Background: Urinary tract infections (UTIs) are common in women, and during pregnancy can cause significant morbidity. Growing and greatly varying antimicrobial resistance (AMR) of Enterobacteriaceae, responsible for most UTIs, necessitates regular local AMR surveillance. In obstetric population, where beta-lactams are the mainstay for treatment of severe UTIs, particular focus should be placed on beta-lactam resistance. This study aimed to evaluate AMR rates and frequency of extended spectrum beta-lactamase (ESBL) and carbapenemase genes in uropathogenic Enterobacteriaceae among reproductive-age women in St. Petersburg, Russia.Materials/methods: Urine samples were collected from consecutive reproductive-age women, who attended the D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology from October 2017 to November 2019, and cultured according to routine procedures. Susceptibility to antibiotics and ESBL production was determined using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. All urine samples and Enterobacteriaceae isolates were tested for ESBL and carbapenemase genes using real-time PCR.Results: Enterobacteriaceae were detected in 91 (56 pregnant and 35 non-pregnant) of 119 (76%) included women. The vast majority of Enterobacteriaceae strains were susceptible to nitrofurantoin, fosfomycin and meropenem (99-100%). The frequency of strains susceptible to penicillins and cephalosporins ranged from 59% to 82%; 78% of strains were susceptible to ciprofloxacin. ESBL production was phenotypically detected in 15 (16%) Enterobacteriaceae strains, with CTX-M genes revealed in all cases. In all corresponding urine samples, CTX-M genes were also detected. The remaining 104 urine samples were negative for CTX-M genes. In none of the isolates and urine samples, carbapenemase genes were present.Conclusions: The frequency of ESBL producing Enterobacteriaceae was relatively high (16%), with CTX-M genes detected in all cases in both urine and urine cultures. Rapid PCR detection of CTX-M genes directly in urine samples from women with pyelonephritis can be valuable for timely informing treatment choices.

译文

背景:泌尿系统感染(UTIs)在女性中很常见,在怀孕期间可能会导致严重的发病率。负责大多数UTI的肠杆菌科细菌耐药性(AMR)的增长和差异很大,因此需要定期进行局部AMR监测。对于以β-内酰胺类药物为主要治疗重度尿路感染的产科人群,应特别关注β-内酰胺类药物的耐药性。这项研究的目的是评估俄罗斯圣彼得堡育龄妇女泌尿系统致病性肠杆菌科细菌的AMR发生率和超广谱β-内酰胺酶(ESBL)和碳青霉烯酶基因的频率。材料/方法:从连续生育年龄的妇女中收集尿液样本,参加了DO奥特(Ott)妇产科与生殖研究所于2017年10月至2019年11月,并按常规程序进行培养。根据欧洲抗生素敏感性试验委员会(EUCAST)指南,使用圆盘扩散法确定对抗生素和ESBL的敏感性。结果:在包括119名女性在内的119名女性中,有91名(56名孕妇和35名非孕妇)检出了肠杆菌科。绝大多数肠杆菌科菌株对呋喃妥因,磷霉素和美罗培南敏感(99-100%)。对青霉素和头孢菌素敏感的菌株的频率范围为59%至82%。 78%的菌株对环丙沙星敏感。在15个(16%)肠杆菌科菌株中表型检测到ESBL产生,在所有情况下均显示CTX-M基因。在所有相应的尿液样本中,也检测到了CTX-M基因。其余104个尿液样本中CTX-M基因阴性。结论:产ESBL肠杆菌科细菌的频率相对较高(16%),在所有病例中尿液和尿液培养物中均检测到CTX-M基因。直接从肾盂肾炎妇女的尿液样本中快速检测CTX-M基因的PCR对及时告知治疗选择可能很有价值。

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