Burden of Multidrug Resistant Escherichia coli among Patients with Urinary Tract Infections in a Tertiary Care Centre- A Retrospective Analysis

Abstract

Introduction: Multidrug Resistant (MDR) Escherichia coli isolates causing Urinary Tract Infections (UTIs), capable of producing Extended Spectrum Beta Lactamase (ESBL), AmpC beta lactamase and resistance to carbapenems pose serious challenges to the clinicians causing worse clinical scenarios. The detection of these isolates has prime importance in infection control and improving therapeutic management of patients, as their prevalence is increasing worldwide. Injudicious use of antibiotics has led to selective pressure, resulting in the emergence of antibiotic resistance in gram negative bacteria globally. This rise in antimicrobial resistance has decreased the options for empirical therapy, causing a global health concern in infections associated with ESBL producing and AmpC producing isolates. Aim: To investigate the burden of ESBL producing, AmpC beta-lactamase producing, carbapenem resistant, and MDR Escherichia coli isolated from urine samples in a tertiary care centre. Materials and Methods: The present retrospective study conducted from January to December 2019. A total of 10,535 urine samples were received during the study period, to find out the burden of drug resistant Escherichia coli isolates in urine samples, analyse their antibiogram and patients’ socio-demographic information. Records of microscopic observations to antibiogram of each isolate was noted down from the register for urine samples, and further analysed. The data was coded, verified, entered and analysed using Statistical Package for Social Sciences (SPSS) version 18.0. Results: Among the total urine samples (10,535), 1434 (13.6%) Escherichia coli isolates were identified, of which 553 (38.6%) were found to be ESBL producing, 497 (34.6%) AmpC betalactamase producing, 172 (12%) Carbapenem resistant, and 765 (53.3%) MDR. Majority of the isolates were from the age group of 51-60 years 288 (20.08%). The least susceptibility of the isolates was detected against penicillin G 1410 (98.3%), followed by ampicillin 1160 (80.9%) and cephazolin 74 (67.9%). Among the MDR isolates, the maximum drug resistance (398, 52%) was seen in penicillin, cephems, quinolones and Folate pathway antagonist group of antimicrobials. Conclusion: Identification of the drug resistant isolates is of high priority and crucial for therapeutic management of the patients, and infection control. Stringent antimicrobial stewardship policies and judicious use of antimicrobials can decrease the spread of antimicrobial resistant genes in the hospital environment.

Keywords

• ampc β-lactamases
• carbapenem resistance
• co-morbidities
• co-infection
• extended spectrum beta lactamase