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Evaluating the pattern of antibiotic resistance of urinary tract infection (UTI)-causing bacteria in the urine culture samples of patients in the infectious ward of Imam Khomeini Hospital, Kermanshah, in Iran from 2016–2018

Abstract

Background

Increasing resistance of bacteria to antimicrobial agents is a significant problem worldwide. This study aimed to assess the pattern of antibiotic resistance among bacteria that cause urinary tract infections (UTIs) in patients admitted to the infectious ward of Imam Khomeini Hospital in Kermanshah between 2016 and 2018, based on urine culture samples.

Methods

The present study was a cross-sectional and descriptive study. The study’s statistical population included all patients referred to the infectious disease ward of Imam Khomeini Hospital due to urinary tract infections during the project period. Urine samples were collected in sterile containers, and by using a calibrated loop, the urine sample was cultured on EMB and blood agar media under sterile conditions. Microbial sensitivity was performed by standard disk diffusion method, and the results were analyzed using SPSS-V 16 software.

Results

The antibiotic resistance assays showed that the highest resistance included nalidixic acid (73.5%), ciprofloxacin (72.1%), cotrimoxazole (70.6%), and ceftazidime (61.8%), cefixime (57.4%), ceftriaxone (48.5%), gentamicin (32.4%), cephalothin (16.6%), nitrofurantoin (10.3%), norfloxacin (5.9%), cefotaxime (4.4%), imipenem (2.9%), cefepime (2.9%), ampicillin (2.9%), ceftizoxime (1.5%), vancomycin (1.5%), cefazolin (1.5%), and chloramphenicol (1.5%), respectively. In addition, investigating the antibiotic resistance of UTI-causing bacteria according to the gender and age of the patients in the present study showed no significant statistical difference (P > 0.05).

Conclusion

The bacteria causing urinary infections in the study area mainly belonged to the E. coli and Klebsiella families. Considering the determination of antibiotic sensitivity patterns in common organisms in the studied area, its report to doctors can be considered in experimental treatments.

1 Background

Urinary tract infections (UTIs) are humans’ most common bacterial infections, occurring in all age groups [1]. Lack of proper diagnosis and timely treatment can cause severe complications, such as urinary tract disorders, scars remaining in the kidney parenchyma, blood pressure, and uremia, and in pregnant women, they cause premature birth and even miscarriage [2]. Urinary tract infections, including cystitis and pyelonephritis, are common in the hospital. Among the pathogens that cause urinary infections, E. coli is the dominant pathogen that causes nearly 80% of infections and infects 8–10 million people in the USA annually [3, 4].

Based on the statistics of international organizations, 17–29 billion dollars are spent annually on the treating hospital infections, of which 39% are related to the costs caused by urinary infections [4]. Gram-negative bacilli are the most common etiological factor of UTI; among them, E. coli accounts for more than 80% of acute urinary tract infections [5]. Staphylococcus saprophyticus is the cause of 5–10% of urinary infections; other bacterial causes include Klebsiella, Proteus, Pseudomonas, and Enterobacter. These cases are not very common and are usually related to urinary system abnormalities or urinary catheters [5, 6].

Infectious diseases are always considered a serious threat to health. With the discovery of antibiotics, the death caused by infectious diseases has decreased significantly. However, these diseases are returning due to the uncontrolled use of antibiotics and resistance to them. Owing to the increase in resistance to antibiotics, the world urgently needs to change the pattern of consumption and prescription of this valuable medicinal source [7, 8]. If the consumption of medicines remains with the same pattern, even the production and development of new medicines cannot prevent the increase of resistance to antibiotics. In addition to the lack of uncontrolled use of antibiotics, measures to reduce the spread of infection through regular vaccination, regular hand washing, and paying attention to food hygiene are necessary [9]. It should be noted that antibiotics can only treat bacterial infections and are ineffective against viral infections such as colds, sore throats, and influenza.

In other words, it can be stated that antibiotics become resistant to these medicines through gene mutation and new generations arise that cannot be combated [10]. One of the most important factors of this type of medicine resistance is the uncontrolled and excessive use of antibiotics. This phenomenon endangers human society, so its danger has been likened to terrorism. These bacteria’s resistance to antibiotics is one of the biggest challenges that threaten the health of humans in the modern era [11, 12].

