Prevalence of multidrug resistance and extended spectrum beta-lactamases among uropathogenic Escherichia coli isolates in a tertiary care hospital in South India: An alarming trend
Uropathogenic Escherichia coli: Multidrug resistance and ESBL
Keywords:
Escherichia coli, extended spectrum beta-lactamases, multidrug resistance, urinary tract infectionAbstract
Background and Aims: Escherichia coli is the most common etiological agent in both community acquired and hospital acquired urinary tract infections. Emergence of multidrug resistance (MDR) among E. coli isolates is quite alarming. The aim of this study was to define the current prevalence of MDR and extended spectrum beta-lactamases (ESBL) production among E. coli isolates from urine samples in our hospital. Materials and Methods: Urine samples from 1225 patients were processed for wet mount followed by culture and sensitivity. All the samples were inoculated on to Hi Media Hi chrome agar plates (HiMedia Laboratories Pvt. Ltd., Mumbai, India) and growth showing significant bacteriuria (≥10 5 cfu/ml) were further identified by the standard biochemical procedures and antibiotic sensitivity done as per Clinical and Laboratory Standards Institute guidelines. Detection of ESBL was done by the combined disc method. Percentage of antibiotic resistance and sensitivity and Chi-square test were used. Results: Out of 1225 samples processed, significant bacterial isolates were obtained in 357 (29.1%). The total number of E. coli isolated were 179 (50.1%) of which multidrug resistant E. coli isolates were 148 (82.6%) and 71 (39.66%) were ESBL producers. High degree of resistance was observed to amoxycillin (93.2%) and amoxycillin-clavulanic acid (90.5%). More than 80% sensitivity was seen only to imipenem (98.4%), amikacin (83.3%) and nitrofurantoin (86.6%). Conclusion: Multidrug resistant strains of E. coli are widely prevalent in the community. Antibiotics like imipenem require hospitalization, parenteral administration, drug monitoring for toxicity, all of which incur high cost to the patient and have to be used judiciously.
References
Stamm WE, Norrby SR. Urinary tract infections: Disease panorama and challenges. J Infect Dis 2001;183 Suppl 1:S1-4.
Hyle EP, Lipworth AD, Zaoutis TE, Nachamkin I, Fishman NO, Bilker WB, et al. Risk factors for increasing multidrug resistance among extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. Clin Infect Dis 2005;40:1317-24.
Mowla R, Imam KM, Asaduzzaman M, Nasrin N, Raihan SZ, Chowdhury AK. Emergence of multidrug resistant extended-spectrum ß-lactamase producing Eshcherichia coli associated with urinary tract infections in Bangladesh. J Basic Clin Pharm 2011;3:225-8.
Hassan SA, Jamal SA, Kamal M. Occurrence of multidrug resistant and ESBL producing E. coli causing urinary tract infections. J Basic Appl Sci 2011;7:39-43.
CLSI. Performance standards for antimicrobial susceptibility testing; Twenty second informational supplement. CLSI document M100-S22. Wayne, PA: Clinical and Laboratory Standards Institute; 2012.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81.
Rice LB, Bonomo R. Antibacterial agents and susceptibility test methods. In: Murray PR, Baron EJ, Jorgensen JH, Landry HL, Pfaller MA, editors. Manual of Clinical Microbiology. 9 th ed. Washington: ASM Press; 2007. p. 1127.
Forbes DA, Sahm DF, Weissfeld AS. Infections of the urinary tract. In: Forbes BA, Sahm DF, Weissfeld AS, editors. Bailey and Scott′s Diagnostic Microbiology. 12 th ed. St. Louis: Mosby; 2007. p. 842-54.
Cheasty T, Smith HR. Escherichia. In: Borriello SP, Murray PR, Funke G, editors. Topley and Wilson′s Microbiology and Microbial Infections. 10 th ed. London: Hodder & Arnold Publishers Ltd.; 2005. p. 1379-80.
Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician 2011;84:771-6.
