Abstract
A prospective study was carried out to determine the distribution of ESBL producing uropathogens in different units of a tertiary care hospital in Colombo and in community acquired UTIs presenting to this hospital. A total of 2303 urine samples from adult patients were received in the microbiology laboratory of the hospital during a four-month period, of which 626 were significant positive cultures. Escherichia coli and Klebsiella species accounted for 46% (n=286) of the total isolates with the majority (n=228, 80%) being E. coli. Thirty three percent (n=94) of these isolates produced extended-spectrum β-lactamases (ESBLs). Half (50%) of the Klebsiella isolates were ESBL producers while 29% of the E. coli produced ESBLs. Ten of 11 isolates in the intensive care unit and 6 of 8 in the genito-urinary unit were ESBL producers. The ESBL rate in the general medical and surgical wards and the out-patient department were 33% and 14% respectively. Out of the 181 isolates from community acquired UTIs, 13% produced ESBLs. Resistance to multiple drugs was considerably higher in ESBL positives compared to ESBL negative isolates. Urinary catheters, diabetes mellitus, previous antibiotic use, urinary tract abnormalities and recurrent urinary tract infections were associated with a higher risk of acquiring ESBL producing organisms (P DOI: http://dx.doi.org/10.4038/sljid.v2i2.4235 Sri Lankan Journal of Infectious Diseases Vol.2(2) 2012: 30-36
Highlights
Urinary tract infections (UTIs) are among the most common conditions causing individuals to seek medical care
Most of the E. coli and Klebsiella isolates included in the study (211/286) were from general medical and surgical wards
Coliforms isolated from UTI were very likely to be ESBL producers if they were isolated in the intensive care units (ICU) or GU setting or from patients in general medical and surgical wards who presented with hospital acquired infections
Summary
Urinary tract infections (UTIs) are among the most common conditions causing individuals to seek medical care. Antibiotic treatment for UTI is usually given empirically before the laboratory results of urine culture are available, or sometimes without doing a urine culture in uncomplicated, community acquired infections. Changing epidemiology and ever-increasing antimicrobial resistance in uropathogens can cause difficulties in choice of appropriate empirical treatment. Enterobacteriaceae including Escherichia coli and Klebsiellae are the leading cause of UTI.[1] Production of extended-spectrum β-lactamases (ESBLs) has been identified as a major cause of drug resistance in these bacteria. ESBL producing strains are resistant to the penicillins, oxyimino-cephalosporins and monobactams.[2] plasmid mediated ESBL resistance is commonly associated with co-resistance to many other antibiotics including aminoglycosides, co-trimoxazole and quinolones which are common non β-lactam antibiotics used for treatment of complicated and uncomplicated UTI
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