Article published in The American Journal of Tropical Medicine and Hygiene

 Am. J. Trop. Med. Hyg., 105(5), 2021, pp. 1347–1355

doi:10.4269/ajtmh.21-0691

Copyright © 2021 by The American Society of Tropical Medicine and Hygiene

 

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

 

Tulsi Nayaju^1†, Milan Kumar Upreti^1†, Alina Ghimire¹, Basudha Shrestha², Basanta Maharjan², Rajesh Dhoj Joshi², Binod Lekhak³, and Upendra Thapa Shrestha^3*

 

¹Department of Microbiology, GoldenGate International College, Kathmandu, Nepal; 

²Kathmandu Model Hospital, Kathmandu, Nepal;

³Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

 

^*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.

 

ABSTRACT

 

This study aimed to determine the occurrence of antibiotic resistance genes for b-lactamases; bla_TEM and bla_CTX-M in uropathogenic Escherichia coli isolate 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 b-lactamase (ESBL) confirmation. In addition, bla_TEM and bla_CTX-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 bla_TEM and bla_CTX-M genes. The bla_TEM and bla_CTX-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-resistant strains.

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