ALARMING RATES OF PREVALENCE OF ESBL PRODUCING E. COLI IN URINARY TRACT INFECTION CASES IN A TERTIARY CARE NEUROSPECIALITY HOSPITAL
Abstract
Introduction: Extended spectrum beta-lactamases (ESBL) are enzymes that confer resistance to most beta lactam antibiotics, including Penicillins, Cephalosporins, and the Monobactam, Aztreonam. ESBL strains are on the rise in case of community acquired and healthcare associated infections. Escherichia coli are the most common uropathogen worldwide. Prevalence of ESBL production and their antimicrobial susceptibility patterns in urinary E.coli isolates in a tertiary care Neurospeciality hospital were studied.
Materials and Methods: Urinary E.coli isolates were identified and their susceptibility was tested using Vitek2.Isolates were classified as point of admission UTI (POA-UTI), catheter associated UTI (CAUTI), hospital Acquired UTI (HAUTI). Susceptibility analysis was done.
Results: 198 E.coli urinary isolates were obtained between November, 2015 and March, 2017. Out of 87 POA-UTI cases 73.56% were found to be ESBL producers, among which the sensitivity pattern was Ertapenem (81.6%), Piperacillin (57.47%), Amikacin (80.47%), Fosfomycin (97.70%), Nitrofurantoin ( 82.75%), Ciprofloxacin ( 17.24%). All the E.coli isolates producing CAUTI were ESBL producers, among which the sensitivity pattern was Ertapenem (81.48%), Piperacillin (40.74%), Amikacin (70.37%), Fosfomycin (96.29%), Nitrofurantoin (77.77%), Ciprofloxacin (18.51%). Among other isolates E.coli strains producing HAUTI, the sensitivity pattern was Ertapenem (72.61%), Piperacillin (45.23%), Amikacin (79.76%), Fosfomycin (98.80%), Nitrofurantoin (79.31%), Ciprofloxacin (16.66%).
Conclusion: The strains causing CAUTI are ESBL positive with a limited range of antibiotic susceptibility, possibly due to antibiotic pressure. This shows that irrational use of antibiotics show an increase in ESBL producers. Early institution of antibiotics could be a possible solution to this problem. (BL+BLI) combinations seem to have more usefulness in POA-UTI cases than CAUTI cases. Fosfomycin seems to be a better alternative.
Keywords:
ESBL, Urinary tract infections, Susceptibility testing, Escherichia coliDownloads
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