Different Responses of ESBL Indicative Peptide Spectra to Various β- Lactam Exposures Among Community Acquired Urinary Tract Infected Escherichia coli by Using the MALDI-TOF Technique

Abstract The study aims to identify Escherichia coli specific and Extended Spectrum β- Lactamase (ESBL) indicative peptide spectra when co-exposed with ceftazidime or other beta-lactams with clavulanic acid in ESBL producing isolates in community acquired urinary tract infected E. coli by Matrix-Assisted Laser Desorption/Ionization Time - of - Flight Mass Spectrometry (MALDI-TOF) technique. Among 100 tested E. coli isolates, 13 antibiotics were used to profile the resistant isolates. They were mainly demonstrated the resistance to ampicillin, cefoxitin, cefotaxime, ceftazidime, amoxicillin/clavulanic acid, and tetracycline. The high-, low-, and non-ESBL producers, 43.86%, 40.35% and 15.79%, were classified from these resistant isolates according to the ratio of MIC fold between ceftazidime and amoxicillin/clavulanic acid by E-test. Using the MALDI-TOF technique, 5 E. coli -specific peptide spectra were identified which were located at 4362, 4531, 5380, 6254, and 9063 Da using a cut-off value of 60% of frequency. The significant intensity reduction of spectra at 10477, and 5096 Da were recorded and suspected as ESBL indicative peptide spectra after the exposure to ceftazidime or cefotaxime alone and concomitantly with amoxicillin/clavulanic acid in the high and low ESBL producers, respectively. The further significant spectra located at 2548, and 8371 and 9713 Da were exclusively related to ceftazidime hydrolysis in the low and high ESBL producers, respectively. There were 3 and 4 significant peptide spectra which were located at 5968, 7153, 9713 and 10477 Da, and 2548, 5096, and 9537 Da were also suspected as being ESBL spectra after exposure to other tested β-lactams in the high and low-ESBL producers, respectively. Keywords: Extended Spectrum β-Lactamase; E. coli; MALDI-TOF, Peptide spectra; β-lactams

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Isolation of Extended-Spectrum β-lactamase- (ESBL-) Producing Escherichia coli and Klebsiella pneumoniae from Patients with Community-Onset Urinary Tract Infections in Jimma University Specialized Hospital, Southwest Ethiopia

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2018/4846159 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Mengistu Abayneh ◽

Getnet Tesfaw ◽

Alemseged Abdissa

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Clavulanic Acid ◽

Urinary Tract Infections ◽

Southwest Ethiopia ◽

Extended Spectrum ◽

Specialized Hospital ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

Background. Klebsiella pneumoniae and Escherichia coli are the major extended-spectrum β-lactamase- (ESBL-) producing organisms increasingly isolated as causes of complicated urinary tract infections and remain an important cause of failure of therapy with cephalosporins and have serious infection control consequence. Objective. To assess the prevalence and antibiotics resistance patterns of ESBL-producing Escherichia coli and Klebsiella pneumoniae from community-onset urinary tract infections in Jimma University Specialized hospital, Southwest Ethiopia, 2016. Methodology. A hospital-based cross-sectional study was conducted, and a total of 342 urine samples were cultured on MacConkey agar for the detection of etiologic agents. Double-disk synergy (DDS) methods were used for detection of ESBL-producing strains. A disc of amoxicillin + clavulanic acid (20/10 µg) was placed in the center of the Mueller–Hinton agar plate, and cefotaxime (30 µg) and ceftazidime (30 µg) were placed at a distance of 20 mm (center to center) from the amoxicillin + clavulanic acid disc. Enhanced inhibition zone of any of the cephalosporin discs on the side facing amoxicillin + clavulanic acid was considered as ESBL producer. Results. In the current study, ESBL-producing phenotypes were detected in 23% (n = 17) of urinary isolates, of which Escherichia coli accounts for 76.5% (n = 13) and K. pneumoniae for 23.5% (n = 4). ESBL-producing phenotypes showed high resistance to cefotaxime (100%), ceftriaxone (100%), and ceftazidime (70.6%), while both ESBL-producing and non-ESBL-producing isolates showed low resistance to amikacin (9.5%), and no resistance was seen with imipenem. In the risk factors analysis, previous antibiotic use more than two cycles in the previous year (odds ratio (OR), 6.238; 95% confidence interval (CI), 1.257–30.957; p = 0.025) and recurrent UTI more than two cycles in the last 6 months or more than three cycles in the last year (OR, 7.356; 95% CI, 1.429–37.867; p = 0.017) were found to be significantly associated with the ESBL-producing groups. Conclusion. Extended-spectrum β-lactamases- (ESBL-)producing strain was detected in urinary tract isolates. The occurrence of multidrug resistance to the third-generation cephalosporins, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracyclines is more common among ESBL producers. Thus, detecting and reporting of ESBL-producing organisms have paramount importance in the clinical decision-making.

