The Status of Extended-spectrum β-lactamase and AmpC β-lactamase production in uropathogenic isolates of Escherichia coli and Klebsiella pneumonia in Bangladesh

Abstract

Background: The rapid dissemination of antibiotic resistance as extended-spectrum beta-lactamases (ESBLs) and AmpC β-lactamases in bacteria became a major public health concern worldwide. Hence, this study was carried out to evaluate the status of uropathogenic isolates of Bangladesh especially Escherichia coli and Klebsiella pneumoniae in terms of ESBL and AmpC β-lactamases enzymes production. Methods: A laboratory-based cross-sectional survey was conducted with 553 urine samples at the Department of Microbiology, Popular Diagnostic Centre Ltd. Dhaka, Bangladesh for a period of 2.5 years from July 2017 to December 2019. Pathogens were obtained upon culture, and screened for ESBL production following the cephalosporin disk diffusion method and cephalosporin-clavulanate combination disc test (confirmatory) method. For AmpC β-lactamases enzymes, cefoxitin disc diffusion, and AmpC disc test (confirmatory) methods were performed. The positive isolates were further genotyped for the presence of blaTEM, blaSHV, blaOXA, and blaCTX-M β-lactamases genes in case of ESBL and blaFOX, blaCMY, and blaDHA genes for AmpC β-lactamases by polymerase chain reaction. Results: Of all urine samples, uropathogens were detected among 28.57% (158, n=553) samples. Among them, 46.20% (73) were E. coli and 20.25% (32) were K. pneumoniae. The prevalence of ESBL and AmpC β-lactamases production in E. coli was 34.24% (25) and 17.80% (13) respectively whereas it was 43.75% (14) and 21.87% (7) in Klebsiella pneumoniae isolates respectively. These resistance properties were further confirmed by phenotypic disc test. In case of ESBLs, most typical isolates possessed two or more resistance genes. Overall, the most prevalent gene was blaCTX-M (84.61%) followed by blaTEM (64.10%), blaOXA (46.15%) and blaSHV (25.64%). In case of AmpC β-lactamases FOX gene was most prevalent (45%) followed by CMY (20%) and DHA 3 (15%). Conclusion: The high prevalence of ESBL and AmpC β-lactamases production in our study emphasizes the judicious use of antibiotics in controlling urinary tract infections in Bangladesh.