Prevalence of multidrug resistance (MDR) and extended spectrum beta-lactamases (ESBLs) among uropathogenic Escherichia coli isolates from female patients in a tertiary care hospital in North India

Abstract

Background: Urinary tract infection (UTI) is a common bacterial infection in women. It is very common during pregnancy and may present as asymptomatic bacteriuria. Escherichia coli is the primary urinary pathogen accounting for 74-90% of uncomplicated urinary tract infection. The aim of the study was to evaluate in-vitro antibiotic susceptibility among urine isolates of Escherichia coli and prevalence of resistance marker like ESBL producer and MDR status.Methods: Mid-stream urine samples of 205 female patients were processed for culture and sensitivity. All the samples were inoculated on culture media and growth showing significant bacteriuria (>105 cfu/ml) were subjected to identification and antibiotic sensitivity testing on Automated system BD Phoenix 100. ESBL status was detected by the system and MDR status was evaluated by standard guidelines.Results: Out of 205 urine samples, 47 samples (22.93%) showed growth of organism. Out of the 47 growth positive samples, 36 (76.60%) samples showed growth of Escherichia coli and out of which 13 (36.11%) were ESBL producer and 23 (63.89%) were ESBL non-producer. Escherichia coli was mostly isolated from younger age group (21-40 years) (61.11%). Antimicrobial susceptibility showed very good sensitivity towards Amikacin, Tigecycline, Carbapenems, Fosfomycin, Piperacillin-tazobactam and Nitrofurantoin. All the isolates of ESBL producer are MDR (100%) and 21.7% of ESBL non-producer are MDR. There is evidence of transfer of resistance genes for non-β-lactam antibiotics along with ESBL resistance marker.Conclusions: Escherichia coli was the predominant uropathogen isolated from female patients and Amikacin, Nitrofurantoin and Fosfomycin can be used as first line drug.

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

“…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.…”

“…Among β-lactamase producers fosfomycin resistance was lowest (7.37%). Low resistance to fosfomycin has also been observed by Das B et al (7.7%) 14 and Rahman MS et al (4.0%). 2 In few studies all the β-lactamase producing isolates were found to be susceptible to fosfomycin.…”

“…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. 25 In most of the studies no resistance to imipenem was observed 14,16,19 but we have observed a high resistance of 66.21%. Chauhan S et al 19 and Das B et al 14 found no resistance to tigecycline while in this study 14.73 % isolates were resistant.…”

“…25 In most of the studies no resistance to imipenem was observed 14,16,19 but we have observed a high resistance of 66.21%. Chauhan S et al 19 and Das B et al 14 found no resistance to tigecycline while in this study 14.73 % isolates were resistant. Varied range of resistance to amikacin was reported: 6.0% to 55.0%.…”

“…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.…”