Prevalence, antibiotic sensitivity pattern and genetic analysis of extended spectrum beta lactamase producing Escherichia coli and Klebsiella spp among patients with community acquired urinary tract infection in Galle district, Sri Lanka

Introduction Community acquired urinary tract infections (CA-UTI) are commonly caused by Escherichia coli and Klebsiella spp which are known extended spectrum beta lactamase (ESBL) producers. Objectives To determine, the prevalence and characteristics of ESBL producing of E. coli and Klebsiella spp in the community, and the association of risk factors with ESBL CA-UTI. Methods Descriptive cross-sectional study with urine cultures performed from clinically suspected CA-UTI patients by CLSI standards. Conventional multiplex PCR was performed for gene analysis. Results Cultures were positive in 178 (38%) patients from 465. Majority were females (103, 58%). Most frequently isolated was E. coli (149, 84%) with 68 (46%) ESBL producers followed by 16 (9%) Klebsiella pneumoniae with 4 (25%) ESBL producers. Majority of patients with ESBL CA-UTI were >50 yrs (35/72, 49%) and 13 (18%) children <10 years were present. ABST of ESBL producers revealed high resistance rates for quinolones (41%) and >80% sensitivity for nitrofurantoin, fosfomycin, mecillinam, aminoglycosides and carbapenems. Presence of ESBL genes were 83% CTX-M, 71% OXA, 24% TEM and 9% SHV with one organism often producing more than one gene in 29 isolates (71%). Haematuria and structural abnormalities of urinary tract were significantly associated with increased ESBL CA-UTI (p<0.01). Conclusions ESBL prevalence of this community was 40% in CA-UTI with E.coli predominance among female majority. >80% ESBL organisms show high sensitivity for aminoglycosides, carbapenems, nitrofurantoin, mecillinam and fosfomycin. Frequently isolated ESBL gene was CTX-M. Haematuria and structural abnormalities of urinary tract were significantly associated with ESBL CA-UTI.