Abstract
This study determines the antibiotic resistance pattern of extended spectrum beta-lactamase (ESBL) producing pathogens responsible for catheter associated urinary tract infection (CAUTI) and the genes associated with the resistance. The study used 35 ESBL-producing pathogens isolated from urine and biofilm found in CAUTI from June 2018 to November 2018. Pathogens were confirmed phenotypically for ESBL production with cefpodoxime combination disc kits. Antibiotic resistance was tested using the Kirby-Baurer disc diffusion method on Muller Hinton Agar. ESBL genotypes were identified with PCR. Urine isolates showed higher frequency of resistance against ciprofloxacin (94.11%), cefuroxime and ceftazidime (82.35%) and with no recorded resistance against Eertepenem (0.0%). The average resistance of the biofilm isolates ranged from 0.0% (Ertepenem) to 88.89% (Cefuroxime, Cefpodoxime, Ciprofloxacin and Trimethoprim). All the targeted genes were identified with CTX-M (40%) being the most dominant among them. The ESBL-producing pathogens showed zero resistance against Ertepenem. Ciprofloxacin and other Cephems commonly used in CAUTI treatment were shown to be less effective. The high resistance is as a result of the bacterial cells present in the biofilm with Klebsiella pneumonia exhibiting more resistance than the ESBL-producing E. coli and CTX-M-1 was identified as the most prevalent gene among the identified genotypes. Ertepenem should therefore be recommended for treatment of Catheter associated urinary tract infection. Key words: Catheter, CAUTI, extended spectrum beta-lactamase (ESBL), urine, biofilm, resistance, microorganisms.
Highlights
The incidence of Catheter Associated Urinary Tract Infection (CAUTI) is inevitable having in mind that there is about 10% daily infection rate when catheter is present in situ (Hartley and Valley, 2014; Hooton et al, 2010)
This study investigates the resistance pattern of ESBLproducing pathogens causing catheter associated urinary tract infection (CAUTI) and the genes associated with such resistance using the polymerase chain reaction method as a novel way to bridge the gap by providing baseline surveillance on CAUTI, it prevalence and antimicrobial resistance pattern at Komfo Anokye Teaching Hospital (KATH) in Ghana
The extended spectrum beta-lactamase (ESBL) producing pathogens isolated from the urine show high resistance to Ciprofloxacin (94.11%) followed by the four Cephems/beta-lactam antibiotics with 82.35% for Cefuroxime and Ceftazidime and 76.47% for Cefpodoxime and Cefazolin
Summary
The incidence of Catheter Associated Urinary Tract Infection (CAUTI) is inevitable having in mind that there is about 10% daily infection rate when catheter is present in situ (Hartley and Valley, 2014; Hooton et al, 2010). This infection can lead to more serious complications such as sepsis and endocarditis, and it is estimated that over 13000 deaths each year are associated with healthcareassociated UTIs in the United States of America The microorganisms responsible for this infection are mostly the micro flora from the patient, healthcare attendants and the environment. E. coli and K. pneumonia are the leading cause of CAUTI with increasing resistant rates (Köves et al, 2017; Percival et al, 2018)
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