Frequency of carbapenem resistant uro-pathogenic Escherichia Coli in ICU patients of a tertiary Care Hospital of Southern Punjab
DOI:
https://doi.org/10.61529/idjp.v34i2.397Abstract
Background: Urinary tract infections in ICU patients is widespread and carbapenem resistant uropathogenic Escherichia Coli in ICU admitted catheterized patients is alarming. To determine the frequency of carbapenem resistant UPEC in ICU patients of a tertiary care hospital in southern Punjab.
Material and Methods: This cross-sectional study was done at Microbiology laboratory of Nishtar Medical University Multan, Pakistan from 01 March 2021 to 31 December 2021. A total of 367 urine samples were taken from patients admitted in ICU department. Urine samples were inoculated on CLED agar according to standard protocols and 160 E. coli were recognized with traditional biochemical tests. According to CLSI 2020 standards, the antimicrobial profile of isolates against carbapenems were determined using the Kirby-Bauer disc diffusion method, and carbapenemase production was determined by using the Modified Hodge test. All data was entered and analyzed in SPSS 26 version.
Results: 271 samples (73.84%) were found positive for urinary tract infections while other 96 (26.15%) samples were found negative for UTIs. Among all the causative agents, E. coli (n=160) was the most commonly isolated organism. Its prevalence was pointedly higher in male, as 84 (52.5%) and 76 (47.5%) were isolated from males and females respectively. A total of 19 (11.88%) isolates of E. coli were carbapenem resistant. Further, 89.47% carbapenem resistant isolates were positive for MHT while rests were negative.
Conclusion: Carbapenem resistance is alarming in UPEC among the patients admitted in ICU department, mainly due to carbapenemase enzyme.
Keywords: CLED, Carbapenem resistant, ICU, UTI, Uropathogenic E. coli.
References
Khavandi S, Arzanlou M, Teimourpour R, Peeridogaheh H. Phenotypic and Molecular Characterization of Carbapenems Resistant Escherichia coli Isolated from Patients with Urinary Tract Infections in Ardabil Province, Iran. Iran J Pathol. 2022; 17(3): 261-7. DOI: https://doi.org/10.30699/IJP.2022.538613.2716
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015; 13(5): 269-84. DOI: https://doi.org/10.1038/nrmicro3432
Alanazi MQ, Alqahtani FY, Aleanizy FS. An evaluation of E. coli in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: retrospective study. Ann Clin Microbiol Antimicrob. 2018; 17: 3. DOI: https://doi.org/10.1186/s12941-018-0255-z
Liu Y, Xiao D, Shi XH. Urinary tract infection control in intensive care patients. Medicine (Baltimore). 2018; 97(38): e12195. DOI: https://doi.org/10.1097/MD.0000000000012195
Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyère F, et al. Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect. 2018; 48(5): 327-58. DOI: https://doi.org/10.1016/j.medmal.2018.03.005
Bonomo RA, Burd EM, Conly J, Limbago BM, Poirel L, Segre JA, Westblade LF. Carbapenemase-producing organisms: a global scourge. Clin Infect Dis. 2018; 66(8): 1290-7. DOI: https://doi.org/10.1093/cid/cix893
Ahmed KA, Hussein S, Qurbani K, Ibrahim RH, Fareeq A, Mahmood KA, et al. Antibacterial resistance: Impact, challenges and future prospects. J Med, Surgery, Public Health. 2024; 2: 10081. DOI: https://doi.org/10.1016/j.glmedi.2024.100081
