Analysis of recurrent urinary tract infection (UTI) in University Hospital – approach of antibiotic resistance in clinical isolates

The fifty-two bacteria were isolated from urinary tract infections in University Hospital in Sumaré, São Paulo State, Brazil. These isolates were analyzed about their antibiotic resistance and their bacterial characteristics. Around percentage from these isolates were identified as belonging to Escherichia coli strains, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. The multiresistance profile (resistance profile major than four 4 antibiotic classes) were viewed in thirteen (13) strains of Escherichia coli, sixteen (16) strains in Klebsiella pneumoniae (being two (2) carbapenem resistant suggesting an existence of KPC strain). The results had demonstrated an indiscriminate antibiotic use concentrated in the increase of quinolones resistance (principally in ciprofloxacin use), and also the rise of KPC super bacteria.


Introduction
In recent years, bacterial resistant infections have become a global health challenge and threaten the health of societies (Khameneh, et al., 2016;Riley, et al., 2012;Anes, et al., 2015;Nischal, 2014;Zhu, et al., 2022;Sakeena, et al., 2018). Due to emergence of resistant infections, existing antibacterial drugs have become less effective or even ineffective; this has led to development of new antibacterial drugs (Khameneh, et al., 2016). Also, quinolones are one of the most commonly prescribed classes of antibacterial in the world and are used to treat a variety of bacterial infections in humans (Aldred KJ, 2014).
The clinical success of ciprofloxacin spawned an array of newer-generation quinolones that displayed an even broader spectrum of activity, especially against Gram-positive species (Aldred KJ, 2014;Emmerson & Jones 2003;Mitscher, 2005;Andriole, 2005;Stein, 1988). Due to the development of antibiotic resistance and the outbreak of infectious diseases caused by resistant pathogenic bacteria, pharmaceutical companies and researchers are now searching for new unconventional antibacterial agents. The demand for individualized therapy and lower risks of adverse effects has always been a goal for health professionals.
Besides, new pharmaceutical formulations seeking to increase efficiency and reduce drug toxicity are currently being researched (Nebert, et al., 2008;Audrey, 2014).

Results and Discussion
The Table 1(a and b) showed the resistance profile to Escherichia coli strains isolated in this work. And in Table 2(a and b), the aspects of Klebsiella pneumoniae resistance showed an important data: the occurrence of sixteen multiresistant strains (69,6%) and among these strains the presence of carbapenem resistant K. pneumoniae (KPC).

Source: Prepared by the authors. Font
Research, Society and Development, v. 11, n. 9, e55711931509, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i9.31509   In these two tables above, we have the 28 patients in which we obtained the bacteria from the urinary tract, in addition to the antibiotics tested on each bacterium. from the results, it was possible to see a large number of resistant strains, in this case resistant to ciprofloxacin and levofloxacin (46.4%), which are the most used antibiotics for the treatment of UTI     In these two tables above, we have the 23 patients in which we obtained the urinary tract bacteria, in addition to the antibiotics tested on each bacterium. from the results, it was possible to observe a large number of resistant strains, totaling 69.6% of resistance to antibiotics in general. We also highlight the case of two patients, HES12 and HES19, in which they have K. pneumoniae with multi-resistance to many antibiotics.
Further this analysis, the occurrence of these bacterial resistance could be an indicative of the non-employed of good pharmaceutical practices for antibiotic use and consequent antibiotic resistance acquisition for bacteria. Also, the use of quinolones, principally ciprofloxacin, showed the involvement of the wrong medical protocols, performed before an easy microbiological resistance analysis of the bacteria causing UTI.

Conclusion
In conclusion, the incorrect use of the antibiotic therapy in the UTI treatment is a principal cause of the bacterial resistance in recurrent infection presented in this clinical etiology. The knowledge around the multiresistant bacteria, their genes and genomic structure is an aim of our group to elucidate the new resistance mechanisms for bacteria causing UTI. Based on the knowledge obtained in this article, the group intends to continue monitoring antibiotic resistance linked to the UTI.