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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 Infect Dis. 2017 02 10; 17(1):138.BI

Abstract

BACKGROUND

Extended Spectrum Beta- Lactamase producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care. While ESBL producing Klebsiella species seem to account for most nosocomial outbreaks, ESBL-producing E. coli have been isolated from both hospitalized and non-hospitalized patients. Although 95-100% ESBL organisms are still considered sensitive to meropenem, rapid emergence of carbapenem resistance has been documented in many countries. The objective of this study was to evaluate urinary tract infections caused by ESBL producers and the antibiotic susceptibility patterns in Sri Lanka.

METHODS

Patients with confirmed ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital from January - June 2015 were recruited to the study. Their urine culture and antibiotic susceptibility reports were evaluated after obtaining informed written consent.

RESULTS

Of 61 culture positive ESBL-UTIs, E. coli caused 53 (86.8%), followed by Klebsiella in 8 (13.1%).30 (49.1%) had a history of hospitalization within the past three months and included 6/8(75%) of Klebsiella UTI and 24/53(45.2%) of E.coli UTI. Antibiotic susceptibility of ESBL organisms were; Meropenem 58 (95%), Imipenem 45 (73.7%), Amikacin 37 (60.6%) and Nitrofurantoin 28(45.9%). In 3(4.9%), E.coli were resistant to Meropenem. These three patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI.

CONCLUSIONS

We observed a higher percentage of E. coli over Klebsiella as ESBL producing organisms suggesting most ESBL-UTIs to be community acquired, Carbapenems seem to remain as the first line therapy for majority of ESBL-UTIs in the local setting. However 4.9% prevalence of meropenem resistance is alarming compared to other countries. Although prior antibiotic utilization and hospitalization may contribute to emergence of ESBL producing Klebsiella and E.coli in Sri Lanka, high prevalence of community acquired ESBL-E. coli needs further investigations to identify potential causes . Being a third world country with a free health care system, observed alarming rate of carbapenem resistance is likely to add a significant burden to health budget. We feel that treatment of infections in general needs a careful approach adhering to recommended antibiotic guidelines in order to prevent emergence of multi drug resistant organisms.

Authors+Show Affiliations

Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.Department of Clinical Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka. nathashaluke@gmail.com.Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28187754

Citation

Fernando, M M P S C., et al. "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, vol. 17, no. 1, 2017, p. 138.
Fernando MM, Luke WA, Miththinda JK, et al. 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 Infect Dis. 2017;17(1):138.
Fernando, M. M., Luke, W. A., Miththinda, J. K., Wickramasinghe, R. D., Sebastiampillai, B. S., Gunathilake, M. P., Silva, F. H., & Premaratna, R. (2017). 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, 17(1), 138. https://doi.org/10.1186/s12879-017-2250-y
Fernando MM, et al. 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 Infect Dis. 2017 02 10;17(1):138. PubMed PMID: 28187754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern -A hospital based cross sectional study. AU - Fernando,M M P S C, AU - Luke,W A N V, AU - Miththinda,J K N D, AU - Wickramasinghe,R D S S, AU - Sebastiampillai,B S, AU - Gunathilake,M P M L, AU - Silva,F H D S, AU - Premaratna,R, Y1 - 2017/02/10/ PY - 2016/04/22/received PY - 2017/02/07/accepted PY - 2017/2/12/entrez PY - 2017/2/12/pubmed PY - 2017/7/6/medline KW - Carbapenem resistance KW - ESBL producers KW - Urinary tract infections SP - 138 EP - 138 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 17 IS - 1 N2 - BACKGROUND: Extended Spectrum Beta- Lactamase producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care. While ESBL producing Klebsiella species seem to account for most nosocomial outbreaks, ESBL-producing E. coli have been isolated from both hospitalized and non-hospitalized patients. Although 95-100% ESBL organisms are still considered sensitive to meropenem, rapid emergence of carbapenem resistance has been documented in many countries. The objective of this study was to evaluate urinary tract infections caused by ESBL producers and the antibiotic susceptibility patterns in Sri Lanka. METHODS: Patients with confirmed ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital from January - June 2015 were recruited to the study. Their urine culture and antibiotic susceptibility reports were evaluated after obtaining informed written consent. RESULTS: Of 61 culture positive ESBL-UTIs, E. coli caused 53 (86.8%), followed by Klebsiella in 8 (13.1%).30 (49.1%) had a history of hospitalization within the past three months and included 6/8(75%) of Klebsiella UTI and 24/53(45.2%) of E.coli UTI. Antibiotic susceptibility of ESBL organisms were; Meropenem 58 (95%), Imipenem 45 (73.7%), Amikacin 37 (60.6%) and Nitrofurantoin 28(45.9%). In 3(4.9%), E.coli were resistant to Meropenem. These three patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: We observed a higher percentage of E. coli over Klebsiella as ESBL producing organisms suggesting most ESBL-UTIs to be community acquired, Carbapenems seem to remain as the first line therapy for majority of ESBL-UTIs in the local setting. However 4.9% prevalence of meropenem resistance is alarming compared to other countries. Although prior antibiotic utilization and hospitalization may contribute to emergence of ESBL producing Klebsiella and E.coli in Sri Lanka, high prevalence of community acquired ESBL-E. coli needs further investigations to identify potential causes . Being a third world country with a free health care system, observed alarming rate of carbapenem resistance is likely to add a significant burden to health budget. We feel that treatment of infections in general needs a careful approach adhering to recommended antibiotic guidelines in order to prevent emergence of multi drug resistant organisms. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/28187754/Extended_spectrum_beta_lactamase_producing_organisms_causing_urinary_tract_infections_in_Sri_Lanka_and_their_antibiotic_susceptibility_pattern__A_hospital_based_cross_sectional_study_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2250-y DB - PRIME DP - Unbound Medicine ER -