Abstract
Treatment of hospital acquired urinary tract infections (UTIs) caused by extended-spectrum beta-Lactamases producing Klebsiella pneumonae is a major problem. This organism expresses a high level of resistance to many groups of antibiotics. Fosfomycin is an agent which is recommended for treatment of UTIs caused by ESBLs producers. The aim of this study is to determine the sensitivity pattern of ESBLs producing urinary K. pneumonae to antimicrobial agents including fosfomycin in patients of MUHs and determine the prevalence of fosfomycin resistance mediated by plasmid mediated fosfomycin modifying enzymes fosA, fosB and fosA3. Methods: Klebsiella pneumonae urinary isolates were collected from patients with hospital acquired UTIs in Mansoura University Hospitals (MUHs). The susceptibility pattern was determined by Kirby Baur method. Isolates resistant to extended spectrum cephalosporins were tested for ESBLs production by double disc diffusion method. Fosfomycin resistance was determined by broth dilution method. Isolates resistant to fosfomycin were tested for fosA, fosB and fosA3 by PCR. Results: A total of 128 ESBLs producing K. pneumonae isolates were collected. The highest sensitivity was to imipenem (94.5%). The lowest was to trimethoprime-sulphamethoxazole (21.8%). Co-resistance of ESBLs isolates with fosfomycin was 23.2%. Eighteen fosfomycin resistant isolates (18/30) were positive to fosA. Conclusion: ESBLs producing urinary Klebsiella pneumonae express moderate sensitivity to fosfomycin. Resistance is mainly mediated by plasmid mediated fosfomycin modifying enzymes fosA.
Highlights
Urinary tract infection (UTI) is one of the most common hospital-acquired infections (HAIs) especially in developing countries [1]
Production of extended-spectrum beta-lactamases (ESBLs) by K. pneumonae restricts the therapeutic options for treatment of infections they cause [5]
Samples were collected from patients hospitalized for longer than 72 hours and developed UTI diagnosed according to the criteria described by the Centers for Disease Control/National Health Service Network (CDC/NHSN) and International Nosocomial Infection Control Consortium (INICC) guidelines [13] [14]
Summary
Urinary tract infection (UTI) is one of the most common hospital-acquired infections (HAIs) especially in developing countries [1]. It represents about 40% of all hospital acquired infections and is mainly catheter associated [2]. Klebsiella pneumonia is an important cause of these infections. Production of extended-spectrum beta-lactamases (ESBLs) by K. pneumonae restricts the therapeutic options for treatment of infections they cause [5]. Treatment of ESBLs producing organisms which are resistant to cephalosporins and to other agents like quinolones and aminoglycosides represents a major problem [6]. Co-resistance to these agents is very common, because the resistance genes are located on mobile genetic elements such as plasmids and transposons [7]
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