Urinary tract infections: epidemiology, mechanisms of infection and treatment options.
Flores-Mireles Ana L,Walker Jennifer N,Caparon Michael,Hultgren Scott J
Nature reviews. Microbiology
Urinary tract infections (UTIs) are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. In this Review, we discuss how basic science studies are elucidating the molecular details of the crosstalk that occurs at the host-pathogen interface, as well as the consequences of these interactions for the pathophysiology of UTIs. We also describe current efforts to translate this knowledge into new clinical treatments for UTIs.
10.1038/nrmicro3432
Advances in prevention and treatment of vancomycin-resistant Enterococcus infection.
Isenman Heather,Fisher Dale
Current opinion in infectious diseases
PURPOSE OF REVIEW:This article reviews data, particularly from the last 2 years, addressing the prevention and treatment of vancomycin-resistant Enterococcus (VRE). We focus on infection control, particularly active screening, use of contact precautions as well as pharmacologic options for therapy. This is timely given the evolving priorities in efforts towards the prevention and treatment of multidrug-resistant organisms globally. RECENT FINDINGS:Key findings include new data regarding the impact of contact precautions on the incidence of VRE colonization and bloodstream infection, new laboratory screening methods, and novel decolonization strategies and treatments. SUMMARY:Additional and specific measures beyond standard precautions for infection prevention of VRE remain controversial. Horizontal measures such as chlorhexidine bathing appear beneficial, as are nontouch environmental cleaning methods. Treatment options for invasive disease have improved considerably in the last decade. Decolonization strategies require further research. Overall, the threat of VRE seems exaggerated.
10.1097/QCO.0000000000000311
Linezolid to treat urinary tract infections caused by vancomycin-resistant .
Pontefract Benjamin Alan,Rovelsky Suzette Amy,Madaras-Kelly Karl Joseph
SAGE open medicine
Background:Vancomycin-resistant can cause urinary tract infection. Linezolid possesses antimicrobial activity against vancomycin-resistant but has limited urinary excretion. Minimal data demonstrate efficacy of linezolid for treatment of urinary tract infections. Objective:The main aim of this study is to compare post-treatment outcomes of linezolid to other antibiotics with vancomycin-resistant activity in the treatment of urinary tract infection caused by vancomycin-resistant . Methods:A retrospective cohort of inpatients within Veterans Health Administration facilities with urinary tract infection caused by vancomycin-resistant was created. Patients with vancomycin-resistant isolated from urine cultures and chart documentation meeting criteria for urinary tract infection were identified. Demographics, comorbidity, treatments, and post-treatment outcomes were extracted from the electronic health record. Outcomes were compared between patients treated with linezolid and alternative antibiotics possessing vancomycin-resistant activity 14 days after treatment completion. Logistic regression adjusted for covariates associated with each outcome. Results:Of 4,683 patients with a positive vancomycin-resistant culture, 624 (13%) met criteria for chart review, and 92 (15%) had documentation of urinary tract infection symptoms and treatment. The primary reason for exclusion was asymptomatic bacteriuria (64%). Patients had high Charlson Comorbidity Scores (mean = 8.7; standard deviation (SD) = 3.3), and 70% were located on general medical/surgical wards on the day of culture collection. Linezolid was prescribed in 54 (59%) cases. No difference between linezolid and comparator antibiotics were observed in re-initiation of antibiotics for vancomycin-resistant urinary tract infection (9% and 5% respectively (p = 0.56), (adjusted odds ratio (OR) = 1.90; 95% confidence interval (CI) = 0.34-10.63)), recurrent positive vancomycin-resistant culture (4% and 11%, respectively (p = 0.23), (adjusted OR = 0.36; 95% CI = 0.05-2.31)), or mortality (7% and 3%, respectively (p = 0.39) (adjusted OR = 2.96; 95% CI = 0.37-41.39)). Conclusion:Most patients with vancomycin-resistant identified on urine culture were asymptomatic. Linezolid appears effective as comparator antibiotics for the treatment of mild vancomycin-resistant urinary tract infection.
10.1177/2050312120970743
Linezolid Resistance in Associated With Urinary Tract Infections of Patients in a Tertiary Hospitals in China: Resistance Mechanisms, Virulence, and Risk Factors.
