Higher Prevalence of Extended Spectrum β-Lactamase Producing Uropathogenic Escherichia coli Among Patients with Diabetes from a Tertiary Care Hospital of Kathmandu, Nepal

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  • 1 Department of Microbiology, GoldenGate International College, Kathmandu, Nepal;
  • | 2 Kathmandu Model Hospital, Kathmandu, Nepal;
  • | 3 Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

This study aimed to determine the occurrence of antibiotic resistance genes for β-lactamases; blaTEM and blaCTX-M in uropathogenic Escherichia coli isolates from urinary tract infection (UTI) suspected diabetic and nondiabetic patients. A hospital-based cross-sectional study was conducted in Kathmandu Model Hospital, Kathmandu, in association with the Department of Microbiology, GoldenGate International College, Kathmandu, Nepal, from June to December 2018. A total of 1,267 nonduplicate midstream urine specimens were obtained and processed immediately for isolation of uropathogens. The isolates were subjected to antibiotic susceptibility testing and extended spectrum β-lactamase (ESBL) confirmation. In addition, blaTEM and blaCTX-M genes were detected using specific primers. The overall prevalence of UTI was 17.2% (218/1,267), of which patients with diabetes were significantly more infected; 32.3% (31/96) as compared with nonpatients with diabetes, 15.9% (187/1,171). A total of 221 bacterial isolates were obtained from 218 culture-positive specimens in which E. coli was the most predominant; 67.9% (150/221). Forty-four percent (66/150) of the total E. coli was multidrug resistant and 37.3% (56/150) were ESBL producers. Among 56 isolates, 92.3% (12/13) were from patients with diabetes, and 83.0% (44/53) were from nondiabetics. Furthermore, 84.9% of the screened ESBL producers were confirmed to possess either single or both of blaTEM and blaCTX-M genes. The blaTEM and blaCTX-M genes were detected in 53.6% and 87.5% of the phenotypically ESBL confirmed E. coli, respectively. Higher rates of ESBL producing uropathogenic E. coli are associated among patients with diabetes causing an alarming situation for disease management. However, second-line drugs with broad antimicrobial properties are still found to be effective drugs for multidrug resistance strains.

Author Notes

Address correspondence to Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Bagmati 44600, Nepal. E-mail: upendra.thapashrestha@cdmi.tu.edu.np

These authors contributed equally to this work.

Financial support: The molecular work for the study was financially supported by the Department of Microbiology, GoldenGate International College, Kathmandu, Nepal (Grant number is not applicable).

Disclosure: The study was reviewed and approved by Institutional Review Committee (IRC), of the Public Health Concern Trust, Nepal (phect-NEPAL), Kathmandu Model Hospital, Kathmandu, Nepal, on June 14, 2018, and conducted in accordance with the Declaration of Helsinki. All authors are read and reviewed the final manuscript and give consent for publication. Raw data in the excel file will be provided on request.

Authors’ addresses: Tulsi Nayaju, Milan Kumar Upreti, and Alina Ghimire, Department of Microbiology, GoldenGate International College, Kathmandu, Nepal, E-mails: nayajutulsi1@gmail.com, milanupreti@gmail.com, and sukuvaku@gmail.com. Basudha Shrestha, Basanta Maharjan, and Rajesh Dhoj Joshi, Kathmandu Model Hospital, Microbiology, Kathmandu, Nepal, E-mails: basudha111@gmail.com, asant06maharjan@yahoo.com, and rdhojrajesh@gmail.com. Binod Lekhak and Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal, E-mails: binodlekhak9@gmail.com and upendrats@gmail.com.

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