The Antibiotic Resistance and Multidrug Resistance Pattern of Uropathogenic Escherichia coli at Soba University Hospital: A Descriptive Retrospective Survey
Keywords:
Escherichia coli, urinary tract infection, multidrug resistance, Soba University Hospital
Abstract
Background: The irrational use of antibiotics for the treatment of urinary
tract infections (UTIs) may lead to increased antimicrobial resistance among
uropathogenic Escherichia coli (E. coli), as well as multidrug resistance worldwide,
which will limit available treatment options for UTIs caused by these organisms. This
study aimed to determine the resistance pattern of E. coli causing UTIs in out-patients
and in-patients of Soba University Hospital.
Methods: Data were collected from the laboratory records in the Department of
Microbiology in Soba Teaching Hospital by using a predesigned checklist and then
analyzed using the statistical package for social sciences. Bivariate analysis (Chisquare test) was used to compare between variables.
Results: Out of the 231 E. coli urine cultures, 160 (69.3%) were collected from females.
The results showed high resistance to ampicillin (92.4%), amoxicillin-clavulanic acid
(83.3%), cephalexin (90.6%), cefuroxime (72%), ceftazidime (71%), ceftriaxone (72%),
ciprofloxacin (68%), and co-trimoxazole (75.3%). Collectively, around 188 (81.4%) were
multidrug-resistant. On the other hand, the sensitivities of E. coli isolates were 68.8%,
93.1%, 89.4%, and 100% to gentamicin, amikacin, nitrofurantoin, and carbapenems,
respectively.
Conclusion: The rate of E. coli resistance was observed to be high to the commonly
prescribed drugs for UTIs, including ampicillin, amoxicillin/clavulanic acid, different
cephalosporins, fluoroquinolones, and co-trimoxazole. However, E. coli showed lower
resistance rates to nitrofurantoin, amikacin, and carbapenems. Thus, these drugs can
be reserved for the empirical treatment of UTIs caused by E. coli.
References
[1] Mazzariol, A., Bazaj, A., and Cornaglia, G. (2017). Multi-drug-resistant gram-negative
bacteria causing urinary tract infections: a review. Journal of Chemotherapy, vol. 29,
no. 1, pp. 2–9.
[2] Medina, M. and Castillo-Pino, E. (2019). An introduction to the epidemiology
and burden of urinary tract infections. Therapeutic Advances in Urology.
https://doi.org/10.1177/1756287219832172
[3] Flores-Mireles, A. L., Walker, J. N., Caparon, M., et al. 2015 (). Urinary tract infections:
epidemiology, mechanisms of infection and treatment options. Nature Reviews
Microbiology, vol. 13, no. 5, pp. 269–284.
[4] Alanazi, M. Q., Alqahtani, F. Y., and Aleanizy, F. S. (2018). An evaluation of E. coli in
urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia:
retrospective study. Annals of Clinical Microbiology and Antimicrobials, vol. 17, no.
1, p. 3.
[5] Hooton, T. M. (2012). Clinical practice. Uncomplicated urinary tract infection. New
England Journal of Medicine, vol. 366, no. 11, pp. 1028–1037.
[6] Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence,
bacteriology, risk factors, and disease burden. Infectious Disease Clinics of North
America, vol. 28, no. 1, pp. 1–13.
[7] Nicolle, L. E. and AMMI Canada Guidelines Committee. (2005). Complicated urinary
tract infection in adults. Canadian Journal of Infectious Diseases and Medical
Microbiology, vol. 16, no. 6, pp. 349–360.
[8] Levison, M. E. and Kaye, D. (2013). Treatment of complicated urinary tract infections
with an emphasis on drug-resistant gram-negative uropathogens. Current Infectious
Disease Reports, vol. 15, no. 2, pp. 109–115.
[9] Beahm, N. P., Nicolle, L. E., Bursey, A., et al. (2017). The assessment and management
of urinary tract infections in adults: guidelines for pharmacists. Canadian Pharmacists
Journal, vol. 150, no. 5, pp. 298–305.
[10] Tandogdu, Z. and Wagenlehner, F. M. (2016). Global epidemiology of urinary tract
infections. Current Opinion in Infectious Diseases, vol. 29, no. 1, pp. 73–79.
[11] Gupta, K., Hooton, T. M., Naber, K. G., et al. (2011). International clinical practice
guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis
in women: a 2010 update by the Infectious Diseases Society of America and
the European Society for Microbiology and Infectious Diseases. Clinical Infectious
Diseases, vol. 52, no. 5, pp. e103–e20.
[12] Al Yousef, S. A., Younis, S., Farrag, E., et al. (2016). Clinical and laboratory profile
of urinary tract infections associated with extended spectrum beta-lactamase
producing Escherichia coli and Klebsiella pneumoniae. Annals of Clinical &
Laboratory Science, vol. 46, no. 4, pp. 393–400.
