Community-Acquired Uropathogenic Escherichia coli, Antimicrobial Susceptibility, and Extended-Spectrum Beta-Lactamase Detection

Abstract

INTRODUCTION Urinary tract infection is the second-leading reason for consults in primary health care. Bacterial urinary tract infections are the most common, of which Escherichia coli is the main etiologic agent. Antimicrobial resistance and multidrug resistance complicate eff ective community treatment, especially if resistance is caused by extendedspectrum beta-lactamase production. WHO recommends that antimicrobial susceptibility be evaluated in diff erent regions of the world at diff erent times. Community-acquired E. coli's susceptibility to colistin has not yet been studied in Cuba, and mcr-1 gene screening is necessary. OBJECTIVE Evaluate community-acquired uropathogenic E. coli isolates' susceptibility to antibiotics, including colistin, and identify extended-spectrum beta-lactamase-producing bacteria. METHODSWe conducted a descriptive cross-sectional study that included 281 community-acquired uropathogenic E. coli isolates (153 from the Isle of Youth Special Municipality's Hygiene, Epidemiology, and Microbiology Center and 128 from Microbiology Laboratories of 7 institutions in Havana) from June 2016 through July 2018. We used the disk diff usion method to determine susceptibility to ampicillin, ampicillin/ sulbactam, cefazolin, trimethoprim/sulfamethoxazole, ciprofl oxacin, nitrofurantoin and fosfomycin. The disk elution method was used to determine susceptibility to colistin. The combined disk method was used to identify extendedspectrum beta-lactamases. Estimates were made regarding the frequency and percentages of antimicrobial susceptibility and resistance, as well as multidrug-resistance patterns. RESULTSOf the 281 isolates, 68.3% (192/281) were resistant to ampicillin, 54.8% (154/281) were resistant to ciprofl oxacin, and 49.5% (139/281) were resistant to trimethoprim/ sulfamethoxazole. Resistance to colistin was not detected. On the other hand, 14.2% (40/281) were susceptible to the 8 antibiotics we evaluated, 22.1% (62/281) showed resistance to only 1 antibiotic, and 63.7% (179/281) were resistant to 2 or more antibiotics. In the extended-spectrum beta-lactamase determination, 34.5% (97/281) had inhibition zones ≤14 mm with cefazolin. Of those with inhibition zones, 64.9% (63/97) were positive in the phenotype test, and 35.1% (34/97) were negative. In extended-spectrum beta-lactamaseproducing bacteria, 1.6% (1/63) were resistant to fosfomycin, and 3.2% (2/63) were resistant to nitrofurantoin. The most common multidrug-resistance pattern (22.9%; 30/131) was to ampicillin/sulbactam, ampicillin, cefazolin, ciprofl oxacin, and trimethoprim/sulfamethoxazole. CONCLUSIONS Uropathogenic E. coli resistance to the antibiotics most frequently used in community medical practice is quite common, and extended-spectrum beta-lactamaseproducing bacteria is the mechanism for beta-lactam antibiotic resistance. Multidrug-resistance patterns include resistance to the antibiotics most used in community-acquired infections. Fosfomycin and nitrofurantoin are the most active in extendedspectrum beta-lactamase producing...

Infecciones del tracto urinario por Escherichia coli productora de beta-lactamasas de espectro extendido de origen comunitario e intrahospitalario: una revisión bibliográfica

“…(Sierra, Díaz et al, 2019) Por ende, el sistema VITEK se posiciona como una herramienta valiosa, especialmente en la confirmación de betalactamasas de espectro extendido (BLEE) ya que utiliza antibióticos como cefepima, cefotaxima y ceftazidima de manera individual y en combinación con ácido clavulánico, (Mendieta, Tello et al, 2023) esta combinación especifica de antibióticos y su inhibidor permite discernir de manera precisa resultados negativos o positivos. (Carmona Yenisel et al, 2022) En este contexto, el sistema automatizado VITEK se caracteriza por ser una herramienta prometedora para la identificación y caracterización de las BLEE, investigaciones revelan que este sistema ha demostrado una sensibilidad notable del 97% lo que indica la capacidad del sistema para identificar con precisión la presencia de BLEE, minimizando así los falsos negativos y una especificidad del 88%. (Miranda Padilla, 2023) En publicaciones realizadas por varios investigadores, se aprecia una diferencia donde la mayor prevalencia de ITU por Escherichia coli BLEE se da en el género femenino, tanto en entornos hospitalarios como comunitarios por lo que, Yugsi P. y colaboradores mencionan en su investigación que entre los años 2019 y 2021, se documentaron un total de 877 aislados clínicos de Escherichia coli, con el 75,5% correspondiente al género femenino y el 24,5% al masculino.…”

Dominance of Escherichia coli sequence types ST73, ST95, ST127 and ST131 in Australian urine isolates: a genomic analysis of antimicrobial resistance and virulence linked to F plasmids

“…Pandemic ExPEC lineages, such as ST131, have also been central to a global increase in extended-spectrum β-lactamase (ESBL)producing E. coli, as well as resistance to other clinically important antibiotic classes [4,7,8]. A combination of sulphonamide and trimethoprim is a standard treatment for UTIs but resistance rates to these frontline antibiotics are increasing globally, leading to the elevated use of extended-spectrum β-lactams and fluoroquinolones [9][10][11][12][13]. Previously we performed whole genome sequencing (WGS) on 67 trimethoprim-resistant ExPEC from patients attending a regional Australian hospital in 2006-2008 [14] and reported genes conferring resistance to extended-spectrum β-lactams, heavy metals and quaternary ammonium ions co-occurring with genes encoding resistance to trimethoprim.…”