Nowadays, the treating these types of infections has faced severe problems due to the increasing use of antibiotics and the subsequent increase in antibiotic resistance. The basis for treating urinary infections is selecting a highly efficient and effective antibiotic [13]. Antibiotics that were once effective now have minimal effect on bacteria that cause urinary tract infections, primarily due to the emergence and spread of bacteria-resistant strains, population growth, travel, and uncontrolled and excessive use of antibiotics [11, 12, 14]. Different studies suggest that regardless of the pattern of antibiotic consumption, antibiotic-resistance genes can be transferred among bacterial populations [14]. Urinary tract infections are more common in females than males. Around half of all females experience at least one infection during their lifetime, and recurrences are common [15,16,17].

Changing the sensitivity pattern of bacteria to different antibiotics over time and in different geographical areas has become a serious problem. Hence, antibiotic treatment of infections should be based on the information obtained from the antibiotic sensitivity and resistance pattern. Due to the increasing use of antibiotics and the subsequent increase in antibiotic resistance, as well as the differences in antibiotic sensitivity in dealing with different bacteria, recognizing the sensitivity pattern of this organism to antibiotics can be helpful in the treatment of most patients suffering from a urinary tract infection [18,19,20]. The present study aims to evaluate the antibiotic resistance pattern of UTI-causing bacteria in urine culture samples of infectious ward patients of Imam Khomeini Hospital in Kermanshah between 2016 and 2018.

2 Methods

2.1 Study locations and ethical approval

The present study was a cross-sectional and descriptive study. After obtaining the consent form from all patients, the study’s statistical population included all patients referred to the infectious disease ward of Imam Khomeini Hospital due to urinary tract infections during the project period. Based on the study by Mahmoudi et al. [21], E. coli isolates in urinary infection samples have the highest resistance to co-trimoxazole antibiotics (74%). Based on 74% resistance, the minimum sample volume formula and 95% confidence, and the error of 0.1, the minimum sample size is 74 people. The code of ethics (IR.KUMS.REC.1398.191) was received from the Kermanshah University of Medical Sciences after obtaining permission from the research assistant. Inclusion criteria were catheterized patients with a final diagnosis of urinary tract infection, no history of hospitalization and catheterization, and no antibiotic use for two weeks before sending their samples to the laboratory. In addition, patients who consumed antibiotics during sampling or one month after hospitalization were excluded from this research.

2.2 Sample collections and culture procedure

For the final diagnosis of urinary tract infection, midstream urine samples were collected in sterile containers and using a calibrated loop (0.01 ml). The midstream urine sample was cultured on EMB and blood agar media under sterile conditions incubated at 37 °C. After 18–24 h, the samples in which the number of grown colonies was equal to or more than 100,000 CUF/ml were considered positive regarding urinary infection. To identify the bacteria, biochemical tests and differential culture media such as indole production and motility (sulfide indole motility: SIM), triple sugar iron agar (TSI), urease, methyl red (methyl red), Voges–Proskauer, lysine decarboxylase (LD) were used.

2.3 Antibiotic susceptibility test

Antibiotic resistance tests were performed using 11 antibiotic disks, including ceftazidime (30 μg), cefotaxime (30 μg), imipenem (10 μg), cefixime (5 μg), nitrofurantoin (300 μg), cotrimoxazole (25 μg), nalidixic acid (30 μg), ciprofloxacin (5 μg), gentamicin (10 μg), ampicillin (25 μg), and cefoxitin (30 μg) [16]. The sample was placed on a plate and incubated at 37 °C. After 24 h, the inhibition zone diameter was measured and used to determine antibiotic susceptibility (i.e., susceptible or resistant) for each microorganism, according to CLSI guidelines [15]. A checklist was completed based on demographic and laboratory information to identify the bacteria that cause urinary tract infections and their antibiotic resistance, which is available in the laboratory of Imam Khomeini Hospital, by the project executor.

2.4 Statistical analysis

Data were performed using Microsoft Office Excel 2013, SPSS version 16 (Statistical Package for Social Sciences). The Chi-square or Fisher’s exact test was performed to investigate the significance of the differences. A p-value of less than 0.05 was considered statistically significant.