[13] Ikram, R., Psutka, R., Carter, A., et al. (2015). An outbreak of multi-drug resistant
Escherichia coli urinary tract infection in an elderly population: a case-control study
of risk factors. BMC Infectious Diseases, vol. 15, no. 1, p. 224.
[14] Raeispour, M. and Ranjbar, R. (2018). Antibiotic resistance, virulence factors and
genotyping of uropathogenic Escherichia coli strains. Antimicrobial Resistance &
Infection Control, vol. 7, no. 118, pp. 018–0411.
[15] Komolafe, O. O. (2003). Antibiotic resistance in bacteria - an emerging public health
problem. Malawi Medical Journal, vol. 15, no. 2, pp. 63–67.
[16] Sabir, S., Ahmad Anjum, A., Ijaz, T., et al. (2014). Isolation and antibiotic susceptibility
of E. coli from urinary tract infections in a tertiary care hospital. Pakistan Journal of
Medical Sciences, vol. 30, no. 2, pp. 389–392.
[17] Foxman, B. (2002). Epidemiology of urinary tract infections: incidence, morbidity, and
economic costs. American Journal of Medicine, vol. 8, no. 113, pp. 01054–01059.
[18] Huang, L.-F., Lo, Y.-C., Su, L.-H., et al. (2014). Antimicrobial susceptibility patterns
among Escherichia coli urinary isolates from community-onset health careassociated urinary tract infection. Journal of the Formosan Medical Association,
vol. 113, no. 12, pp. 970–973.
[19] Murugan, K., Savitha, T., and Vasanthi, S. (2012). Retrospective study of antibiotic
resistance among uropathogens from rural teaching hospital, Tamilnadu, India. Asian
Pacific Journal of Tropical Disease, vol. 2, no. 5, pp. 375–380.
[20] Alperin, M., Burnett, L., Lukacz, E., et al. (2019). The mysteries of menopause and
urogynecologic health: clinical and scientific gaps. Menopause, vol. 26, no. 1, pp.
103–111.
[21] Mukherjee, M., Basu, S., Mukherjee, S. K., et al. (2013). Multidrug-resistance and
extended spectrum beta-lactamase production in uropathogenic E. coli which
were isolated from hospitalized patients in Kolkata, India. Journal of Clinical and
Diagnostic Research, vol. 7, no. 3, pp. 449–453.
[22] Bashir, S., Sarwar, Y., Ali, A., et al. (2011). Multiple drug resistance patterns in various
phylogenetic groups of uropathogenic E. coli isolated from Faisalabad region of
Pakistan. Brazilian Journal of Microbiology, vol. 42, no. 4, pp. 1278–1283.
[23] Subbalaxmi, M. V., Lakshmi, V., and Lavanya, V. (2010). Antibiotic resistance –
experience in a tertiary care hospital in south India. Journal of the Association of
Physicians of India, vol. 58, pp. 18–22.
[24] Kheder, S. I. (2011). Cephalosporins usage and resistance trend in a Sudanese
hospital surgical wards. Journal of Pharmaceutical and Biomedical Sciences, vol. 11,
no. 3, pp. 1–6.
[25] Abdalla, S. N. and Yousef, B. A. (2016). Prescribing patterns of antimicrobials in the
Internal Medicine Department of Ibrahim Malik Teaching Hospital in Khartoum. Pan
African Medical Journal, vol. 34, p. 89.
[26] Elfaki, A. (2009). Assessment of antibiotics prescription in hospitalized patients at
Elobeid Hospital, Sudan. Sudan Journal of Medical Sciences, vol. 4, no. 3, pp. 269–
272.
[27] Morrill, H. J., Morton, J. B., Caffrey, A. R., et al. (2017). Antimicrobial resistance
of Escherichia coli urinary isolates in the Veterans Affairs Health Care System.
Antimicrobial Agents and Chemotherapy, vol. 61, no. 5, pp. 02236-16.
[28] Xie, J., Talaska, A. E., and Schacht, J. (2011). New developments in aminoglycoside
therapy and ototoxicity. Hearing Research, vol. 281, no. 1–2, pp. 28–37.
[29] Andriole, V. T. (2005). The quinolones: past, present, and future. Clinical Infectious
Diseases, vol. 15, no. 41, p. 428051.
[30] Sanchez, G. V., Baird, A. M., Karlowsky, J. A., et al. (2014). Nitrofurantoin retains
antimicrobial activity against multidrug-resistant urinary Escherichia coli from US
outpatients. Journal of Antimicrobial Chemotherapy, vol. 69, no. 12, pp. 3259–3262.
