Occurrence of ESBL-producing Escherichia coli and Klebsiella pneumoniae in urinary tract infection (UTI) patients

Afiukwa Ngozi, Iroha Ifeanyichukwu, Nwuzo Agabus, Ejikeugwu Chika*, Nwakaeze Emmanuel, Ukpai Ekenem, Anthonia Orji
Department of Applied Microbiology, Faculty of Sciences, Ebonyi State University, Abakaliki, P.M.B 053, Ebonyi State, Nigeria

A B S T R A C T
A urinary tract infection (UTI) is an infection in any part of the urinary tract system that includes infections of the kidneys, ureters, bladder and urethra; and UTI accounts for several hospital visits around the world – causing morbidity and mortality. A total of 687 urine samples of patients with UTIs were analyzed for the presence of ESBL producing Escherichia coli and Klebsiella pneumoniae. The isolation and characterization of these organisms were carried out using microbiology standard techniques. The antibiotic susceptibility test was carried out using disc diffusion method while the phenotypic determination of ESBLs was done using double disc synergy test (DDST). The outcome of this investigation showed that E. coli were more prevalent than K. pneumoniae in urine samples with their corresponding values of 111 (54.68 %) and 92 (45.32 %) respectively. E. coli and K. pneumoniae were more prevalent in urine samples of patients between the ages of 11 to 60 years and less common in children (< 11 years) and the elderly (> 60 years) in both females and males. Both E. coli and K. pneumoniae were significantly higher in female than male patient’s urine samples (P<0.05). Their prevalence in urine was highest within the age range of 21-30 years. Both E. coli and K. pneumoniae were found across all the occupational groups of the patients investigated and were most prevalent among students and least among teachers. The occurrences of E. coli and Klebsiella pneumoniae were generally lower in pupils (0-10 years) and the elderly (71-80 years of age). All the isolates of E. coli and Klebsiella pneumoniae obtained were most resistant to cefuroxime, ceftazidime and cefotaxime. However, they were most susceptible to imipenem, meropenem and ertapenem. Among the antibiotics evaluated, imipenem was found to be the most active against the isolates, followed by ertapenem and then meropenem. ESBLs were found to be more prevalent in females than males. More so, of the 203 (111 E. coli and 92 K. pneumoniae) isolates screened for ESBL production, only 13 E. coli isolates and 7 K. Pneumoniae isolates were ESBL producers. ESBL producing E. coli (n=13) and K. pneumoniae (n=7) were more prevalent in females than males with their corresponding values of 9 (69.23 %), 6 (85.71 %) and 4 (30.77 %), 1 (14.29 %) respectively. Since UTI is a common bacterial infection that warrant most hospital visits, it is critical to back clinical diagnosis of the infection and/or diseases with proper antimicrobial susceptibility testing especially those that detect the occurrence of multidrug resistant bacteria such as ESBL-producing E. coli and K. pneumoniae isolates. Conclusively, this study reported the occurrence of ESBL-producing E. coli and K. pneumoniae isolates with varying rates of susceptibility to some available antibiotics. Concerted efforts are needed to contain the emergence and spread of resistant bacteria in this environment – especially in the hospital were blind-antimicrobial therapy usually abound.
Keywords: Klebsiella pneumoniae, Escherichia coli, UTIs, ESBLs, Antibiotics, Resistance