Background:
Emergence of multidrug-resistant uropathogenic strains mainly the global spread of extended-spectrum betalactamase (ESBL) genes accompanied both by uncontrolled use of antibacterial agents and a considerable decrease in their activities makes
the monitoring of the resistance pattern one of necessary means that could help the medical practitioners to choose the best treatment. For
this purpose and during four months from March 1 to June 30 (2019), an experimental study has been carried out on urine specimens of 123
inpatients (IP) and outpatients (OP) at infectious disease service Boudjemaa TOURABI Public Hospital of Bechar (Algeria), aiming the
detection of ESBL-producing Enterobacteriaceae uropathogenic strains.
Methods:
Firstly, the antibiotic susceptibility testing has been carried out by using the disk diffusion method to determine not only the
multidrug resistance patterns, but also the multiple antibiotic resistance indexes of uropathogenic strains isolated from clinical IP and OP
samples. Secondly, the ESBL detection was done by using the following methods: synergy tests based on the synergy between a thirdgeneration cephalosporin and clavulanate, double-disc synergy test (DDST) and phenotypic tests on a cloxacillin-containing agar.
Results:
As a result, 56 patients had a urinary tract infection (UTI) in overall 123 patients; a frequency of 45,52%. Through a UTI’s
frequency of 64,7%, the female gender was the most affected. All age groups were affected by UTI, with a mean age of 38,47±19,97 years
old. Knowing that UTIs’ patients having ages ranged from 16 to 49 years old were most affected compared to other ages’ groups, with a
frequency of 66,6 and 50% for female and male gender, respectively. The microbial strains represented by the bacteria group were
predominant, ie (98,22%) followed by yeasts (1,78%), where Gram-negative bacilli showed (96,36%) of the uropathogenic agents, so
(3,64%) were Gram-positive bacteria. The antibiotic resistance profile of isolated Enterobacteriaceae showed very high resistance rates for
the species of Escherichia coli, Klebsiella spp, and Proteus spp to aminopenicillins, cephalosporins, and less against carbapenems and other
drug groups. E. coli had presented the highest multidrug resistance followed by Klebsiella spp with a MAR index ranged from 0,53 to 0,82.
Within this range, a total of 28 isolate (25 E. coli, 2 Klebsiella spp, and 1 Proteus mirabilis) had shown resistance against 9 to 14 out of the 17 tested antibiotics. The rate of ESBL-producing Enterobacteriaceae strains was 23,07 and 55,26% for inpatients and outpatients
respectively, where E.coli was the most important ESBL producers out of all isolated strains.
Conclusion:
An alarming ESBLs rate for outpatients which is usually higher among inpatients with UTI, who receive several classes of
antibiotics. Such condition should be considered as a major public health concern, and measures must be taken to establish the sources and
drivers of this issue. Thus, the findings of this research pushes health sector stakeholders as well as scientific communities to act on
reducing the transmission of the multidrug-resistant strains that threatens several classes of life-saving antibiotics.
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