Isolation and Identification of UTI Causing Agents and Frequency of ESBL (Extended Spectrum Beta Lactamase) in Pakistan (original) (raw)
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Prevalence of ESBL Producing Bacteria in Community-Acquired UTI from Eastern Part of India
Journal of Pure and Applied Microbiology
Urinary tract infection (UTI) in the community is a common infection in humans. The causative microorganisms for UTIs may vary in different places and also vary in their antibiotic sensitivity and resistant patterns. This study aimed to find out the incidence of gram-negative bacteria along with their antibiotic sensitivity pattern in community-acquired UTIs and to calculate the existence of Extended-spectrum beta-lactamase (ESBL) positivity among them. A Sum of 515 urine samples was tested and the causative organisms were identified. Antibiotic susceptibility tests were executed where it had shown growth for bacteria by both manual and automated methods. ESBL tests were performed to identify ESBL-producing isolates. From a total of 515 samples, 65 (12.65%) were culture positive for UTIs. The rate of infection was higher in females than in males. The most prevailing bacteria were Escherichia coli and Klebsiella pneumoniae. Out of total culture-positive isolates, only 43.08% were ESB...
Study of Magnitude of Uti Caused by Esbl-Producing Escherichia Coli and Associated Risk Factors
Asian Journal of Pharmaceutical and Clinical Research
Objective: Globally, urinary tract infections (UTIs) caused by Escherichia coli that produce extended-spectrum lactamase (ESBL) have become more common. Our study determined the magnitude of UTI occurring due to ESBL-producing E. coli and associated risk factors. Different methods for their phenotypic detection were also compared. Methods: Uropathogenic E. coli isolated in significant numbers were assayed microbiologically. E. coli isolates (n=247) that were found significant in number tested for ESBL production using three different phenotypic methods: Phenotypic combined disk diffusion test (PCDDT), double-disk approximation test (DDAT), and E-test for ESBL production. An antibiotic susceptibility test was performed for different antibiotics. Various risk factors associated with UTIs were correlated with ESBL- and non-ESBL-producing E. coli. Results: We found that diabetes mellitus type 2 was the most common risk factor for UTI caused due to ESBL-producing E. coli (25%). Pregnant ...
International journal of reproduction, contraception, obstetrics and gynecology, 2018
Urinary tract infection (UTI) is one of the most common bacterial infection in women and responsible for significant morbidity and health care costs. It is a common problem in pregnancy due to morphological and physiological changes that takes place in genito-urinary tract during pregnancy. Asymptomatic bacteriuria (ASB) is the presence of actively multiplying bacteriuria of more than 10 5 /ml of urine without any symptom. Escherichia coli is the primary urinary tract pathogen accounting for 74 to 90% of uncomplicated urinary tract infection. Other bacteria include Staphylococcus saprophyticus, Klebsiella spp, Proteus spp, Enterococcus spp and ABSTRACT Background: Urinary tract infection (UTI) is a common bacterial infection in women. It is very common during pregnancy and may present as asymptomatic bacteriuria. Escherichia coli is the primary urinary pathogen accounting for 74-90% of uncomplicated urinary tract infection. The aim of the study was to evaluate in-vitro antibiotic susceptibility among urine isolates of Escherichia coli and prevalence of resistance marker like ESBL producer and MDR status. Methods: Mid-stream urine samples of 205 female patients were processed for culture and sensitivity. All the samples were inoculated on culture media and growth showing significant bacteriuria (>10 5 cfu/ml) were subjected to identification and antibiotic sensitivity testing on Automated system BD Phoenix 100. ESBL status was detected by the system and MDR status was evaluated by standard guidelines. Results: Out of 205 urine samples, 47 samples (22.93%) showed growth of organism. Out of the 47 growth positive samples, 36 (76.60%) samples showed growth of Escherichia coli and out of which 13 (36.11%) were ESBL producer and 23 (63.89%) were ESBL non-producer. Escherichia coli was mostly isolated from younger age group (21-40 years) (61.11%). Antimicrobial susceptibility showed very good sensitivity towards Amikacin, Tigecycline, Carbapenems, Fosfomycin, Piperacillin-tazobactam and Nitrofurantoin. All the isolates of ESBL producer are MDR (100%) and 21.7% of ESBL non-producer are MDR. There is evidence of transfer of resistance genes for non-βlactam antibiotics along with ESBL resistance marker. Conclusions: Escherichia coli was the predominant uropathogen isolated from female patients and Amikacin, Nitrofurantoin and Fosfomycin can be used as first line drug.