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Extended-spectrum resistance to β-lactams/β-lactamase inhibitors (ESRI) evolved from low-level resistant Escherichia coli

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz393 ◽

2019 ◽

Cited By ~ 3

Author(s):

Ángel Rodríguez-Villodres ◽

María Luisa Gil-Marqués ◽

Rocío Álvarez-Marín ◽

Rémy A Bonnin ◽

María Eugenia Pachón-Ibáñez ◽

...

Keyword(s):

Escherichia Coli ◽

Clavulanic Acid ◽

Genomic Analysis ◽

E Coli ◽

Extended Spectrum ◽

Copy Numbers ◽

Resistance Patterns ◽

Amoxicillin Clavulanic Acid

Abstract Objectives Escherichia coli is characterized by three resistance patterns to β-lactams/β-lactamase inhibitors (BLs/BLIs): (i) resistance to ampicillin/sulbactam and susceptibility to amoxicillin/clavulanic acid and piperacillin/tazobactam (RSS); (ii) resistance to ampicillin/sulbactam and amoxicillin/clavulanic acid, and susceptibility to piperacillin/tazobactam (RRS); and (iii) resistance to ampicillin/sulbactam, amoxicillin/clavulanic acid and piperacillin/tazobactam (RRR). These resistance patterns are acquired consecutively, indicating a potential risk of developing resistance to piperacillin/tazobactam, but the precise mechanism of this process is not completely understood. Methods Clinical isolates incrementally pressured by piperacillin/tazobactam selection in vitro and in vivo were used. We determined the MIC of piperacillin/tazobactam in the presence and absence of piperacillin/tazobactam pressure. We deciphered the role of the blaTEM genes in the new concept of extended-spectrum resistance to BLs/BLIs (ESRI) using genomic analysis. The activity of β-lactamase was quantified in these isolates. Results We show that piperacillin/tazobactam resistance is induced in E. coli carrying blaTEM genes. This resistance is due to the increase in copy numbers and transcription levels of the blaTEM gene, thus increasing β-lactamase activity and consequently increasing piperacillin/tazobactam MICs. Genome sequencing of two blaTEM-carrying representative isolates showed that piperacillin/tazobactam treatment produced two types of duplications of blaTEM (8 and 60 copies, respectively). In the clinical setting, piperacillin/tazobactam treatment of patients infected by E. coli carrying blaTEM is associated with a risk of therapeutic failure. Conclusions This study describes for the first time the ESRI in E. coli. This new concept is very important in the understanding of the mechanism involved in the acquisition of resistance to BLs/BLIs.

