Antibiotic sensitivity patterns among ESBL UTIs in Sri Lanka

Abstract

BACKGROUND: Extended-spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections (UTI) are increasing in incidence and poses a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. The prevalence of ESBL producing organisms particularly in the Asian region remains unknown. In a study carried out in a tertiary care center in India,70/218(32.1%) clinical isolates of Enterobacteriaceae were confirmed as ESBL. Of them K. pneumonia were the most common ESBL producers(46.4%), followed by E coli (31.7%). Previous studies to evaluate antibiotic susceptibility shows high sensitivity to meropenem (95-100%) with aminoglycoside susceptibility ranging from 45-60%. Objective of this study was to evaluate the antibiotic sensitivity patterns of ESBL UTIs in Sri Lanka. METHODS & MATERIALS: Patients with ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama over a period of 6 months from January-July 2015 were recruited to the study. Their Urine culture and ABST reports were analysed after obtaining informed written consent. RESULTS: There were 52 patientswho consented for the study;males30 (57.7%),mean (SD) age 64.11 (12.59)years. The most common organisms causing the ESBL-UTI were E. coli in 44(84.6%),followed by Klebsiella in 8 (15.4%) . The ESBL organisms were mostly sensitive to carbapenems;Meropenem 50 (96.2%) and Imipenem in 38(73.1%). The other sensitivity patterns were Amikacin in 30 (57.7%), Nitrofurantoin in 24 (46.2%) andCeftriaxone in 2 (3.8%). None were sensitive to Ceftazidime. Meropenem resistance was found in 2 (3.8%) and wereE.coli. These two patients had received multiple antibiotics including meropenem in the recent past for recurrant UTI.CONCLUSION: It is evident from the above data that Carbapenems remain as the first line therapy for the majority of UTIs caused by ESBL producing organisms in the local setting. However 3.8% prevalence of meropenem resistance among the study population should draw attention of clinicians and needs implementation of measures to prevent emergence and spread of carbapenum resistant ESBL organisms.