Screening of ESBL Producing Multidrug Resistant E. coli from Urinary Tract Infection Suspected Cases in Southern Terai of Nepal

Abstract

Background and objectives: Multidrug-resistant E. coli expressing extended-spectrum β-lactamase pose serious challenges to clinicians for the therapeutic management of clinical cases in urinary tract infection. The ability of beta-lactamase to cause resistance varies with its activity, quantity, cellular location of gram-negative organisms and its permeability of the producer strain. Therefore, this study was focused to determine the dominance of MDR E. coli and evaluation of status of β-lactamase enzyme produced by MDR E. coli. Materials and methods: A total of 321 successive midstream urine samples were processed among suspected cases of urinary tract infection. Standard microbiological techniques were used for isolation and identification of uropathogens. The antimicrobial susceptibility pattern of bacterial isolates was determined by Kirby-Bauer Disc Diffusion technique. The MDR E. coli isolates were screened for ESBL by double disc synergy test and confirmed with combined disc diffusion test. The p- value<0.05 was considered as statistically significant. Results: The maximum numbers of MDR E. coli isolates were isolated as of female patients with 55.75% than male of 44.24%. Most of the MDR E. coli isolates were isolated from less than 20 years with 30.97% and was dropped in between 40-60 years with 20.35%. The MDR E. coli isolates in association with gender and age group was found to be statistically insignificant (p=0.310). Among 69 suspected ESBL E. coli isolates, 62.31% were confirmed as ESBL producer. Conclusion: E. coli isolates showed shocking rate of drug resistance to the frequently prescribed drugs. The high rate of ESBL-producing MDR E. coli was also observed. There is an increasing need for periodic monitoring of drug susceptibility pattern to prevent the spread and development of antimicrobial resistant strains and ESBL producers.