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Title: Studies on the epidemiology and pathogenesis of Proteus mirabilis infections of the urinary tract in patients with urostomies
Author: Caliskan, Zeliha
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2005
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Abstract:
Urine samples were collected from 71 urostomy patients over a period 2 years. E. coli was the most stable (stability index 88%) followed by Pr. Mirabilis (72%), Ent. faecalis (55%) and Kleb. pneumoniae (52.5%). Perianal swabs were obtained from 6 patients with Pr. mirabilis urinary infections and 3 of these produced Pr. mirabilis on culture. Urostomy strains of Pr. mirabilis had higher protease, urease and swarming abilities than strains from other sources. The mannose resistant haemagglutination assay revealed that all the 20 urostomy isolates and 15 of the environmental isolates of Pr. mirabilis were positive for MR/P fimbriae. Examination of the sensitivity of Pr. mirabilis isolates to antiseptics revealed that the minimum inhibitory concentration of chlorhexidine ranged from 50-800microg/ml compared to 0.1-0.3microg/ml for triclosan. All urostomy isolates were sensitive to ampicillin, amoxicillin, gentamicin, ciprofloxacin and cefadroxyl. Resistance was confined to trimethoprim (17/30) and nitrofurantoin (30/30). Analysis of the sensitivity of all the Pr. mirabilis isolates revealed an association between resistance to chlorhexidine and the multiplicity of drug resistance. Isolates of Pr. mirabilis from four sources, typed using Dienes typing and pulsed field gel electrophoresis (PFGE), resulted in many different types. Both methods showed that urostomy isolates of Pr. mirabilis were all distinct strains. Cross-infection, therefore, between urostomy patients is rare. Antibody-coated bacteria were found in all the urine samples tested. Serum antibodies to all the isolates tested were high (typically =1:1024). The results of the endotoxin assays indicated that particularly in patients infected with Pr. mirabilis, bacterial lysis and release of endotoxin is occurring in conduit urine.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.583589  DOI: Not available
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