Naslov
Mechanisms of resistance in Gram-negative urinary pathogens: from molecular insights to clinical relevance

Autori
Bedenić, Branka ; Meštrović, Tomislav

Izvornik
Diagnostics (2075-4418) 11 (2021), 5; 800, 15

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, pregledni rad, stručni

Ključne riječi
urinary tract infections ; resistance ; beta-lactamases

Sažetak
Urinary tract infections (UTI) are tthe most frequent hospital infections and the second among community acquired infections after respiratory tract infections. UTI pathogens are prone to acquire various resistance determinants including extended-spectrum beta-lactamases (ESBL), plasmid- AmpC β-lactamases (p-AmpC), carbapenemases belonging to class A, B and D, qnr genes encoding reduced susceptibility to fluoroquinolones and genes encoding enzymes which hydrolyze aminoglycosides. In E. coli and K. pneumoniae the dominant resistance mechanisms are ESBLs belonging to CTX-M, TEM and SHV family, p-AmpC and recently carbapenemases belonging to class A, B and D. OXA- 48 has recently outnumbered other carbapenemases in most EU countries. Urinary P. aeruginosa isolates were shown to possess MBLs and ESBLs belonging to PER and GES family. CHDL asigned to OXA-23-like and OXA-24-like were found in urinary A. baumannii isolates. Identification of resistance mechanisms is based in majority of routine laboratories on phenotypic tests for detection of beta-lactamases such as double-disk synergy test or Hodge test. PCR for detection of resistance genes is done in reference laboratories, mostly for research purposes. The choice of therapy of UTI depends on the type of infection, causative agents, in vitro susceptibility, age of the patient and general condition of the patient. Fluoroquinolones and cotrimoxazole are predominantly used in outpatient setting. The review showed high variety of different resistance mechanisms among urinary isolates. The prevalence of different resistance mechanisms depends on the local epidemiology

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti

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