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Prevalence, antibiotic sensitivity pattern and genetic analysis of extended spectrum beta lactamase producing Escherichia coli and Klebsiella spp among patients with community acquired urinary tract infection in Galle district, Sri Lanka

Authors:

Upul Priyadharshana ,

Teaching Hospital Karapitiya,Galle, LK
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Lasanthi B. Piyasiri,

Teaching Hospital Karapitiya,Galle, LK
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Champa Wijesinghe

University of Ruhuna, Galle, LK
About Champa
Faculty of Medicine
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Abstract

Introduction: Community acquired urinary tract infections (CA-UTI) are commonly caused by Escherichia coli and Klebsiella spp which are known extended spectrum beta lactamase (ESBL) producers.

 

Objectives: To determine, the prevalence and characteristics of ESBL producing of E. coli and Klebsiella spp in the community, and the association of risk factors with ESBL CA-UTI.

 

Methods: Descriptive cross-sectional study with urine cultures performed from clinically suspected CA-UTI patients by CLSI standards. Conventional multiplex PCR was performed for gene analysis.

 

Results: Cultures were positive in 178 (38%) patients from 465. Majority were females (103, 58%). Most frequently isolated was E. coli (149, 84%) with 68(46%)   ESBL producers   followed by 16(9%) Klebsiella pneumoniae with   4 (25%) ESBL producers.  Majority of patients with ESBL CA-UTI were >50 yrs (35/72, 49%) and 13 (18%) children <10 years were present. ABST of ESBL producers revealed high resistance rates for quinolones (41%) and   >80%   sensitivity   for   nitrofurantoin, fosfomycin, mecillinam, aminoglycosides and carbapenems. Presence of ESBL genes were 83% CTX –M, 71% OXA, 24% TEM and 9% SHV with one organism often producing more than one gene in 29 isolates (71%). Haematuria and structural abnormalities of urinary tract were significantly associated with increased ESBL CA-UTI (p<0.01).

 

Conclusions: ESBL prevalence of this community was 40% in CA-UTI with   E.coli predominance among female   majority.   >80% ESBL   organisms   show   high sensitivity   for aminoglycosides, carbapenems, nitrofurantoin, mecillinam and fosfomycin. Frequently isolated ESBL gene was CTX-M. Haematuria and structural abnormalities of urinary tract were significantly associated with ESBL CA-UTI.

DOI: https://doi.org/10.4038/cmj.v64i4.8990
How to Cite: Priyadharshana, U., Piyasiri, L.B. and Wijesinghe, C., 2019. Prevalence, antibiotic sensitivity pattern and genetic analysis of extended spectrum beta lactamase producing Escherichia coli and Klebsiella spp among patients with community acquired urinary tract infection in Galle district, Sri Lanka. Ceylon Medical Journal, 64(4), pp.140–145. DOI: http://doi.org/10.4038/cmj.v64i4.8990
Published on 31 Dec 2019.
Peer Reviewed

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