title: Extended-spectrum ß-Lactamase-producing Enterobacteriaceae as a Common Cause of Urinary Tract Infections in Sri Lanka.
abstract: BACKGROUND
  Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasingly reported as pathogens in urinary tract infections (UTIs). However, in Sri Lanka, the clinical and molecular epidemiology of ESBL-PE implicated in UTIs has not been well described.
  
  
  METHODS
  We conducted prospective, laboratory-based surveillance from October to December 2013 at a tertiary care hospital in southern Sri Lanka and enrolled patients ≥1 year of age with clinically relevant UTIs due to ESBL-PE. Isolate identity, antimicrobial drug susceptibility, and ESBL production were determined. Presence of ß-lactamase genes, bla(SHV), bla(TEM), and bla(CTX-M), was identified by polymerase chain reaction.
  
  
  RESULTS
  During the study period, Enterobacteriaceae were detected in 184 urine samples, with 74 (40.2%) being ESBL producers. Among 47 patients with ESBL-PE who had medical records available, 38 (80.9%) had clinically significant UTIs. Most UTIs (63.2%) were community acquired and 34.2% were in patients with diabetes. Among 36 cultured ESBL-PE isolates, significant susceptibility (>80%) was only retained to amikacin and the carbapenems. The group 1 bla(CTX-M) gene was present in 90.0% of Escherichia coli isolates and all Klebsiella pneumoniae and Enterobacter cloacae isolates. The bla(SHV) and bla(TEM) genes were more common in K. pneumoniae (75% and 50%) and E. cloacae (50% and 50%) isolates than in E. coli (10% and 20%) isolates, respectively.
  
  
  CONCLUSIONS
  The majority of UTIs caused by ESBL-PE were acquired in the community and due to organisms carrying the group 1 CTX-M ß-lactamase. Further epidemiologic studies of infections due to ESBL-PE are urgently needed to better prevent and treat these infections in South Asia.
authors.affiliation: Duke Global Health Institute, Durham, NC, USA. gayani.tillekeratne@dm.duke.edu.
authors.forename: L Gayani
authors.initials: LG
authors.lastname: Tillekeratne
authors.affiliation: Teaching Hospital Karapitiya, Galle, Sri Lanka.
authors.forename: Dhammika
authors.initials: D
authors.lastname: Vidanagama
authors.affiliation: Genetech Research Institute, Colombo, Sri Lanka.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Tippalagama
authors.affiliation: Teaching Hospital Karapitiya, Galle, Sri Lanka.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Lewkebandara
authors.affiliation: Durham Veteran Affairs Medical Center, Durham, NC, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Joyce
authors.affiliation: Durham Veteran Affairs Medical Center, Durham, NC, USA.
authors.forename: Bradly P
authors.initials: BP
authors.lastname: Nicholson
authors.affiliation: Department of Microbiology, Ruhuna University Faculty of Medicine, Galle, Sri Lanka.
authors.forename: Ajith
authors.initials: A
authors.lastname: Nagahawatte
authors.affiliation: Department of Medicine, Ruhuna University Faculty of Medicine, Galle, Sri Lanka.
authors.forename: Champica K
authors.initials: CK
authors.lastname: Bodinayake
authors.affiliation: Genetech Research Institute, Colombo, Sri Lanka.
authors.forename: Aruna Dharshan
authors.initials: AD
authors.lastname: De Silva
authors.affiliation: Duke Global Health Institute, Durham, NC, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
keywords: Community-acquired urinary tract infections; Enterobacteriaceae; Extended-spectrum ß-lactamases; Sri Lanka