Prevalence and Risk Factors of Extended Spectrum Beta-Lactamase-Producing Uropathogens among UTI Patients in the Governmental Hospitals of North West Bank: A Cross-Sectional Study

Abstract

Background: Urinary tract infections caused by Extended Spectrum Beta-Lactamase producing organisms (UTI-ESBL) are increasing in incidence and pose a great threat to modern medicine. The objective of this study was to assess the prevalence and risk factors of Extended Spectrum Beta-Lactamase (ESBL)-producing uropathogens among patients with urinary tract infections in the north of West Bank and to determine the antimicrobial susceptibility profile of the isolated bacteria. Methods: A total of 427 patients who were attending the governmental hospitals in the northern cities of the West Bank were included in the study. They were older than 12 years and diagnosed with UTI in the period from June 2017 to September 2017. Isolated bacteria was collected from the microbiology labs of the respective hospitals and tested for the ESBL production and their antibiotic susceptibilities were determined. Information regarding the risk factors was collected from the patient ' s medical records. Univariate analyses were performed for potential risk factors for the development of UTI-ESBL, and then multivariate analyses were performed for all significant variables. Results: Out of the 427 urine cultures screened for ESBL, 163 (38.4%) were confirmed to be ESBL producers. E. coli was the most frequent uropathogen. K. pneumoniae produced the highest rate of ESBL (54.9%), followed by E. coli (42.5%), and Proteus mirabilis (7.14%). Patients with recurrent UTI had 5 times relative risk of having ESBL producing uropathogens (odd ratio (OR), 4.7) followed by previous antibiotic use (OR, 3.07), hemodialysis (OR, 2.92), chronic kidney disease (OR, 2.69) and finally diabetes mellitus (OR, 1.87). ESBL isolates were susceptible to fosfomycin (100%), nitrofurantoin (93.9%), pipracillin/tazobactam (94.5%), ertapenem (98.2%), meropenem (98.8%), and amikacin (93.9%). Conclusion: The prevalence of ESBL-producing uropathogens was 38.4%. Recurrent UTI appeared to be the strongest risk factor for ESBL-UTI. ESBL-producing uropathogens were highly susceptible to amikacin, nitrofurantoin, and much more to fosfomycin and piperacillin/tazobactam in addition to carbapenems.

Comprehensive study of antimicrobial susceptibility pattern and extended spectrum beta-lactamase (ESBL) prevalence in bacteria isolated from urine samples

“…[35][36][37] . In contrast, several studies reported the highest ESBL production among K. pneumoniae followed by E. coli which do not match our results [38][39][40] , since we found E. coli as the predominant ESBL producer.…”

Spectrum and antibiotic resistance in community- and hospital-acquired urinary tract infections among adults: Experience from a large tertiary care center in a developing country

“…K. pneumoniae was the dominant extended-spectrum β-lactamase (ESBL) producing organism, accounting for 58.1% of cases, followed by E. coli at 54%. These are slightly higher numbers than previously reported in our region in 2018 21 where E. coli accounted for 42.5%, K. pneumoniae for 54.9% , and P. mirabilis for 7.14%. Given the high rates of ESBL production in E. coli and K. pneumoniae , it was not surprising to observe high resistance rates to cephalosporins and ampicillin.…”

Detection of β-lactamase genes (blaTEM, bla CTX-M and bla SHV) in uropathogens isolated from patients with UTI

“…The rate of ESßL production was greater in K. pneumoniae (76.6 percent) than in E. coli (68.2%) among the ESßLproducing uropathogens isolated in our sample. These findings are consistent with other studies that found a higher rate of ESβL production in K. pneumoniae (54.9%) than in E. coli (42.4%) 28 .…”