Increased Isolation of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli From Community-Onset Urinary Tract Infection Cases in Uttarakhand, India

Abstract

Background: Management of community-acquired urinary tract infection (CA-UTI) relies heavily on empirical antibiotic therapy. Knowledge of the proportion of drug-resistant isolates especially extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli ( E. coli ), and various risk factors for acquisition are essential. Method: Outpatient-treated CA-UTI cases were enrolled (continuously for three months), and microbiological analysis of urine sample was performed for significant bacterial growth followed by identification of conventional and matrix-assisted laser desorption/ionization-time of flight (MALDI-ToF) spectrometry method. Subsequent drug resistance and phenotypic ESBL detection were as per guidelines of the Clinical Laboratory Standard Institute (CLSI, USA). Univariate and multivariate analyses (logistic regression) of known and relevant risk factors of ESBL E. coli were performed as per standard statistical technique, using the SPSS computer package (IBM Corp., Armonk, NY). Results: Two hundred and forty-one samples (of 694 samples) yielded significant growth. Sixty-one of 131 (46.6%) E. coli isolates were found to be ESBL producers. Non-beta-lactam antibiotic resistance in ESBL producers was high compared to non-ESBL producers (e.g., 88.5% vs 42.3% for quinolone resistance, 80.3% vs 34.3% for gentamicin resistance, etc.). Multivariate analysis (after univariate analysis detected probable factors of a likely ESBL model) indicated significant associations of ESBL-producing E. coli with advancing age (>55 years), prior hospitalization in last one year, use of antibiotics in previous six months, and presence of comorbid illness such as diabetes mellitus and chronic lung disease. Conclusion: High proportion of our community-acquired uropathogens are ESBL-producing E. coli and likely resistant to important antimicrobial agents such as quinolones, gentamicin, etc. Factors like advancing age, prior hospitalization, and antibiotic use, as well as comorbidities such as diabetes and chronic lung disease, may be strongly associated with ESBL E. coli and should be remembered while administering or preparing guidelines for empiric management of CA-UTI subjects.

Pattern of uropathogens and antibiotic sensitivity in diabetes patients attending to out – Patient department and diabetes clinic of a teaching hospital

“…This observation questions the use of fluoroquinolone as the empiric treatment. [ 22 ] This is consistent with earlier studies. [ 5 ] Therefore, nitrofurantoin and fosfomycin may be used as the empirical drug of choice in the study area as a potential treatment of UTI.…”

“…These findings were similar to many studies abroad but dissimilar to a study from Kerala. [ 21 22 ] However, Gram-negative isolates were sensitive to carbapenems and antipseudomonal penicillins, these drugs cannot be recommended in outpatient settings due to their supervised drug administration protocols. Fosfomycin and nitrofurantoin have shown intermediate to full susceptibility pattern (68.8% and 71.9% respectively).…”

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

“…32 However, the prevalence of ESBL producers in our study was comparatively less than previous studies reported by Bajpai et al 33 (36.8%), Taneja et al 34 (40.2%), Gautam et al . 35 (33%) and Kumar et al 36 (46.6%) from different parts of India. This increased prevalence of ESBL-producing E. coli isolates is a serious peril for healthcare as these organisms can cause many severe infections in humans even in countries with advanced public health and healthcare facilities.…”

Prevalence of ESBL Producing Bacteria in Community-Acquired UTI from Eastern Part of India

“…This was quite similar as observed through a research work by N. Kumar et al where the presence of ESBL producers was 46.6% in uropathogens. 18 These two organisms have been common pathogens for both community-acquired hospital-acquired (HA). The multidrug resistance (MDR) of ESBL-producing isolates has been a matter of concern.…”