Antimicrobial Resistance Pattern of Escherichia Coli From Urinary Tract Infections in Relation to ESBL and pap gene Production and Fosfomycin Sensitivity
Keywords:Escherichia coli, ESBL, fosfomycin, CRE, pap gene, antimicrobial resistance
Introduction: Urinary Tract Infections (UTI) is becoming increasingly difficult to treat due to emergence of
multi-drug resistant uropathogens. Fosfomycin can be used as an alternative due to lack of cross-resistance.
We aimed to evaluate in-vitro activity of fosfomycin against uropathogenic E.coli.
Material and Methods: The study period was September 2017 to August 2018. Two hundred and fifty
two urine samples were collected from women having uncomplicated cystitis. Out of these168 isolates was
E.coli, Antimicrobial susceptibility testing was performed using the Kirby-baeur disk diffusion method.
ESBL screening was done using the double disc synergy test. Fosfomycin susceptibility was determined
by the disk diffusion method for E.coli. Prevalence of the pap gene among the isolates were checked using
Results: The study showed that among E.coli isolates frequency of ESBL producers were 30.95% while
4 % were identified as carbapenem resistant Enterobacteriaceae (CRE). Among the isolates, 84.50%
were susceptible to fosfomycin. There was 92.0% fosfomycin susceptibility in ESBL producing E.coli,
and 71.42% showed fosfomycin susceptibility in CRE. The overall pap gene prevalence was 18% and the
expression was 22% among the ESBL isolates and 20% among the CRE.
Conclusion: The study demonstrates that, a considerable proportion (68%) of the multidrug-resistant
E.coli with diverse resistance mechanisms, including ESBL and CRE. Fosfomycin resistance was low even
among ESBL and CRE isolates. Pap genes were prevalent among the ESBL isolates .For the treatment of
uncomplicated cystitis fosfomycin is a useful antibiotic agent.
Objective: The aim of this study was to establish in vitro susceptibility of uropathogenic E.coli to fosfomycin
and to check the prevalence of the expression of pap gene a virulence determinant among the isolates from
uncomplicated cystitis in females.