title: Distribution of ESBLs among Escherichia coli isolates from outpatients with recurrent UTIs and their antimicrobial resistance.
abstract: BACKGROUND
  Extended-spectrum β-lactamase (ESBL)-producing strains of Enterobacteriaceae are considered to be emerging pathogens. They are a major problem in hospitalized as well as community-based patients. Major outbreaks involving ESBL strains have been reported from all over the world. Recurrent urinary tract infection (UTI) is one of the risk factors for infection with ESBL-producing E. coli in hospitalized and non-hospitalized patients.
  
  
  METHODS
  Ninety-one E. coli isolates from outpatients with recurrent UTIs were surveyed phenotypically and genotypically for ESBL production and tested for antimicrobial susceptibility.
  
  
  RESULTS
  Of 91 E. coli isolates, 75.8% were resistant to each of cefotaxime and ceftazidime and 74.7% produced ESBLs. CTX-M-type was the most frequent ESBL (accounting for 70.3%), with CTX-M-1 being the only subtype possessed by these isolates. The prevalence of OXA- and SHV-type was 32.9% and 10.9%, respectively. None of the isolates produced TEM β-lactamase. All OXA-type ESBL were produced concomitantly with CTX-M1. Both ESBL producers and non-producers had high resistance to ampicillin followed by trimethoprim-sulphamethoxazole, third-generation cephalosporins, and tetracycline. No isolate showed resistance to imipenem and meropenem. In total, resistance rates of ESBL producers were higher than those of ESBL non-producers, as was multidrug resistance (52.7% versus 8.7%, respectively).
  
  
  CONCLUSIONS
  Our study documented high distribution of ESBLs among E. coli isolates from outpatients with recurrent UTIs, with CTX-M as the predominant ESBL. In the current situation, it is important that antibiotic treatment is be started only after a proper sensitivity report is obtained from the laboratory.
authors.affiliation: Wasit University, Wasit Province, Iraq. sareaamaseer@yahoo.com.
authors.forename: Sareaa
authors.initials: S
authors.lastname: Al-Mayahie
authors.forename: Jaafar Jh
authors.initials: JJ
authors.lastname: Al Kuriashy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010045:Outpatients; D016133:Polymerase Chain Reaction; D012008:Recurrence; D014552:Urinary Tract Infections / Q000382:microbiology*; D055815:Young Adult; D001618:beta-Lactamases / Q000032:analysis* / Q000235:genetics*
chemical_list: D001618:beta-Lactamases