A Cross-Sectional Study of Extended-Spectrum β-Lactamase-Producing Escherichia coli Isolated From Clinical Samples: Single-Center Investigation in Indonesia

Abstract

The emergence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-producing E. coli) is a significant public health concern, particularly in developing countries like Indonesia, where reports on the prevalence and characteristics of these resistant strains are scarce. This lack of data hampers effective infection control and antibiotic stewardship efforts. This study is aimed at investigating the prevalence and assessing the antimicrobial susceptibility profiles of ESBL-producing E. coli isolated from clinical samples of Indonesian patients, thereby contributing to an understanding of antibiotic resistance patterns in this region. A cross-sectional study was conducted at RSUD dr. Adhyatma Hospital, Semarang, Indonesia, over 3 years (from January 2022 to December 2024). Clinical specimens were obtained from patients diagnosed with E. coli infections, and isolates were identified and assessed for antibiotic susceptibility utilizing the VITEK2 Compact system. Data were examined via the Fisher's exact test. Out of 449 E. coli isolates, 199 (44.3%) were identified as ESBL, with the highest prevalence in pus (35.6%) and urine (27.2%). ESBL-producing E. coli isolates demonstrated high sensitivity (above 90%) to amoxicillin-clavulanic acid, ceftazidime, ertapenem, meropenem, and tigecycline. Our study also underlined the higher prevalence of multidrug resistance (MDR) in ESBL compared to non-ESBL. The results highlight the urgent need for enhanced surveillance and infection control measures in healthcare settings to combat the spread of ESBL-producing E. coli. Healthcare professionals, including nurses and clinicians, must be aware of this resistance pattern to guide empirical treatment choices and improve patient outcomes in managing infections caused by these resistant strains.

Figure 1

Susceptibility profiles of E. coli isolates. Aminopenicillins (AM: ampicillin; AMS: ampicillin/sulbactam; and AMC: amoxicillin + clavulanic acid); first-generation cephalosporin (CZO: cefazolin); third-generation cephalosporins (CAZ: ceftazidime; CTX: cefotaxime; and CRO: ceftriaxone); fourth-generation cephalosporin (FEP: cefepime); monobactam (AZM: aztreonam); carbapenems (ETP: ertapenem and MEM: meropenem); aminoglycosides (GM: gentamicin); fluoroquinolone (CIP: ciprofloxacin); glycylcycline (TGC: tigecycline); nitrofuran (NIT: nitrofurantoin); and sulfonamides–trimethoprim (SXT: trimethoprim + sulfamethoxazole).