Background
Extended spectrum β-lactamase (ESBL) especially, the CTX-M producing Escherichia coli has emerged world wide as the leading cause of community onset UTI in the era of antibiotic resistance. The CTX-M producers often exhibit co-resistance towards fluoroquinolones and are a growing challenge to patient care. The purpose of this study was to determine the incidence of fluoroquinolone resistance among CTX-M producing uropathogenic E.coli (UPEC).
Methods
UPEC isolated from HIV (n=76) and non-HIV antenatal patients (n=42) were screened for ESBL production as per CLSI guidelines. bla
CTX-M
was detected by PCR. Susceptibility to ciprofloxacin was assessed as per CLSI guidelines. Fisher’s exact test (two tailed) was employed to analyze the statistical significance of the results.
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Results
ESBL producers were more common among the UPEC isolates from HIV compared to those from non-HIV patients (75% vs 52.4%, p=0.015, OR=2.7273). Significant difference was observed in the incidence of bla
CTX-M
among the ESBL producers from HIV and non-HIV patients (70.2% vs 31.8%, p=0.002, OR=5.042). Compared to the CTX-M non-producers, majority of the CTX-M producers were resistant to ciprofloxacin in both the groups (HIV, 92.5% Vs 58.8%, p=0.0037, OR=8.6333, and non-HIV, 71.4% vs 20%, p= 0.5235, OR=10).
Conclusion
Fluoroquinolones are the most common non-β lactam antibiotic used in the treatment of infections caused by ESBL producing organisms. The results of our study suggest the possible emergence of plasmid mediated fluoroquinolone resistance among the CTX-M producing E. coli. The co-resistance exhibited by the CTX-M producers is a cause of concern, as it might facilitate the co-selection process.
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