Extended-Spectrum Beta-Lactamase Producing Escherichia coli and Klebsiella pneumoniae are Emerging as Major Pathogens Responsible for Urinary Tract Infection

Abstract

Escherichia coli and Klebsiella pneumoniae are responsible for UTI in 80-90% cases [2][3][4] . Extended-spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae are increasingly being isolated in cultures from urine samples in Bangladesh 5-8 . Advanced age, diabetes mellitus (DM), use of urinary catheters, previous hospital admission and antibiotic intake are reported as risk factors for ESBL positivity 9,10 . Data regarding ESBL positive organisms are limited in our country. This study was designed to describe the frequency of ESBL positive E. coli and K. pneumoniae causing UTI, their associated risk factors and antibiotic sensitivity pattern in a tertiary care setting of Bangladesh. Methods :This prospective cross-sectional study was done in the Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from January 2014 to March 2014. Adult patients who got admitted with a clinical diagnosis of UTI were initially enrolled for the study. Those with a growth of micro-organism from their urine samples were then selected for the study and finally one hundred consecutive culture positive UTI cases due to E. coli or K. pneumoniae infection, irrespective of their ESBL positivity were purposively included in this study. Original

Frequency, Risk Factors and Antibiotic Sensitivity Pattern of Extended-Spectrum Beta-Lactamase Producing Escherichia coli and Klebsiella pneumoniae Causing Urinary Tract Infection: Experience from a Tertiary Care Hospital of Bangladesh

“…[1][2][3][4][5][6]9,15 In the current study, almost two-thirds of UTI cases were due to ESBL-positive organisms. In four different studies done in Bangladesh over the preceding years by Rahman MM et al 5 , Rahman MR et al 9 , Asna SMHZ et al 6 and Iqbal S et al 7 revealed up to 60% of all UTI cases were due to ESBL-positive organisms. In different studies in India 10 , Nepal 16 , Iran 17 and Turkey 18 up to 48% of UTI cases were due to ESBL-positive organisms.…”

“…10,[16][17][18][19] Antibiotic sensitivity patterns were also similar. [6][7][8][9][10][16][17][18] Current study had some limitations. It was a single center study, comprising small number of study population over a short period of time and most of our study participants were diabetic.…”

“…[1][2][3][4] In Bangladesh, only a few studies were reported on ESBL-positive organisms, mostly describing their prevalence and antibiotic sensitivity patterns. [5][6][7][8][9] Diabetes mellitus (DM), past history of UTI and prior antibiotic use are reported risk factors for UTI due to ESBL-positive organisms. 10,11 In this study, we have tried to evaluate the frequency of UTI due to ESBL-positive Escherichia coli and Klebsiella pneumoniae, their antibiotic sensitivity patterns and risk factors.…”

Urinary Tract Infection due to Extended-Spectrum Beta-Lactamase Producing Organisms is a Risk Factor for Acute Kidney Injury among Patients with Type 2 Diabetes Mellitus

“…15 In our study, we evaluated ESBL-positivity of organisms causing UTI as risk factor for AKI. UTI due to ESBL-positive organisms are increasingly been reported in Bangladesh [16][17][18] and Rahim MA et al 10 reported that diabetic females with long duration and poor glycaemic control are risk factors for UTI due to ESBL-positive organisms. Similar observation was reported in other studies.…”

Urinary Tract Infection due to Extended-spectrum Beta-lactamase Producing Organisms is a Risk Factor for Bacteraemia Among Patients with Type 2 Diabetes Mellitus

“…4,5 Antimicrobials remain the cornerstone for treatment of UTI and increasing antimicrobial resistance, specially extended-spectrum beta-lactamase (ESBL) producing organisms is an ever increasing problem. [6][7][8][9] ESBL-positive organisms are inherently resistant to penicillin and cephalosporin; thus UTI caused by ESBLpositive organism require injectable agents like carbapenems and aminoglycosides or nitrofurantoin, pivmecillinam and fluoroquinolones; many organisms causing UTI are also resistant to these oral agents. 2,8 Bangladesh J Medicine 2020; 31 : 9-12 Moreover, UTI complicated by bacteraemia indicates complicated infection and merits intravenous antimicrobials in hospital settings; thus increasing treatment cost by many folds.…”