EXTENDED-SPECTRUM BETA-LACTAMASES PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE FROM HOSPITAL AND COMMUNITY ACQUIRED URINARY TRACT INFECTION IN UNIVERSITY COLLEGE HOSPITAL, IBADAN

Abstract

Introduction: Extended Spectrum Beta-lactamases (ESBLs) are responsible for
multi-drug resistant strains of Escherichia coli and Klebsiella species worldwide.
They are not routinely tested for and may be responsible for clinical failure in
treatment of urinary tract infection in University College Hospital, Ibadan.
Aim: The aim of this study was to evaluate the prevalence of ESBL-producing
Escherichia coli and Klebsiella species in urinary tract infection in University
College Hospital, Ibadan and identify the associated factors.
Methods: In this cross-sectional survey, Escherichia coli and Klebsiella species
causing urinary tract infection at the University College Hospital were studied with
corresponding clinical details obtained from clinical notes. Associated factors were
determined using correlation and multivariate analyses.
Results: The prevalence of ESBLs in Escherichia coli and Klebsiella species
isolated from urine specimen in University College Hospital Ibadan, Nigeria was
found to be 11%. The prevalence of ESBL production amongst cases of hospital
acquired urinary tract infection was 10%, while the prevalence amongst
community acquired urinary tract infection was 7%. Factors independently
associated with hospital acquired urinary tract infection (all P < .05) were past
history of quinolone or third generation cephalosporin use and presence of
immunosuppression. Only past history of quinolone (P < .05) use was found to be
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independently associated with community acquired urinary tract infection.
Antibiotic sensitivity was generally lower among ESBL producers. Antibiotic
resistance rates were higher among both hospital and community ESBL positive
isolates and multidrug resistance was found among them. For the commonly used
antibiotic tested, in the hospital gentamicin had the highest activity (40.4% with
37% in E .coli and 38.9% in Klebsiella spp.), while in the community ciprofloxacin
had the highest activity (50% with 52.2% in E .coli and 45.5% in Klebsiella spp.).
Conclusion: ESBL producing E. coli and Klebsiella spp. are prevalent in urinary
tract infection in University College Hospital, Ibadan. These organisms represent
both therapeutic challenge and a preventable cause of poor outcome in treatment of
urinary tract infection. There is need to establish routine screening for ESBL
strains in the Clinical Microbiology laboratory.