Expression of plasmid-mediated resistance genes ESBLs and PMQR among uropathogens, isolated from non-dialysis CKD patients with pyelonephritis

Abstract

Urinary tract infections (UTIs) are thought to be the most common group of bacterial infections, worldwide. It is estimated that the proportion of UTIs remains at a high level reaching 150 million episodes per year worldwide and accounting for $6 billion in health care expenditures. In USA more than 100,000 hospital admissions per year are the UTIs patients, among them the patients with pyelonephritis are the most frequent. For the US outpatients, approximately 15 % of antibiotics used are prescribed for UTIs. However, recent studies in Europe and the United States have demonstrated a steady increase in the rate of uropathogen resistance to commonly prescribed antibiotics, and this obviously will lead to a reduction in therapeutic possibilities of UTI. CDC has estimated that more thаn 2 million infections and 23,000 deaths are due to antibiotic resistance each year. By 2050, it is estimated, that antibiotic resistance will cause 10 million deaths every year. Infection is an importаnt cause of mоrbidity and mоrtality amоng patients with kidney failurе and is the sеcond lеading causе of death following CVD. At the EU/EEA level, more than half (54 %) of the E.coli isolates reported to EARS-Net for 2020 were resistant to at least one of the antimicrobial groups under regular surveillance, i.e. aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems. A majority (87.4 %) of the third-generation cephalosporin-resistant E.coli isolates from 2020 were extended-spectrum beta-lactamase (ESBL) positive. Use of broad-spectrum antimicrobials is a known risk factor for colonization and spread of resistant Enterobacteriaceae, including E.coli. The high levels of ESBLs and increasing resistance to key antimicrobial groups might also lead to an increased consumption of carbapenems, which in turn can increase the selection pressure and facilitated the spread of carbapenem-resistant Enterobacteriaceae. The article presents data on the antibacterial susceptibility of isolated uropathogens, and their association with the presence or absence of plasmid-mediated resistance genes ESBLs and PMQR.