Urinary tract infections (UTIs) are one of the most commonly presented infections among men and women as they acquire it at least once in their lifetime and disease can recur. In recent era, one of the challenges faced by humans is progressively increasing dissemination of antimicrobial resistance among pathogens causing UTIs and other diseases. A hospital-based investigation was carried out including 200 UTI patients affirmed by clinicians. Samples selected based on initial screening by nitrite test were cultured and gram-stained. 161 isolates of gram-negative bacteria were characterized based on morphological and biochemical analysis. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion method against 16 selected antibiotics. Genotyping was done for blaTEM and blaCTX-M by PCR. Out of the 161 isolated gram-negative bacteria, E. coli (N=116, 72%) was the most common followed by Klebsiella oxytoca (N=22, 13%), Klebsiella pneumoniae (N=14, 9%), Proteus mirabilis (N...
BIRDEM Medical Journal, 2017
Background: Urinary tract infection (UTI) due to extended-spectrum beta-lactamase (ESBL) producing organisms are increasing. This study was designed to evaluate the frequency of ESBL-positive Escherichia coli and Klebsiella pneumoniae causing UTI, their antibiotic sensitivity pattern and possible risk factors. Methods: This case-control study was done in BIRDEM General Hospital, Dhaka, Bangladesh from January to March 2016. Patients with UTI due to ESBL-positive E. coli and K. pneumoniae were cases and non-ESBL organisms were controls. Results: Total 98 patients with UTI due to E. coli (84) and K. pneumoniae (14) were eligible for analysis. Twothirds of E. coli (56/84, 66.7%) and two-fifths of K. pneumoniae (6/14, 42.9%) were ESBL-positive (cases, 62) and rest 36 patients were controls (UTI due to non-ESBL E. coli or K. pneumoniae). There was no significant difference in relation to age (p=0.757), sex (p=0.548), presence (p=0.696), duration (p=0.050) or control of diabetes (p=0.448) between cases and controls. Regarding risk factors responsible for UTI due to ESBLpositive organisms, long duration (≥5 years) of diabetes was significant (OR=6.87, 95% CI=2.34-20.16, p=0.0004). On multivariate logistic regression, presence (p=0.002) and long duration of diabetes (p=0.002), past history of UTI (p=0.004) and history of hospitalization due to UTI (p=0.005) appeared as significant risk factors for UTI due to ESBL-positive E. coli or K. pneumoniae. Imipenem, amikacin, gentamycin and nitrofurantoin were among the most sensitive antibiotics. Conclusion: Almost two-thirds of the UTI cases were due to ESBL-positive organisms in this study. Imipenem, aminoglycosides and nitrofurantoin were among the most sensitive antibiotics. Long duration of diabetes, past history of UTI and hospitalization due to UTI were significant risk factors for ESBL-positivity.
2022
Background: The occurrence of Extended-Spectrum Beta-Lactamases (ESBLs) producing Escherichia coli in urinary tract infections is becoming a serious problem and poses unique challenges to clinical microbiologists, clinicians, infection control professionals and antibacterial-discovery scientists. Clinical outcomes data indicate that ESBLs are clinically significant and, when detected, indicate the need for the use of appropriate antibacterial agents. That is why it is vital to understand the prevalence and resistance profile of such isolates in order to create an effective treatment plan. Objectives: We aimed to assess the ESBL producing E coli isolates from Urinary Tract infected patients of South Asian Countries and to study the antimicrobial resistance patterns of the ESBL producing E coli in Urinary Tract infected patients. Methods: From 12 to 17th September 2021, we searched online databases (Pubmed and Google scholar) for published studies of ESBL producing isolates with UTI infected patients from South Asian countries including Nepal, India, Pakistan, Bangladesh and Sri Lanka. Primarily, articles were searched and screened on the basis of title, abstract and availability of full texts by all the researchers and finally the information extracted from 17 articles were stored in Microsoft excel 2013. For search, we used the keywords like: ‘Extended-Spectrum Beta-Lactamase’ or ‘ESBL’ or ‘ESBL-producers’ or ‘Enterobacteriaceae’ or ‘UTI’ or ‘CTX-M’ or ‘TEM’ or ‘SHV’ or ‘South Asia’ or ‘SAARC’ or ‘Nepal 'or ‘Bangladesh’ or ‘India’ or ‘Pakistan’ or ‘Sri-Lanka’. Results: A total of 17 full text articles published from year 2009 to 2021 from different South Asian countries (Nepal, India, Bangladesh, Pakistan and Sri Lanka) were included for the review. The pooled studies included a total of 31961 urine samples from UTI patients of which 3536 samples were reported to be E coli. On phenotypic confirmation, 1078 out of 3536 E coli were confirmed to be ESBL producer. Two out of 17 (11.76%) articles have considered molecular detection of ESBL producing E coli. Nepal was found to report the highest percentage of ESBL producing E coli i.e. 69.2% followed by Bangladesh (15.21%), India (7.14%), Sri Lanka (6.12%) and Pakistan (2.32%). Conclusion: This study suggests E coli to be the dominant ESBL producing uropathogen in South Asian region. So there is an increasing need for periodic monitoring of drug susceptibility pattern to prevent the spread and development of antimicrobial resistant strains and ESBL producers.