[31] Hasan, A. S., Nair, D., Kaur, J., et al. (2007). Resistance patterns of urinary isolates in
a tertiary Indian hospital. Journal of Ayub Medical College Abbottabad, vol. 19, no.
1, pp. 39–41.
[32] Sahm, D. F., Thornsberry, C., Mayfield, D. C., et al. (2001). Multidrug-resistant urinary
tract isolates of Escherichia coli: prevalence and patient demographics in the United
States in 2000. Antimicrobial Agents and Chemotherapy, vol. 45, no. 5, pp. 1402–
1406.
[33] Khawcharoenporn, T., Vasoo, S., and Singh, K. (2013). Urinary tract infections due
to multidrug-resistant enterobacteriaceae: prevalence and risk factors in a Chicago
emergency department. Emergency Medicine International, vol. 2013, article 258517.
[34] Tenney, J., Hudson, N., Alnifaidy, H., et al. (2018). Risk factors for aquiring multidrugresistant organisms in urinary tract infections: a systematic
bacteria causing urinary tract infections: a review. Journal of Chemotherapy, vol. 29,
no. 1, pp. 2–9.
[2] Medina, M. and Castillo-Pino, E. (2019). An introduction to the epidemiology
and burden of urinary tract infections. Therapeutic Advances in Urology.
https://doi.org/10.1177/1756287219832172
[3] Flores-Mireles, A. L., Walker, J. N., Caparon, M., et al. 2015 (). Urinary tract infections:
epidemiology, mechanisms of infection and treatment options. Nature Reviews
Microbiology, vol. 13, no. 5, pp. 269–284.
[4] Alanazi, M. Q., Alqahtani, F. Y., and Aleanizy, F. S. (2018). An evaluation of E. coli in
urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia:
retrospective study. Annals of Clinical Microbiology and Antimicrobials, vol. 17, no.
1, p. 3.
[5] Hooton, T. M. (2012). Clinical practice. Uncomplicated urinary tract infection. New
England Journal of Medicine, vol. 366, no. 11, pp. 1028–1037.
[6] Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence,
bacteriology, risk factors, and disease burden. Infectious Disease Clinics of North
America, vol. 28, no. 1, pp. 1–13.
[7] Nicolle, L. E. and AMMI Canada Guidelines Committee. (2005). Complicated urinary
tract infection in adults. Canadian Journal of Infectious Diseases and Medical
Microbiology, vol. 16, no. 6, pp. 349–360.
[8] Levison, M. E. and Kaye, D. (2013). Treatment of complicated urinary tract infections
with an emphasis on drug-resistant gram-negative uropathogens. Current Infectious
Disease Reports, vol. 15, no. 2, pp. 109–115.
[9] Beahm, N. P., Nicolle, L. E., Bursey, A., et al. (2017). The assessment and management
of urinary tract infections in adults: guidelines for pharmacists. Canadian Pharmacists
Journal, vol. 150, no. 5, pp. 298–305.
[10] Tandogdu, Z. and Wagenlehner, F. M. (2016). Global epidemiology of urinary tract
infections. Current Opinion in Infectious Diseases, vol. 29, no. 1, pp. 73–79.
[11] Gupta, K., Hooton, T. M., Naber, K. G., et al. (2011). International clinical practice
guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis
in women: a 2010 update by the Infectious Diseases Society of America and
the European Society for Microbiology and Infectious Diseases. Clinical Infectious
Diseases, vol. 52, no. 5, pp. e103–e20.
[12] Al Yousef, S. A., Younis, S., Farrag, E., et al. (2016). Clinical and laboratory profile
of urinary tract infections associated with extended spectrum beta-lactamase
producing Escherichia coli and Klebsiella pneumoniae. Annals of Clinical &
Laboratory Science, vol. 46, no. 4, pp. 393–400.
[13] Ikram, R., Psutka, R., Carter, A., et al. (2015). An outbreak of multi-drug resistant
Escherichia coli urinary tract infection in an elderly population: a case-control study
of risk factors. BMC Infectious Diseases, vol. 15, no. 1, p. 224.
[14] Raeispour, M. and Ranjbar, R. (2018). Antibiotic resistance, virulence factors and
genotyping of uropathogenic Escherichia coli strains. Antimicrobial Resistance &
Infection Control, vol. 7, no. 118, pp. 018–0411.
[15] Komolafe, O. O. (2003). Antibiotic resistance in bacteria - an emerging public health
problem. Malawi Medical Journal, vol. 15, no. 2, pp. 63–67.
[16] Sabir, S., Ahmad Anjum, A., Ijaz, T., et al. (2014). Isolation and antibiotic susceptibility
of E. coli from urinary tract infections in a tertiary care hospital. Pakistan Journal of
Medical Sciences, vol. 30, no. 2, pp. 389–392.
