Evaluation of multi drug resistance among extended spectrum β-lactamase-producing Escherichia coli causing urinary tract infection in Erbil City
Background and objective: Bacterial resistant to broad spectrum β-lactams, which is mediated by the extended spectrum beta lactamase enzyme, has emerged recently as increasing problem. Extended spectrum beta lactamase producing strains can also displaying multi-drug resistance. Thus, increased number of infections due to these strains is a public health issue associated with high morbidity, mortality, high health-care costs and prolonged hospitalization. Therefore, this study aimed to evaluate multi-drug resistance among extended spectrum beta lactamase producing E. coli causing urinary tract infections.
Methods: A total of 400 mid-stream urine specimens were collected from patients with urinary tract infection. Disk diffusion agar method on Muller-Hinton agar plates was carried out. Double Disc Synergy Test was used for detection of extended spectrum beta lactamase producer. All the isolates that were screened out for extended spectrum beta lactamase production were also subjected to confirmation by using the Phenotypic Confirmatory Combination Disc Diffusion Test.
Results: The urinary tract infection cases were mainly due to Gram negative bacteria (87%). E. coli was isolated from 195 (48%) specimens. Sixty isolates of E. coli (31%) were found to be extended spectrum beta lactamase producers. The resistance to antibiotics tested was significantly higher (P <0.001) among extended spectrum beta lactamase producing isolates.
Conclusion: The prevalence of multi-drug resistance to the antibiotics among extended spectrum beta lactamase producing E. coli isolates was established. Imipenems are recommended for the treatment of serious infections caused by these organisms.
Altayar MA, Thokar MA, Mohammad MA. Extended spectrum B-lactamase-producing Escherichia coli in clinical isolates in Benghazi, Libia: Phenotypic detection and antimicrobial susceptibility pattern. Medical Journal of Islamic World Academy of Sciences 2012; 20(2):49-56.
Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, et al. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemother 2007; 59(2):165-74.
Hassan MI, Alkharsah KR, Alzahrani AJ, Obeid OE, Khamis AH, Diab A. Detection of extended spectrum beta-lactamases-producing isolates and effect of AmpC overlapping. J Infect Dev Ctries 2013; 7(8):618-29.
Tukaram V, Nilekar S, Shivraj NK. ESBLs—A Challenge to the Clinicians. Indian Medical Gazette 2012; 22(2):87-91.
kreem Al-salamy A. Detection of extended spectrum-beta lactamase enzymes producing E. coli that isolated from urine. Kufa Journal For Veterinary Medical Sciences 2012; 3(1):55-66.
Gundogan N, Avci E. Prevalence and antibiotic resistance of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella species isolated from foods of animal origin in Turkey. Afr J Microbiol Resch 2013; 7(31): 4059-64.
Dalela G. Prevalence of Extended Spectrum Beta Lactamase (ESBL) Producers among Gram Negative Bacilli from Various Clinical Isolates in a Tertiary Care Hospital at Jhalawar, Rajasthan, India. J Clin Diagn Res 2012; 6:182-7.
Egbebi A, Famurewa O. Prevalence of extended spectrum beta-lactamase (ESBL) production among Klebsiella isolates in some parts of South West Nigeria. Microbiol Biotech Res 2011; 1(2): 64-8.
Ejaz H. Detection of extended-spectrum β-lactamases in Klebsiella pneumoniae: Comparison of phenotypic characterization methods. Pak J Med Sci 2013; 29(3):768-72.
Auer S, Wojna A, Hell M. Oral treatment options for ambulatory patients with urinary tract infections caused by extended-spectrum-β-lactamase-producing Escherichia coli. Antimicrob Agents Chemother 2010; 54(9):4006-8.
Paterson DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006; 43(Supplement 2):S43-8.
Amutha R, Murugan T, Devi MR. Studies on multidrug resistant Pseudomonas aeruginosa from pediatric population with special reference to extended spectrum beta lactamase. Indian Journal of Science and Technology 2009; 2(11):11-3.
Batarseh A, Soneah S, Mardeni R, Elmadni K, Noor M, Abu Ashour N. Antibiotic resistance pattern of multidrug resistant and extended-spectrum beta-lactamaseproducing-Escherichia coli urinary isolates at Queen Rania Al-Abdullah Hospital for children. Jordan.Z.U.M.J 2013; 19(5).
Khanfar HS, Bindayna KM, Senok AC, Botta GA. Extended spectrum beta-lactamases (ESBL) in Escherichia coli and Klebsiella pneumoniae: trends in the hospital and community settings. J Infect Dev Ctries 2009; 3(4):295-8.
Leong A. Principles and Practice of Medical Laboratory Sciences. New York, Churchill Livingston; 1997.
Dowzicky MJ, Park CH. Update on antimicrobial susceptibility rates among gram-negative and gram-positive organisms in the United States: results from the Tigecycline Evaluation and Surveillance Trial (TEST) 2005 to 2007. Clin Ther 2008; 30(11):2040-50.
Giriyapur RS, Nandihal NW, Krishna B, Patil AB, Chandrasekhar M. Comparison of disc diffusion methods for the detection of extended-spectrum beta lactamase-producing Enterobacteriaceae. J Lab Physicians 2011; 3(1):33-6.
Drieux L, Brossier F, Duquesnoy O, Aubry A, Robert J, Sougakoff W, et al. Increase in hospital-acquired bloodstream infections caused by extended spectrum β-lactamase-producing Escherichia coli in a large French teaching hospital. Eur J Clin Microbiol Infect Dis 2009; 28(5):491-8.
Chaudhary N, Murthy S. Prevalence of Multidrug Resistance in Uropathogenic Klebsiella Species With Reference to Extended Spectrum β -Lactamases Production. Research Journal of Pharmaceutical, Biological and Chemical Sciences 2013; 4(3):728-35.
Jantunen M, Saxen H, Lukinmaa S, Ala-Hauhala M, Siitonen A. Genomic identity of pyelonephratogenic Escherichia coli isolated from blood, urine and faeces of children with urosepsis. J Med Microbiol 2001; 50:650-2.
Behrouzi A, Rahbar M, Vandy and Yousefi J. Frequency of extended spectrum beta-lactamase (ESBLs) producing Escherichia coli and Klebseilla pneumonia isolated from urine in an Iranian 1000-bed tertiary care hospital. African Journal of Agriculture research 2010; 9:881-4.
Gedik H. Risk factors for drug resistant bacterial infections: Hospital based study. Afr J Microbiol Res 2012; 6(6):1190-6.
Ejaz H, Zafa A, Mahmood S, Javed MM. Urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae. African Journal of Biotechnology 2013; 10(73):16661-6.
Nimri L, Azaizeh B. First Report of Multidrug-Resistant ESBLProducing Urinary Escherichia coli in Jordan. British Microbiology Research Journal 2012; 2(2):71-81.
Tumbarello M, Citton R, Spanu T, Sanguinetti M, Romano L, Fadda G, et al. ESBL-producing multidrug-resistant Providencia stuartii infections in a university hospital. J Antimicrob Chemother 2004; 53(2):277-82.
Kang C-I, Wi YM, Lee MY, Ko KS, Chung DR, Peck KR, et al. Epidemiology and risk factors of community onset infections caused by extended-spectrum β-lactamase-producing Escherichia coli strains. J Clin Microbiol 2012; 50(2):312-7.
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