2009
Urinary tract infections (UTI) are the most prevalent infections worldwide, mostly caused by Escherichia coli. These bacteria also produce enzymes called extended spectrum β β β β-lactamases (ESBL) which render penicillins and cephalosporins inactive. The present study included 116 E. coli, isolated from urine of in-patients suffering from UTI. Antibiotic susceptibility testing and ESBL detection were carried out according to Clinical Laboratory and Standards Institute (CLSI) criteria. Fifteen antibiotics were tested in this study. A total of 66 (56.9%) isolates were found to be ESBL producers. A total of 83% isolates were resistant to 4 or more antibiotics. Imipenem and meropenem showed high potency with 98 and 97% isolates being susceptible, respectively. Susceptibility to gentamicin was 48%, kanamycin 43%, both ofloxacin and enoxacin 38%, ciprofloxacin 35%, doxycycline 18% and to co-trimoxazole only 17%. This study reveals that E. coli isolated from UTI in this region are multi-drug resistant and produce ESBL in large proportions.
Journal of Ancient Diseases & Preventive Remedies
Background: Urinary tract infections caused by Extended Spectrum Beta-Lactamase producing organisms (UTI-ESBL) are increasing in incidence and pose a great threat to modern medicine. The objective of this study was to assess the prevalence and risk factors of Extended Spectrum Beta-Lactamase (ESBL)-producing uropathogens among patients with urinary tract infections in the north of West Bank and to determine the antimicrobial susceptibility profile of the isolated bacteria. Methods: A total of 427 patients who were attending the governmental hospitals in the northern cities of the West Bank were included in the study. They were older than 12 years and diagnosed with UTI in the period from June 2017 to September 2017. Isolated bacteria was collected from the microbiology labs of the respective hospitals and tested for the ESBL production and their antibiotic susceptibilities were determined. Information regarding the risk factors was collected from the patient ' s medical records. Univariate analyses were performed for potential risk factors for the development of UTI-ESBL, and then multivariate analyses were performed for all significant variables. Results: Out of the 427 urine cultures screened for ESBL, 163 (38.4%) were confirmed to be ESBL producers. E. coli was the most frequent uropathogen. K. pneumoniae produced the highest rate of ESBL (54.9%), followed by E. coli (42.5%), and Proteus mirabilis (7.14%). Patients with recurrent UTI had 5 times relative risk of having ESBL producing uropathogens (odd ratio (OR), 4.7) followed by previous antibiotic use (OR, 3.07), hemodialysis (OR, 2.92), chronic kidney disease (OR, 2.69) and finally diabetes mellitus (OR, 1.87). ESBL isolates were susceptible to fosfomycin (100%), nitrofurantoin (93.9%), pipracillin/tazobactam (94.5%), ertapenem (98.2%), meropenem (98.8%), and amikacin (93.9%). Conclusion: The prevalence of ESBL-producing uropathogens was 38.4%. Recurrent UTI appeared to be the strongest risk factor for ESBL-UTI. ESBL-producing uropathogens were highly susceptible to amikacin, nitrofurantoin, and much more to fosfomycin and piperacillin/tazobactam in addition to carbapenems.
Cureus, 2021
Background: Management of community-acquired urinary tract infection (CA-UTI) relies heavily on empirical antibiotic therapy. Knowledge of the proportion of drug-resistant isolates especially extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli), and various risk factors for acquisition are essential. Method: Outpatient-treated CA-UTI cases were enrolled (continuously for three months), and microbiological analysis of urine sample was performed for significant bacterial growth followed by identification of conventional and matrix-assisted laser desorption/ionization-time of flight (MALDI-ToF) spectrometry method. Subsequent drug resistance and phenotypic ESBL detection were as per guidelines of the Clinical Laboratory Standard Institute (CLSI, USA). Univariate and multivariate analyses (logistic regression) of known and relevant risk factors of ESBL E. coli were performed as per standard statistical technique, using the SPSS computer package (IBM Corp., Armonk, NY). Results: Two hundred and forty-one samples (of 694 samples) yielded significant growth. Sixty-one of 131 (46.6%) E. coli isolates were found to be ESBL producers. Non-beta-lactam antibiotic resistance in ESBL producers was high compared to non-ESBL producers (e.g., 88.5% vs 42.3% for quinolone resistance, 80.3% vs 34.3% for gentamicin resistance, etc.). Multivariate analysis (after univariate analysis detected probable factors of a likely ESBL model) indicated significant associations of ESBL-producing E. coli with advancing age (>55 years), prior hospitalization in last one year, use of antibiotics in previous six months, and presence of comorbid illness such as diabetes mellitus and chronic lung disease. Conclusion: High proportion of our community-acquired uropathogens are ESBL-producing E. coli and likely resistant to important antimicrobial agents such as quinolones, gentamicin, etc. Factors like advancing age, prior hospitalization, and antibiotic use, as well as comorbidities such as diabetes and chronic lung disease, may be strongly associated with ESBL E. coli and should be remembered while administering or preparing guidelines for empiric management of CA-UTI subjects.