Jan N, Meshram SU, Kulkarni A. Plasmid profile analysis of multidrug resistant E. coli isolated from UTI patients of Nagpur City, India. Rom Biotechnol Lett 2009;14:4635-40.
Zhanel GG, Karlowsky JA, Harding GK, Carrie A, Mazzulli T, Low DE, et al. A Canadian national surveillance study of urinary tract isolates from outpatients: Comparison of the activities of trimethoprim-sulfamethoxazole, ampicillin, mecillinam, nitrofurantoin, and ciprofloxacin. The Canadian Urinary Isolate Study Group. Antimicrob Agents Chemother 2000;44:1089-92.
Karlowsky JA, Kasloff S, Nichol KA, Hoban DJ, Zhanel GG. Genetic relatedness of multidrug-resistant Escherichia coli cultured from geographically diverse outpatient, midstream urine specimens. Diagn Microbiol Infect Dis 2007;58:283-7.
Sahm DF, Thornsberry C, Mayfield DC, Jones ME, Karlowsky JA. Multidrug-resistant urinary tract isolates of Escherichia coli: Prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother 2001;45:1402-6.
Mukherjee M, Basu S, Mukherjee SK, Majumder M. Multidrug-resistance and extended spectrum beta-lactamase production in uropathogenic E. coli which were isolated from hospitalized patients in Kolkata, India. J Clin Diagn Res 2013;7:449-53.
Manges AR, Johnson JR, Foxman B, O′Bryan TT, Fullerton KE, Riley LW. Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N Engl J Med 2001;345:1007-13.
Cheasty T, Smith HR. Escherichia. In: Borriello SP, Murray PR, Funke G, editors. Topley and Wilson′s Microbiology and Microbial Infections. 10 th ed. London: Hodder & Arnold Publishers Ltd.; 2005. p. 1369-70.
Mekki AH, Hassan AN, Elsayed DE. Extended spectrum beta lactamases among multi drug resistant Escherichia coli and Klebsiella species causing urinary tract infections in Khartoum. J Bacteriol Res 2010;2:18-21.
Mohammed A, Mohammed S, Asad K. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India. Ann Clin Microbiol Antimicrob 2007;6:17.
Baral P, Neupane S, Marasini BP, Ghimire KR, Lekhak B, Shrestha B. High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal. BMC Res Notes 2012;5:38.
Pallett A, Hand K. Complicated urinary tract infections: Practical solutions for the treatment of multiresistant Gram-negative bacteria. J Antimicrob Chemother 2010;65 Suppl 3:iii25-33.
Peralta G, et al. Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. Bacteremia. A multicentric cohort study. BMC Infectious Diseases 2012;12:245.
Lagace P, Nichol KA, Nicolle LE, DeCorby M, McCracken M, Mulvey MR et al. Treatment of lower urinary tract infection caused by multidrug-resistant extended-spectrum-β-lactamase-producing Escherichia coli with amoxicillin/clavulanate: Case report and characterization of the isolate. J Antimicrob Chemother 2006;57:1262-3.
Delzell JE, Lefevre ML. Urinary Tract Infections During Pregnancy. Am Fam Physician 2000;61:713-20.
Hilbert DW. Antibiotic Resistance in Urinary Tract Infections: Current Issues and Future Solutions. In, Tenke P (Ed.) Urinary Tract Infections 2011. ISBN: 978-953-307-757-4, InTech, DOI: 10.5772/24171. Available from: http://www.intechopen.com/books/urinary-tract-infections/antibiotic-resistance-in-urinary-tract-infections-current-issues-and-future-solutions. [Last accessed on 2014 Feb 25].
Gupta V, Kaur J, Kaistha N. Re-emerging chloramphenicol sensitivity and emerging low level ciprofloxacin resistance among Salmonella enterica serotype typhi isolates in North India. Trop Doct 2009;39:28-30.
Baerheim A. Empirical treatment of uncomplicated cystitis. Scand J Prim Health Care 2012;30:1-2.
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