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Etiological and Resistance Profile of Bacteria Involved in Urinary Tract Infections in Young Children

BioMed Research International ◽

10.1155/2017/4909452 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Antonio Sorlózano-Puerto ◽

José María Gómez-Luque ◽

Juan de Dios Luna-del-Castillo ◽

José María Navarro-Marí ◽

José Gutiérrez-Fernández

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Clavulanic Acid ◽

Total Activity ◽

Geographic Area ◽

E Coli ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections ◽

Reduced Activity

Background.The objective of this study was to identify the bacteria most frequently responsible for urinary tract infection (UTI) in the population of under-2-year-olds in our geographic area and to evaluate the activity of antibiotics widely used for UTI treatment during a 4-year study period.Materials and Methods.A retrospective analysis was conducted of data on the identification and susceptibility of microorganisms isolated in urine samples from children under 2 years of age.Results.A total of 1,045 uropathogens were isolated.Escherichia coliaccounted for the majority (60.3%) of these, followed byEnterococcus faecalis(22.4%) andKlebsiellaspp. (6.5%). The highestE. colisusceptibility rates (>90%) were to piperacillin-tazobactam, cefuroxime, cefotaxime, ceftazidime, imipenem, gentamicin, nitrofurantoin, and fosfomycin, and the lowest were to amoxicillin-clavulanic acid and cotrimoxazole. Among all bacteria isolated, we highlight the overall high activity of piperacillin-tazobactam, imipenem, nitrofurantoin, and fosfomycin against both community and hospital isolates and the reduced activity of amoxicillin-clavulanic acid, cephalosporins, gentamicin, and cotrimoxazole. There was no significant change in the total activity of any of the studied antibiotics over the 4-year study period.Conclusion.Empiric treatment with amoxicillin-clavulanic acid, cotrimoxazole, cephalosporins, and gentamicin may be inadequate due to their limited activity against uropathogens in our setting.

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ANTIBIOTIC SUSCEPTIBILITY OF ESCHERICHIA COLI ISOLATE FROM URINARY TRACT INFECTION OF THALASSEMIC PATIENTS IN THI-QAR PROVINCE

Southern Brazilian Journal of Chemistry - Southern Brazilian Journal of Chemistry, Volume 28, No. 28, 2020 ◽

10.48141/sbjchem.v28.n28.2020.04_okab_pgs_22_33.pdf ◽

2020 ◽

Vol 28 (28) ◽

pp. 22-33

Author(s):

Alaa Abood Yasir OKAB ◽

Manal B SALIH

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Clavulanic Acid ◽

Rural Areas ◽

Antibiotic Resistant ◽

E Coli ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

Escherichia coli (E. coli) is the most common type of pathogen that causes Urinary tract infection disease. It can be presented as a pathogenic or non-pathogenic strain and found not only in the animal but also in the human intestine. This bacterium can cause opportunistic infection when the human host comprised of thalassemia patients or changes the healthy hemostatic flora. This study aimed to analyze the presence of bacteria in thalassemia patients with urinary tract infection. A total of 303 samples were collected during the period from August 2019 to January 2020 from thalassemia patients who suffered from urinary tract infection. The results showed that there were 6.9% of patients infected with E. coli, 2.6% of patients were infected with S. aureus, 0.7% with both Proteus and Klebsiella, while 89.1% of patients had a negative sample for bacteria. Also, the incidence of urinary tract infections in females is higher than in males. Besides, its occurrence in rural areas is higher than in city residents. Moreover, among 16 antibiotics tested to sensitize bacteria to antibiotics, Imipenem showed 100% efficacy on all isolated bacteria. In contrast, Netilmicin showed 80.1% efficacy, Gentamycin 80.1%, and Amikacin 76.2%. Ampicillin, Aztreonam, Amoxicillin-Clavulanic Acid, Tetracycline, and Ticarcillin-Clavulanic Acid, did not show any effectiveness toward the bacteria while other antibiotics showed different activities. Furthermore, the isolated microbes from thalassemia patients were the highest resistance to antibiotics in comparison with other studies, and this antibiotic-resistant may be due to the weakening of the patient's immune status and frequent blood taking and the antibodies it contains.