3 Results

Seventy-four patients with urinary tract infections referred to the infectious ward of Imam Khomeini Hospital were studied. The following sections deliberately describe each phase using the data from these patients.

3.1 Identifying the frequency of bacteria causing urinary infection

After carrying out bacterial cultures, eight different bacteria species were identified from the urine sample with significant growth. The most common bacterium causing urinary tract infections in patients was E. coli (58.82%), followed by Klebsiella (19.12%), Acinetobacter (11.76%), Staphylococcus aureus (2.95%), and Pseudomonas (2.94%). Staphylococcus epidermidis (1.47%), Pseudomonas aeruginosa (1.47%), and Staphylococcus auricularis (1.47%) which were the least frequent isolates in this population, as shown in Fig. 1.

Fig. 1
figure 1

Frequency of bacteria causing blood infection in the studied patients

3.2 Identifying the frequency of used antibiotics

Based on the results of this study, the most common antibiotics used in the studied patients were nalidixic acid (73.53%), ciprofloxacin (72.06%), cefixime (72.05%), and cotrimoxazole (70.59%), ceftazidime (61.76%), ceftriaxone (61.76%), amikacin (33.82%), imipenem (27.94%), gentamicin (32.35%), cephalothin (16.18%), and vancomycin (14.7%), respectively, as shown in Table 1.

Table 1 Number and frequency percentage of antibiotics used in the studied patients

3.3 Identifying the frequency of UTI-causing bacteria based on age

Patients were divided into six age groups: ≤ 30 years, 31–40 years, 41–50 years, 51–60 years, 61–70 years, and ≥ 71 years (Table 2). Accordingly, in Table 2, the urinary infection with the bacterial agent E. coli was more (40%) in the ≥ 71 age group and the lowest in the 41–50 age group (2.5%). Klebsiella bacterial agent was seen in all age groups except ≤ 30. The bacterial agent Acinetobacter was seen in age groups ≥ 41. The bacterial agent Staphylococcus aureus was seen only in two age groups ≥ 71 and ≤ 30. Bacterial agents Staphylococcus epidermidis, Pseudomonas aeruginosa, and Staphylococcus auricularis were seen in the age groups 61–70, 51–60, and ≤ 30, respectively. In contrast, the bacterial agent Pseudomonas was seen only in groups 51–60 and those ≥ 71.

Table 2 Number and percentage of frequency of bacteria causing urinary infection based on the age of the studied patients

3.4 Identifying the frequency of UTI-causing bacteria based on gender

Table 3 shows the frequency of UTI-causing bacteria according to gender. E. coli showed a higher percentage of urinary tract infections in females (55%) than in males (45%). Meanwhile, UTIs caused by Klebsiella bacteria were 64.5% and 35.5% in women and men, respectively. In addition, UTIs caused by the bacterial agent Acinetobacter were 62.5 and 37.5% in women and men, respectively. The prevalence of UTI caused by Staphylococcus aureus and Pseudomonas bacteria was the same (50%) in both sexes. In contrast, the prevalence of UTI caused by Staphylococcus epidermidis and Staphylococcus auricularis bacteria was seen only in the female population, and Pseudomonas aeruginosa bacteria were seen only in the male population.

Table 3 Number and frequency percentage of UTI-causing bacteria based on gender in the studied patients

3.5 Antibiotic resistance of UTI-causing bacteria

Antibiotic resistance test of bacteria causing urinary tract infections showed that the highest resistance was related to ciprofloxacin (72.1%), nalidixic acid (73.5%), and cotrimoxazole (70.6%). On the other hand, the lowest antibiotic resistance of the bacteria responsible for urinary tract infections was related to vancomycin (1.5%), ceftizoxime (1.5%), cefazolin (1.5%), and chloramphenicol (1.5%) as mentioned in Table 4.

Table 4 Number and frequency percentage of antibiotic resistance of UTI-causing bacteria in the studied patients

3.6 Identifying the frequency of antibiotic resistance of UTI-causing bacteria based on the age

As seen in Table 5, ciprofloxacin showed the highest resistance among all antibiotics in the age group of 61–70. While rifampin, metronidazole, tazocin, clindamycin, and isoniazid antibiotics did not cause resistance in any age group. Based on the results of the present study, no statistically significant difference was observed in terms of antibiotic resistance of UTI-causing bacteria based on the age of the patients (P > 0.05).

