Prevalence and Risk Factors of Extended Spectrum Beta-Lactamase-Producing Uropathogens among UTI Patients in the Governmental Hospitals of North West Bank: A Cross-Sectional Study

Abstract

Background: Urinary tract infections caused by Extended Spectrum Beta-Lactamase producing organisms (UTI-ESBL) are increasing in incidence and pose a great threat to modern medicine. The objective of this study was to assess the prevalence and risk factors of Extended Spectrum Beta-Lactamase (ESBL)-producing uropathogens among patients with urinary tract infections in the north of West Bank and to determine the antimicrobial susceptibility profile of the isolated bacteria. Methods: A total of 427 patients who were attending the governmental hospitals in the northern cities of the West Bank were included in the study. They were older than 12 years and diagnosed with UTI in the period from June 2017 to September 2017. Isolated bacteria was collected from the microbiology labs of the respective hospitals and tested for the ESBL production and their antibiotic susceptibilities were determined. Information regarding the risk factors was collected from the patient's medical records. Univariate analyses were performed for potential risk factors for the development of UTI-ESBL, and then multivariate analyses were performed for all significant variables. Results: Out of the 427 urine cultures screened for ESBL, 163 (38.4%) were confirmed to be ESBL producers. E. coli was the most frequent uropathogen. K. pneumoniae produced the highest rate of ESBL (54.9%), followed by E. coli (42.5%), and Proteus mirabilis (7.14%). Patients with recurrent UTI had 5 times relative risk of having ESBL producing uropathogens (odd ratio (OR), 4.7) followed by previous antibiotic use (OR, 3.07), hemodialysis (OR, 2.92), chronic kidney disease (OR, 2.69) and finally diabetes mellitus (OR, 1.87). ESBL isolates were susceptible to fosfomycin (100%), nitrofurantoin (93.9%), pipracillin/tazobactam (94.5%), ertapenem (98.2%), meropenem (98.8%), and amikacin (93.9%). Conclusion: The prevalence of ESBL-producing uropathogens was 38.4%. Recurrent UTI appeared to be the strongest risk factor for ESBL-UTI. ESBL–producing uropathogens were highly susceptible to amikacin, nitrofurantoin, and much more to fosfomycin and piperacillin/tazobactam in addition to carbapenems.