Antibiotic Resistance Pattern of Extended Spectrum Beta Lactamase Producing Escherichia coli Isolated From Patients With Urinary Tract Infection in Morocco

Abstract

Extended-spectrum β-lactamases producing Escherichia coli (ESBL-EC) lend resistance to most β-lactam antibiotics. Because of limited treatment options, ESBL-EC infections are generally more difficult to treat, leading to higher hospital costs, reduced rates of microbiological and clinical responses, and a threat to the patient’s life. This study aimed to determine the antibiotic resistance pattern of ESBL-EC isolated from patients with urinary tract infection in Morocco. This retrospective laboratory-based study was conducted at Cheikh Khalifa International University Hospital, Casablanca, from January 2016 to June 2019. A total of 670 urine samples were collected from urinary tract infection patients and processed by standard microbiological methods. In vitro susceptibility testing to different antibiotics of all identified isolates of Escherichia coli (E. coli) was performed following Kirby–Bauer’s disc diffusion method on Mueller–Hinton Agar according to the EUCAST standards. The reviewing of ESBL-EC was confirmed by the appearance of a characteristically shaped zone referred to as a “champagne cork” using the Combined Disk Test. Among a total of 438 E. coli isolated from nonrepetitive urine samples, two hundred fifty-nine (59%) were ESBL-EC, of which 200 (77%) were isolated from adult patients (over the age of 50) and the majority were female. All ESBL-EC isolates were resistant to third-generation cephalosporin and quinolones and sensitive to carbapenem and fosfomycin. Knowledge of antimicrobial resistance patterns in ESBL-EC, the major pathogen associated with urinary tract infection, is indispensable as a guide in choosing empirical antimicrobial treatment.

High prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates: A 5-year retrospective study at a Tertiary Hospital in Northern Thailand

“…In comparison, ESBL-positive K. pneumoniae strains revealed similar resistance rates to cefotaxime (100%) and ceftazidime (85.4%). These data are consistent with previous studies conducted in China ( Quan et al., 2017 ), Nepal (Chander et al., 2013), Ethiopia ( Abayneh et al., 2018 ) and Morocco ( Kettani Halabi et al., 2021 ). In addition, cefoperazone/sulbactam, a third-generation cephamycin beta-lactamase inhibitor combination, had antibacterial potential against ESBL-producing isolates (resistance rates of 10.7% and 43.3% in E. coli and K. pneumoniae , respectively).…”

“…In the present study, the prevalence of ESBL-producing isolates ( E. coli and K. pneumoniae ) was found more in males than females. The results are comparable to the studies done in Iran ( Peerayeh et al., 2016 ) and elsewhere ( Ouedraogo et al., 2016 ), but differ from other investigations that revealed that a high prevalence of ESBL producers detected in female patients ( Chander and Shrestha, 2013 ; Abayneh et al., 2018 ; Kettani Halabi et al, 2021 ). The reason for these differences is not clear.…”

“…Notably, penicillin combined with a beta-lactamase inhibitor such as piperacillin/tazobactam was demonstrated to be effective against ESBL producers (resistance rates of 8.5% and 27.9% in E. coli and K. pneumoniae , respectively). Conversely, other studies documented that 40% ( Kettani Halabi et al., 2021 ) and 74.5% ( Najjuka et al., 2016 ) of ESBL-producing pathogens were resistant to this antimicrobial agent. In this study, some third-generation cephalosporins exhibited low effectiveness against ESBL-positive pathogens.…”

“…Several investigations support that advanced age (mostly over 60 years) is a risk factor for severe infection with ESBL producers. ( Hongsuwan et al., 2014 ; Heytens et al., 2017 ; Kettani Halabi et al, 2021 ). One potential reason for this is that old age is associated with poor health and status.…”

“…ESBLs are frequently transmitted by plasmids and can thereby be distributed among hospitalized patients, driving their spread across regions ( Paterson and Bonomo, 2005 ; Paterson, 2006 ). The increasing emergence of ESBL-producing pathogens has been documented worldwide and varies among countries ( Quan et al., 2017 ; Abayneh et al., 2018 ; Mineau et al., 2018 ; Kettani Halabi et al., 2021 ). In Thailand, the prevalence of ESBL-producing microorganisms in asymptomatic individuals has been recorded, with incidences ranging from 13.0% to 31.2% ( Kiratisin et al., 2008 ; Hongsuwan et al., 2014 ; Sawatwong et al., 2019 ).…”