Fritzenwanker M, Imirzalioglu C, Herold S, Wagenlehner FM, Zimmer KP, Chakraborty T. Treatment options for carbapenem-resistant gram-negative infections. Dtsch Ärztebl Int. 2018; 115(20-21): 345-52. DOI: https://doi.org/10.3238/arztebl.2018.0345
Bader MS, Loeb M, Leto D, Brooks AA. Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents. Postgrad Med. 2020; 132(3): 234-50. DOI: https://doi.org/10.1080/00325481.2019.1680052
Awan M, Rasheed F, Saeed M, Irum S, Ashraf F, Imran AA. Dissemination and detection of carbapenemases producing gram-negative rods. Pak Armed Forces Med J. 2019; 69(1): 9-14. Available from: https://www.pafmj.org/PAFMJ/article/view/2486/2043
Duszyńska W, Rosenthal V, Szczęsny A, Woźnica E, Ulfik K, Ostrowska E, et al. Urinary tract infections in intensive care unit patients—a single-centre, 3-year observational study according to the INICC project. Anaesthesiol Intensive Ther. 2016; 48(1): 1-6. DOI: https://doi.org/10.5603/ait.2016.0001
Kumar A, Chaudhry D, Goel N, Tanwar S. Epidemiology of intensive care unit-acquired infections in a tertiary care hospital of North India. Indian J Crit Care Med. 2021; 25(12): 1427. DOI: https://doi.org/10.5005/jp-journals-10071-24058
den Heijer CD, Penders J, Donker GA, Bruggeman CA, Stobberingh EE. The importance of gender-stratified antibiotic resistance surveillance of unselected uropathogens: A Dutch Nationwide Extramural Surveillance study. PLoS One. 2013; 8(3): e60497. DOI: https://doi.org/10.1371/journal.pone.0060497
Kishore N, Modi S, Khanduri S, Kakati B. Urinary tract infection in critically ill patients with diabetes mellitus: Spectrum of uropathogens and antimicrobial susceptibility pattern. Bali J Anesthesiol. 2020; 4(Suppl 2): S55-60.
DOI: http://dx.doi.org/10.4103/BJOA.BJOA_97_20
Ghadiri H, Vaez H, Razavi-Azarkhiavi K, Rezaee R, Haji-Noormohammadi M, Rahimi AA, et al. Prevalence and antibiotic susceptibility patterns of Extended-Spectrum ß-Lactamase and Metallo-ß-Lactamase–producing uropathogenic Escherichia Coli isolates. Lab Med. 2014; 45(4): 291-6. DOI: https://doi.org/10.1309/lmhep4vqhey2pook
Khan R, Saif Q, Fatima K, Meher R, Shahzad HF, Anwar KS. Clinical and bacteriological profile of UTI patients attending a North Indian tertiary care center. Integrative Med Nephrol Androl. 2015; 2(1): 29-34. DOI: https://doi.org/10.4103/2225-1243.150009
Lesani SS, Soleimani M, Shakib P, Zolfaghari MR. Prevalence of blaCTX-M, blaSHV, and blaTEM genes in Escherichia Coli strains isolated from urinary tract infection samples of patients in the Intensive Care Unit in Qom, Iran. Gene Cell Tissue. 2020; 7(2): e102700. DOI: https://doi.org/10.5812/gct.102700
Wang Q, Zhang X, Xia P, Chen Y, Wang Q, Feng W, Sun F. Spectrum and antimicrobial resistance of uropathogens from patients with urinary tract infection in urology and non-urology departments. Saudi Med J. 2014; 35(2): 198-200. Available from: https://smj.org.sa/content/smj/35/2/198.full.pdf
Baral P, Neupane S, Marasini BP, Ghimire KR, Lekhak B, Shrestha B. High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal. BMC Res Notes. 2012; 5: 38. DOI: https://doi.org/10.1186/1756-0500-5-38
AlKhawaja S, Alkhawaja S, Saeed NK, Fawzy NA, EL-Moez AA, Hussian SM. Catheter-Associated urinary tract infections at intensive care unit in Bahrain. EC Microbiol. 2017; 8: 71-9. Available from: https://ecronicon.net/assets/ecmi/pdf/ECMI-08-00238.pdf
