Prevalence of multidrug resistance (MDR) and extended spectrum beta-lactamases (ESBLs) among uropathogenic Escherichia coli isolates from female patients in a tertiary care hospital in North India
Keywords:Asymptomatic bacteriuria, Extended spectrum beta-lactamase, Multidrug resistance, Urinary tract infection, Uropathogen
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 (>105 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-β-lactam 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.
Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in Antimicrobial Resistance among Urinary Tract Infection Isolates of Escherichia coli from Female Outpatients in the United States. Antimicrob Agents Chemother 2002; 46(8):2540-45.
Patnaik M, Panigrahi K, Das B, Pathi B, Poddar N, Lenka PR et al. Prevalence, risk factors and causative organisms of asymptomatic bacteriuria in pregnancy. Int J Adv Med. 2017;4(5):1348-54.
Abdel-Aziz Elzayat M, Barnett-Vanes A, Dabour MFE, Cheng F. Prevalence of undiagnosed asymptomatic bacteriuria and associated risk factorsduring pregnancy: a cross-sectional study at two tertiary centres in Cairo, Egypt. BMJ Open 2017;7(3):e013198.
Oli AN, Akabueze VB, Ezeudu CE, Eleje GU, Ejiofor OS, Ezebialu IU et al. Bacteriology and Antibiogram of Urinary Tract Infection Among Female Patients in a Tertiary Health Facility in South Eastern Nigeria. The Open Microbiol J 2017;11:292-300.
Paari P, Sindhuja TP, Dhinakaran S, Paul CMP. A cross-sectional study on asymptomatic bacteriuria among antenatal women attending an urban tertiary health care centre in Southern India. Int J Reprod Contracept Obstet Gynecol. 2017;6(10):4522-25.
Babypadmini S, Appalaraju B. Extended Spectrum β-Lactamases in Urinary Isolates of Escherichia coli and Klebsiella pneumoniae- Prevalence and Susceptibility Pattern in a Tertiary Care Hospital. Indian J Med Microbiol. 2004;22(3):172-4.
Ranjini CY, Kasukurthi LR, Madhumati B, Rajendran R. 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. Community Acquir Infect. 2015;2(1):19-24.
Shaifali I, Gupta U, Mahmood SE, Ahmed J. Antibiotic Susceptibility Patterns of Urinary Pathogens in Female Outpatients. N Am J Med Sci. 2012; 4(4):163-9.
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(1):89-94.
McCarty JM, Richard G, Huck W, Tucker RM, Tosiello RL, Shan M et al. A randomized trial of short-course ciprofloxacin, ofloxacin or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Am J Med 1999;106(3):292-9.
Manjula NG, Math GC, Patil SA, Gaddad SM, Shivannavar CT. Incidence of Urinary Tract Infections and Its Aetiological Agents among Pregnant Women in Karnataka Region. Advances Microbiol. 2013;3(6):473-8.
Gessese YA, Damessa DL, Amare MM, Bahta YH, Shifera AD, Tasew FS et al. Urinary pathogenic bacterial profile, antibiogram of isolates and associated risk factors among pregnant women in Ambo town, Central Ethiopia: a cross-sectional study. Antimicrob Resist Infect Control. 2017; 6(1):132.
Arora G, Kaur P, Agrawal D. Urinary tract infection in women of rural population of Haryana: a rising problem. Int J Reprod Contracept Obstet Gynecol. 2016;5(12):4470-74.
Kumari A, Kumar S, Kumar S. Observation on Prevalence and Mechanism of Multi Drug Resistant Escherichia coli Causing Uncomplicated Urinary Tract Infection in Female. International Journal of Contemporary Medical Research 2016;3(10):2895-7.
Mukherjee M, Koley S, Mukherjee SK, Basu S, Ghosh B, Chakraborty S. Phylogenetic background of E.coli isolated from asymptomatic pregnant women from Kolkata, India. J Infect Dev Ctries 2015;9(7):720-4.
Hotchandani R, Aggarwal KK. Urinary Tract Infections in Women. Indian J Clinical Practice. 2012;23(4);187-92.
Sanchez GV, Babiker A, Master RN, Luu T, Mathur A, Bordon J. Antibiotic Resistance among Urinary Isolates from Female Outpatients in the United States in 2003 and 2012. Antimicrob Agents Chemother 2016;60(5):2680-3.
Raz R, Chazan B, Kennes Y, Colodner R, Rottensterich E, Dan M et al. Empiric Use of Trimethoprim-Sulfamethoxazole (TMP-SMX) in the Treatment of Women with Uncomplicated Urinary Tract Infections, in a Geographical Area with a High Prevalence of TMP-SMX-Resistant Uropathogens. Clin Infect Dis. 2002;34(9):1165-69.
Gobernado M, Valdes L, Alos JI, Gracia-Rey C, Dal-Re R, Garcia-de-Lomas J et al. Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain. Rev Esp Quimioter 2007;20(1):68-76.
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;2(5):103-20.
Das A, Banerjee T. Prevalence of Urinary Tract Infections and Susceptibility Pattern of Uropathogens in Women of Reproductive age Group from North India. J Advances Med. 2015;4(1-2):5-9.