Occurrence of Extended Spectrum b-lactamases among E. coli and Klebsiella pneumoniae Isolated from Urinary Tract Infection from Tertiary Health Care Center in Amravati District

Abstract Background Childhood urinary tract infection (UTI) may cause increased major morbidity and long-term clinical consequences. Extended-spectrum β-lactamase (ESBL) is produced by the members of the Enterobacteriaceae family, which are the primary infectious agents that cause UTI in children. Isolation of ESBL-producing Enterobacteriaceae (ESBL-E) typically occurred in healthcare facilities; however, the incidence of community-associated (CA) UTIs due to ESBL-E has increased worldwide. It has led to an increase in the use of carbapenems. In this study, we determine the characteristics of community-onset UTIs caused by ESBL-E in children to suggest non-carbapenem options for the treatment of childhood UTIs due to ESBL-E in order to preserve carbapenems. Methods A total of 2,157 isolates of ESBL-E were collected from children below 18 years old who were clinically certified UTI or urosepsis between January 2008 and August 2018 at tertiary university hospital in Korea. Their electronic medical records were retrospectively reviewed. Long-term healthcare facility stay within the preceding month and isolates recovered more than 72 hours after hospitalization were the criteria of healthcare-associated (HA) infection. Results The most common isolates were E. coli 1815 (84.2%) followed by K. pneumoniae 342 (15.8%). CA infection was detected in 1,513 of the 2157 ESBL-E (70.1%). The prevalence of CA ESBL-E infection increased significantly from 68 cases in 2008 to 325 cased in 2017. Antibiotic susceptibility test showed highest sensitivity to ertapenem, meropenem, and amikacin (>90%) followed by cefoxitin (82%), and piperacillin–tazobactam (TZP) (80.5%). CA E. coli showed higher sensitivity to amikacin and TZP compared with HA E coli. CA K. pneumoniae showed much higher sensitivity to TZP compared with HA K. pneumoniae. Of total ESBL-E, the antimicrobial resistance rate to aminoglycoside such as amikacin and gentamicin showed full sensitivity during the study period; furthermore, a rate of resistance to TZP has been decreasing over the years. Conclusion Identifying antibiotic susceptibility patterns of ESBL-E is a useful guide for treatment strategy of UTI. This study showed that there are non-carbapenem options for the treatment of CA ESBL UTI in children. Disclosures All authors: No reported disclosures.

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Outcome of community-onset ESBL-producing Escherichia coli and Klebsiella pneumoniae bacteraemia and urinary tract infection: a population-based cohort study in Denmark

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa361 ◽

2020 ◽

Vol 75 (12) ◽

pp. 3656-3664

Author(s):

Rasmus Richelsen ◽

Jesper Smit ◽

Henrik Carl Schønheyder ◽

Pavithra Laxsen Anru ◽

Belen Gutiérrez-Gutiérrez ◽

...

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Cohort Study ◽

Urinary Tract ◽

Tract Infection ◽

Klebsiella Pneumoniae ◽

Population Based ◽

Esbl Production ◽

E Coli ◽

Community Onset

Abstract Objectives To assess the impact of ESBL production on mortality and length of hospital stay (LOS) of community-onset infections due to Escherichia coli or Klebsiella pneumoniae. Methods A population-based cohort study including all adult patients hospitalized with a first-time community-onset E. coli or K. pneumoniae bacteraemia or urinary tract infection in the North Denmark Region between 2007 and 2017. For each bacterial agent, we computed 1 year Kaplan–Meier survival curves and cumulative incidence functions of LOS, and by use of Cox proportional hazard regression we computed HRs as estimates of 30 day and 1 year mortality rate ratios (MRRs) and LOS among patients with and without ESBL-producing infections. Results We included 24 518 cases (among 22350 unique patients), of whom 1018 (4.2%) were infected by an ESBL-producing bacterium. The 30 day cumulative mortality and adjusted MRR (aMRR) in patients with and without ESBL-producing isolates was as follows: E. coli bacteraemia (n = 3831), 15.8% versus 14.0%, aMRR = 1.01 (95% CI = 0.70–1.45); E. coli urinary tract infection (n = 17151), 9.5% versus 8.7%, aMRR = 0.97 (95% CI = 0.75–1.26); K. pneumoniae bacteraemia (n = 734), 0% versus 17.2%, aMRR = not applicable; and K. pneumoniae urinary tract infection (n = 2802), 13.8% versus 10.7%, aMRR = 1.13 (95% CI = 0.73–1.75). The 1 year aMRR remained roughly unchanged. ESBL-producing E. coli bacteraemia was associated with an increased LOS compared with non-ESBL production. Conclusions ESBL production was not associated with an increased short- or long-term mortality in community-onset infections due to E. coli or K. pneumoniae, yet ESBL-producing E. coli bacteraemia was associated with an increased LOS.

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Multiple-Antibiotic Resistance Mediated by Plasmids and Integrons in Uropathogenic Escherichia coli and Klebsiella pneumoniae

Bangladesh Journal of Microbiology ◽

10.3329/bjm.v24i1.1231 ◽

1970 ◽

Vol 24 (1) ◽

pp. 19-23 ◽

Cited By ~ 7

Author(s):

Taslima Taher Lina ◽

Sabita Rezwana Rahman ◽

Donald James Gomes

Keyword(s):

Escherichia Coli ◽

Drug Resistance ◽

Urinary Tract Infection ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Tract Infection ◽

Klebsiella Pneumoniae ◽

High Rate ◽

E Coli ◽

Class 1

Antibiotic resistance in urinary tract infection (UTI) is a growing public health problem in the world. In this study, a total of 182 uropathogens were isolated from patients with symptoms of urinary tract infection (UTI). Escherichia coli (88%) was the most prevalent isolate, while Klebsiella pneumoniae was recovered from 12% cases. The male/female ratio was 1:3. About 56% female and 51% male patients belonged to the age group >40 years. The antibiotic resistance rates of the isolates to fifteen different drugs were investigated. E. coli and K. pneumoniae showed variable pattern of susceptibility. The percentage of resistance to different drugs was higher in E. coli isolates compared to that of K. pneumoniae. Among the total number of isolates about 87% were resistant to at least three commonly used antibiotics. All the isolates were sensitive to imipenem. Analysis of the plasmid DNA had shown that the plasmid pattern was very diverse in both E. coli and K. pneumoniae. All the isolates contained multiple numbers of plasmid ranging from 1.0 to >140 MDa. Middleranged plasmids (30 to 80 MDa), the transferable resistance plasmids, were found to be present in 86% E. coli and 85% K. pneumoniae isolates. The strong association observed between plasmid profiles and drug resistance patterns suggest that plasmids other than the common plasmids may have epidemiological significance. The presence of class 1 and class 2 integrons were also investigated. A relatively high occurrence of class 1 integrons, that are associated with lateral transfer of antibacterial resistance genes, was observed in K. pneumoniae (88%) than in E. coli isolates (54%). Class 2 integrons were not found in any of the E. coli and K. pneumoniae isolates. These results show the high rate of drug resistance and the presence of high rate of transferable elements in these MDR isolates. Keywords: Uropathogens, Escherichia coli, Klebsiella pneumoniae, Multidrug-resistant (MDR) bacteria, Plasmid profiles, IntegronsDOI: http://dx.doi.org/10.3329/bjm.v24i1.1231 Bangladesh J Microbiol, Volume 24, Number 1, June 2007, pp 19-23

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