Detection of ESBL and MBL among uropathogenic Escherichia coli in a tertiary care hospital in Maharashtra
DOI:
https://doi.org/10.18203/2320-6012.ijrms20261326Keywords:
Antimicrobial resistance, Escherichia coli, ESBL, MBL, Urinary tract infectionAbstract
Background: Urinary tract infection (UTI) is one of the most common infections worldwide. Although the spectrum of etiological agents causing UTI has remained relatively constant, their antimicrobial susceptibility patterns have changed over time due to the emergence of resistant strains. Escherichia coli, a gram-negative bacillus, is the most common uropathogen. Antimicrobial resistance mediated by extended-spectrum β-lactamases (ESBL) and metallo-β-lactamases (MBL) in E. coli contributes significantly to prolonged hospital stay and increased treatment costs in patients with UTI.
Methods: All urine samples received from inpatients and outpatients in the microbiology laboratory were processed for microscopy and cultured on Blood agar and MacConkey agar. Isolates were identified based on colony morphology and standard biochemical tests. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method according to CLSI guidelines. ESBL production in E. coli was detected by the cephalosporin/clavulanate disk test and MBL production by the imipenem/EDTA disk test.
Results: Of the 2234 urine samples processed, 845 yielded significant growth. E. coli was the most common isolate (41.89%). The uropathogenic E. coli (UPEC) strains showed more resistance to ampicillin (96.78%) and cephalosporins (93.55%) and comparatively less resistance to imipenem (11.93%) and nitrofurantoin (13.55%). ESBL and MBL production were observed in 55.81% and 10.65% of E. coli isolates, respectively.
Conclusions: The increasing prevalence of ESBL- and MBL-producing E. coli among uropathogens is a major concern. Judicious and rational use of antimicrobial agents, guided by local susceptibility patterns, is essential to reduce treatment costs, limit morbidity and curb the further spread of resistance in UTI cases.
References
Shiralizadeh S, Taghizadeh S, Asgharzadeh M, Shokouhi B, Gholizadeh P, Rahbar M, et al. Urinary tract infections: raising problem in developing countries. Rev Res Med Microbiol. 2018;29(4):159-65.
Belete MA, Saravanan M. A systematic review on drug resistant urinary tract infection among pregnant women in developing countries in Africa and Asia; 2005–2016. Infect Drug Resis. 2020;18:1465-77.
Finer G, Landau D. Pathogenesis of urinary tract infections with normal female anatomy. Lancet infect Dis. 2004;1;4(10):631-5.
Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women. Int Urogynecol J. 2015;26(6):795-804.
Epp A, Larochelle A, Lovatsis D, Walter JE, Easton W, Farrell SA, et al. Recurrent urinary tract infection. J Obst Gynaecol. 2010;32(11):1082-90.
Pain F. Urinary tract infections: fever, dysuria. introduction to clinical infectious diseases: a problem-based approach. 2025;29:263.
Geerlings SE. Clinical presentations and epidemiology of urinary tract infections. Microbiology Spect. 2016;30;4(5):10-128.
Shah C, Baral R, Bartaula B, Shrestha LB. Virulence factors of uropathogenic Escherichia coli (UPEC) and correlation with antimicrobial resistance. BMC Microbiol. 2019;2;19(1):204.
Terlizzi ME, Gribaudo G, Maffei ME. UroPathogenic Escherichia coli (UPEC) infections: virulence factors, bladder responses, antibiotic and non-antibiotic antimicrobial strategies. Front Microbiol. 2017;8:1566.
Bader MS, Loeb M, Leto D, Brooks AA. Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents. Postgrad Med. 2020;132(3):234-50.
Petri WA. Sulfonamides, trimethoprim, sulfamethoxazole, quinolones and agents for urinary tract infections. Goodman & Gilman’s the pharmacological basis of therapeutics. New York (NY): McGraw Hill. 2006:1111-25.
