Persistent Extended-Spectrum β-Lactamase Urinary Tract Infection

DeBusscher, Joan; Zhang, Lixin; Buxton, Miatta; Foxman, Betsy; Barbosa-Cesnik, Cibele

doi:10.3201/eid1511.081501

Cited by 16 publications

(14 citation statements)

References 7 publications

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“…Antimicrobial resistance among UPEC shows considerable variations during different time periods and in different areas. The problem becomes further complicated with the emergence of ESBL producing UPEC [25,26].…”

Section: Discussionmentioning

confidence: 99%

Antibiogram and characterization of resistance markers among Escherichia coli Isolates from urinary tract infections

Kumar

Sood

Sharma

et al. 2013

J Infect Dev Ctries

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Introduction: Urinary tract infection is the most frequently diagnosed kidney and urologic disease, and Escherichia coli is by far its most common etiological agent. Uropathogenic E. coli are responsible for approximately 90% of urinary tract infections seen in individuals with ordinary anatomy therefore, it is essential to review the antibiogram of uropathogenic E. coli periodically to help clinicians decide on the appropriate therapy. Methodology: We evaluated E. coli isolated from urinary tract infections at the National Salmonella and Escherichia Centre for antibiogram, plasmid transferability and stability of resistance markers. Results: In total, 90.9% of the isolates were found to be sensitive to nitrofurantoin while the highest proportion of the isolates was found to be resistant to nalidixic acid. Minimum inhibitory concentrations of all antimicrobials for different isolates were well within the limits specified by the Clinical and Laboratory Standards Institute. Resistance against tetracycline was not transferred either by conjugation and transformation. Streptomycin resistance was found to be lost in the maximum number of tested isolates showing loss at the 10

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Section: Discussionmentioning

confidence: 99%

Antibiogram and characterization of resistance markers among Escherichia coli Isolates from urinary tract infections

Kumar

Sood

Sharma

et al. 2013

J Infect Dev Ctries

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“…Alternative antibiotic choices for treatment of patients with ESBL-producing bacterial infection are limited. Carbapenems remain the most effective drugs of choice, but these antibiotics need to be administered by an intravenous or intramuscular route (DeBusscher et al, 2009). PCR specific for b-lactamase resistance genes of the ceftriaxone-resistant isolate showed that this strain was negative for bla TEM , bla SHV , bla OXA and bla CTX-M genes.…”

Section: Discussionmentioning

confidence: 99%

Recurrent urinary tract infection due to co‐infection with extended spectrum β‐lactamase‐producer uropathogenic Escherichia coli and enteroaggregative E. coli

et al. 2014

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Introduction: Urinary tract infections (UTIs) are the most common bacterial infections in women of all ages. The emergence of resistance to newer classes of antibiotics, including third generation cephalosporins, has limited the drug choices for treatment of UTI. We report here a recurrent UTI due to co-infection with multiple-antibiotic-resistant (MAR) Escherichia coli pathotypes.Case presentation: A 73-year-old woman with diabetes mellitus type 2 presented with fever, nausea, vomiting, burning sensation, painful and frequent urination. She was diagnosed with recurrent UTI (RUTI) due to co-infection with pansensitive enteroaggregative E. coli (EAEC) and MAR extended spectrum b-lactamase (ESBL)-producing uropathogenic E. coli (UPEC) and treated with azithromycin and levofloxacin (each for 10 days). Unfortunately, she did not respond. Plasmid profile analysis showed that the MAR E. coli strain harboured multiple plasmids including ,38 and ,80 MDa plasmids. PCR for detection of b-lactamase genes showed that the isolate was negative for blaTEM, blaSHV, blaOXA and blaCTX-M. To the best of our knowledge, this is the first report of co-infection with an EAEC and MAR ESBL-producer UPEC in Bangladesh. Conclusion:We recommend that all pathotypes of E. coli as well as the other more common uropathogens should be considered in the diagnosis of RUTI and multiple antibiotics should be prescribed only in severe conditions.

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“…Worldwide, this growing antimicrobial resistance may be due to irrational use of antibiotics and its transfer by various means, including antibiotic resistant plasmids, bacteriophages, transpons, and integrons [8,38]. Continuous exposure of patients with recurrent UTI to antimicrobials is the major cause of high resistance rates leading to persistence and in the prevalence of UPEC strains [39].…”

Section: Discussionmentioning

confidence: 99%

Distribution of ESBLs among Escherichia coli isolates from outpatients with recurrent UTIs and their antimicrobial resistance

Al-Mayahie

Kuriashy

2016

J Infect Dev Ctries

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Introduction: Extended-spectrum β-lactamase (ESBL)-producing strains of Enterobacteriaceae are considered to be emerging pathogens. They are a major problem in hospitalized as well as community-based patients. Major outbreaks involving ESBL strains have been reported from all over the world. Recurrent urinary tract infection (UTI) is one of the risk factors for infection with ESBL-producing E. coli in hospitalized and non-hospitalized patients. Methodology: Ninety-one E. coli isolates from outpatients with recurrent UTIs were surveyed phenotypically and genotypically for ESBL production and tested for antimicrobial susceptibility. Results: Of 91 E. coli isolates, 75.8% were resistant to each of cefotaxime and ceftazidime and 74.7% produced ESBLs. CTX-M-type was the most frequent ESBL (accounting for 70.3%), with CTX-M-1 being the only subtype possessed by these isolates. The prevalence of OXA-and SHV-type was 32.9% and 10.9%, respectively. None of the isolates produced TEM β-lactamase. All OXA-type ESBL were produced concomitantly with CTX-M1. Both ESBL producers and non-producers had high resistance to ampicillin followed by trimethoprimsulphamethoxazole, third-generation cephalosporins, and tetracycline. No isolate showed resistance to imipenem and meropenem. In total, resistance rates of ESBL producers were higher than those of ESBL non-producers, as was multidrug resistance (52.7% versus 8.7%, respectively). Conclusions: Our study documented high distribution of ESBLs among E. coli isolates from outpatients with recurrent UTIs, with CTX-M as the predominant ESBL. In the current situation, it is important that antibiotic treatment is be started only after a proper sensitivity report is obtained from the laboratory.

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Persistent Extended-Spectrum β-Lactamase Urinary Tract Infection

Cited by 16 publications

References 7 publications

Antibiogram and characterization of resistance markers among Escherichia coli Isolates from urinary tract infections

Antibiogram and characterization of resistance markers among Escherichia coli Isolates from urinary tract infections

Recurrent urinary tract infection due to co‐infection with extended spectrum β‐lactamase‐producer uropathogenic Escherichia coli and enteroaggregative E. coli

Distribution of ESBLs among Escherichia coli isolates from outpatients with recurrent UTIs and their antimicrobial resistance

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