Ma Xiaoyu,Zhang Fan,Bai Bing,Lin Zhiwei,Xu Guangjian,Chen Zhong,Sun Xiang,Zheng Jinxin,Deng Qiwen,Yu Zhijian
Frontiers in public health
has been commonly considered as one of the major pathogens of the urinary tract infection (UTI) in human host worldwide, whereas the molecular characteristics of clinical isolates from the patients with UTI in China remains seldomly reported. This study aimed to investigate the resistance mechanism, molecular characteristics and risk factors of clinical isolates from patients with UTI in China. A total of 115 non-duplicated clinical isolates from patients with UTI were retrospectively collected in a tertiary hospital in China and their clinical data was further analyzed. The linezolid and tedizolid susceptibility were determined by agar dilution. The resistance genes, including (A)(B)(C)(M)(B), , and MLST-based housekeeping genes were investigated by PCR. In 115 non-duplicated clinical isolates from the patients with UTI in this hospital setting, the frequency of linezolid or tedizolid-resistant/intermediate isolates were 22.61 and 13.04%, respectively, and the frequency of linezolid-resistant/intermediate clinical isolates carrying with (A) were 86%. Among the five linezolid-resistant strains found in this study, three positive isolates and the other two linezolid-resistant strains were G2576U genetic mutations in the V domain of the 23S rRNA genes. The ST clonality analysis indicated that 31.42% (11/35) of ST16 UTI isolates were not susceptible to linezolid. Moreover, the univariable analysis indicated that the high risk factors of linezolid-resistant/intermediate infections involved the indwelling catheter, trachea cannula catheter and the carriage of (A) or . Furthermore, the indwelling catheter and trachea cannula catheter were demonstrated as the independent predictors of linezolid-resistant/intermediate strains in patients with UTI by multivariable analysis. Linezolid-resistant/intermediate associated with urinary tract infections of patients in this hospital setting from China might be explained by the high carriage frequency of genes and moreover, indwelling catheter and trachea cannula should be considered as the independent predictors of linezolid-resistant/intermediate infections. The transmission mechanism of linezolid-resistant/intermediate in this hospital setting should be further studied.
10.3389/fpubh.2021.570650
Linezolid for the Treatment of Urinary Tract Infections Caused by Vancomycin-Resistant Enterococci.
Wingler Mary Joyce,Patel Neel R,King S Travis,Wagner Jamie L,Barber Katie E,Stover Kayla R
Pharmacy (Basel, Switzerland)
Vancomycin-resistant enterococci (VRE) account for a large proportion of hospital-acquired infections. Determining optimal treatment of VRE urinary tract infections (UTIs) is challenging. The purpose of this study was to determine if a difference in efficacy or safety exists between linezolid and non-linezolid treatments for VRE UTIs. This retrospective cohort evaluated patients admitted between 1 June 2012-30 November 2017 who were treated for VRE UTI. Patients must have had at least one sign, symptom, or laboratory confirmation of UTI to be included. The primary endpoint of this study was difference in clinical cure between linezolid and non-linezolid treatment options. Secondary endpoints included 30-day recurrence, 30-day infection-related readmission, inpatient mortality, infection-related hospital length of stay (LOS), and time to appropriate therapy. A total of 45 patients (33 linezolid and 12 non-linezolid) were included. Clinical cure occurred in 71.4% linezolid and 58.3% non-linezolid ( = 0.476). No patients had a 30-day infection-related readmission or 30-day recurrence. Of the 45 patients, 6 (13.3%) patients died during admission, and 5 of those deaths were in the linezolid group ( = 1.000). No significant difference was found for clinical cure between linezolid and non-linezolid treatment options for VRE UTIs.
10.3390/pharmacy9040175
Analysis of molecular epidemiological characteristics and antimicrobial susceptibility of vancomycin-resistant and linezolid-resistant Enterococcus in China.
BMC medical genomics
BACKGROUND:This study investigates the distribution and characteristics of linezolid and vancomycin susceptibilities among Enterococcus faecalis (E. faecalis) and Enterococcus faecium (E. faecium) and explores the underlying resistance mechanisms. METHODS:A total of 2842 Enterococcus clinical isolates from patients were retrospectively collected, and their clinical data were further analyzed. The minimum inhibitory concentrations (MICs) of vancomycin and linezolid were validated by broth dilution method. The resistance genes optrA, cfr, vanA, vanB and vanM were investigated using polymerase chain reaction (PCR). Housekeeping genes and resistance genes were obtianed through whole-genome sequencing (WGS). RESULTS:Of the 2842 Enterococcus isolates, 88.5% (2516) originated from urine, with E. faecium accounted for 60.1% of these. The vanA gene was identified in 27/28 vancomycin resistant Enterococcus (VRE) isolates, 4 of which carried both vanA and vanM genes. The remaining strain was vanM positive. The optrA gene was identified in all E. faecalis isolates among linezolid resistant Enterococcus (LRE). E. faecium showed a higher multiple antibiotic resistance index (MAR index) compared to E. faecalis. The multi-locus sequence typing (MLST) showed the sequence type of E. faecium mainly belongs to clonal complex (CC) 17, nearly E. faecalis isolates analyzed were differentiated into 7 characteristics of sequence types (STs), among which ST16 of CC16 were the major lineage. CONCLUSION:Urine was the primary source of VRE and LRE isolates in this study. E. faecium showed higher levels of resistance compared to E. faecalis. OptrA gene was detected in 91.6% of LRE, which could explain linezolid resistance, and van genes were detected in all vancomycin resistant Enterococcus strains, while vanA was a key resistance mechanism in VRE identified in this study.
10.1186/s12920-024-01948-x