Prevalance of extended-spectrum beta-lactamase producing uropathogenic eschereria coli and antimicrobial susceptibility pattern in a tertiarycare hospital in North India

Background: Urinary tract infections (UTIs) remain the common infections in outpatients as well as hospitalized patients. Extended Spectrum Beta- Lactamase producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care. ESBL-producing E. coli have been isolated from both hospitalized and non-hospitalized patients. Current knowledge on antimicrobial sensitivity pattern is essential for appropriate therapy. The aim of this study was to evaluate the prevalence of ESBL uropathogenic E.coli and the antibiotic susceptibility patterns of ESBL and non ESBL producers, which is essential to guide appropriate antibiotic treatment. Material and Methods: Urine samples from 1551 patients received in Department of microbiology, PMC, Patna were processed for wet mount followed by culture and sensitivity. All the samples were inoculated on Nutrient agar, Bood Agar, and Mackoncky Agar. 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 diffusion method as per standard protocol. Results and observations: Out of the 1551 processed urine samples 398 (25.66%). samples were culture positive. The total number of E. coli isolated were 253 (63.56%). More number of Females 147 (58.10) had significant UTI due to E. coli compared with males 167 (41.95%). High level of resistance was seen with Ampicillin 221(87.35%), Cefotaxime 183(72.33%) Ceftriaxone 181 (71.54%), Ceftazidme 175 (69.16%) and Cefepime 167 (66.00%). Resistance to other classes of antibiotics was detected as Ciprofloxacin 191(75.49%), Norfloxacin 203 (80.23%), Cotrimoxazole 201 (79.44%) Nitrofurantoin 133 (52.56%), Gentamycin 121 (47.82%) and Amikacin 79 (31.22%). Among β lactam inhibitors, Amoxyclav 198 (78.26%), Cefoperazone-sulbactam 112 (44.26%). and Pipericillin tazobactam 103 (40.71%). Sensitivity to imipenem was 177(69.96%). No any E.coli isolates were resistant to Tigecycline and fosphomycin. (Table 1). MDR isolates represented 173(68.37%). Among these Multidrug resistant strains, ESBLs positive strains were 141 (55.73%) isolates while, the number of AmpC positive strains were 31 (12.25%) isolates. All AmpC producer were co-producers of ESBL, the remaining 113 (44.66%) isolates were pure ESBLs. Conclusion: This study highlights the Prevalance 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.