Community-Associated Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in a Nephrology Center

• Fatema S Bukhatwa

  Medical Laboratory, Nephrology Department,  Alhwari Hospital, Benghazi, Libya

  Author

• Salha F Ben Jweiref

  University of Benghazi, Faculty of Science, Department of Botany, Libya

  Author

• Asraa F ALjahani

  Department of Microbiology, Faculty of Dentistry, University of Benghazi, Libya

  Author

• Eman M Elzouki

  Department of Medical Laboratory, College of Medical Technology, Derna, Libya

  Author

• Salam F ELmoshity

  University of Benghazi, Faculty of Science, Department of Microbiology, Benghazi, Libya

  Author

Urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli are increasingly difficult to manage, particularly among patients with repeated healthcare exposure. This study characterized uropathogens and determined the prevalence and antimicrobial susceptibility of ESBL-producing E.coli among hospital- and community-associated urinary tract infections in Benghazi, Libya. A cross-sectional laboratory investigation was conducted from April to December 2023 among 120 symptomatic patients attending Al-Hawari Nephrology Hospital and community outpatient services. Midstream urine specimens were cultured on blood and MacConkey agars; isolates were identified by colony morphology, Gram staining, and conventional biochemical tests. Antimicrobial susceptibility was evaluated by disk diffusion, and ESBL production in E.coli was confirmed phenotypically using double-disk synergy and combination-disk tests. Gram-negative organisms accounted for 70% of isolates and E.coli was the predominant uropathogen (50%, 60/120). Of the E.coli isolates, 27% (16/60) were ESBL producers. ESBL-positive isolates were more frequent among inpatients (63%) than outpatients (37%) and among females (56%) than males (44%). Resistance among ESBL-producing isolates was highest to ciprofloxacin (94%), cefotaxime (90%), ceftazidime (85%), cefuroxime (80%), and colistin (70%). Susceptibility remained high to ertapenem (95%), amikacin (90%), and nitrofurantoin (75%). These findings demonstrate a clinically important ESBL burden and support routine susceptibility testing, strengthened infection-control measures, and antimicrobial stewardship guided by local resistance data.

1. Fatema S Bukhatwa, Medical Laboratory, Nephrology Department,  Alhwari Hospital, Benghazi, Libya

   Medical Laboratory, Nephrology Department,  Alhwari Hospital, Benghazi, Libya

2. Salam F ELmoshity, University of Benghazi, Faculty of Science, Department of Microbiology, Benghazi, Libya

   University of Benghazi, Faculty of Science, Department of Microbiology, Benghazi, Libya

Bradford, P. A. (2001). Extended-spectrum beta-lactamases in the 21st century: Characterization, epidemiology, and detection of this important resistance threat. Clinical Microbiology Reviews, 14(4), 933–951. https://doi.org/10.1128/CMR.14.4.933-951.2001ز DOI: https://doi.org/10.1128/CMR.14.4.933-951.2001

Castanheira, M., Simner, P. J., & Bradford, P. A. (2021). Extended-spectrum beta-lactamases: An update on their characteristics, epidemiology, and detection. JAC-Antimicrobial Resistance, 3(3), dlab092. DOI: https://doi.org/10.1093/jacamr/dlab092

Cheesbrough, M. (2006). District laboratory practice in tropical countries (2nd ed., Part 2). Cambridge University Press. DOI: https://doi.org/10.1017/CBO9780511543470

Ejaz, H., Younas, S., Abosalif, K. O. A., Zorgani, A., Almagatef, A., Sufya, N., Bashein, A., & Tubbal, A. (2017). Detection of CTX-M-15 among uropathogenic Escherichia coli isolated from five major hospitals in Tripoli, Libya. Oman Medical Journal, 32(4), 322–327. DOI: https://doi.org/10.5001/omj.2017.61

Jarlier, V., Nicolas, M. H., Fournier, G., & Philippon, A. (1988). Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: Hospital prevalence and susceptibility patterns. Reviews of Infectious Diseases, 10(4), 867–878. DOI: https://doi.org/10.1093/clinids/10.4.867

