Extended Spectrum Beta- Lactamase (ESBL) producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care. Although 95-100% ESBL organisms are considered sensitive to meropenem, rapid emergence of carbapenem resistance has been documented in many countries. The choice of treatment for carbapenamase producing organisms is very limited. The present study is aimed to evaluate the antibiotic susceptibility patterns in urinary tract infections caused by ESBL producing E.coli and Klebsiella species.

A total of 576 Urine samples from out-patients are taken and data regarding previous hospitalization and antibiotic administration is collected. E.coli and Klebsiella pneumoniae are major isolates in this prospective study. The study also involves the effect of demographic variables on ESBL producers and sensitivity to antibiotics. Maximum ESBL isolates were reported from K.pneumoniae (93%) and majority of the isolates were from female urine samples. ESBL producing  E.coli also showed maximum sensitivity to colistin (95%) followed by nitrofurantoin (88.4%) and ESBL producing K.pneumoniae showed maximum sensitivity to colistin (93.4%) followed by nitrofurantoin (58.9%).From the present study it was concluded that, Nitrofurantoin can be incorporated as a key antibiotic for Antimicrobial stewardship programme for empirical therapy.

Keywords: UTI, ESBL, Nitrofurantoin, Colistin.

1. Rosemary Ikram1, Rebecca Psutka2, Alison Carter1 and Patricia Priest2. 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. 2015. 15: 224.
2. Nicolle LE. Urinary tract infection: traditional pharmacologic therapies. Am J Med. 2002. 8:113 Suppl 1A:35S-44S.
3. Nicolle LE. Urinary tract infection: traditional pharmacologic therapies. Dis Mon. 2003. 49(2):111-28. 2014.
4. Mody L, and Manisha JM. Urinary Tract Infections in Older Women. JAMA. 2014. 311 (8): 844-854
5. Fernando MMPSC, Luke WANV, Miththinda JKND, Wickramasinghe RDSS,Sebastiampillai BS, Gunathilake MPML, Silva FHDS. Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern –A hospital based cross sectional study. BMC Infectious Diseases. 2017.17:138.
6. Kontopoulou K. Hospital outbreak caused by Klebsiella pneumoniaeproducing KPC-2 β-lactamase resistant to colistin. J. Hosp. Infect. 2010. 76:70–73.
7. Khatoon R, Shameem Ahmad Khan, Noor Jahan. Antibiotic resistance pattern among aerobic bacterial isolates from osteomyelitis cases attending a Tertiary care hospital of North India with special reference to ESBL, AmpC, MBL and MRSA production. International Journal of Research in Medical Sciences. Int J Res Med Sci. 2017. 5(2):482-490.
8. Rossolini GM, Mantengoli E. Antimicrobial resistance in Europe and its potential impact on empirical therapy. Clinical Microbiology & Infection 2008. 14 Suppl 6:2-8.
9. Valerio Del Bono, Daniele Roberto Giacobbe and Francesca Mattioli. Meropenem for treating KPC-producing Klebsiella pneumoniae bloodstream infections: Should we get to the PK/PD root of the paradox. Virulence. 2017. 8 (1): 66-73.
10. Collee AG Fraser, Marmion BP and Simmons A. Mackie and McCartney Practical Medical Microbiology. 2016. 14^th
11. Gales AC, et al. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (1997–1999). Clin. Infect. Dis. 2001. 32(Suppl. 2):104–113.
12. Paterson DL. Resistance in gram-negative bacteria: enterobacteriaceae. Am J Med. 2006 Jun;119(6 Suppl 1):S20-8.
13. Nordmann P. Carbapenamase producing enterobacteriaceae; Overview of a major public health challenge. Med Mal Infect. 2014 Feb;44(2):51-6.
14. Karuniawati A, Saharman YR, Lestari DC. Detection of carbapenemase encoding genes in Enterobacteriace, Pseudomonas aeruginosa, and Acinetobacter baumanii isolated from patients at Intensive Care Unit Cipto Mangunkusumo Hospital in 2011. Acta Med Indones 45: 101–106.

Dr T. Sirisha

Assistant Professor, Department of Microbiology, GIMSR, GITAM (Deemed to be University)