beta-lactam susceptibility of Escherichia coli isolates from urinary tract infections exhibiting different resistance phenotypes (original) (raw)
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A review: E.coli Resistance towards Beta-lactam Antibiotics
Background: Escherichia coli is a gram-negative, coccobacillus, and facultative anaerobes bacterium. E.coli is the main pathogenic bacteria that cause infection in outpatient and inpatient. E. coli causes 85% of UTIs (Urinary Tract Infections) and about 50% of nosocomial infections. E.coli also causes other infections such as diarrhea, sepsis, and meningitis. Antibiotics resistance has become a global health issue. It causes 150 000 death worldwide. The aim of this literature review is to study the scientific literature related to research on E.coli resistance towards beta-lactam antibiotics from clinical samples in various hospitals in 2010-2020. Method: The method of this review was by collecting various primary literatures such as international journals published in the last 10 years (2010-2020) from the official websites. Result: Antibiotics resistance of ten beta-lactam antibiotics tested was obtained. The percentage of antibiotics resistance in each antibiotics were as follow : penicillin 100 %; ampicillin 72,82%; amoxicillin 90,86 %; cefotaxime 83,8 % ; cefuroxime 79,56 % ; cefixime 80,87 %; cefazolin 92,43 %; ceftazidime 76,96 %; ceftriaxone 71,90 %; and Imipenem 22,78 %. Conclusion: The highest level of resistance was penicillin with 100 % and the lowest was Imipenem at 22,78 %.
Antimicrobial agents and chemotherapy, 1999
The activities of ampicillin-sulbactam and amoxicillin-clavulanate were studied with 100 selected clinical Escherichia coli isolates with different beta-lactam susceptibility phenotypes by standard agar dilution and disk diffusion techniques and with a commercial microdilution system (PASCO). A fixed ratio (2:1) and a fixed concentration (clavulanate, 2 and 4 micrograms/ml; sulbactam, 8 micrograms/ml) were used in the agar dilution technique. The resistance frequencies for amoxicillin-clavulanate with different techniques were as follows: fixed ratio agar dilution, 12%; fixed concentration 4-micrograms/ml agar dilution, 17%; fixed ratio microdilution, 9%; and disk diffusion, 9%. Marked discrepancies were found when these results were compared with those obtained with ampicillin-sulbactam (26 to 52% resistance), showing that susceptibility to amoxicillin-clavulanic acid cannot be predicted by testing the isolate against ampicillin-sulbactam. Interestingly, the discrimination between ...
MEDICC Review
INTRODUCTION Urinary tract infection is the second-leading reason for consults in primary health care. Bacterial urinary tract infections are the most common, of which Escherichia coli is the main etiologic agent. Antimicrobial resistance and multidrug resistance complicate eff ective community treatment, especially if resistance is caused by extendedspectrum beta-lactamase production. WHO recommends that antimicrobial susceptibility be evaluated in diff erent regions of the world at diff erent times. Community-acquired E. coli's susceptibility to colistin has not yet been studied in Cuba, and mcr-1 gene screening is necessary. OBJECTIVE Evaluate community-acquired uropathogenic E. coli isolates' susceptibility to antibiotics, including colistin, and identify extended-spectrum beta-lactamase-producing bacteria. METHODS We conducted a descriptive cross-sectional study that included 281 community-acquired uropathogenic E. coli isolates (153 from the Isle of Youth Special Municipality's Hygiene, Epidemiology, and Microbiology Center and 128 from Microbiology Laboratories of 7 institutions in Havana) from June 2016 through July 2018. We used the disk diff usion method to determine susceptibility to ampicillin, ampicillin/ sulbactam, cefazolin, trimethoprim/sulfamethoxazole, ciprofl oxacin, nitrofurantoin and fosfomycin. The disk elution method was used to determine susceptibility to colistin. The combined disk method was used to identify extendedspectrum beta-lactamases. Estimates were made regarding the frequency and percentages of antimicrobial susceptibility and resistance, as well as multidrug-resistance patterns. RESULTS Of the 281 isolates, 68.3% (192/281) were resistant to ampicillin, 54.8% (154/281) were resistant to ciprofl oxacin, and 49.5% (139/281) were resistant to trimethoprim/ sulfamethoxazole. Resistance to colistin was not detected. On the other hand, 14.2% (40/281) were susceptible to the 8 antibiotics we evaluated, 22.1% (62/281) showed resistance to only 1 antibiotic, and 63.7% (179/281) were resistant to 2 or more antibiotics. In the extended-spectrum beta-lactamase determination, 34.5% (97/281) had inhibition zones ≤14 mm with cefazolin. Of those with inhibition zones, 64.9% (63/97) were positive in the phenotype test, and 35.1% (34/97) were negative. In extended-spectrum beta-lactamaseproducing bacteria, 1.6% (1/63) were resistant to fosfomycin, and 3.2% (2/63) were resistant to nitrofurantoin. The most common multidrug-resistance pattern (22.9%; 30/131) was to ampicillin/sulbactam, ampicillin, cefazolin, ciprofl oxacin, and trimethoprim/sulfamethoxazole. CONCLUSIONS Uropathogenic E. coli resistance to the antibiotics most frequently used in community medical practice is quite common, and extended-spectrum beta-lactamaseproducing bacteria is the mechanism for beta-lactam antibiotic resistance. Multidrug-resistance patterns include resistance to the antibiotics most used in community-acquired infections. Fosfomycin and nitrofurantoin are the most active in extendedspectrum beta-lactamase producing bacteria. All the isolates were susceptible to colistin.
