Antibiotic sensitivity pattern for non-beta lactam antibiotics and carbapenems in extended-spectrum beta-lactamase (ESBL) producing uropathogens versus non-ESBL producing uropathogens

Abstract

INTRODUCTION AND OBJECTIVES: Urinary tract infections (UTIs) are frequent and predominantly caused by coliforms. ESBL producers are increasing in number limiting therapeutic options. It is therefore vital to institute precise, empiric antibiotic guidelines in order to prevent life-threatening urosepsis. The objective of this study was to compare antibiotic sensitivity (ABST) pattern of ESBL producers and non-ESBL producers against selected non-beta lactams and carbapenem antibiotics. METHODOLOGY: Retrospective analysis of ABST of significant urinary coliform isolates was done. STUDY SETTING: Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya and Base Hospital, Wathupitiwala, Sri Lanka. STUDY PERIOD: 01.01.2012 - 01.01.2016. STUDY GROUPS: ESBL producers and non-ESBL producers, 63 in each group. Sensitivity profiles of amikacin, gentamicin, netilmicin, nitrofurantoin, nalidixic acid, norfloxacin, ciprofloxacin, imipenem and meropenem were analyzed. Statistical analysis: R programming language. Level of significance P<0.05. RESULTS: ESBL producers were present in 63 patients, 36 (57.1%) of whom were females and 39 were inpatients (61.9%). Non-ESBL producers were isolated from urine of 63 patients, of whom 49 (77.8%) were females and 17 (26.9%) inpatients. Antibiotic sensitivity of ESBL producers ranged from 82.2% to 100% for netilmicin, amikacin, meropenem and imipenem, 65% for nitrofurantoin and from 14.8% to 32.1% for nalidixic acid, ciprofloxacin, norfloxacin and gentamicin. Antibiotic sensitivity of the non-ESBL producers ranged from 56.7% for nalidixic acid and from 76.8% to 85.1% for ciprofloxacin, nitrofurantoin, norfloxacin and gentamicin. CONCLUSION: A female predominance was noted in both non ESBL and ESBL producers but there was a significant dominance of ESBL producers in male patients. ESBL producers were significantly common amongst inpatients than outpatients. ESBL-producers had significantly high resistance against nalidixic acid, ciprofloxacin, norfloxacin and gentamicin compared to non-ESBL producers. However, more than 2/3rd of isolates in both groups were sensitive to nitrofurantoin.