Abstract
Background:Emergence of multi-drug resistant uropathogenic E. coli strains is an increasing problem to empirical treatment of urinary tract infections in many countries. This study investigated the magnitude of this problem in Jordan.Methods:A total of 262 E. coli isolates were recovered from urine samples of Jordanian patients which were suspected to have urinary tract infections (UTIs). All isolates were primarily identified by routine biochemical tests and tested for antimicrobial susceptibility by disc diffusion method. Fifty representative Multidrug Resistance (MDR) E. coli isolates to 3 or more antibiotic classes were tested for the presence of resistance genes of blaCTX-M- 1, 9 and 15, carbapenemase (blaIMP, blaVIM, blaNDM-1, blaOXA-48), fluoroquinolones mutated genes (parC and gyrA) and clone of ST131 type using PCR methods.Results:A total of 150/262 (57.3%) of E. coli isolates were MDR. Urine samples of hospitalized patients showed significantly more MDR isolates than outpatients. Fifty representative MDR E. coli isolates indicated the following molecular characteristics: All were positive for mutated parC gene and gyrA and for ST131 clone, and 78% were positive for genes of CTX-M-15, 76% for CTX-M-I and for 8% CTX-M-9, respectively. Additionally, all 50 MDR E. coli isolates were negative for carbapenemase genes (blaIMP, blaVIM, blaNDM-1, blaOXA-48), except of one isolate was positive for blaKPC-2 .Conclusion:This study indicates alarming high rates recovery of MDR uropathogenic E. coli from Jordanian patients associated with high rates of positive ST131 clone, fluoroquinolone resistant and important types of blaCTX-M.
Highlights
Emergence of E. coli strains that produce extended-spectrum beta-lactamases (ESBLs) were increased steadily among commensal and clinical E. coli isolates worldwide including Jordan [1 - 5]
A new E. coli clone designated sequence type ST131 was found in stool and urine specimens of patients in different countries, and it has been characterized as serotype O25:H4, and it was often associated with fluoroquinolone resistance and CTX-M-15 production [3, 9]
A total of 150 (57.3%) of E. coli isolates were multidrug resistance (MDR) to 3 or more antibiotic classes
Summary
Emergence of E. coli strains that produce extended-spectrum beta-lactamases (ESBLs) were increased steadily among commensal and clinical E. coli isolates worldwide including Jordan [1 - 5]. These strains are capable of hydrolyzing penicillins, broad-spectrum cephalosporins and monobactams, but they do not affect the cephamycins or carbapenems and their activity is inhibited by clavulanic acid [6]. Increased occurrence of multidrug resistance (MDR) E. coli to 3 or more antibiotic classes causing urinary tract infections will be associated with treatment failure, in association with bacterial strains carrying CTX-M extended-spectrum ESBLs. The genes coding for ESBLs are usually carried by plasmid, which facilitates their spread. Emergence of multi-drug resistant uropathogenic E. coli strains is an increasing problem to empirical treatment of urinary tract infections in many countries. This study investigated the magnitude of this problem in Jordan
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