Higher Prevalence of Extended Spectrum β-Lactamase Producing Uropathogenic Escherichia coli Among Patients with Diabetes from a Tertiary Care Hospital of Kathmandu, Nepal

Am J Trop Med Hyg. 2021 Aug 23;105(5):1347-1355. doi: 10.4269/ajtmh.21-0691.

Abstract

This study aimed to determine the occurrence of antibiotic resistance genes for β-lactamases; blaTEM and blaCTX-M in uropathogenic Escherichia coli isolates from urinary tract infection (UTI) suspected diabetic and nondiabetic patients. A hospital-based cross-sectional study was conducted in Kathmandu Model Hospital, Kathmandu, in association with the Department of Microbiology, GoldenGate International College, Kathmandu, Nepal, from June to December 2018. A total of 1,267 nonduplicate midstream urine specimens were obtained and processed immediately for isolation of uropathogens. The isolates were subjected to antibiotic susceptibility testing and extended spectrum β-lactamase (ESBL) confirmation. In addition, blaTEM and blaCTX-M genes were detected using specific primers. The overall prevalence of UTI was 17.2% (218/1,267), of which patients with diabetes were significantly more infected; 32.3% (31/96) as compared with nonpatients with diabetes, 15.9% (187/1,171). A total of 221 bacterial isolates were obtained from 218 culture-positive specimens in which E. coli was the most predominant; 67.9% (150/221). Forty-four percent (66/150) of the total E. coli was multidrug resistant and 37.3% (56/150) were ESBL producers. Among 56 isolates, 92.3% (12/13) were from patients with diabetes, and 83.0% (44/53) were from nondiabetics. Furthermore, 84.9% of the screened ESBL producers were confirmed to possess either single or both of blaTEM and blaCTX-M genes. The blaTEM and blaCTX-M genes were detected in 53.6% and 87.5% of the phenotypically ESBL confirmed E. coli, respectively. Higher rates of ESBL producing uropathogenic E. coli are associated among patients with diabetes causing an alarming situation for disease management. However, second-line drugs with broad antimicrobial properties are still found to be effective drugs for multidrug resistance strains.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diabetes Complications / drug therapy*
  • Diabetes Complications / epidemiology
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Drug Resistance, Multiple, Bacterial / genetics*
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / epidemiology
  • Female
  • Healthy Volunteers
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Nepal / epidemiology
  • Prevalence
  • Sex Factors
  • Tertiary Care Centers
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / epidemiology
  • Uropathogenic Escherichia coli / drug effects*
  • Uropathogenic Escherichia coli / genetics*
  • Young Adult
  • beta-Lactamases / genetics*
  • beta-Lactamases / metabolism

Substances

  • Anti-Infective Agents
  • beta-Lactamases