Kettani Halabi, M., Lahlou, F. A., Diawara, I., El Adouzi, Y., Marnaoui, R., & Benmessaoud, R. (2021). Antibiotic resistance pattern of extended-spectrum beta-lactamase-producing Escherichia coli isolated from patients with urinary tract infection in Morocco. Frontiers in Cellular and Infection Microbiology, 11, 720701. https://doi.org/10.3389/fcimb.2021.720701 DOI: https://doi.org/10.3389/fcimb.2021.720701

Lee, D. S., Lee, S. J., & Choe, H. S. (2018). Community-acquired urinary tract infection by Escherichia coli in the era of antibiotic resistance. BioMed Research International, 2018, 7656752. DOI: https://doi.org/10.1155/2018/7656752

Lindblom, A., Kiszakiewicz, C., Kristiansson, E., Yazdanshenas, S., Kamenska, N., & Karami, N. (2022). The impact of the ST131 clone on recurrent ESBL-producing E. coli urinary tract infection: A prospective comparative study. Scientific Reports, 12, 1–9. DOI: https://doi.org/10.1038/s41598-022-14177-y

Livermore, D. M., Canton, R., Gniadkowski, M., Nordmann, P., Rossolini, G. M., Arlet, G., Coque, T. M., & Luzzaro, F. (2007). CTX-M: Changing the face of ESBLs in Europe. Journal of Antimicrobial Chemotherapy, 59(2), 165–174. DOI: https://doi.org/10.1093/jac/dkl483

Maina, D., Makau, P., Nyerere, A., & Revathi, G. (2013). Antimicrobial resistance patterns in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates in a private tertiary hospital, Kenya. Microbiology Discovery, 1(5). DOI: https://doi.org/10.7243/2052-6180-1-5

Mancuso, G., Midiri, A., Zummo, S., Gerace, E., Scappatura, G., & Biondo, C. (2021). Extended-spectrum beta-lactamases and carbapenemase-producing fermentative Gram-negative bacilli in clinical isolates from a university hospital in Southern Italy. New Microbiologica, 44, 227–233.

Naziri, Z., Derakhshandeh, A., Soltani Borchaloee, A., Poormaleknia, M., & Azimzadeh, N. (2020). Treatment failure in urinary tract infections: A warning witness for virulent multidrug-resistant ESBL-producing Escherichia coli. Infection and Drug Resistance, 13, 1839–1850. https://doi.org/10.2147/IDR.S256131 DOI: https://doi.org/10.2147/IDR.S256131

Nielubowicz, G. R., & Mobley, H. L. T. (2010). Host–pathogen interactions in urinary tract infection. Nature Reviews Urology, 7, 430–441. DOI: https://doi.org/10.1038/nrurol.2010.101

Paterson, D. L., & Bonomo, R. A. (2005). Extended-spectrum beta-lactamases: A clinical update. Clinical Microbiology Reviews, 18(4), 657–686. DOI: https://doi.org/10.1128/CMR.18.4.657-686.2005

Pitout, J. D. D., & Laupland, K. B. (2008). Extended-spectrum beta-lactamase-producing Enterobacteriaceae: An emerging DOI: https://doi.org/10.1016/S1473-3099(08)70041-0

public-health concern. The Lancet Infectious Diseases, 8(3), 159–166.

Ruppé, É., Woerther, P.-L., & Barbier, F. (2015). Mechanisms of antimicrobial resistance in Gram-negative bacilli. Annals of Intensive Care, 5, 61. DOI: https://doi.org/10.1186/s13613-015-0061-0

Woerther, P.-L., Burdet, C., Chachaty, E., & Andremont, A. (2013). Trends in human fecal carriage of extended-spectrum beta-lactamases in the community: Toward the globalization of CTX-M. Clinical Microbiology Reviews, 26(4), 744–758. DOI: https://doi.org/10.1128/CMR.00023-13

World Health Organization. (2020). Antimicrobial resistance: Global report and surveillance guidance. World Health Organization.

• PDF

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.