Table 5 Number and frequency percentage of antibiotic resistance of UTI-causing bacteria based on age

3.7 Identifying the frequency of antibiotic resistance of UTI-causing bacteria based on gender

Table 6 shows that men’s antibiotic resistance was related to nalidixic acid (73.14%) and ceftazidime (67.74%). Cotrimoxazole (78.39%) and nalidixic acid (72.97%) antibiotics had the highest resistance in women. Based on the results of the present study, no statistically significant difference was observed in terms of antibiotic resistance of UTI-causing bacteria found on the gender of the patients (P > 0.05). Only more antibiotic resistance to gentamicin was reported as significant in males than in females (P = 0.039).

Table 6 Number and frequency percentage of antibiotic resistance of UTI-causing bacteria based on the gender

4 Discussion

The incidence of antibiotic resistance is increasing dramatically worldwide. UTI, which affects numerous individuals yearly, is an infectious illness generated by bacteria with various antibiotic resistance patterns [22]. On the other hand, the increasing spread of antibiotic resistance causes additional treatment costs, hospitalizations, and more deaths [23]. Considering that many studies have not been conducted to evaluate the results of antibiotic resistance treatment in pathogens in the western region of Iran, the present study was conducted to investigate the effects and clinical consequences of antibiotic resistance in urinary pathogens in patients with UTI. This study was conducted on 74 patients diagnosed with urinary tract infection (UTI)-causing bacteria in the urine culture samples admitted to Imam Khomeini Hospital in Kermanshah between 2016 and 2018.

The results of the present study also showed that E. coli and Klebsiella, in general, were the most common causes of urinary tract infections, consistent with other studies [24]. These findings were in line with the studies of other researchers in this field [25, 26]. In addition, consistent with our results, Motamedifar et al. [27] reported that E. coli was the most common cause of UTI, followed by Klebsiella species. Farajnia et al. [28] showed that E. coli, P. aeruginosa, and Staphylococcus saprophyticus bacteria are the most common causes of UTI in patients under 9 nine years and older. Meanwhile, in our study, E. coli bacteria caused the most common causes of UTI in people over 71 years of age, and it did not match our results. According to the reports of other researchers, such as Raya et al. [29], Vazuras et al. [30], and Duicu et al. [31], in this field, E. coli was the leading cause of UTI in our study. Therefore, the role of E. coli in causing UTIs has been presented in many researchers’ reports [32]. These changes depend on various factors such as geographic region, people’s race, type of pollution, etc. [33].

In our study, E. coli bacteria were the leading cause of UTI in 16 people (40%) in the age group ≥ 71. However, in reporting the results of our data, the patterns of UTIs caused by other bacterial agents other than E. coli were not the same in different age groups. On the other hand, apart from the type of bacteria causing UTI, no statistically significant difference was seen among people in different age groups. The report of the study by Shasharkinia et al. indicated that statistically, there was a significant relationship between the type of bacteria that causes UTI and the age of people, in which the main cause of UTI in all ages is E. coli (75%) followed by Proteus (11%) which was not consistent with the results of our study [34].

Complete treatment of UTI in patients occurs when the infection’s bacterial cause and the antibiotic sensitivity patterns are diagnosed in time [35]. By comparing the reports of several studies on the resistance of different antibiotics in Iran and other countries, it was observed that the resistance of different antibiotics to urinary pathogens in Iran and other countries is a cause of great concern for treating UTI patients [36]. In the present study, the antibiotic resistance of different bacteria differed; each was resistant to some antibiotics and sensitive to others. Molazade et al. [37] reported that the most common organisms were E. coli at 64.3%, Klebsiella at 14.5%, and Staphylococcus at 6.4%. Bacteria had the highest sensitivity to ciprofloxacin and nitrofurantoin and had the highest resistance to co-trimoxazole and cephalothin antibiotics. In this regard, in our study, the highest resistance belonged to nalidixic acid (73.5%), ciprofloxacin (72.1%), and cotrimoxazole (70.6%), ceftazidime (61.8%), cefixime (57.4%), and ceftriaxone (48.5%), respectively. In the study conducted by Molazade et al., it was recommended to use ciprofloxacin and nitrofurantoin in cases where it is necessary to treat urinary tract infections in an outpatient way. The selection of antibiotics for treating urinary tract infections should be based on the prevalence of bacteria in each region and their sensitivity to the desired antibiotic.