[17] Foxman, B. (2002). Epidemiology of urinary tract infections: incidence, morbidity, and
economic costs. American Journal of Medicine, vol. 8, no. 113, pp. 01054–01059.
[18] Huang, L.-F., Lo, Y.-C., Su, L.-H., et al. (2014). Antimicrobial susceptibility patterns
among Escherichia coli urinary isolates from community-onset health careassociated urinary tract infection. Journal of the Formosan Medical Association,
vol. 113, no. 12, pp. 970–973.
[19] Murugan, K., Savitha, T., and Vasanthi, S. (2012). Retrospective study of antibiotic
resistance among uropathogens from rural teaching hospital, Tamilnadu, India. Asian
Pacific Journal of Tropical Disease, vol. 2, no. 5, pp. 375–380.
[20] Alperin, M., Burnett, L., Lukacz, E., et al. (2019). The mysteries of menopause and
urogynecologic health: clinical and scientific gaps. Menopause, vol. 26, no. 1, pp.
103–111.
[21] Mukherjee, M., Basu, S., Mukherjee, S. K., et al. (2013). Multidrug-resistance and
extended spectrum beta-lactamase production in uropathogenic E. coli which
were isolated from hospitalized patients in Kolkata, India. Journal of Clinical and
Diagnostic Research, vol. 7, no. 3, pp. 449–453.
[22] Bashir, S., Sarwar, Y., Ali, A., et al. (2011). Multiple drug resistance patterns in various
phylogenetic groups of uropathogenic E. coli isolated from Faisalabad region of
Pakistan. Brazilian Journal of Microbiology, vol. 42, no. 4, pp. 1278–1283.
[23] Subbalaxmi, M. V., Lakshmi, V., and Lavanya, V. (2010). Antibiotic resistance –
experience in a tertiary care hospital in south India. Journal of the Association of
Physicians of India, vol. 58, pp. 18–22.
[24] Kheder, S. I. (2011). Cephalosporins usage and resistance trend in a Sudanese
hospital surgical wards. Journal of Pharmaceutical and Biomedical Sciences, vol. 11,
no. 3, pp. 1–6.
[25] Abdalla, S. N. and Yousef, B. A. (2016). Prescribing patterns of antimicrobials in the
Internal Medicine Department of Ibrahim Malik Teaching Hospital in Khartoum. Pan
African Medical Journal, vol. 34, p. 89.
[26] Elfaki, A. (2009). Assessment of antibiotics prescription in hospitalized patients at
Elobeid Hospital, Sudan. Sudan Journal of Medical Sciences, vol. 4, no. 3, pp. 269–
272.
[27] Morrill, H. J., Morton, J. B., Caffrey, A. R., et al. (2017). Antimicrobial resistance
of Escherichia coli urinary isolates in the Veterans Affairs Health Care System.
Antimicrobial Agents and Chemotherapy, vol. 61, no. 5, pp. 02236-16.
[28] Xie, J., Talaska, A. E., and Schacht, J. (2011). New developments in aminoglycoside
therapy and ototoxicity. Hearing Research, vol. 281, no. 1–2, pp. 28–37.
[29] Andriole, V. T. (2005). The quinolones: past, present, and future. Clinical Infectious
Diseases, vol. 15, no. 41, p. 428051.
[30] Sanchez, G. V., Baird, A. M., Karlowsky, J. A., et al. (2014). Nitrofurantoin retains
antimicrobial activity against multidrug-resistant urinary Escherichia coli from US
outpatients. Journal of Antimicrobial Chemotherapy, vol. 69, no. 12, pp. 3259–3262.
[31] Hasan, A. S., Nair, D., Kaur, J., et al. (2007). Resistance patterns of urinary isolates in
a tertiary Indian hospital. Journal of Ayub Medical College Abbottabad, vol. 19, no.
1, pp. 39–41.
[32] Sahm, D. F., Thornsberry, C., Mayfield, D. C., et al. (2001). Multidrug-resistant urinary
tract isolates of Escherichia coli: prevalence and patient demographics in the United
States in 2000. Antimicrobial Agents and Chemotherapy, vol. 45, no. 5, pp. 1402–
1406.
[33] Khawcharoenporn, T., Vasoo, S., and Singh, K. (2013). Urinary tract infections due
to multidrug-resistant enterobacteriaceae: prevalence and risk factors in a Chicago
emergency department. Emergency Medicine International, vol. 2013, article 258517.
[34] Tenney, J., Hudson, N., Alnifaidy, H., et al. (2018). Risk factors for aquiring multidrugresistant organisms in urinary tract infections: a systematic
