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Review
. 2015 Apr 30:2:26.
doi: 10.3389/fmed.2015.00026. eCollection 2015.

Escherichia coli Isolated from Urinary Tract Infections of Lebanese Patients between 2005 and 2012: Epidemiology and Profiles of Resistance

Ziad Daoud  1 , Elie Salem Sokhn  2 , Khalil Masri  3 , Ghassan M Matar  4 , Shira Doron  5
Affiliations
Review

Escherichia coli Isolated from Urinary Tract Infections of Lebanese Patients between 2005 and 2012: Epidemiology and Profiles of Resistance

Ziad Daoud et al. Front Med (Lausanne). .

Abstract

The early treatment of urinary tract infections (UTIs) is directly related to decrease in morbidity, which makes the empirical treatment of great importance. Recently, beta lactamases of several types have emerged as significant mechanisms of resistance in Gram-negative bacilli, especially Escherichia coli. Our aim was to study the urinary E. coli isolated from Lebanese patients and to characterize their mechanisms of resistance. The study analyzed data between 2005 and 2012 of UTIs caused by E. coli. The mechanisms of resistance were characterized by phenotypic and genotypic methods and the pulsed-field gel electrophoresis (PFGE) was used to determine the different bacterial clusters. As expected, the highest incidence was observed with E. coli (60.53-73.98%) followed by K. pneumoniae (5.32-8.33%). ICU isolates were constantly associated with the lowest rates of susceptibility to extended-spectrum cephalosporins, ciprofloxacin, as well as most of the tested antibiotics. A 100% occurrence of CTX-M in extended-spectrum β-lactamase (ESBL)-producing isolates was recorded, followed by TEM, SHV, and OXA. In addition, 15.9% harbored 4 different ESBL enzymes and only 13 isolates (14.8%) harbored only one enzyme (CTX-M). Over the years, the simultaneous susceptibility of E. coli to ceftazidime and ciprofloxacin decreased from 62.5% in 2006 to 48.7% in 2012. PFGE results demonstrated that 10 clusters were 32 generated, denoting diversity among detected isolates. Understanding the epidemiology of resistance is 33 instrumental for the implementation of recommendations for the management of antimicrobials, infection 34 control measures, as well as active surveillance and antimicrobial stewardship.

Keywords: E. coli; ESBL; bacterial resistance; carbapenemases; urinary infections.

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Figures

Figure 1
Figure 1
Distribution of urinary E. coli in percent by location and year.
Figure 2
Figure 2
Percentages of susceptibility of urinary E. coli to ceftazidime and ciprofloxacin over the years. NS/S: trends of the isolates non-susceptible to ceftazidime/susceptible to ciprofloxacin. S/NS: trends of the isolates susceptible to ceftazidime/non-susceptible to ciprofloxacin. S/S: trends of the isolates susceptible to ceftazidime/susceptible to ciprofloxacin. NS/NS: trends of the isolates non-susceptible to ceftazidime/non-susceptible to ciprofloxacin.
Figure 3
Figure 3
Percentages of susceptibility of urinary isolates of E. coli in all/in/and out-patients. (A) Amikacin. (B) Ampicillin. (C) Amoxicillin–clavulanic acid. (D) Cefuroxime. (E) Cefoxitin. (F) Ceftazidime. (G) Aztreonam. (H) Imipenem. (I) Nitrofurantoin. (J) Trimethoprim–sulfamethoxazole. (K) Ciprofloxacin.
Figure 3
Figure 3
Percentages of susceptibility of urinary isolates of E. coli in all/in/and out-patients. (A) Amikacin. (B) Ampicillin. (C) Amoxicillin–clavulanic acid. (D) Cefuroxime. (E) Cefoxitin. (F) Ceftazidime. (G) Aztreonam. (H) Imipenem. (I) Nitrofurantoin. (J) Trimethoprim–sulfamethoxazole. (K) Ciprofloxacin.
Figure 4
Figure 4
Dendrogram generated by the PFGE of 88 urinary isolates of E. coli (2012).
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