In line with the results of the present study, which shows that women are more likely to suffer from urinary tract infections than men, in the study of Haqgoo et al. [38], 72.3% of patients with positive urine culture were women and 27.7% were men. In the study of Jarsiah et al. [39], it was also observed that the number of positive cultures is more in women than in men. In the study of Ramezanzadeh et al. [40], most of the bacteria were also isolated from women’s samples. It was also reported in Laupland et al. [41] study that the rate of urinary infection was higher in women. The present study’s findings are supported by all of the mentioned results, which suggest that women may be more susceptible to this condition because of their shorter urethra and the proximity of its outlet to the vagina and anus.

Majumder et al. reported that the main cause of UTI in their study population was E.coli bacteria (75%), followed by Klebsiella (10.7%) and Enterococcus (6%). Most (73.3%) of antibiotic resistance in this study were female, and this gender difference was statistically significant. The most potent antibiotics in this study were imipenem, meropenem, amikacin, and nitrofurantoin. The effectiveness of these drugs was 91–100%. Over 60% antibiotic resistance against amoxicillin, nalidixic acid, cefixime, ciprofloxacin, co-trimoxazole, and cephalosporins was reported [42], which is consistent with the findings of our study to some extent.

In the present study, most bacterial resistance to antibiotics was seen in the age groups of 31–40 and 41–50. The reason for this can be that these ages are more sexually active. These results are more or less consistent with other studies [43]. Including, in the study of Haqgou et al., the average age of patients with positive urine culture was 61.0 ± 18.6 years, which is not consistent with the results of the present study [38].

In a study carried out by Asadpour et al. [13] to identify the pattern of antibiotic resistance of E. coli in the urine samples of patients, 980 urine samples were examined. Of the 195 E. coli isolates, 93.76% were from females, while the remaining were from males. The highest sensitivity was obtained for imipenem. The highest level of resistance in the penicillin family belonged to oxacillin and ampicillin, and in the cephalosporins family, the highest level belonged to cephalothin. Also, the lowest resistance to cefoxitin was obtained. Among the quinolones, the highest resistance was reported for nalidixic acid. Also, the lowest resistance was reported for gentamicin, nitrofurantoin, and cefoxitin, with 8.2%, 8.71%, and 11.79%, respectively. Also, 36.92% of the strains produced ESBL [13]. In another study by Razak et al. [44], 573 urine samples were examined with the diagnosis of urinary tract infection. E. coli was the most common pathogen (37.95%), followed by Klebsiella (21.41%) and Acinetobacter (10.94%), respectively. E. coli was very sensitive to antibiotics nitrofurantoin (81.92%) and amikacin (69.88%) and was very resistant to ampicillin. Klebsiella was very sensitive to imipenem and was reportedly to be very resistant to ampicillin [44], which was consistent with the results of our study.

Overall, the present study’s general results are consistent with previous studies’ results. Despite this, the amount of drug resistance to all kinds of antibiotics in other regions of the world due to genetic changes in the strains that cause resistance, differences in the amount of antibiotic consumption, arbitrary use of antibiotics, differences in the availability of antibiotics, the extent and the new, temporal, spatial, cultural, and health conditions of the studied communities have been different [40]. In addition, the reasons for the observed differences have been previously mentioned. Other factors that may contribute to discrepancies in study results include variations in patient population characteristics, differences in hospitalization conditions and ward types, and variations in the method of drug administration (e.g., oral versus injection).

5 Conclusions

Based on the results of the present study, the most common bacteria causing urinary tract infections were E. coli and Klebsiella. The probability of a positive urine culture result was higher in women than in men. The incidence of urinary tract infections (UTIs) is positively correlated with age, as older individuals are more susceptible to developing these infections. Given the considerable antibiotic resistance demonstrated by bacteria responsible for urinary tract infections in both the present study and recent research, it is recommended that clinicians take this issue into account when devising treatment strategies for affected patients. Moreover, considering the increasing prevalence of antibiotic resistance globally and in Iran, planning and training for correctly using antibiotics in necessary cases and in the correct manner are recommended. In order to better and more accurately investigate the pattern of antibiotic resistance in the province of Kermanshah in Iran, it is suggested to conduct more comprehensive studies with a larger number of samples in different cities of the province and different hospitals.