JOURNAL of CLINICAL AND DIAGNOSTIC RESEARCH, 2013
Background and Objective: Urinary Tract Infections (UTIs) are mostly caused by Escherichia coli. The appropriate therapy demands a current knowledge on the antimicrobial susceptibility pattern amongst these pathogens, as an inappropriate use of antibiotics may lead to complications and treatment failure. The UTIs which are caused by multidrug resistant Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria further pose a severe problem, as the treatment options are limited. The aim of this study was to identify the pattern of multi drug resistance amongst the uropathogenic E. coli (UPEC) isolates which were obtained from hospitalized patients. Materials and Methods: Forty UPEC were isolated from 200 urine samples of hospitalized patients who were clinically suspected for UTIs. Antimicrobial susceptibility screening was performed by using 16 antibiotics, by the Kirby Bauer disk diffusion technique. The isolates which were resistant to the third generation cephalosporins were subjected to the ESBL confirmatory test by using drug and drug-inhibitor combination disks by following the CLSI guidelines. Results: All the 40 isolates except three were multidrug resistant. They showed the highest sensitivities for nitrofurantoin (72.5%) and amikacin (70%). A high level of resistance was observed against ampicillin (97.5%), nalidixic acid and cefelexin (95%), amoxicillin (92.5%), cotrimoxazole (82.5%) and ciprofloxacin (80%) respectively. Thirty different antibiotic resistance patterns were observed against the different antibiotics. Twenty-eight out of the 40 isolates were resistant to the third generation cephalosporins. However, the phenotypic test for the ESBL confirmation indicated that eighteen out of the twenty-eight isolates were ESBL producers and that eleven different drug resistance patterns were observed amongst them. Conclusions: Therefore, this study accounts for the varied multidrug resistance pattern amongst the uropathogenic E. coli which were isolated from hospitalized patients in Kolkata, an eastern region of India. Nitrofurantoin and amikacin should be assigned as potent drugs to treat this infection in this region of the country. These varied resistance patterns present major therapeutic and infection control challenges and they suggest a heterogeneous population of the uropathogenic E. coli isolates which circulate in this sector of India.
Introduction Extended spectrum beta lactamases (ESBL) enzymes were first described in Germany in 1983 from Klebsiella pneumonia. ESBL enzymes are usually plasmid mediated and gain broad resistance to cephalosporins: (cefotaxime, ceftazidime, ceftriaxone), and monobactams (aztreonam). 1 A new class of ESBL, called CTX-M enzymes, has emerged during late 1990 and early 2000s, which was widely detected among Escherichia coli (E. coli) isolates. These ESBL-producing E. coli are able to resist penicillins, cephalosporins and are found mostly in urinary tract infections (UTI). 2,3 ESBL-producing strains can also display multi-drug resistance (MDR), including resistance to aminoglycosides and fluoroquinolones. Therefore, therapeutic options for these strains are limited. 4-6 Continuous exposure of such bacterial strains to ß-lactams could induce mutation and production of new ß-lactamases, expand their activity even against the fourth generation cephalosporins. Thus, these new ß-lactamases are called extended spectrum ß-lactamases. 7 ESBL-producing Background and objective: Bacterial resistant to broad spectrum β-lactams, which is mediated by the extended spectrum beta lactamase enzyme, has emerged recently as increasing problem. Extended spectrum beta lactamase producing strains can also displaying multi-drug resistance. Thus, increased number of infections due to these strains is a public health issue associated with high morbidity, mortality, high health-care costs and prolonged hospitalization. Therefore, this study aimed to evaluate multi-drug resistance among extended spectrum beta lactamase producing E. coli causing urinary tract infections. Methods: A total of 400 mid-stream urine specimens were collected from patients with urinary tract infection. Disk diffusion agar method on Muller-Hinton agar plates was carried out. Double Disc Synergy Test was used for detection of extended spectrum beta lactamase producer. All the isolates that were screened out for extended spectrum beta lactamase production were also subjected to confirmation by using the Phenotypic Confirmatory Combination Disc Diffusion Test. Results: The urinary tract infection cases were mainly due to Gram negative bacteria (87%). E. coli was isolated from 195 (48%) specimens. Sixty isolates of E. coli (31%) were found to be extended spectrum beta lactamase producers. The resistance to antibiotics tested was significantly higher (P <0.001) among extended spectrum beta lactamase producing E. coli isolates compared with non-extended spectrum beta lactamase producing isolates. Conclusion: The prevalence of multi-drug resistance to the antibiotics among extended spectrum beta lactamase producing E. coli isolates was established. Imipenems are recommended for the treatment of serious infections caused by these organisms.
2005
A Functional Classification Scheme for B-Lactamases Urinary tract infections are subdivided into urethritis, cystitis, prostatitis and pyelonephritis according to the localisation of infection. According to the type of infection, they can be divided into symptomatic, asymptomatic, acute (first or single), recurrent, chronic, complicated and uncomplicated infections. Clinical symptoms of acute, uncomplicated infections such as cystitis and leucocyturia in young women are sufficient reason for the early initiation of a three-day empirical antimicrobial therapy. Urine culture should be carried out prior to the initiation of antimicrobial therapy especially in pregnant women, diabetics, recurrent UTIs and in the case of unsuccessful prior treatment in patients with pyelonephritis. All symptomatic UTIs, as well as asymptomatic bacteriuria in pregnant women, diabetics and, preschool children must be treated. All Patients are given prophylaxis prior to urologie-gynaecologic surgery. In complicated UTIs it is especially important to determine and eliminate, or at least control, the factors that complicate UTIs. Antimicrobial agents suitable for UTI therapy include fluoroquinolones, co-trimoxazole, p-Iactam antibiotics, aminoglycosides and nitrofurantoin. Tetracycline, quinolones, nitroimidezole macrolides, and azalides in cases of sexually transmitted infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae (N. gonorrhoeae); Trichomonas vagina/is (T. vagina/is) and Ureap/asma urealyticum. Cystitis is treated for 1-3 days or 7 days, asymptomatic bacteriuria for 3-7 days, uncomplicated pyelonephritis for 10-14 days and bacterial prostatitis for 2-4 weeks. Recommended duration of therapy for chronic and complicated UTIs is 7-14 days. In some patients, therapy can last for several weeks, even up to six months. Chemoprophylaxis in recurrent, uncomplicated UTIs should be given for at least six months (8). Bacteriuria is common in pregnancy. If left untreated, asymptomatic bacteriuria will lead to acute pyelonephritis in 20-30% of cases. This may result in low birth weight infants, premature delivery and occasionally, stillbirth. Therefore, it is a serious threat for the mother and unborn child. Bacteriuria is associated with a 50% increase in the risk of premature delivery, pre-eclampsia, hypertension, anaemia and post-partum endometritis. Effective treatment of asymptomatic bacteriuria significantly reduces the incidence of pyelonephritis, premature deliveries and low birth weight infants. Before agents are prescribed in pregnancy, it is essential to ensure that they are safe for both the foetus and the mother. J3-lactam antibiotics such as' nitrofurantoin, ampicillin, amoxicillin and cephalosporins are frequently used. Studies have shown that the pharmacokinetics of some p-Iactam antibiotics is altered during pregnancy, resulting in faster renal elimination and lower plasma concentrations of these drugs. Therefore, the dose should be increased in pregnancy for these drugs (9). 1.4 BETA-l.ACTAM RESISTANCE Beta-Iactam antibiotics are the most frequently prescribed antibiotics in the world. Resistance to this important class of antibiotics poses a very complex problem (lO). Many strains of E. coli are resistant to a wide range of p-Iactam antibiotics. Initially the use of Il. French CL et al., (1996): Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-laetam beta-lactamase-inhibitor combinations by hyperproduction of SHV-5 beta-lactamase,
2020
Escherichia coli (E.coli) species are able to produce extended-spectrum β-Lactamase (ESBLs) that cause high resistance to the beta-lactam antibiotics. Present study was undertaken to know the occurrence of ESBLs productions in E.coli and to determining the antibiotic susceptibility patterns in resistant organisms for suitable therapeutic approaches. Clinical specimens of urine were collected from patients attending the Medical Microbiology Laboratories at Surat. Urine culture was done by conventional microbiological techniques. Isolation and identification of E. coli was carried out by standard procedure. Antibiotic sensitivity was done by the Kirby Bauer method. Production of ESBLs was detected by phenotypic confirmatory tests. During the study period 1500 urine samples were processed. Totally, 125 clinical isolates of E.coli were isolated and identified. ESBLs production was seen in 66% of isolates. All the ESBLs producing isolates were multidrug resistant (drug resistant to≥3 dru...
