title: Clinical and Laboratory Profile of Urinary Tract Infections Associated with Extended Spectrum β-Lactamase Producing Escherichia coli and Klebsiella pneumoniae.
abstract: BACKGROUND
  Urinary tract infection (UTI) is mainly due to invasion of the urethra, bladder or kidneys by pathogens. The emergence of extended spectrum β-lactamases (ESBL) is responsible for frequently observed empirical therapy failures.
  
  
  OBJECTIVE
  To study the clinical and laboratory characteristics of UTIs caused by ESBL producing Escherichia coli (E. coli) and Klebsiella pneumonia (K. pneumonia).
  
  
  METHODS
  A cross-sectional clinical and laboratory study was performed at King Khalid Hospital, Hafr Al Batin, Saudi Arabia between March 2014 to October 2015. A total of 908 urine samples from suspected UTI patients was collected. Samples were isolated on Cysteine Electrolyte-Deficient (CLED) agar. Positive cultures were identified and tested for antimicrobial susceptibility by MicroScan(®) WalkAway-96 SI System, and then ESBL was confirmed by double disc synergy test (DDST) and phenotypic confirmatory disc diffusion test (PCDDT).
  
  
  RESULTS
  A total of 680 samples (288 males and 392 females) were culture positive. 520 samples (76.5%) of E. Coli were found and 160 samples of K. pneumonia were identified (23.5%). ESBL testing showed 296 (218 E. coli and 78 K. pneumonia) samples of positive isolates. Non-ESBL isolates showed highest resistance to ampicillin followed by Mezocillin and Trimethoprim-Sulphamethoxazole-which are usually recommended as the initial treatment of UTI-while ESBL isolates showed resistance to third generation cephalosporin along with Ampicillin and Trimethoprim-Sulphamethoxazole. In this study, four significant risk factors for ESBL infection such as diabetes, recurrent UTI, previous use of antibiotics and previous hospitalization were found.
  
  
  CONCLUSIONS
  Identifying the risk factors and antibiotic susceptibility patterns associated with ESBL producing E. coli and K. pneumonia is a useful guide for treatment strategy and control of ESBL UTI.
authors.affiliation: Department of Medical Laboratory Technology, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Kingdom of Saudi Arabia.
authors.forename: Sulaiman Ali
authors.initials: SA
authors.lastname: Al Yousef
authors.affiliation: Department of Medical Laboratory Technology, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Kingdom of Saudi Arabia.
authors.forename: Sabry
authors.initials: S
authors.lastname: Younis
authors.affiliation: Department of Medical Laboratory Technology, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Kingdom of Saudi Arabia.
authors.forename: Eman
authors.initials: E
authors.lastname: Farrag
authors.affiliation: Faculty of Women for Art, Science and Education, Ain Shams University, Cairo, Egypt.
authors.forename: Husseiny Sh
authors.initials: HSh
authors.lastname: Moussa
authors.affiliation: Microbiology Department, Faculty of Pharmacy, MSA University, Cairo, Egypt.
authors.forename: Faten Sayed
authors.initials: FS
authors.lastname: Bayoumi
authors.affiliation: Department of Medical Laboratory Technology, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Kingdom of Saudi Arabia ahmedelyamani22@gmail.com.
authors.forename: Ahmed Mohamed
authors.initials: AM
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D064790:Clinical Laboratory Services; D003710:Demography; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D014552:Urinary Tract Infections / Q000382:microbiology*; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases
keywords: E. coli; ESBL; K. pneumonia; UTI