Availability of data and materials

Not applicable.

Abbreviations

UTI:

Urinary tract infection

E. coli:

Escherichia coli

References

  1. Medina M, Castillo-Pino E (2019) An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol 11:1756287219832172

    Article  PubMed  PubMed Central  Google Scholar 

  2. Uwaezuoke SN, Ndu IK, Eze IC (2019) The prevalence and risk of urinary tract infection in malnourished children: a systematic review and meta-analysis. BMC Pediatr 19(1):1–20

    Article  Google Scholar 

  3. Abbo LM, Hooton TM (2014) Antimicrobial stewardship and urinary tract infections. Antibiotics 3(2):174–192

    Article  PubMed  PubMed Central  Google Scholar 

  4. Foxman B (2003) Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon 49(2):53–70

    Article  PubMed  Google Scholar 

  5. Agency EM (2011) Trends in the sales of veterinary antimicrobial agents in nine European countries (2005–2009). European Medicines Agency, London

  6. Behzadi P, Behzadi E, Ranjbar R (2015) Urinary tract infections and Candida albicans. Central European J Urol 68(1):96–101

    Google Scholar 

  7. Organization WH (2001) WHO global strategy for containment of antimicrobial resistance. World Health Organization

  8. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ (2015) Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 13(5):269–284

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mortazavi F, Shahin N (2009) Changing patterns in sensitivity of bacterial uropathogens to antibiotics in children. Pak J Med Sci 25(5):801–805

    Google Scholar 

  10. Kibret M, Abera B (2011) Antimicrobial susceptibility patterns of E. coli from clinical sources in northeast Ethiopia. African Health Sci 11:40–5

    Google Scholar 

  11. Raj JRM, Vittal R, Shivakumaraswamy SK, Deekshit VK, Chakraborty A, Karunasagar I (2019) Presence & mobility of antimicrobial resistance in Gram-negative bacteria from environmental samples in coastal Karnataka, India. Indian J Med Res 149(2):290

    Article  CAS  Google Scholar 

  12. Davies J, Davies D (2010) Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev 74(3):417–433

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Asadpour Rahimabadi K, Hashemitabar G, Mojtahedi A (2016) Antibiotic-resistance patterns in E. coli isolated from patients with urinary tract infection in Rasht. J Guilan Univ of Med Sci 24(96):22–9

    Google Scholar 

  14. Hejazi F, Ahanjan M, Akha O, Salehiyan M (2018) Phenotypic study of urinary tract infection producing bacteria and antibiotic resistance pattern in diabetic patients. J Mazandaran Univ Med Sci 28(163):38–46

    Google Scholar 

  15. Grigoryan L, Trautner BW, Gupta K (2014) Diagnosis and management of urinary tract infections in the outpatient setting: a review. JAMA 312(16):1677–1684

    Article  PubMed  Google Scholar 

  16. Momtaz H, Karimian A, Madani M, Safarpoor Dehkordi F, Ranjbar R, Sarshar M et al (2013) Uropathogenic Escherichia coli in Iran: serogroup distributions, virulence factors and antimicrobial resistance properties. Ann Clin Microbiol Antimicrob 12:1–12

    Article  Google Scholar 

  17. Niranjan V, Malini A (2014) Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients. Indian J Med Res 139(6):945

    CAS  PubMed  PubMed Central  Google Scholar 

  18. VA ARS, Shenoy S, Yadav T, Radhakrishna M (2013) The antibiotic susceptibility patterns of uropathogenic Escherichia coli, with special reference to the fluoroquinolones. J Clin Diagn Res JCDR 7(6):1027

    Google Scholar 

  19. Meddings JA, Reichert H, Rogers MA, Saint S, Stephansky J, McMahon LF Jr (2012) Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med 157(5):305–312

    Article  PubMed  PubMed Central  Google Scholar 

  20. Razine R, Azzouzi A, Barkat A, Khoudri I, Hassouni F, Charif Chefchaouni A et al (2012) Prevalence of hospital-acquired infections in the university medical center of Rabat. Morocco Int Arch Med 5(1):1–8

