Prevalence Of Extended Spectrum Beta-Lactamases (ESBLs)-Producing Escherichia Coli Isolated From UTI Patients Attending some Selected Hospitals In Minna, Nigeria

Abstract

Globally, urinary tract infections are one of the most common infections in need of urgent clinical attention. The prevalence of extended spectrum beta-lactamases (ESBL)producing Escherichia coli isolated from urine samples of some UTI patients and s of apparently healthy individuals in Minna, Nigeria, is investigated. Standard microbiological techniques were used to conduct this study. A total of 170 catch midstream urine samples submitted to the Medical Microbiology Laboratories of 4 different hospitals (and samples from healthy individuals) were randomly collected for 5 months and examined for microbial growths. Female patients (65.9%) submitted more urine samples for UTI test than their male counterpart (34.1%). The age ranges of 21 -30 (26.5%) and 31 40 (25.3%) had the highest percentages of infection rate while those within the ages 110 (3.5%) and ≥ 71 (2.3%) were the least infected. This study observed a prevalence of 23.5% of E. coli in Minna metropolis and a significant number (30%) of healthy individuals (HI) was observed to harbor the E. coli in their urine. The isolates were highly susceptible to Gentamicin (65%), Ofloxacin (65%), Tetracycline (62.5%), Cotrimoxazole (62.5%), and Streptomycin (57.5%). Mildly susceptible to Pefloxacin (37.5%), Chloramphenicol (37.5%), and Ciprofloxacin (35%). There were significant resistance to most of the beta-lactames tested [Cefuroxime (80%), Amoxicillin (42.5%), Augmentin (40), Cefotaxime (20%) and Ceftaxidime (7.5%)]. Two of the isolates were resistant to all the 13 antibiotics tested; 70% (28) of the isolates had multiple antibiotics resistance index (MARI) ≥0.3. Multidrug resistance was expressed in 37.5% of the isolates tested. The study showed a vast resistant pool in the environment. Only 25% of the E. coli isolated from the urine samples produced beta-lactamases phenotypically, most of which expressed resistance to more than 5 of the antibiotics tested and had MARI of ≥ 0.5. Further evaluation showed that 25% (10/40) of the E. coli isolated from the UTI patients in Minna, Nigeria, were ESBLproducers and could harbor one or two of the genes. TEM gene was expressed in 70% (7) of the isolates that produced ESBL phenotypically, 60% Isegohi et al./ Nig. J. Biotech. Vol. 37 Num. 2: 56-73 (Dec 2020) 57 (6) harbored CTXM gene, 20% (2) had the OXA gene while none of the bacteria harbored the SHV gene. The study established a 5.9% ESBL prevalence among the E. coli isolated from UTI in the environment studied. This study established that E. coli is one of the prevalent bacteri urea majorly isolated from UTI patients in Minna. The prevalent E. coli are multidrug resistant and could harbor more than one ESBL gene . keywords: Escherichia coli, Minna, UTI, ESBL, Multidrug resistance Corresponding Author: igwejames42@yahoo.com Introduction Different studies have defined urinary tract infections (UTIs) as the growth of pathogenic microorganisms in the urinary tract, which might elicit inflammatory disorders resulting in burning sensations while urinating, increase in temperature, dysuria, itching, pain around the pelvic region, development of wounds and inflammation of the genital area, genital and suprapubic pain, and in some cases permanent kidney damage (Prakash and Saxena, 2013; Hoberman et al., 2003). UTIs can result in cystitis, an infection of the upper urinary tract that includes the urethras, renal pelvis and kidneys and pyelonephritis, an infection of the lower urinary tract that includes the infection of urethra and urinary bladder (Lane and Takhar, 2011). With respect to frequency of occurrence of bacteria in UTI, Escherichia coli, Staphylococcus, Klebsiella pneumoniae, Proteus, Pseudomonas, Enterococc us, and Enterobacter are the most implicated agents (Mirsoleymani et al., 2014). Urogenital anomalies occur in individuals who retain urine longer than expected in their bladder (Dougherty and Rawla, 2020). Studies have shown that pregnant women with inflamed intraamniotic balloons, which result to