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Avaliação do Perfil de Sensibilidade aos Antibióticos na Infeção Urinária da Comunidade

Acta Médica Portuguesa ◽

10.20344/amp.5352 ◽

2014 ◽

Vol 27 (6) ◽

pp. 737 ◽

Cited By ~ 2

Author(s):

Rui Passadouro ◽

Raquel Fonseca ◽

Felícia Figueiredo ◽

Andreia Lopes ◽

Cristina Fernandes

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Clavulanic Acid ◽

Urinary Tract Infections ◽

Antibiotic Susceptibility ◽

Empirical Therapy ◽

Activity Level ◽

E Coli ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

Introduction: The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal. Material and Methods: We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%). Results: Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin. Discussion: Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%). Conclusion: Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapy recommendations for optimized therapeutical choices. Keywords: Urinary Tract Infections; Drug Resistance, Bacterial; Anti-Bacterial Agents; Community-Acquired Infections.

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In Vitro Efficacy of Flomoxef against Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Associated with Urinary Tract Infections in Malaysia

Antibiotics ◽

10.3390/antibiotics10020181 ◽

2021 ◽

Vol 10 (2) ◽

pp. 181

Author(s):

Soo Tein Ngoi ◽

Cindy Shuan Ju Teh ◽

Chun Wie Chong ◽

Kartini Abdul Jabar ◽

Shiang Chiet Tan ◽

...

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Urinary Tract Infections ◽

In Vitro Susceptibility ◽

E Coli ◽

Extended Spectrum ◽

Tract Infections ◽

Esbl Producers

The increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has greatly affected the clinical efficacy of β-lactam antibiotics in the management of urinary tract infections (UTIs). The limited treatment options have resulted in the increased use of carbapenem. However, flomoxef could be a potential carbapenem-sparing strategy for UTIs caused by ESBL-producers. Here, we compared the in vitro susceptibility of UTI-associated ESBL-producers to flomoxef and established β-lactam antibiotics. Fifty Escherichia coli and Klebsiella pneumoniae strains isolated from urine samples were subjected to broth microdilution assay, and the presence of ESBL genes was detected by polymerase chain reactions. High rates of resistance to amoxicillin-clavulanate (76–80%), ticarcillin-clavulanate (58–76%), and piperacillin-tazobactam (48–50%) were observed, indicated by high minimum inhibitory concentration (MIC) values (32 µg/mL to 128 µg/mL) for both species. The ESBL genes blaCTX-M and blaTEM were detected in both E. coli (58% and 54%, respectively) and K. pneumoniae (88% and 74%, respectively), whereas blaSHV was found only in K. pneumoniae (94%). Carbapenems remained as the most effective antibiotics against ESBL-producing E. coli and K. pneumoniae associated with UTIs, followed by flomoxef and cephamycins. In conclusion, flomoxef may be a potential alternative to carbapenem for UTIs caused by ESBL-producers in Malaysia.

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Antibiotic Susceptibility of Escherichia Coli Isolate from Urinary Tract Infection Of Thalassemic Patients in Thi-Qar Province

Southern Brazilian Journal of Chemistry - Southern Brazilian Journal of Chemistry, Volume 28, No. 28, 2020 ◽

10.37633/sbjc.28(28)2020.22-33 ◽

2020 ◽

Vol 28 (28) ◽

pp. 22-33

Author(s):