Pouladfar G, Basiratnia M, Anvarinejad M, Abbasi P, Amirmoezi F, Zare S. The antibiotic susceptibility patterns of uropathogens among children with urinary tract infection in Shiraz. Medicine. 2017; 96(37): e7834. DOI: https://doi.org/10.1097/md.0000000000007834
Waheed A, Saleem S, Shahzad N, Akhtar J, Saeed M, Jameel I, et al. Prevalence of extended spectrum [beta]-lactamase SHV and OXA producing gram-negative bacteria at tertiary care hospital of Lahore, Pakistan. Pak J Zoology. 2019 Dec 31;51(6):2345. Available from: https://researcherslinks.com/current-issues/Prevalence-of-Extended-Spectrum-lactamase/20/1/2469/html
Ali I, Kumar N, Ahmed S, Dasti JI. Antibiotic resistance in uropathogenic E. coli strains isolated from non-hospitalized patients in Pakistan. J Clin Diagn Res. 2014; 8(9): DC01-DC04. DOI: https://doi.org/10.7860/JCDR/2014/7881.4813
Malik S, Rana JS, Nehra K. Prevalence and antibiotic susceptibility pattern of uropathogenic Escherichia Coli strains in Sonipat region of Haryana in India. Biomed Biotech Res J. 2021; 5(1): 80-7. DOI: http://dx.doi.org/10.4103/bbrj.bbrj_212_20
Meletis G. Carbapenem resistance: Overview of the problem and future perspectives. Ther Adv Infect Dis. 2016; 3(1): 15-21. DOI: https://doi.org/10.1177/2049936115621709
Amladi AU, Abirami B, Devi SM, Sudarsanam TD, Kandasamy S, Kekre N, et al. Susceptibility profile, resistance mechanisms & efficacy ratios of fosfomycin, nitrofurantoin & colistin for carbapenem-resistant Enterobacteriaceae causing urinary tract infections. Indian J Med Res. 2019; 149(2): 185-91. DOI: https://doi.org/10.4103/ijmr.ijmr_2086_17
Hossain A, Hossain SA, Fatema AN, Wahab A, Alam MM, Islam MN, et al. Age and gender-specific antibiotic resistance patterns among Bangladeshi patients with urinary tract infection caused by Escherichia coli. Heliyon. 2020; 6(6): e04161. DOI: https://doi.org/10.1016/j.heliyon.2020.e04161
Amjad A, Mirza IA, Abbasi SA, Farwa U, Malik N, Zia FJ. Modified Hodge test: A simple and effective test for detection of carbapenemase production. Iranian J Microbiol. 2011; 3(4): 189. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3330182/pdf/IJM-3-189.pdf
Amudhan MS, Sekar U, Kamalanathan A, Balaraman S. blaIMP and blaVIM mediated carbapenem resistance in Pseudomonas and Acinetobacter species in India. J Infect Dev Ctries. 2012; 6(11): 757-62. DOI: https://doi.org/10.3855/jidc.2268
Datta S, Dey R, Dey JB, Ghosh S. A comparative study of modified Hodge test and Carba NP test for detecting carbapenemase production in Gram-negative bacteria. Medical Journal of Dr. DY Patil University. 2017; 10(4): 365-9. DOI: http://dx.doi.org/10.4103/0975-2870.213930
Patidar N, Vyas N, Sharma S, Sharma B. Phenotypic detection of carbapenemase production in carbapenem-resistant Enterobacteriaceae by modified hodge test and modified strip carba NP test. J Lab Physicians. 2021; 13(01): 014-21. DOI: https://doi.org/10.1055/s-0041-1723859
Gurung S, Kafle S, Dhungel B, Adhikari N, Thapa Shrestha U, Adhikari B, et al. Detection of OXA-48 gene in carbapenem-resistant Escherichia Coli and Klebsiella pneumoniae from urine samples. Infect Drug Resist. 2020: 2311-21. DOI: https://doi.org/10.2147/IDR.S259967
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Editor Office
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
