Antimicrobial resistance in patients with suspected urinary tract infections in primary care in Assam, India

Abstract

Objectives We investigated the prevalence and diversity of antimicrobial resistance in bacteria isolated from urine samples of community-onset urinary tract infection (UTI) patients in southern Assam, India. Methods Freshly voided midstream urine samples were collected from patients attending primary healthcare centres, with the patients’ epidemiological data also recorded. Species identification was confirmed using a VITEK 2 compact automated system. Phenotypic confirmation of ESBLs was performed using the combined disc diffusion method (CLSI 2017) and carbapenemase production was phenotypically characterized using a modified Hodge test. Common ESBLs and carbapenem-resistance mechanisms were determined in Escherichia coli isolates using PCR assays. Incompatibility typing of the conjugable plasmids was determined by PCR-based replicon typing; the phylotypes and MLSTs were also analysed. Results A total of 301 (59.7%) samples showed significant bacteriuria along with symptoms of UTI and among them 103 isolates were identified as E. coli of multiple STs (ST3268, ST3430, ST4671 and others). Among them, 26.2% (27/103) were phenotypically ESBL producers whereas 12.6% (13/103) were carbapenemase producers. This study describes the occurrence of diverse ESBL genes—blaCTX-M-15, blaSHV-148, blaPER-1 and blaTEM—and two E. coli isolates carrying the blaNDM-1 carbapenemase gene. ESBL genes were located within transconjugable plasmids of IncP and IncF type whereas blaNDM-1 was carried in an IncFrepB type plasmid. Conclusions This study illustrates the high rate of MDR in E. coli causing UTI in primary care in rural Assam. UTIs caused by ESBL- or MBL-producing bacteria are very difficult to treat and can often lead to treatment failure. Thus, future research should focus on rapid diagnostics to enable targeted treatment options and reduce the treatment failure likely to occur with commonly prescribed antibiotics, which will help to combat antimicrobial resistance and the burden of UTIs.

Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms

“…Paul et al . [ 27 ] previously reported a 26.2% ESBL prevalence in Assam (NE India), whereas Behera et al . [ 28 ] reported 43% combined prevalence in E. coli and Klebsiella pneumoniae from community UTIs from E. India, and, in 2021, Kumar et al [ 29 ] reported a 46.6% ESBL prevalence in E. coli from Uttarakhand in N India.…”

A Prospective, Observational and Comparative Study of In-Vitro Susceptibility of Isepamicin against Clinical Isolates from Various Clinical Sources (Triple I Study - Isepamicin in India)

“…The high susceptibility and more effective in-vitro potential of Isepamicin against gram-negative bacterial isolates, as compared with other aminoglycosides, could be attributed to the lower impact of 1 6'-N-acetyltransferase enzyme on Isepamicin 14 . This enzyme is the most common aminoglycoside-modifying enzyme present in these pathogens and causes resistance to aminoglycosides.…”

Characterization of uropathogenic E. coli from various geographical locations in India

“…Other studies from different geographical locations in India have reported UPEC with a very high rate of drug resistance. 48 , 49 Irrational use of antimicrobial agents in developing countries is considered a major factor responsible for the emergence of MDR strains. 50 The management of UPEC infections is complicated by the occurrence of diverse UPEC with multiple virulence characteristics and resistance to multiple drugs, and by poor socioeconomic conditions in developing countries including India.…”