Alaa Abood Yasir Okab ◽

Manal Salih

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Clavulanic Acid ◽

Rural Areas ◽

Antibiotic Resistant ◽

E Coli ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

Escherichia coli (E. coli) is the most common type of pathogen that causes Urinary tract infection disease. It can be presented as pathogenic or non-pathogenic strain and found not only in the animal but also in the human intestine. This bacterium can cause opportunistic infection when the human host comprised of thalassemia patients or changes the healthy hemostatic flora. This study aimed to analyze the presence of bacteria in thalassemia patients with urinary tract infection. A total of 303 samples were collected during the period from August 2019 to January 2020 from thalassemia patients who suffered from urinary tract infection. The results showed that there were 6.9% of patients infected with E. coli, 2.6% of patients were infected with S. aureus, 0.7% with both Proteus and Klebsiella, while 89.1% of patients had a negative sample for bacteria. Also, the incidence of urinary tract infections in females is higher than in males. Besides, its occurrence in rural areas is higher than in city residents. Moreover, among 16 antibiotics tested to sensitize bacteria to antibiotics, Imipenem showed 100% efficacy on all isolated bacteria. In contrast, Netilmicin showed 80.1% efficacy, Gentamycin 80.1%, and Amikacin 76.2%. Ampicillin, Aztreonam, Amoxicillin-Clavulanic Acid, Tetracycline, and Ticarcillin-Clavulanic Acid, did not show any effectiveness toward the bacteria while other antibiotics showed different activities. Furthermore, the isolated microbes from thalassemia patients were the highest resistance to antibiotics in comparison with other studies, and this antibiotic-resistant may be due to the weakening of the patient's immune status and frequent blood taking and the antibodies it contains.

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Antimicrobial Susceptibility Patterns of Escherichia coli among Tunisian Outpatients with Community-Acquired Urinary Tract Infection (2012-2018)

Current Urology ◽

10.1159/000499238 ◽

2020 ◽

Vol 14 (4) ◽

pp. 200-205

Author(s):

Nawel Daoud ◽

Manel Hamdoun ◽

Hela Hannachi ◽

Chedlia Gharsallah ◽

Wiem Mallekh ◽

...

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Clavulanic Acid ◽

Antimicrobial Susceptibility ◽

Diffusion Method ◽

E Coli ◽

Amoxicillin Clavulanic Acid ◽

Susceptibility Patterns

Introduction: Community-acquired urinary tract infection is one of the most common reasons for consultation in everyday practice; it represents a major source of antibiotic consumption. Escherichia coli (E. coli) is the main pathogen incriminated. Objective:· The aim of this study was to evaluate antimicrobial susceptibility patterns of community-acquired uropathogenic E coli throughout a 7-year period. Methodology: All strains of E. coli isolated from urine samples between January 1st 2012 and December 31st 2018 were included. Presence of ≥ 103 CFU/ml in urine culture media was considered as significant for urinary tract infection. The identification of E. coli strains was realized using standard laboratory techniques. Antibiotic susceptibility testing was performed using the disk diffusion method according to the CA-SFM/ EUCAST criteria. Results: A total of 1,335 E. coli strains were isolated. Overall susceptibility rates to antimicrobial agents were as follows: ampicillin 39.1%, amoxicillin-clavulanic acid 64.9%, cefotaxime 94.9%, trimethoprim/sulfamethox-azole 67.6%, ciprofloxacin 89.2%, ofloxacin 86.9%, amikacin 98.6%, gentamicin 93.9%, nitrofurantoin 97.6% and fosfomycin 99.3%. All isolates were susceptible to carbapenems. The frequency of extended spectrum beta-lactamases-producing E. coli strains was 4.7%. Susceptibility rates of E. coli for ampicillin, trimethoprim/sulfamethoxazole and amikacin remained relatively stable over the study period, whereas susceptibility to amoxicillin-clavulanic acid, cefotaxime and fluoroquinolones showed a 2-phase pattern. As for gentamicin, a continuous decrease in susceptibility rates was observed. Conclusion: Antimicrobial susceptibility profiles of uropathogenic E. coli are constantly changing, due to modifications in the antibiogram interpretation criteria and antibiotic prescription habits. Rigorous surveillance of resistance rate is necessary to determine appropriate empirical treatment and limit the spread of multiresistant strains.