overdistention of the uterus are prone to pyelitis and pyelonephritis with severe consequences (Sani et al., 2019). Martin, et al., (2019) demonstrated that age groups ≤19 years and the elderly, female gender, married individuals, patients with genitourinary tract abnormalities, diabetes, hospitalized patients and those with indwelling catheter >6 days are susceptible to high microbial proliferation in their urinary tracts. Factors such as patients residence, tribe, level of education, marital status, circumcision, pregnancy, hypertension, HIV, abortion, sexual intercourse had no correlation with UTI but can contribute to reinfection. According to the CDC, (2019), within 3 months of birth, male children have more probability of contracting UTI while females become more vulnerable thereafter. UTI could be community acquired or hospital acquired (nosocomial) and expressed in patients as acute, chronic, complicated or uncomplicated and in some cases asymptomatic, depending on an individual’s immune status (Nelson and Good, 2015). Other factors of importance in cases associated with UTI are malnutrition, poor hygiene and low socio-economic status, which are common in rural settings (Ahmed & Avasara, 2008). The clinical symptoms of this disease vary depending on the sites of infection, the causative organisms, pregnancy, the severity of the infection and the age of the infected patients (Dias et al., 2010). In 2019, Sani et al., had reported that E. coli was the most predominant organism causing UTI in Minna (27.3% prevalence) and females (27.9%) are the most infected. This is followed by Staphylococcus aureus (24.6%) and Pseudomonas species (1.3%) being the least. According to Pandit et al., (2020), treatment of UTI is becoming difficult due to the emergence, reemergence and spread of multidrug-resistant uropathogens encoding extended-spectrum β-lactamases (ESBLs), which are plasmid mediated. Extended spectrum beta lactamases (ESBLs) are class A β-lactamases produced by the Enterobacteriaceae family of Gram-negative organisms that hydrolyze penicillin, oxyimino-cephalosporins, and monobactams but not cephamycins or carbapenems (Mehrgan and Rahbar, 2008). These types of enzymes are inhibited in vitro by clavulanate (Lohani et al., 2020). The most prevalent genes of ESBLs are CTX-M types, TEM, OXA and SHV (Abrar et al., 2019). Other clinically important genes include VEB, PER, BEL-1, BES-1, SFO-1, TLA, and IBC (Jacoby and Munoz-Price, 2005; Falagas and Karageorgopoulos, 2009; Dhillon and Clark, 2012). These genes evolve in bacteria that develop resistance to antibiotics majorly prescribed in an environment Isegohi et al./ Nig. J. Biotech. Vol. 37 Num. 2: 56-73 (Dec 2020) 58 (Lohani et al., 2020). These studies further showed that antibiotics such as imipenem, gentamycin and nitrofurantoin are the best drugs for the treatment of infections linked to ESBLproducing E coli isolates from UTI. Study conducted by Baziboroun et al., (2018) further substantiates the fact that high percentage of the UTI isolates did express significant levels of resistance against ceftazidime, cefotaxime, ceftriaxone, cefixime and ciprofloxacin, ranging from 61-100%, while the highest percentage of susceptibilities were observed against meropenem, piperacillintazobactam (100%), followed by nitrofurantoin and amikacin (91%). These studies show vast resistance to betalactams while other studies have isolated fluoroquinolone-resistant uropathogens (Wu, et al., 2014), carbapenem-resistant Enterobacteriaceae, (Schechner, et al., 2013) and vancomycin-resistant Enterococci (PapadimitriouOlivgeris, et al., 2014) among UTI patients. This might be linked to factors such as misuse of antibiotics in the society and poultries, reexposure of infected patients, acquisition of plasmid mediated ESBL genes, use and administration of drugs without appropriate culture and sensitivity tests for asymptomatic and mildly symptomatic UTI patients (Igwe et al., 2014). This study was hence designed to evaluate the prevalence of E. coli in UTI in Minna, investigate the antimicrobial susceptibility patterns of selected antibiotics and also assay for the presence of ESBL. Materials and Methods