Longhi C, Maurizi L, Conte AL, Marazzato M, Comanducci A, Nicoletti M, et al. Extraintestinal pathogenic Escherichia coli: beta-lactam antibiotic and heavy metal resistance. Antibiotics. 2022;11(3):328.
Abdelmoktader A, El Far AT. Methods of ESBLs detection in clinical microbiology lab. Virol Immunol J. 2019;3(4):222.
Clinical laboratory standard institute. Performance standards for antimicrobial susceptibility testing; twenty-second informational supplement. Clin Laborat Standard Inst. 2012;2:70–71.
Goyal A, Kaur K. Assessment of drug sensitivity of different urinary isolates to nitrofurantoin and its comparison with other drugs- a retrospective study. J Clin of Diagn Res. 2022;16(4):6-8.
Ahmed SS, Shariq A, Alsalloom AA, Babikir IH, Alhomoud BN. Uropathogens and their antimicrobial resistance patterns: Relationship with urinary tract infections. Int J Health Sci (Qassim). 2019;13(2):48-55.
Singhal A, Sharma R, Jain M, Vyas L. Hospital and community isolates of uropathogens and their antibiotic sensitivity pattern from a tertiary care hospital in North West India. Ann Med Health Sci Res. 2014;4:51-6.
Patel HB, Soni ST, Bhagyalaxmi A, Patel NM. Causative agents of urinary tract infections and their antimicrobial susceptibility patterns at a referral center in Western India: An audit to help clinicians prevent antibiotic misuse. J Family Med Prim Care. 2019;8(1):154-9.
Sibi G, Kumari P, Kabungulundabungi N. Antibiotic sensitivity pattern from pregnant women with urinary tract infection in Bangalore, India. Asian Pac J Trop Med. 2014;71:116-20.
Yadav K, Sharma N. Detection of ESBL & MBL producing E. coli from urine samples in a tertiary care hospital in Jaipur, Rajasthan. Sch J App Med Sci. 2017;5(4):1259-72.
Jagadeesan S, Tripathi BK, Patel P, Muthathal S. Urinary tract infection and Diabetes Mellitus-Etio-clinical profile and antibiogram: A North Indian perspective. J Family Med Prim Care. 2022;11(5):1902-6.
Arora G, Kaur P, Agrawal D. Urinary tract infection in women of rural population of Haryana: a rising problem. International J Reprod Cont Obst Gynecol. 2016;5:4470-4.
Sood S, Gupta R. Antibiotic resistance pattern of community acquired uropathogens at a tertiary care hospital in Jaipur, Rajasthan. Indian J Community Med. 2012;37:39-44.
Shakya P, Shrestha D, Maharjan E, Sharma VK, Paudyal R. ESBL production among E. coli and klebsiella spp. causing urinary tract infection: a hospital based study. Open Microbiol J. 2017;11:23-30.
Thapa Shrestha U, Shrestha S, Adhikari N, Rijal KR, Shrestha B, Adhikari B, et al. Plasmid Profiling and Occurrence of β-Lactamase Enzymes in Multidrug-Resistant Uropathogenic Escherichia coli in Kathmandu, Nepal. Infect Drug Resist. 2020;13:1905-17.
Bhargava K, Nath G, Bhargava A, Kumari R, Aseri GK, Jain N. Bacterial profile and antibiotic susceptibility pattern of uropathogens causing urinary tract infection in the eastern part of Northern India. Front Microbiol. 2022;13:965053.
Bahramian A, Khoshnood S, Hashemi N, Moradi M, Karimi-Yazdi M, Jalallou N, et al. Identification of metallo-β-lactamases and AmpC production among Escherichia coli strains isolated from hemodialysis patients with urinary tract infection. Mol Biol Rep. 2021;48(12):7883-92.
Brungi S, Kogila S, Reddy R. Phenotypic detection of extended spectrum beta lactamase and metallo beta lactamase producers among multidrug resistant Escherichia coli and Klebsiella spp. in urinary tract infections. IP International J Med Microbiol Trop Dis. 2012;9:246-52.
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