title: Resistance trends and risk factors of extended spectrum β-lactamases in Escherichia coli infections in Aleppo, Syria.
abstract: BACKGROUND
  Recently, there has been a notable surge in urinary tract infections (UTIs) by extended spectrum β-lactamase (ESBL)-producing Escherichia coli, which considerably limits treatment options. This study aimed to determine prevalence, phenotypic patterns, and ESBL-production status of E coli in isolates from UTI patients along with uncovering locally relevant risk factors for contracting ESBL-producing E coli infections.
  
  
  METHODS
  One hundred four nonrepetitive urine samples were collected from 3 major hospitals in Aleppo, Syria. Antibiotic susceptibility and ESBL production were studied by disc diffusion and double disk synergy tests according to Clinical Laboratory Standards Institute guidelines. Epidemiologic analysis was done using χ(2) and multivariate logistic regression tests.
  
  
  RESULTS
  This study revealed high prevalence of multidrug-resistant (MDR) E coli reaching 63%, whereas ESBL-producing E coli exceeded 52%. The latter exhibited alarmingly elevated levels of coresistance to non-β-lactam antibiotics leading to vast increase in MDR rates in comparison with non-ESBL-producing E coli (83.6% vs 12.2%, respectively).
  
  
  CONCLUSIONS
  We found previous exposure to third-generation cephalosporins and fluoroquinolones to be a significant risk factor for ESBL-producing E coli infections, in addition to other known factors such as hospitalization and catheterization. Tigecycline and carbapenems demonstrated near perfect efficacy against tested E coli, so they rank high among treatment options.
authors: Department of Biochemistry and Microbiology, Faculty of Pharmacy, University of Aleppo, Jamea Street, Aleppo, Syria.
authors: Bodour
authors: B
authors: Al-Assil
authors: Maysa
authors: M
authors: Mahfoud
authors: Abdul Rezzak
authors: AR
authors: Hamzeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018432:Drug Resistance, Multiple; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000201:enzymology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013593:Syria; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000201:enzymology*; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases