Study of extended spectrum beta lactamase producing uropathogens and their antibiotic susceptibility pattern (original) (raw)
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Iraqi Journal of Science, 2024
The emergence of antimicrobial-resistant ESBL-producing Escherichia coli and Klebsiella pneumoniae among community-acquired uropathogens represents an important therapeutic challenge. Henceforth, the purpose of the study was to investigate the antibiotic susceptibility patterns of ESBL-producing Escherichia coli and Klebsiella pneumoniae among community-acquired urinary tract infections and then identify the risk factors. Escherichia coli and Klebsiella pneumoniae strains were isolated from patients with symptomatic community-acquired urinary tract infections. The ESBL-producing and antimicrobial susceptibility tests were then performed using the broth microdilution technique. Among 826 Escherichia coli and Klebsiella pneumoniae uropathogens, 17.43% were found to be ESBL producers. According to logistic regression analysis, the risk factors for ESBL-producing community-acquired urinary tract infections are urinary tract infections in the preceding 6 months and recurrent urinary tract infections. All ESBL producers were sensitive to meropenem, followed by imipenem (98.61%), amikacin sulfate (90.28%), and nitrofurantoin (80.56%). Significant ESBL-positive Escherichia coli and Klebsiella pneumoniae were identified which were found to be associated with recurrent UTIs. Meropenem was effective against both ESBL-positive and-negative bacteria.
Increasing trend of antibiotic resistance and expression of Extended Spectrum Beta Lactamases (ESBLs) are serious threats for public health as they render the treatment ineffective. Present study was designed to elucidate the antibiotic-susceptibility patterns of ESBL and non-ESBL producing E. coli and K. pneumoniae causing urinary tract infections so that the ineffective antibiotics could be removed from the line of treatment. Methodology: The bacterial isolates obtained from the urine of patients visiting a tertiary health care facility were cultured for strain identification using API20E. Antimicrobial susceptibility and ESBL detection were done by Kirby-bauer diffusion technique. Results: Almost 53.4% isolates of E. coli and 24.5% isolates of K. pneumoniae were found to be ESBL producers. The ESBL producing bacteria were found to be more resistant towards various antibiotics. The most effective drugs against E. coli ESBL isolates were imipenem (99.54%), ampicillin-sulbactam (97.48%), piperacillin-tazobactam (96.86%), fosfomycin (94.51%), amikacin (92.26%) and nitrofurantoin (90.68%). The most effective drugs against K. pneumoniae ESBL isolates were imipenem (97.62%), piperacillin-tazobactam (95.35%), ampicillin-sulbactam (90.48%) and amikacin (88.37%). The antibiotics having the highest resistance, particularly by the ESBL producers were amoxicillin clavulanic acid, sulphamethoxalzole/ trimethoprim, cefuroxime, cefpirome, ceftriaxone and ciprofloxacin. Most of the isolates showed multi drug resistance (MDR). Conclusion: High frequency of ESBL producing E. coli and K. pneumoniae were observed as compared to previous data. Penicillins, cephalosporins and some representatives of fluoroquinolones were least effective against the common UTIs and are recommended to be removed from the line of treatment.
Uropathogenic Escherichia coli is the main uropathogen involved in community and hospital acquired urinary tract infections. The increased rate of resistance towards different classes of antibiotics limits the treatment options for such infections. This study aim to determine the local resistance rate against different classes of antibiotics that are commonly used in treatment of urinary tract infections. Also to determine the rate of ESBL production and the correlation with other antibiotic resistance among producing isolates. In this study, 112 UPEC isolates were collected from patients who were suffered from symptoms of UTIs, antibiotic susceptibility was determined by disk diffusion method against β-lactams, fluoro-quinolones, folate pathway inhibitors, aminoglycosides, tetracyclines and nitrofurans. Also, Extended spectrum β-lactamase (ESBL) production rate was determined based on the observed reduction in susceptibility towards β-lactams antibiotics in routine susceptibility testing which confirmed using double disk synergy test. The UPEC isolates exhibited increased resistance rate towards different antibiotic classes especially sulphamethoxazole-trimethoprim, fluoro-quinolones and β-lactams which are mainly used in the treatment. About 50% of UPEC isolates were found to be ESBL producing. The ESBL producing isolates exhibited high resistance rate towards non β-lactam antibiotic especially sulphamethoxazole-trimethoprim and fluoro-quinolones (67.8% and 63% respectively.) along with other antibiotics. However, ESBL producing isolates exhibited low resistance against piperacilin-tazobactam, nitrofurantoin, imipenem and meropenem (17.8%, 16%,3.5% and 1.7%, respectively). Therefore, it is recommended to use piperacilin-tazobactam, nitrofurantoin, imipenem or meropenem in treatment of UPEC resistant strains
Prevalence of Multidrug Resistant Uropathogenic E. coli: Role of β-lactamase
International Journal of Current Microbiology and Applied Sciences, 2017
Urinary tract infection (UTI) is one of the most frequent health problems in clinical settings. E. coli is the most prevalent organism causing both community as well as hospital acquired UTI. Uropathogenic E. coli shows increasing rates of resistance to various antibiotics. The frequent and improper usage of antibiotics resulted in the development of resistant strains of bacteria. To determine antimicrobial susceptibility pattern of uropathogenic E. coli isolates and evaluate the production of ESBL (Extended Spectrum β-Lactamases) and AmpC by the multidrug resistant strains. Uropathogenic E. coli strains, over the period of the study, were collected and studied. Antibiotic susceptibility testing was done. Phenotypic detection of ESBL production was done among the multidrug resistant (MDR) strains using the Modified Double Disc Synergy Test (MDDST). All the isolates which showed a synergistic effect with cefepime were further assessed for the production of AmpC enzyme by AmpC disc test. Two hundred non duplicate E. coli strains were recovered during the period of the study. Out of them 139 (69.5%) strains were MDR, of which 129 (64.5%) isolates were found to be ESBL producers (P < 0.001). Pure ESBL production was seen in 98 (49%) isolates, while31 (15.5%) isolates were co-producers of ESBL and AmpC. MDR uropathogenic E. coli becomes prevalent in clinical setting. This is attributed to both ESBLs and AmpC production. It is essential to limit antibiotic consumption and to establish protocol for routine and regular monitoring of ESBL production among clinical isolates.
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.
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.
Innovative publication, 2016
Urinary tract infection (UTI) is one of the commonest infections worldwide. Although, the spectrum of etiological agents causing UTI have not changed but the antimicrobial susceptibility profile among them is changing over time and area specifically along with increase in antimicrobial resistance. Hence, this study was done to analyse the etiological agents and susceptibility pattern of E. coli, the most common UTI pathogen. Antibiotic susceptibility pattern and bacteria isolated from urine of patients who visited hospital between January 1 to December 31, 2015 was done. Bacteria were identified by standard microbiological methods and susceptibility test was done according to Kirby Bauer disc diffusion method. Of 107 urine samples, E. coli 73 (67.7%) was the most common isolate followed by Staphylococcus and Klebsiella spp. Most of E. coli isolates were sensitive to amikacin and nitrofurantoin. Out of total E. coli isolates, 57 were ESBL producers and 28 were MBL producers. The result indicates increase in multidrug resistant strains of E. coli. Further, study indicates the need for periodic monitoring of drug susceptibility pattern in a way to prevent the spread, and development of antimicrobial resistant strains, eventually.
Nepal Medical College journal, 2022
Escherichia coli and Klebsiella spp. are two important uropathogens showing resistance to betalactams by producing extended spectrum beta lactamase (ESBL), leading to difficulty in treating infections with these bacteria. Majority of the ESBLs are of TEM, CTXM, and SHV types reported from Nepal. This study was conducted in Clinical Microbiology Department of Nepal Medical College Teaching Hospital from November 2021 to mid-January 2022 to determine prevalence of ESBL and antimicrobial susceptibility pattern among two common uropathogens. A total of 402 E. coli and Klebsiella spp. isolated from urine samples were included in the study. ESBL producing strains were identified by combination disc method and antibiotic susceptibility testing was done by Kirby Bauer's disc diffusion method. PCR was done to detect the TEM and CTXM genes. Prevalence of ESBL among E. coli and Klebsiella spp. was found to be 14.9% (60/402). Among the E. coli, 16.1% (58/360) and only 4.8% (2/42) of Klebsiella spp. were ESBL producers. Antibiogram showed, 56.7% ESBL producers were susceptible to ciprofloxacin, 46.7% to co-trimoxazole, 96.7% to nitrofurantoin. However, all isolates were susceptible to amikacin, piperacillin-tazobactam, and carbapenems (both meropenem and imipenem). Among total 30 ESBL isolates selected by systematic random sampling, 3 isolates (all three E. coli) showed presence of TEM and 3 other isolates (two E. coli and one Klebsiella spp.) showed CTXM genes.