title: Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern -A hospital based cross sectional study.
abstract: Extended Spectrum Beta- Lactamase producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care. While ESBL producing Klebsiella species seem to account for most nosocomial outbreaks, ESBL-producing E. coli have been isolated from both hospitalized and non-hospitalized patients. Although 95-100% ESBL organisms are still considered sensitive to meropenem, rapid emergence of carbapenem resistance has been documented in many countries. The objective of this study was to evaluate urinary tract infections caused by ESBL producers and the antibiotic susceptibility patterns in Sri Lanka.
  
  
  
  Patients with confirmed ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital from January - June 2015 were recruited to the study. Their urine culture and antibiotic susceptibility reports were evaluated after obtaining informed written consent.
  
  
  
  Of 61 culture positive ESBL-UTIs, E. coli caused 53 (86.8%), followed by Klebsiella in 8 (13.1%).30 (49.1%) had a history of hospitalization within the past three months and included 6/8(75%) of Klebsiella UTI and 24/53(45.2%) of E.coli UTI. Antibiotic susceptibility of ESBL organisms were; Meropenem 58 (95%), Imipenem 45 (73.7%), Amikacin 37 (60.6%) and Nitrofurantoin 28(45.9%). In 3(4.9%), E.coli were resistant to Meropenem. These three patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI.
  
  
  
  We observed a higher percentage of E. coli over Klebsiella as ESBL producing organisms suggesting most ESBL-UTIs to be community acquired, Carbapenems seem to remain as the first line therapy for majority of ESBL-UTIs in the local setting. However 4.9% prevalence of meropenem resistance is alarming compared to other countries. Although prior antibiotic utilization and hospitalization may contribute to emergence of ESBL producing Klebsiella and E.coli in Sri Lanka, high prevalence of community acquired ESBL-E. coli needs further investigations to identify potential causes . Being a third world country with a free health care system, observed alarming rate of carbapenem resistance is likely to add a significant burden to health budget. We feel that treatment of infections in general needs a careful approach adhering to recommended antibiotic guidelines in order to prevent emergence of multi drug resistant organisms.
authors.affiliation: Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: M M P S C
authors.initials: MM
authors.lastname: Fernando
authors.affiliation: Department of Clinical Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka. nathashaluke@gmail.com.
authors.forename: W A N V
authors.initials: WA
authors.lastname: Luke
authors.affiliation: Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: J K N D
authors.initials: JK
authors.lastname: Miththinda
authors.affiliation: Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: R D S S
authors.initials: RD
authors.lastname: Wickramasinghe
authors.affiliation: Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: B S
authors.initials: BS
authors.lastname: Sebastiampillai
authors.affiliation: Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: M P M L
authors.initials: MP
authors.lastname: Gunathilake
authors.affiliation: Professorial Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
authors.forename: F H D S
authors.initials: FH
authors.lastname: Silva
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
authors.forename: R
authors.initials: R
authors.lastname: Premaratna
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy; D003430:Cross-Sectional Studies; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification*; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D013188:Sri Lanka / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000890:Anti-Infective Agents; D015780:Carbapenems; D001618:beta-Lactamases
keywords: Carbapenem resistance; ESBL producers; Urinary tract infections