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Characterization of ESBL-producing Escherichia coli recovered from companion dogs in Tai'an, China

The Journal of Infection in Developing Countries ◽

10.3855/jidc.8138 ◽

2017 ◽

Vol 11 (03) ◽

pp. 282-286 ◽

Cited By ~ 4

Author(s):

Song Li ◽

Junhe Liu ◽

Yufa Zhou ◽

Zengmin Miao

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Epidemiological Data ◽

Pet Dogs ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Companion Dogs ◽

Amoxicillin Clavulanic Acid ◽

Esbl Producers

Introduction: Animals are considered to be reservoirs of extended-spectrum beta-lactamase (ESBL)-producing bacteria, but few epidemiological data on ESBL-producing Escherichia coli urinary tract isolates in pet dogs are available in China. Methodology: This study was conducted to describe the prevalence and characterization of ESBL producers among E. coli urinary tract isolates from pet dogs in Tai'an, China. Results: A total of 118 E. coli were obtained from urinary samples of 80 companion dogs suffering from acute or chronic cystitis, of which three isolates from different dogs were ESBL producers. One isolate from dog A was of phylogroup A/ST410/CTX-M-15/TEM-1; one from dog B was of phylogroup B1/ST533/CTX-M-15/TEM-1; one from dog C was of phylogroup D/ST648/CTX-M-15. All ESBL producers were resistant to ampicillin, cephalexin, cefalotin, cefpodoxime, ceftiofur, enrofloxacin, marbofloxacin, and trimethoprim/sulfamethoxazole, but were susceptible to imipenem and amoxicillin/clavulanic acid. E. coli of ST533 carrying blaCTX-M-15 were first detected in pet dogs in China. Conclusions: Collectively, the findings could expand our knowledge about the prevalence and characterization of ESBL-producing E. coli urinary tract isolates in pet dogs in China.

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Prevalence of Extended Spectrum Beta-Lactamase Producing Escherichia coli and Klebsiella pneumoniae Isolated from Urinary Tract Infected Patients Attending Tertiary Care Hospital of Central Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v15i3.22602 ◽

2019 ◽

Vol 15 (3) ◽

pp. 211-217

Author(s):

Surya Narayan Mahaseth ◽

Raj Kumari Sanjana ◽

Brajesh Kumar Jha ◽

Khilasa Pokharel

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Urine Samples ◽

Beta Lactamase ◽

Initial Screening ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Extended Spectrum ◽

Esbl Producers

Background: Urinary tract infection (UTI) is one of the major health problems in Nepal. Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are two important bacteria associated with UTI. This study was designed to assess the prevalence of extended spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae in urinary isolates at College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal. Methods: We aseptically received 5564 mid-stream urine samples of suspected UTI patients from September 2016 to August 2018. The randomly collected 5564 urine samples were processed by standard Microbiological guidelines as recommended by Clinical and Laboratory Standards Institute (CLSI). All isolates including E. coli and K. pneumoniae were identified using the specific biochemical and sugar fermentation tests. Antibiotic sensitivity test was performed for all the isolates against all commonly used antibiotics by modified Kirby-Bauer disk diffusion method and interpreted following CLSI guidelines. First performed initial screening method then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT). Results: Out of 5,564 urine specimens investigated, E. coli was isolated in 1219 (63.99%) and K. pneumoniae in 223 (11.70%) cases. Initial screening revealed 615 (50.45%) isolates of E. coli and 127 (56.95%) K. pneumoniae to be resistant. Further testing by PCDDT method confirmed 102 (16.58%) E. coli and 25 (19.68%) K. pneumoniae isolates to be ESBL producers. These ESBL producers’ uropathogens revealed high degree of resistance to cephalosporins (100%) and quinolones (52%-92%) group of antibiotics. Conclusions: In our study the prevalence of ESBL producing K. pneumoniae was found to be 19.68%, those of E. coli was to be 16.58% by PCDDT. In this study, all ESBL producing K. pneumoniae isolates were sensitive (100%) to meropenem and E. coli showed 98.04% sensitive to meropenem. Hence, for the treatment of these ESBL infections, currently, carbapenems are the recommended drug of choice.

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