title: Multidrug resistance and extended-spectrum β-lactamases genes among Escherichia coli from patients with urinary tract infections in Northwestern Libya.
abstract: Multidrug resistance (MDR) and emergence of extended-spectrum β-lactamases (ESBLs) that mediate resistance to β-lactam drugs among Escherichia coli and other uropathogens have been reported worldwide. However, there is little information on the detection of ESBLs genes in E. coli from patients with urinary tract infections (UTIs) in the Arab countries using polymerase chain reaction (PCR), and in Libya such information is lacking.
  
  
  
  All patients attending Zawiya Teaching Hospital in Zawiya city between November 2012 and June 2013 suspected of having UTIs and from whom midstream urine samples were taken as part of the clinical workup were included in this prospective study. Samples were examined for uropathogens by standard bacteriological procedures. VITEK-2 automated microbiology system was used to identify the isolated uropathogens and determine the susceptibility of E. coli and Klebsiella spp. isolates to antimicrobials. In addition, phenotypically ESBLs-positive E. coli isolates were tested for ESBLs genes by PCR.
  
  
  
  The present study enrolled 1,790 patients with UTIs. Uropathogens were found in 371 (20.7%) urine specimens examined. Mixed pathogens were detected in two specimens with 373 total pathogens isolated. E. coli and Klebsiella spp. were the predominant uropathogens at 55.8% (208/373) and 18.5% (69/373), respectively. Other pathogens were detected in 25.7% (96/373) of urine samples. Of the E. coli and Klebsiella spp. tested, 69.2 and 100% were resistant to ampicillin, 6.7 and 33.3% to ceftriaxone, and 23.1 and 17.4% to ciprofloxacin, respectively. MDR (resistance to ≥3 antimicrobial groups) was found in 69 (33.2%) of E. coli and in 29 (42%) of Klebsiella spp. isolates. ESBLs were detected phenotypically in 14 (6.7%) of E. coli and in 15 (21.7%) of Klebsiella spp. isolates. Thirteen out of the 14 phenotypically ESBL-positive E. coli were positive for ESBL genes by PCR. bla TEM gene was detected in seven isolates, bla OXA gene in 10 isolates and bla CTX-M gene in six isolates. bla SHV gene was not detected in the present study.
  
  
  
  The isolation of MDR ESBL-producing uropathogens undoubtedly will limit the choices clinicians have to treat their patients with UTIs. Therefore, there is an urgent need for surveillance studies on antimicrobial resistance and prevalence of ESBLs among uropathogens to guide the clinical treatment of UTIs in Libya in the future.
authors: Al-Maya Pharmaceutical Factory, Tripoli, Libya.
authors: Abubaker A
authors: AA
authors: Abujnah
authors: Faculty of Medicine, Tripoli University, Tripoli, Libya.
authors: Abdulaziz
authors: A
authors: Zorgani
authors: Zawiya Teaching Hospital, Zawiya, Libya.
authors: Mohamed A M
authors: MA
authors: Sabri
authors: US Naval Medical Research Unit-3, Cairo, Egypt.
authors: Hanan
authors: H
authors: El-Mohammady
authors: US Naval Medical Research Unit-3, Cairo, Egypt.
authors: Rania A
authors: RA
authors: Khalek
authors: El-Nakheel Compound, Cairo, Egypt; ghenghesh_micro@yahoo.com.
authors: Khalifa S
authors: KS
authors: Ghenghesh
mesh_terms: D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008002:Libya / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D018571:Sentinel Surveillance; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000187:drug effects* / Q000235:genetics*
chemical_list: D001618:beta-Lactamases
keywords: Escherichia coli; Libya; extended-spectrum β-lactamases; multidrug resistance; urinary tract infections
references: J Infect Dev Ctries. 2009;3(3):187-90
references: 19759473
references: Eur J Clin Microbiol Infect Dis. 2004 Mar;23(3):163-7
references: 14986159
references: J Infect Dev Ctries. 2011 Dec;5(12):840-9
references: 22169782
references: J Infect Dev Ctries. 2010 Apr;4(4):202-6
references: 20440056
references: Med Princ Pract. 2005 Nov-Dec;14(6):401-7
references: 16220013
references: J Antimicrob Chemother. 2005 Jul;56(1):52-9
references: 15917288
references: J Natl Med Assoc. 2009 Dec;101(12):1268-73
references: 20070015
references: Clin Microbiol Infect. 2000 Sep;6(9):460-3
references: 11168179
references: Int J Infect Dis. 2009 Mar;13(2):140-4
references: 18703368
references: J Infect Dev Ctries. 2014 Sep;8(9):1129-36
references: 25212077
references: J Infect Dev Ctries. 2011 Dec;5(12):850-5
references: 22169783
references: Euro Surveill. 2008 Nov 20;13(47). pii: 19044
references: 19021958
references: J Infect Chemother. 2011 Oct;17(5):646-51
references: 21487942
references: Clin Microbiol Rev. 2001 Oct;14(4):933-51, table of contents
references: 11585791
references: Libyan J Med. 2013;8:1-8
references: 23537612
references: J Clin Microbiol. 1995 Jul;33(7):1779-83
references: 7545179
references: Appl Environ Microbiol. 2004 Jan;70(1):1-7
references: 14711619
references: J Clin Diagn Res. 2013 Oct;7(10):2173-7
references: 24298468
references: Can J Urol. 2012 Oct;19 Suppl 1:42-8
references: 23089347