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      Rising prevalence of multidrug-resistant uropathogenic bacteria from urinary tract infections in pregnant women

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          Abstract

          Objectives

          This study aimed to determine the prevalence of urinary tract infections (UTI) in pregnant women and characterise the uropathogenic bacterial strains associated with symptomatic and asymptomatic bacteriuria in Lahore, Pakistan.

          Methods

          Between December 2018 and June 2019, we analysed the uropathogenic bacterial strains from midstream urine samples in 80 pregnant women. The age of the pregnant women ranged from 19 to 45 years, and they resided in urban and rural areas. We also recorded socioeconomic factors in this cohort. The isolated strains were phenotypically identified and evaluated for multiple drug resistance (MDR) patterns against recommended antimicrobial drugs.

          Results

          Of the 80 pregnant women, 65 had UTI, reflecting an 81% prevalence of UTI in women during pregnancy. The majority of participants aged 24–35 years, were multipara, and were in their third trimester. Results showed that 67 uropathogenic bacterial strains belonged to Escherichia (31%), Klebsiella (23%), Pseudomonas (16%), Streptococcus (4%), Enterococcus (4%), Staphylococcus (4%), and Proteus (3%) genera, as identified using biochemical characterisation. The highest overall resistance of Escherichia was seen against amoxicillin, pipemidic acid, and ampicillin; for Klebsiella against pipemidic acid, ampicillin, and cefotaxime; and for Pseudomonas against ciprofloxacin and cefotaxime. The three strains with the highest MDR were identified using 16S rRNA as Pseudomonas aeruginosa strain UA17, Escherichia coli strain UA32, and Klebsiella pneumoniae strain UA47.

          Conclusion

          In this study, the MDR uropathogenic strains showed the highest resistance pattern. The alarming signs of MDR uropathogenic infections are infrequently addressed and thus, urgent attention to this matter is essential.

          الملخص

          أهداف البحث

          تهدف هذه الدراسة لتحديد مدى انتشار التهابات المسالك البولية عند الحوامل وتوصيف السلالات البكتيرية المسببة للأمراض البولية المرتبطة مع البيلة الجرثومية المصحوبة وغير المصحوبة بأعراض في لاهور، الباكستان.

          طرق البحث

          بين ديسمبر ٢٠١٨ ويونيو ٢٠١٩، قمنا بتحليل السلالات البكتيرية المسببة للأمراض البولية من عينات البول الوسطية لعدد ٨٠ سيدة حامل. وكانت الفئة العمرية للسيدات الحوامل من ١٩-٤٥ عاما وينتمون إلى المناطق الحضرية والريفية. كما قمنا أيضا بتسجيل العوامل الاجتماعية والاقتصادية لهذه المجموعة. وتم التعرف على السلالات المعزولة ظاهريا وتقييمها لنمط مقاومة الأدوية المتعددة ضد الأدوية المضادة للميكروبات الموصى بها.

          النتائج

          من بين ٨٠ سيدة حامل، كان ٦٥ لديهن التهابات المسالك البولية، ما يعكس انتشار (٨١٪) التهابات المسالك البولية عند السيدات أثناء الحمل. وكانت أعمار أغلب المشاركات ٢٤-٣٥ عاما، ومتعددات الحمل، وكن في الثلث الثالث من الحمل. كما أظهرت النتائج أن ٦٧ من السلالات البكتيرية المسببة للأمراض البولية تنتمي إلى الإشريكية القولونية (٣١٪)، والكلبسيلة الرئوية (٢٣٪)، والبكتيريا الزائفة (١٦٪)، والبكتيريا العقدية (٤٪) والمكورات المعوية (٤٪)، والمكورات العنقودية (٤٪)، والبكتيريا المتقلبة (٣٪). كما تم تحديدهم من خلال التوصيف الكيميائي الحيوي. ولوحظ أن أعلى أنماط المقاومة الإجمالية للأموكسيسيلين، وحمض البيبميديك، والأمبيسلين ضد الإشريكية القولونية، وحمض البيبميديك، والأمبيسلين، وسيفوتاكسيم ضد الكلبسيلة الرئوية، وسيبروفلوكساسين وسيفوتاكسيم ضد الزائفة. وتم تحديد ثلاثة أعلى سلالات لمقاومة الأدوية المتعددة التي كانت من سلالة الزائفة الزنجارية، وسلالة الإشريكية القولونية، وسلالة الكلبسيلة الرئوية.

          الاستنتاجات

          في هذه الدراسة، أظهرت السلالات المسببة لأمراض الجهاز البولي أعلى نمط لمقاومة الأدوية المتعددة. العلامات المقلقة لأمراض الجهاز البولي المقاومة للأدوية المتعددة نادرا ما يتم تناولها والاهتمام العاجل بهذه المسألة أمر ضروري.

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          Most cited references 52

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          MEGA7: Molecular Evolutionary Genetics Analysis Version 7.0 for Bigger Datasets.

          We present the latest version of the Molecular Evolutionary Genetics Analysis (Mega) software, which contains many sophisticated methods and tools for phylogenomics and phylomedicine. In this major upgrade, Mega has been optimized for use on 64-bit computing systems for analyzing larger datasets. Researchers can now explore and analyze tens of thousands of sequences in Mega The new version also provides an advanced wizard for building timetrees and includes a new functionality to automatically predict gene duplication events in gene family trees. The 64-bit Mega is made available in two interfaces: graphical and command line. The graphical user interface (GUI) is a native Microsoft Windows application that can also be used on Mac OS X. The command line Mega is available as native applications for Windows, Linux, and Mac OS X. They are intended for use in high-throughput and scripted analysis. Both versions are available from www.megasoftware.net free of charge.
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            Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

            Summary Background Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. Methods Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene bla NDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan. Findings We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries. Interpretation The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed. Funding European Union, Wellcome Trust, and Wyeth.
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              Antibiotic susceptibility testing by a standardized single disk method.

               A BAUER,  W. Kirby,  J Sherris (1966)
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                Author and article information

                Contributors
                Journal
                J Taibah Univ Med Sci
                J Taibah Univ Med Sci
                Journal of Taibah University Medical Sciences
                Taibah University
                1658-3612
                11 November 2020
                February 2021
                11 November 2020
                : 16
                : 1
                : 102-111
                Affiliations
                Department of Biotechnology, Institute of Molecular Biology and Biotechnology, The University of Lahore, Main Campus, Lahore, Pakistan
                Author notes
                []Corresponding author. Institute of Molecular Biology and Biotechnology, The University of Lahore, Main Campus, Lahore, 54000, Pakistan. zahidses@ 123456gmail.com
                Article
                S1658-3612(20)30162-1
                10.1016/j.jtumed.2020.10.010
                7858016
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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