234 Prevalence and Antimicrobial Resistance of ESBL-Producing Escherichia coli in Urinary Tract Infections at LAUTECH Teaching Hospital, Ogbomoso, Nigeria

Abstract

Abstract Introduction/Objective Extended spectrum beta-lactamase producing Escherichia coli are more recognized as prevalent pathogens in many hospital settings, especially in urinary tract infections (UTIs). Escherichia coli are much more resistant to β-lactam antibiotics and other commonly available antibiotics. This study was conducted with the aim of determining the prevalence of ESBL-producing Escherichia coli in urinary tract infection patients visiting healthcare facilities, determining the antimicrobial resistance pattern of isolated ESBL-producing E. coli strains to facilitate infection control policy development and antimicrobial stewardship programs within the hospital. Methods/Case Report A cross-sectional survey was carried out at LAUTECH Teaching Hospital, Ogbomoso. Fifty (50) catheter urine and midstream urine samples were collected from clinically confirmed UTI patients. Ethical approval was obtained from ethical review committee and informed consent of patients was requested. Escherichia coli isolates were identified with Gram staining and biochemical tests. Antimicrobial susceptibility test was determined by the Kirby-Bauer disk diffusion method according Clinical & Laboratory Standard Institute (CLSI) guidelines. Extended spectrum beta lactamase (ESBL) production was screened and confirmed by combination of disk tests with cefotaxime, ceftazidime, and clavulanic acid. Data were analyzed using SPSS version 20, and chi-square tests were employed to determine statistical associations between ESBL production and demographic variables such as age, sex, and patient status. A p-value of < 0.05 was considered statistically significant. Results Fifty (50) isolates of Escherichia coli were analyzed; 57.5 % were ESBL-positive. Prevalence was highest in the age group of 61-80 years suggesting a age risk factor. Inpatients (46.7%) showed a much higher percentage compared to outpatients(10.7%), suggesting that hospital-acquired infection may play a more important role in the acquisition of ESBL. The ESBL-producing strains had a strong resistance to commonly used antibiotics: ceftriaxone (97.5%), cotrimoxazole (88.2%), ampicillin (75.6%), ciprofloxacin (71.8%), and sulbactam (55.8%), and susceptibility to amikacin (74.6%), imipenem (75.3%), nitrofurantoin (71.2%), and gentamicin (71.4%). Conclusion The proliferation of ESBL-producing bacteria is an important alarm for all countries around the world, due to their high resistance to various antimicrobial agents. This study shows an extremely high prevalence of ESBL producing bacteria among UTI patients, particularly the hospitalized and elderly. This study justify routine ESBL screening in clinical microbiology laboratory as a mandatory practice to prevent treatment failures. ESBL screening needs to be institutionalized as a regular hospital practice and infection control practices need to be optimized to reduce the transmission of multidrug-resistant organisms. Thus, the use of proper antibiotics, along with avoiding the overuse or misuse of antibiotics with a high resistance pattern, should be considered to minimize the development of these infections. Furthermore, molecular studies are recommended to characterize resistant bacteria.