Background and objectives: Urinary tract infections carry a high risk of recurrence and antibiotic resistance due to biofilm formation. This study aims to identify the common bacterial pathogen responsible for UTI in Erbil setting and identify their pathogenic characteristics and sensitivity to commonly used antibiotics, using the minimal inhibitory concentration (MIC) method.
Methods: 96-flat wells microtiter plate was used for detection of the degree of biofilm formation of E. coli strains isolated from patients with urinary tract infection. Standard breakpoint MIC have been compared with MIC results of antibiotics
Results: Only 5.6% of total samples showed UTI, the most common bacterial isolate was E. coli (43.2%). Around 26% of pyuric cases appeared to be of sterile type. The biofilm formation involved 9.4% strong adhesion. Around 50% of isolates showed beta hemolysis. The most sensitive antibiotics include nitrofurantine (81.3%), gatifluxacin (40.6%) and Ciprofloxacine (37.5%).
Conclusion: Most common pathogens in UTI are E.coli. There was no correlation between biofilm formation and the presence of any of the other virulence factor such as antibiotic resistants and hemolysis. The more effective antibiotics against E.coli in this setting are gatifluxacine, Ciprofloxacin and nitrfuratoin having most MIC fall close to their standard breakpoints.
Keywords: Antibiotic, biofilm, hemolysis, UTI.
1. Vandepitte J, Verhaegen J, Engbaek K, Rohner P, Piot P, Heuck C Basic laboratory procedures in clinical bacteriology 2nd edition. Geneva, WHO; 2003). P30
2. Tullus K, Wingberg J. UTI in Childhood. IN: Urinary Tract Infection. (W. Brumfitt ED.) (1998), PP.175-194. Chpman & Hall Medical, London, New York, Tokyo, Madras. (1998)
3. Foxman B. Epidemiology of Urinary tract infection: Incidience, morbidity, and economic costs. Am J Med 2002; 113:5S-13S
7. Gristina A. Biomaterial-centered infection: microbial adhesion versus tissue integration. Science 1987;237:1588-95.
8. Dieter RS. Sterile pyuria: a differential diagnosis. Compr Ther. 2000; 26(3):150-2.
9. Mabbetta AN, Uletta GC, Wattsa RE, Treea JJ, Totsikaa M, Onga CY, et al. Virulence properties of asymptomatic bacteriuria Escherichia coli. International Journal of Medical Microbiology 2009; 299: 53–63.
10.Schembri MA, Sokurenko EV, Klemm P. Functional flexibility of the FimH adhesin: insights from a random mutant library. Infect Immun 2006; 8: 2638–46.
11.Mathur T, Singhal S, Khan S, Upadhyay DJ, FatmaT, Rattan A. Detection of biofilm formation among the clinical isolates of Staphyloccoci: An evaluation of three different screening methods. Indian Journal of Medical Microbiology 2006: 24 (1): 25-9.
12.JohnsonJR,RobertsPL,StammWE. P fimbriae and other virulence factors in Escherichia coli urosepsis: association withpatients’characteristics. J Infect Dis 1987;156:225–9.
13.Saginur R, Denis MS, Ferris W, Aaron SD, Chan F, Lee C, et al. Multiple combination bactericidal testing of Staphylococcal biofilms from implant-associated infections. Antimicrob Agents Chemother 2006; 50(1): 55–61.
14.Andrews JM. Methods for Antimicrobial Susceptibility Testing (Version 8). J Antimicrob Chemother 2009; 64(3):454-89.
15.Kjall P. Study of cell signaling using bacterial toxin and organic electronic devices, PH.D theses 2007, Karolinska institute.
16.Jantunen ME, Saxen H, Lukinmaa S, Alattouhala M, Siitonen A. Genomic study of pelonephritogenic Escherichia coli isolated from blood, urine and faeces of children with urosepsis. J.Med Microbiol 2001; 50:650-2.
17.Tayal SC, Pattman RS. Sterile pyuria: consider chlamydial infection. Br J Clin Pract. 1996 ; 50(3):166-7.
