title: Clinical analysis of bacterial strain profiles isolated from urinary tract infections: A 30-year study.
abstract: OBJECTIVE
  We analyzed bacterial strains isolated from urine samples of patients with urinary tract infections (UTI) at Okayama University Hospital over a 30-year period to characterize trends in species and antimicrobial susceptibilities.
  
  
  METHODS
  Clinical isolates were collected from in- and out-patients with pyuria and bacteriuria who were treated between 1984 and 2014 (one episode per patient and plural isolates were counted in polymicrobial infection). We examined these isolates to identify pathogens and tested for antimicrobial susceptibility.
  
  
  RESULTS
  Isolates from complicated UTI over a 30-year period revealed Pseudomonas aeruginosa (P. aeruginosa) was the most frequently isolated in the first decade (1984-1994), MRSA in the second decade (1995-2004), and Escherichia coli (E. coli) in the latest decade (2005-2014). In uncomplicated UTI examined over 20 years, E. coli was the most frequently isolated species accounting for 47-94% of isolates. Fluoroquinolone (FQs)-insusceptible E. coli were first isolated in 1994 and increased to about 35% in 2013 in patients with complicated UTI.
  
  
  CONCLUSIONS
  Complicated UTI involving P. aeruginosa and MRSA decreased over the last 10 years. Our data suggest that several factors such as shorter hospitalizations, shorter indwelling catheter use, and appropriate antimicrobial use has decreased colonization of P. aeruginosa and MRSA with relative increases in isolation of E. coli including FQs-insusceptible strains. We must continue our surveillance of antimicrobial-resistant bacteria isolated from urine samples and evaluate antibiograms, since their persistence in the urinary tract would be problematic.
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Electronic address: gmd17055@s.okadai.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Urology, Abiko Toho Hospital, 1851-1 Abiko, Abiko 270-1166, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Uehara
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Masumi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Sadahira
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Mitsuhata
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Motoo
authors.initials: M
authors.lastname: Araki
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Ayano
authors.initials: A
authors.lastname: Ishii
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Kariyama
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Nasu
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Okayama Urological Research Group (OURG), 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kumon
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001437:Bacteriuria / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D008137:Longitudinal Studies; D008826:Microbial Sensitivity Tests; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D011776:Pyuria / Q000382:microbiology; D014552:Urinary Tract Infections / Q000382:microbiology* / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Antibiogram; Antimicrobial susceptibility; Fluoroquinolone-insusceptible Escherichia coli; Urinary tract infection