Prevalence of multidrug resistance and extended spectrum beta-lactamases among uropathogenic escherichia coli isolates in urban tertiary care hospital in north India
Journal Title: Medpulse International Journal of Microbiology - Year 2018, Vol 7, Issue 3
Abstract
Background: Escherichia coli is the most prevalent etiological agent in both community acquired as well as hospital acquired urinary tract infections. Emergence of multidrug resistance (MDR) and ESBL producing E. coli causing urinary tract infections (UTI) is a serious concern. The aim of this study was to define the current prevalence of MDR, extended spectrum beta-lactamases (ESBL) production and AmpC producers. Materials and Methods: Urine samples from 1251patients received in Department of microbiology, PMC, Patna were processed for wet mount followed by culture and sensitivity. All the samples were inoculated on to Blood Agar, Mackoncky Agar and Nutrient agar and growth showing significant bacteriuria (≥105 cfu/ml) were further identified by the standard biochemical procedures and antibiotic sensitivity done as per Clinical and Laboratory Standards Institute guidelines. Phenotypic Detection of ESBL and AmpC were performed by combined disc method and AmpC disc test as per standard protocol. Results and Observations: Out of the 1251 processed midstream urine samples, 353 (28.21%) samples were culture positive. The total number of E. coli isolated were 237 (67.13%). More number of Females 143 (60.33%) had significant UTI due to E. coli compared with males 94 (39.66%). Maximum number of E. coli isolated was in the 18-65 years age group164 (69.19%) Antibiotic susceptibility testing was done for the 237 consecutive non-duplicate E. coli isolates. High level of resistance was seen with ampicillin 211(89.02%), cefotaxime 179 (75.5%) ceftriaxone 177 74.68%),ceftazidme 168 (70.88%) and cefepime 167 (70.46%). amoxyclav 193 (81.4%), ciprofloxacin (78.48%), norfloxacin189 (79.74%) and cotrimoxazole187 (78.9%). Nitrofurantoin 133 (56.11%), Gentamycin 123 (51.8%) and Amikacin 69 (29.11%) exhibit moderate resistant against E.coli isolates. No any E.coli isolates were resistant to Tigecycline and fosphomycin. Sensitivity to imipenem was 210( 88.60%). MDR isolates represented 166(70.04%) while susceptible strains detected in 71 (29.95%) Among these Multidrug resistant strains, ESBLs positive strains were 133 (56.11%) isolates while, the number of AmpC positive strains were 31 (13.08%) isolates. All AmpC producer were co-producers of ESBL, the remaining 102 (43.03%) isolates were pure ESBLs ESBLs positive isolates were found to be more resistant than ESBLs negative isolates to other classes of antimicrobials. Conclusion: This study highlights the Prevalence of MDR, ESBL and AMP C producers of E.coli in UTI. In our study Carbapenems and amkacin are promising drug for ESBL producers while Fosphomycin and Tigecycline use as reserve drug.
Authors and Affiliations
Satyendra Narayan Singh, Trinain Kumar Chakraverti, Ranjan Kumar Srivastava
Keywords
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