18.Kelly D, Campbell JI, King TP, Grant G, Jansson EA, Coutts AG, et al. Commensal anaerobic gut bacteria attenuate inflammation by regulating nuclear-cytoplasmic shuttling of PPAR- gamma and RelA. Nat. Immunol 2004; 5:104–12.
19.Anderson GG, Palermo JJ, Schilling JD, Roth R, Heuser J, Hultgren SJ. Intracellular bacterial biofilm-like pods in urinary tract infections. Science 2003; 301: 105–107.
20.Justice SS,Hung C,Theriot JA,Fletcher DA, Anderson GG,Footer MJ, et al. Differentiation and developmental pathways of uropatho- genic Escherichia coli in urinary tract pathogenesis. Proc Natl Acad Sci 2004;101,1333–8.
21.Mysorekar IU,Hultgren SJ. Mechanisms of uropathogenic Escherichia coli persistence and eradication from the urinary tract. Proc Natl Acad Sci 2006; 103: 14170–5.
Background and Objectives: The importance of precordial ST-segment depression in patients with early inferior ST-segment elevation myocardial infarction remain unclear. Many studies have reported that patients with precordial ST-segment depression appear to have large infarctions.
The objectives of this study was to evaluate the effect of precordial ST-segment depression in patients with early inferior ST-segment elevation myocardial infarction on the left ventricular systolic function and left ventricular regional wall abnormalities.
Patients & Methods: Fifty eight patients with first inferior ST-segments elevation myocardial infarction (37 male, 21 female), their ages ranged from 30-91year,mean age 60.59±11.21 who underwent thrombolysis in the Coronary Care Unit of Erbil Teaching Hospital for the period from August 2008 to August 2009 were included in this study. Two-dimensional echocardiography was performed in the first week of acute inferior myocardial infarction. Patients were classified according to the absence (group I, 30 ,51.72%) or presence (group II ,28 , 48.28%) of precordial ST- segment depression .
Results: Group-II patients had a higher significant incidence of left ventricular systolic dysfunction (8,28.57%) than group I (2,6.67%),P=0.027 ,despite thrombolytic therapy (alteplase). Group-II patients had higher significant incidence of left ventricular regional wall abnormalities ( 12,42.9%) than group-I (3,10%),P 0.00 ,despite thrombolytic therapy (alteplase).
Conclusions: Early two-dimensional echocardiography is recommended for patients with inferior ST-segment elevation myocardial infarction associated with precordial ST-segment depression for the earliest detection of regional wall abnormalities and left ventricular systolic dysfunction.
Keywords: Left ventricular systolic function.
Background and objective: Stroke is a worldwide health problem. This study was carried out to find out the risk factors associated with stroke in Erbil city.
Methods: A hospital based case-control study was carried out in Erbil city from January, 1st 2009 to June, 30th 2009. The sample included (173 cases and 173 controls) cases admitted to Erbil teaching hospitals with first-ever stroke diagnosed by the consultant internist or neurologists and confirmed by brain CT-scan. Sex and age-matched (� 5 years) patients admitted to the same hospital, who do not have stroke, were taken as a control group.
Results: The mean � SD ages of cases and controls were 62.2 �13.4 and 61.54 �13.16 years, respectively with a male: female ratio of 1.1:1. Nearly 70% were ischaemic and 30% were haemorrhagic. A slightly more than half (51.45%) of strokes occurred in the 7th and 8th decades of life. Multiple logistic regression analysis revealed statistically significant association between smoking (P<0.001), exercise (P<0.001), hypertension (P=0.001), family history of stroke (P=0.004), BMI (P=0.012) and PCV% (P<0.001) with stroke. However multiple logistic regressions of risk factors for ischaemic and haemorrhagic strokes separately revealed that diabetes was significantly associated with ischaemic stroke (P=0.025) while body mass index was significantly associated with haemorrhagic stroke (P=0.001).
Conclusion: Majority of stroke patients were of older age. The most frequent risk factor among stroke cases were lack of exercise, overweight and obesity and hypertension.
Key words: First-ever stroke, risk factor, Erbil.
1. Park K. Parks textbook of preventive and social medicine. 18th ed. Jabalpur (India): Banarsidas Bhanot Publishers, 2005.