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

Abstract

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.

Antibiotic resistance, virulence and genetic diversity of Klebsiella pneumoniae in community- and hospital-acquired urinary tract infections in Iran

“…In this study, 46 (95.8%) of phenotypically ESBL-positive isolates indicated the presence of the ESBL genes. The absence of the ESBL genes in two of the phenotypically ESBL-positive isolates suggests that ESBL production in these isolates might be related to other classes of ESBLs, which requires further studies [37]. In accordance with our findings, a high prevalence of CTX-M is reported among the ESBL-positive strains from Asia, America, and Africa [35,38,39].…”

Co-infection With Chromosomally-Located blaCTX-M-14 and Plasmid-Encoding blaCTX-M-15 in Pathogenic Escherichia coli in the Republic of Korea

“…Similar cases have been reported to be associated with co-infection of ESBL-producing pathogenic E. coli in other countries, such as Bangladesh and China ( Ahmed et al, 2014 ; Xu and He, 2019 ). These findings indicate that co-infecting pathogenic E. coli strains and Enterobacter cloacae or uropathogenic E. coli isolated from urinary tract infection (UTI) patients also produce ESBL genes.…”

“…According to surveillance for foodborne and waterborne infection outbreaks during the period of 2013–2017 in the Republic of Korea, an estimated 7,600 cases occurred annually, among which 8.7% were associated with multiple pathogen outbreaks involving co-infection ( Korea Centers for Disease Control & Prevention, 2013 , 2014 , 2015 , 2016 , 2017 ). In addition, several cases of co-infection with dual pathogens have been steadily reported in other countries ( Wensley and Coole, 2013 ; Ahmed et al, 2014 ).…”

Clinical risk factors, bacterial aetiology, and outcome of urinary tract infection in children hospitalized with diarrhoea in Bangladesh

“…'Significant' bacteriuria is defined as a clean-catch, midstream specimen containing a bacterial count of 510 5 c.f.u./ml. Bacterial identifications were performed with the API 20E system (Analytab Products, USA) [31]. The agar diffusion technique was used for antibiotic susceptibility testing.…”