    Google Scholar 

  21. Mahmoudi H, Alikhani MY, Arabestani M, Khosravi S (2014) Evaluation prevalence agents of urinary tract infection and antibiotic resistance in patients admitted to hospitals in Hamadan university of medical sciences 1391–92. Pajouhan Scientific Journal 12(3):20–27

    Google Scholar 

  22. Schwartz DJ, Conover MS, Hannan TJ, Hultgren SJ (2015) Uropathogenic Escherichia coli superinfection enhances the severity of mouse bladder infection. PLoS Pathog 11(1):e1004599

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dadgostar P (2019) Antimicrobial resistance: implications and costs. Infect Drug resist. https://doi.org/10.2147/IDR.S234610

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bidell MR, Opraseuth MP, Yoon M, Mohr J, Lodise TP (2017) Effect of prior receipt of antibiotics on the pathogen distribution and antibiotic resistance profile of key Gram-negative pathogens among patients with hospital-onset urinary tract infections. BMC Infect Dis 17(1):1–7

    Article  Google Scholar 

  25. Mirzarazi M, Rezatofighi SE, Pourmahdi M, Mohajeri MR (2013) Antibiotic resistance of isolated gram negative bacteria from urinary tract infections (UTIs) in Isfahan. Jundishapur J Microbiol. https://doi.org/10.5812/jjm.6883

    Article  Google Scholar 

  26. Kornfält Isberg H, Melander E, Hedin K, Mölstad S, Beckman A (2019) Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment. BMC Infect Dis 19(1):1–8

    Article  Google Scholar 

  27. Motamedifar M, Ebrahim-Saraie HS, Mansury D, Khashei R, Hashemizadeh Z, Rajabi A (2016) Antimicrobial susceptibility pattern and age dependent etiology of urinary tract infections in Nemazee Hospital, Shiraz, South-West of Iran. Int J Enteric Pathogens 3(3):1–26931

    Google Scholar 

  28. Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A (2009) Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis 13(2):140–144

    Article  PubMed  Google Scholar 

  29. Raya GB, Dhoubhadel BG, Shrestha D, Raya S, Laghu U, Shah A et al (2020) Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur. Nepal Trop Med Health 48:1–7

    Google Scholar 

  30. Vazouras K, Velali K, Tassiou I, Anastasiou-Katsiardani A, Athanasopoulou K, Barbouni A et al (2020) Antibiotic treatment and antimicrobial resistance in children with urinary tract infections. J Global Antimicrob Resist 20:4–10

    Article  CAS  Google Scholar 

  31. Duicu C, Cozea I, Delean D, Aldea AA, Aldea C (2021) Antibiotic resistance patterns of urinary tract pathogens in children from central Romania. Exp Ther Med 22(1):1–7

    Article  Google Scholar 

  32. Kot B (2019) Antibiotic resistance among uropathogenic. Pol J Microbiol 68(4):403–415

    Article  PubMed  PubMed Central  Google Scholar 

  33. Khodabandeh M, Mohammadi M, Abdolsalehi MR, Hasannejad-Bibalan M, Gholami M, Alvandimanesh A et al (2020) High-level aminoglycoside resistance in Enterococcus faecalis and Enterococcus faecium; as a serious threat in hospitals. Infect Disord Drug Targets (Former Curr Drug Targets Infect Disord) 20(2):223–8

    CAS  Google Scholar 

  34. Fesharakinia A, Malekaneh M, Hooshyar H, Aval M, Gandomy-Sany F (2012) The survey of bacterial etiology and their resistance to antibiotics of urinary tract infections in children of Birjand city. J Birjand Univ Med Sci 19(2):208–215

    Google Scholar 

  35. Motamedifar M, Zamani K, Hassanzadeh Y, Pashoutan S (2016) Bacterial etiologies and antibiotic susceptibility pattern of urinary tract infections at the pediatric ward of Dastgheib hospital, Shiraz, Iran: a three-year study (2009–2011). Arch Clin Infect Dis. https://doi.org/10.5812/archcid.28973

    Article  Google Scholar 

  36. Fallah F, Parhiz S, Azimi L (2018) Distribution and antibiotic resistance pattern of bacteria isolated from patients with community-acquired urinary tract infections in Iran: a cross-sectional study. Int J Health Stud

