DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184901

Antibiotic susceptibility profile and extended spectrum β-lactamases production by uropathogenic Escherichia coli from tertiary care hospital of rural settings

Mustafa Sofiur Rahman, Ritu Garg, Varsha A. Singh, Dipankar Biswas

Abstract


Background: Escherichia coli are the most common cause of urinary tract infections in community as well as hospital settings. Emergence of drug resistance in Escherichia coli due to various mechanisms makes the treatment options very limited. This study was undertaken to detect ESBLs in uropathogenic Escherichia coli isolates and to determine their antimicrobial susceptibility pattern in rural setting.

Methods: A prospective study was done on 502 E. coli isolates from clinically suspected cases of urinary tract infections (UTI) patients of all age groups. All samples were inoculated on Cysteine Lactose Electrolyte Deficient Agar (CLED). Organisms grown in pure culture were identified by standard biochemical tests. Antibiotic susceptibility test was done by the Kirby Bauer Disc diffusion method on Muller Hinton agar. ESBL detection was done as per CLSI guidelines.

Results: Of the 502 isolates of Escherichia coli, nitrofurantoin (82%) was found be most sensitive antimicrobial followed by amikacin (73%), gentamycin (71%) and imipenem (64%). Common empirically used antibiotics like fluroquinolones and Cotrimoxazole drugs showed alarming rate of resistance. 60% isolates were found to be multidrug resistant. ESBL production was detected in 31% isolates. ESBL producing strains were found to be more drug resistant than non ESBL producing strains.

Conclusions: So, drug resistance due to production of ESBLs in Escherichia coli is a serious threat for clinicians. Strict infection control measures and early detection of beta lactamase producing isolates are the need of the hour to contain the emergence of this type of resistance.


Keywords


Antibiotic resistance, ESBL production, Escherichia coli, Urinary tract infection

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References


Chaturvedi A, Garg R, Singh VA. Comparative evaluation of different culture media for the isolation and identification of common urinary pathogens. Int J Res in Med Sci. 2017;5(8):3676-9.

Shariff VA AR, Shenoy MS, Yadav T, Radhakrishna M. The antibiotic susceptibility pattern of uropathogenic Escherichia coli, with special reference to the fluoroquinolones. J Clin Diag Res. 2013;7(6):1027-30.

Shakya P, Shrestha D, Maharjan E, Sharma VK, Paudyal R. ESBL production among E. coli and Klebsiella spp. Causing Urinary Tract Infections: A Hospital Based Study. The Open Microbiology J. 2017;11:23-30.

Arjunan M, AL-Salamah AA, Amuthan M. Prevalence and antibiotics susceptibility of uropathogens in patients from a rural environment, Tamilnadu. Am J Infect Dis. 2010;6(2):29-33.

Kibert M, Abera B. Prevelence and Antibiogram of bacterial isolates from urinary tract infections at Dessie Health Research Laboratory, Ethiopia. Asian Pac J Trop Biomed. 2014;4(2):164-8.

Higashide M, Kuroda M, Omura CTN, Kumano M, Ohkawa S, Ichimura S et al. Methicillin resistant Staphylococcus saprophyticus isolates carrying Staphylococcal Cassette Chromosome mec Have emerged in Urogenital Tract Infections. Antimicrobial Agents Chemotherapy. 2008;52(6):2061-8.

Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community acquired urinary tract infections in women: A nationwide analysis. Clin Infect Dis. 2001;33:89-94.

Varsha Gupta, Aparna Yadav, RM Joshi. Antibiotic resistance pattern in uropathogens. Indian J Medical Microbiol. 2002;20:96-8.

Taneja N, Rao P, Arora J, Dogra A. Occurrence of ESBL and Amp-C β-lactamases and susceptibility to newer antimicrobial agents in complicated UTI. Indian J Med Res. 2008;127:85-8.

Black JA, Moland ES, Thomson KS. AmpC disk test for detection of plasmid-mediated AmpC- b lactamases in Enterobacteriaceae lacking chromosomal AmpC- blactamases. J Clin Microbiol. 2005;43:3110-3.

Banerjee S, Sengupta M, Sarker TK. Fosfomycin susceptibility among multidrug resistant, extended spectrum beta- lactamase producing, carbapenem-resistant Uropathogens. Indian J Urol. 2017;33(2):149-54.

National Centre for Disease Control. National treatment guidelines for antimicrobial use in infectious disease. Version 1.0. 2016:42. Available at:http://pbhealth.gov.in/AMR_guideline7001495889.pdf.

Halwarkar AK, Sataraddi J, Gupta S, Yoganand R, Rao A, Srinivasa H. The detection of ESBL-producing Escherichia coli in patients with symptomatic urinary tract infections using different diffusion methods in a rural setting. J Infection Pub Heal. 2013;6:108-14.

Mehrgan H, Rahbar M. Prevalence of extended-spectrum beta-lactamase-producing Escherichia coli in a tertiary care hospital in Tehran, Iran. Int J Antimicrob Agents. 2008;31(2):147-51.

Ko KS, Suh JY, Peck KR, Lee MY, Oh WS, Kwon KT, et al. In vitro activity of fosfomycin against ciprofloxacin-resistant or extended-spectrum β-lactamase-producing Escherichia coli isolated from urine and blood. Diag Microbiol Infec Dis. 2007;58(1):111-5.

Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, eds. Mackie and MacCartney practical medical microbiology, 14th ed. Edinburgh: Churchill Livingstone;1996:151-79.

Bauer AW, Kirby WMM, Sherris JC, Jurck M. Antibiotic susceptibility testing by a standardized single disc method. Am J Clin Pathol. 1966;45:493-6.

CLSI. Performance standards for antimicrobial susceptibility testing; 23rd Informational Supplement. CLSI Document M100-S23, Wayne PA: Clinical and Laboratory Standards Institute;2013.

Ali I, Shabbir M, UI Iman N. Antibiotics susceptibility pattern of uropathogenic E. coli with special reference to fluoroquinolones in different age and gender groups. J Pak Med Assoc. 2017;67(8):1161-5.

Mandal J, Acharya NS, Buddhapriya D, Parija SC. Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli. Indian J Med Res. 2012;136:842-9.

Farshad S, Ranjbar R, Anvarinejad M, Shahidi M A, Hosseini M. Emergence of multi drug resistant strains of Escherichia coli isolated from urinary tract infection. The Open Conference Proceedings J. 2010:1:192-6.

Rani H, Kaistha N, Gupta V, Chander J. Choice of Antibiotics in Community Acquired UTI due to Escherichia Coli in the Adult Age group. J Clin Diag Res. 2011;5(3):483-5.

Gupta V, Rani H, Singla N, Kaistha N, Chander J. Determination of extended‑spectrum b‑lactamases and AmpC production in uropathogenic isolates of Escherichia coli and susceptibility to fosfomycin. J Laboratory Physicians. 2013;5(2):90-3.

Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, et al. CTX-M: changing the face of ESBLs in Europe. J Antimicro Chemotherapy. 2007 Feb 1;59(2):165-74.

Tankhiwale SS, Jalgaonkar SV, Ahmed S, Hassani U. Evaluation of extended spectrum beta lactamase in urinary isolates. Ind J Med Res. 2004;120:553-6.