الفهرس 
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Abstract
from July 2016 to March 2017, urine specimens were collected from seven hundred and five patients with symptomatic UTI who attended at Minia university hospitals in Minia governorate. Urine specimens were examined and cultivated; specimens with bacterial counts ≥105 CFU/mL were identified based on their phenotypic criteria.
Antimicrobial susceptibility testing was performed for all Enterobacteriaceae isolates. DNA was extracted from Enterobacteriaceae isolates that were resistant to one or more of the tested quinolones; then DNA was screened for PMQR genes including qnr genes (qnrA, qnrB, qnrS, and qnrC) and the efflux pump gene; qepA by PCR as well as mutations in QRDR of gyrA and parC genes using PCR and subsequent sequencing.
Regarding demographic data of study patients; the study revealed that UTI prevalence was the highest among young adults and in females as wllas in married patients. The infection was more prominent in individuals from rural areas. Unemployed individuals accounted for more than half of the study patients.
The study included 419 outpatients with a percentage of 59.4% and 286 (40.6%) inpatients of whom clinical history data were collected. dysuria (91.1%) was the most frequent complaint followed by increased frequency of micturition (79.9%), suprapubic pain (68.2%) and fever (43.4%). Risk factors for UTI were frequently reported including diabetes (31.6%), presence of urogenital abnormality (23.5%) and history of catheterization in 23.1% of study patients. Recurrence was denoted by 50.1% of patients especially outpatients while history of administration of antimicrobial agents was detected in 32.6% of patients.
Four hundred and forty isolates belonged to Enterobacteriaceae family were confirmed with a percentage of 62.5% of patients. Prevalence of Enterobacteriaceae among HAUTI (73.1%) was higher than CAUTI (55.1%). E-coli was the most common causative organism; representing 281 (63.9%) isolates. The rest of isolates were identified as Klebsiella (18.4), 47 as Citrobacter (10.7%), 11 as Enterobacter (2.5%) and 20 as proteus (4.5%).
Antimicrobial susceptibility pattern of isolated Enterobacteriaceae showed varying levels of resistance to the tested antimicrobial agents and showed a considerable rate of MDR in 31.1% of isolates. The highest resistance was recorded against Sulphamethoxazole-Trimethoprim with a percentage of 57.5% followed by Ceftriaxone (49.3%) while none of isolates were resistant to Imipenem. Of the antimicrobials tested, Enterobacteriaceae isolated from UTI showed a relatively high resistance to each of Amoxicillin clavulanic acid, Ceftazidime with resistance rates of 36.1%, 32.3% respectively. Moderate resistance was observed to Nitrofurantoin (25%) and amikacin (19.1%) while nalidixic acid showed 32.5% resistance. Fluroquinolones including Ciprofloxacin, Ofloxacin and Norfloxacin had an overall resistance rate of 24.8% which decreased down to 15.6% among outpatients (CA-UTI) and increased up to 34.9% among inpatients (HA-UTI).
Regarding PMOR genes; neither qnrA nor qnrC were detected in the studied isolates. QnrB, qnrS and qepA genes were detected in 62.9%, 46.9% and 6.3% of resistant isolates respectively; carriage of PMQR genes was correlated with level of resistance to fluoroquinolones. The majority of studied Enterobacteriaceae isolates showed a QRDR region with mutations in codons 83 or 87 of the gyrA gene and codon 80 of parC gene (Ser80Ile).