  37. Molazade A, Gholami M, Shahi A, Najafipour S, Mobasheri F, Ashraf Mansuri J, et al. (2014) Evaluation of Antibiotic Resistance Pattern of Isolated Gram-Negative Bacteria from Urine Culture of Hospitalized patients in Different Wards of Vali-Asr Hospital in Fasa During the Years 2012 and 2013. J Fasa Univ Med Sci/Majallah-i Danishgah-i Ulum-i Pizishki-i Fasa. https://doi.org/10.29252/jmj.12.3.22

  38. Haghgoo SM, Varshochi M, Sabour S, Askari E, Moaddab SR (2014) The prevalence and antibiotic susceptibility pattern of isolated microorganisms from hospitalized patients with heart diseases. J Isfahan Med School. 31(260)

  39. Jarsiah P, Alizadeh A, Mehdizadeh E, Ataee R, Khanalipour N (2014) Evaluation of antibiotic resistance model of Escherichia coli in urine culture samples at Kian hospital lab in Tehran, 2011–2012. J Mazandaran Univ Med Sci 24(111):78–83

    Google Scholar 

  40. Ramazanzadeh R, Moradi G, Zandi S, Mohammadi S, Rouhi S, Pourzare M et al (2016) A survey of contamination rate and antibiotic resistant of Gram-negative bacteria isolated from patients in various wards of Toohid and Besat Hospitals of Sanandaj city during 2013–2014 years. Pajouhan Scientific Journal 14(3):11–19

    Article  Google Scholar 

  41. Laupland KB, Bagshaw SM, Gregson DB, Kirkpatrick AW, Ross T, Church DL (2005) Intensive care unit-acquired urinary tract infections in a regional critical care system. Crit Care 9(2):1–6

    Article  Google Scholar 

  42. Majumder M, Ahmed T, Hossain D, Begum S (2014) Bacteriology and antibiotic sensitivity patterns of urinary tract infections in a tertiary hospital in Bangladesh. Mymensingh Med J 23(1):99–104

    CAS  PubMed  Google Scholar 

  43. Yazdi MKS, Azarsa M, Shirazi MH, Rastegar-Lari A, Owlia P, Mehrabadi JF et al (2012) The frequency of extended spectrum beta lactamase and CTX MI of Escherichia coli isolated from the urine tract infection of patients by phenotypic and PCR methods in the city of Khoy in Iran. J Zanjan Univ Med Sci Health Serv 19(77):53–61

    Google Scholar 

  44. Razak SK, Gurushantappa V (2012) Bacteriology of urinary tract infection and antibiotic susceptibility pattern in a tertiary care hospital in South India. Int J Med Sci Public Health. https://doi.org/10.5455/ijmsph.2012.1.109-112

    Article  Google Scholar 

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Acknowledgements

All the authors are grateful to all the Imam Khomeini Kermanshah Hospital staff for their help and cooperation.

Funding

This work was supported by Kermanshah University of Medical Sciences (Grant number: 98022), Kermanshah, Iran.

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Authors and Affiliations

Authors

Contributions

Author contributions are as follows: MS, AK, and ME were involved in the conceptualization. ME contributed to the data curation. AK and ME contributed to the formal analysis. MS acquired the funding. MS, AK, and ME contributed to the investigation. MS and AK assisted in the methodology. MS contributed to the project administration. MS and AK contributed to the resources. AK and ME contributed to the software. MS, AK, and ME were involved in the supervision. MS, AK, and ME contributed to the validation. AK and ME were involved in the visualization and writing—original draft. ME contributed to the writing—review & editing.

Corresponding author

Correspondence to Mojtaba Esmaeli.

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All precipitants signed a written consent form. Also, the study protocol was approved by the local ethics committee of Kermanshah University of Medical Sciences (IR.KUMS.REC.1398.191).

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Not applicable.

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So far, no conflicts of interest have been reported between the authors.

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Shirvani, M., Keramati, A. & Esmaeli, M. Evaluating the pattern of antibiotic resistance of urinary tract infection (UTI)-causing bacteria in the urine culture samples of patients in the infectious ward of Imam Khomeini Hospital, Kermanshah, in Iran from 2016–2018. Afr J Urol 29, 32 (2023). https://doi.org/10.1186/s12301-023-00364-4

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