Candida auris del complejo Candida haemulonii con el empleo del medio CHROMagar Candida enriquecido con medio de Pal

Background. Candida auris is unique due to its multidrug resistance and misidentification as Candida haemulonii by commercial systems. Its correct identification is important to avoid inappropriate treatments. Aims. To develop a cheap method for differentiating C. auris from isolates identified as C. haemulonii by VITEK2. Methods. Fifteen C. auris isolates, six isolates each of C. haemulonii and Candida duobushaemulonii, and one isolate of Candida haemulonii var. vulnera were tested using CHROMagar Candida medium supplemented with Pal's agar for better differentiation. Results. On CHROMagar Candida medium supplemented with Pal's agar all C. auris strains showed confluent growth of white to cream colored smooth colonies at 37°C and 42°C after 24 and 48h incubation and did not produce pseudohyphae. The isolates of the C. haemulonii complex, on the contrary, showed poor growth of smooth, light-pink colonies at 24h while at 48h the growth was semiconfluent with the production of pseudohyphae. C. haemulonii complex failed to grow at 42°C. Conclusions. We report a rapid and cheap method using CHROMagar Candida medium supplemented with Pal's agar for differentiating C. auris from isolates identified as C. haemulonii by VITEK2 (AU)

Antecedentes. Candida auris es una especie única debido a su resistencia a múltiples fármacos y a la identificación errónea por sistemas comerciales como Candida haemulonii. Su correcta identificación es importante para evitar un tratamiento inadecuado. Objetivos. Desarrollar un método de bajo coste para diferenciar C. auris de aislamientos identificados como C. haemulonii por el método VITEK®2. Métodos. Quince aislamientos de C. auris, seis de C. haemulonii, seis aislamientos de Candida duobushaemulonii y un aislamiento de Candida haemulonii var. vulnera se sembraron en medio CHROMagar Candida enriquecido con medio de Pal para una mejor diferenciación. Resultados. En el medio CHROMagar Candida enriquecido con medio de Pal, todos los aislamientos de C. auris presentaron un crecimiento confluente con colonias lisas de color blanco a blanco amarillento a 37 y 42°C tras 24 y 48 h de incubación; no hubo producción de seudohifas. Los aislamientos del complejo C. haemulonii, en cambio, mostraron un crecimiento menor. Las colonias eran lisas y de un color rosa claro a las 24 h; a las 48 h el crecimiento fue semiconfluente y se observó producción de seudohifas. No hubo crecimiento de ninguno de los aislamientos a 42°C. Conclusiones. El medio CHROMagar Candida enriquecido con medio de Pal es rápido y de bajo coste, y resulta efectivo para identificar C. auris entre cepas previamente identificadas como C. haemulonii por el método VITEK®2 (AU)

Simple low cost differentiation of Candida auris from Candida haemulonii complex using CHROMagar Candida medium supplemented with Pal's medium.

BACKGROUND: Candida auris is unique due to its multidrug resistance and misidentification as Candida haemulonii by commercial systems. Its correct identification is important to avoid inappropriate treatments. AIMS: To develop a cheap method for differentiating C. auris from isolates identified as C. haemulonii by VITEK2. METHODS: Fifteen C. auris isolates, six isolates each of C. haemulonii and Candida duobushaemulonii, and one isolate of Candida haemulonii var. vulnera were tested using CHROMagar Candida medium supplemented with Pal's agar for better differentiation. RESULTS: On CHROMagar Candida medium supplemented with Pal's agar all C. auris strains showed confluent growth of white to cream colored smooth colonies at 37°C and 42°C after 24 and 48h incubation and did not produce pseudohyphae. The isolates of the C. haemulonii complex, on the contrary, showed poor growth of smooth, light-pink colonies at 24h while at 48h the growth was semiconfluent with the production of pseudohyphae. C. haemulonii complex failed to grow at 42°C. CONCLUSIONS: We report a rapid and cheap method using CHROMagar Candida medium supplemented with Pal's agar for differentiating C. auris from isolates identified as C. haemulonii by VITEK2.