Detection of Extended-Spectrum Beta Lactamases and AmpC Beta Lactamases Producing Uropathogenic Escherichia coli in a Tertiary Care Hospital

Abstract

Background: The multidrug resistant among uropathogenic E. coli has become a potential threat to global health. The aim of the current study to evaluate the antimicrobial activities of nitrofurantoin and fosfomycin along with other antimicrobials against Extended Spectrum β-Lactamases (ESBL) and AmpC producer isolates from the most common organism E. coli. Methods: A total of 6046 clean catch midstream urine samples were collected and processed in Microbiology department of tertiary care hospital. The antimicrobial susceptibility of E. coli isolates was initially screened by Kirby-Bauer disk diffusion method. The resistant isolates were confirmed to be ESBL and AmpC producers by their respective phenotypic confirmatory tests of combined disc method. Results: Out of 6046 patients there were 1855 E. coli positive patients. Maximum patients in the age group of 21-30 years were 51.5% followed by 31-40 years where patients were 26%. 64.4% E. coli were isolated from female patients and 35.6% from male patients. E. coli showed higher sensitivity towards, fosfomycin (100%), imipenem (100%), nitrofurantoin (84.1%), piperacillin and tazobactam (77.3%), amikacin (76.1%) and while they showed high degree resistance pattern against Penicillin, cotrimoxazole, ciprofloxacin, norfloxacin and 2 nd and 3 rd generation cephalosporin. Out of 1855 E. coli, multi drug resistance was seen in 520 E. coli isolates. ESBL production was observed among 50% of E. coli isolates by combined disk method. Out of 520 isolates, 150 isolates showed resistance to one or more extended-spectrum cephalosporins and cefoxitin by Kirby-Bauer disk diffusion method. These were selected and screened for ESBL and AmpC production. Among 150 cefoxitin-resistant isolates, AmpC phenotype was detected in 100 isolates (66.6%) by AmpC disc method. The overall occurrence of AmpC in the study was found to be 19.2%. Susceptibility of ESBL and AmpC producers to fosfomycin, imipenem, nitrofurantoin and amikacin were found to be 100%, 98.5%, 89% and 75% respectively. Conclusions: There is increased prevalence of ESBL and AmpC producing E. coli. Thus, early detection of ESBL and AmpC producer E. coli by simple phenotypic methods is necessary to avoid treatment failure, where molecular techniques are not available.

Prevalence of β-lactamase production and multi-drug resistance among uropathogenic Escherichia coli isolates at a tertiary care hospital of North-western India

“…In our study ESBL production was observed in 45.51% of E.coli isolates which is in concordance with findings in many studies from different parts of India. 3,11,15,19 In the current study, the Amp C production was seen in 28.96% (42/145) isolates, similar finding has been reported by Bora A et al 20 from Assam. Compared to these findings other studies have reported a lower prevalence of the AmpC producers.…”

“…This male preponderance could be due to the fact that the samples were received from departments other than obstetrics and gynaecology. Age group analysis revealed that significant numbers of E.coli were isolated from age group of 21-40 years (63.44%) in both males (35.86%) and female patients (27.59%), similar observation was seen in studies by Bakshi R et al (77.35%), 11 Rahman MS et al (56.0%), 2 Shakya P et al (42.19%), 12 Sahu RK et al (40.85%) 13 and Das B et al (58.84%). 14 Increasing rates of β-lactamase producing bacteria are causing serious UTI in the society and hospitals world-wide.…”

“…Compared to these findings other studies have reported a lower prevalence of the AmpC producers. 1,11,16,17,19,21,22 while Shreshtha UT et al 23 reported a higher prevalence of 46.3%. Prevalence of coproduction of AmpC among ESBL isolates in the present study was 42.86%, which is higher than Gupta V et al8.0%, 16 Mwinga MM et al 10.77% 24 and Shreshtha UT et al 19.4%.…”

“…2 In few studies all the β-lactamase producing isolates were found to be susceptible to fosfomycin. 11,16 Resistance to nitrofurantoin in most studies was in the range of 10-20%. 11,14,18,19 In our study and Ranjini CY et al 3 nitrofurantoin resistance was seen in 28.42% and 26.77% isolates respectively while Gupta V et al 16 found no resistance.…”

“…11,16 Resistance to nitrofurantoin in most studies was in the range of 10-20%. 11,14,18,19 In our study and Ranjini CY et al 3 nitrofurantoin resistance was seen in 28.42% and 26.77% isolates respectively while Gupta V et al 16 found no resistance. The ICMR, antimicrobial resistance surveillance network, 2018 data has reported 88.1% and 86.0% of the isolates to be sensitive to two old antibiotics, fosfomycin and nitrofurantoin respectively.…”