2006
S U M M A R Y A high prevalence of β-lactams resistance among Enterobacteriaceae have been reported worldwide; however, there are not sufficient data on this issue in Algeria. β-Lactams susceptibility of 203 Escherichia coli clinical isolates was determined by agar diffusion method, and production of extended-spectrum β-lactamases (ESBL) was screened by double-disk synergy test. This analysis showed five well-defined phenotypes: 1) 62 isolates (30.5%) were susceptible to all β-lactams; 2) 135 isolates (66.5%) presented a broad-spectrum β-lactamases phenotype (BSBL); 3) three isolates (1.5%) were defined as producing ESBLs; 4) two isolates (1%) were AmpC cephalosporinase producers; and 5) one isolate (0.5%) presented a phenotype of cell-decreased permeability to β-lactams. Isoelectric focusing revealed β-lactamases with isolectric points of 5.4 or 7.6 for isolates with BSBL phenotype; ∼9.0 for two ESBL isolates; 5.4, 7.6 and ∼9.0 for the remaining ESBL isolate; and 5.4 and ∼9.0 for the AmpC isolates. The cefotaxime hydrolysis corresponds to the basic bands with an isoelectric point of ∼9.0. Conjugation assay showed transfer of penicillinase and AmpC resistance phenotypes and their corresponding β-lactamases to recipient E. coli BM21 in association with plasmids of 71.4 kb for the AmpC isolates and from 40-56 kb for penicillinase isolates. This result showed that the AmpC phenotype is plasmid mediated. ESBL isolates were found not to transfer their resistance through conjugation experiment. Polymerase chain reaction (PCR) experiments using primers specific to bla TEM , bla AmpC and bla CTX-M genes showed specific amplification with bla CTX-M primer for two ESBL isolates; bla TEM and bla CTX-M for the remaining ESBL isolate; and bla TEM and bla AmpC for the AmpC isolates and their corresponding transconjugants. The study showed a high rate of isolates producing penicillinase, and low frequencies of AmpC and ESBL phenotypes. AmpC β-lactamases were plasmid mediated, and ESBLs belong to the CTM-M type.
2012
Escherichia coli (E.coli) species are able to produce extended-spectrum β-Lactamase (ESBLs) that cause high resistance to the beta-lactam antibiotics. Present study was undertaken to know the occurrence of ESBLs productions in E.coli and to determining the antibiotic susceptibility patterns in resistant organisms for suitable therapeutic approaches. Clinical specimens of urine were collected from patients attending the Medical Microbiology Laboratories at Surat. Urine culture was done by conventional microbiological techniques. Isolation and identification of E. coli was carried out by standard procedure. Antibiotic sensitivity was done by the Kirby Bauer method. Production of ESBLs was detected by phenotypic confirmatory tests. During the study period 1500 urine samples were processed. Totally, 125 clinical isolates of E.coli were isolated and identified. ESBLs production was seen in 66% of isolates. All the ESBLs producing isolates were multidrug resistant (drug resistant to≥3 drugs). This study reveals existence of high percentage ESBLs producing E .coli as well as MDR E.coli. Hence, constant revision of antibiotic polices with infection control interventions are necessary for interruption of the transmission of these endemic isolates