Figure 1Antimicrobial resistance pattern of UPEC isolates from patients with urinary tract infections (UTI). UPEC = uropathogenic Escherichia coli.
Figure 2Comparison of antimicrobial resistance pattern among the ESBL and nonESBL producer UPEC isolates. * = significant. AMO = amoxicillin; AMP = ampicillin; CAZ = ceftazidime; COT = cotrimoxazole; CPM = cefepime; CRO = ceftriaxone; ESBL = extended spectrum beta lactamases; NAL = nalidixic acid; NOR = norfloxacin; PIP = piperacillin; TET = tetracycline; UPEC = uropathogenic Escherichia coli.
Table 1Prevalence of urinary tract infection in relation to significant patients' profiles.
Patients' profiles |
% Urinary tract infection |
Socioeconomic status |
Well |
23.7 |
< Intermediate |
76.3 |
Educational level |
High |
19.9 |
< Intermediate |
80.1 |
Patient status |
Outpatient (community acquired UTI) |
34.6 |
Inpatient (hospital acquired UTI) |
65.4 |
Treatment course |
Complete |
53.8 |
Incomplete |
46.2 |
Past history of recurrent |
Present |
31.4 |
Absent |
68.6 |
Sexual activity |
Active |
74.4 |
Not active |
25.6 |
Clinical diagnosis |
Acute cystitis |
66 |
Acute pyelonephritis |
14.1 |
Asymptomatic bacteriuria |
19.9 |
Table 2Antibiotic resistance profile among the urinary tract infection (UTI) patients with different clinical symptoms.
Antibiotics |
Acute cystitis %R |
Acute pyelonephritis %R |
ABU %R |
p
|
AMO |
68.9 |
50 |
32.2 |
NS |
TET |
66 |
63.6 |
38.7 |
NS |
NAL |
60.2 |
18.2 |
25.8 |
0.038* |
PIP |
63.1 |
40.9 |
41.9 |
NS |
AMP |
86.5 |
59.1 |
61.3 |
NS |
CRO |
51.4 |
22.7 |
19.3 |
0.041* |
CAZ |
40.8 |
50 |
9.7 |
NS |
CPM |
50.5 |
31.8 |
29 |
NS |
NOR |
58.2 |
54.5 |
35.5 |
NS |
COT |
71.8 |
45.4 |
22.6 |
0.029* |
Table 3Relationship between antimicrobial resistance and virulence factors of UPEC isolates.
Virulence markers |
Antimicrobial agents
|
AMO %R |
TET %R |
NAL %R |
PIP %R |
AMP %R |
CRO %R |
CAZ %R |
CPM %R |
NOR %R |
COT %R |
Biofilm formation |
Strong |
82.1 |
67.8 |
17.8 |
71.4 |
96.4 |
64.3 |
60.7 |
67.8 |
75 |
85.7 |
Moderate |
62 |
55.2 |
37.9 |
58.6 |
86.2 |
51.7 |
44.8 |
58.6 |
62.1 |
69 |
Weakly |
57.1 |
66.2 |
53.2 |
51.9 |
75.3 |
31.2 |
27.3 |
31.2 |
48 |
50.6 |
Negative |
31.8 |
36.4 |
77.3 |
45.4 |
50 |
31.8 |
22.7 |
36.4 |
31.8 |
36.4 |
p
|
NS |
NS |
0.043* |
NS |
0.042* |
NS |
NS |
NS |
0.047* |
0.011* |
Hemolysin production |
Positive |
54.7 |
41.5 |
9.4 |
62.3 |
71.7 |
39.6 |
54.7 |
41.5 |
52.8 |
35.8 |
Negative |
61.2 |
69.9 |
67 |
52.4 |
80.6 |
41.7 |
26.2 |
44.7 |
53.4 |
69.9 |
p
|
NS |
0.046* |
0.011* |
NS |
NS |
NS |
NS |
NS |
NS |
0.043* |
HA type |
MRHA |
53.4 |
50 |
60.3 |
34.5 |
67.2 |
43.1 |
32.1 |
55.2 |
46.5 |
43.1 |
MSHA |
62.2 |
66.3 |
39.8 |
68.4 |
83.7 |
39.8 |
38.8 |
36.7 |
57.1 |
67.3 |
p
|
NS |
NS |
NS |
NS |
NS |
NS |
NS |
NS |
NS |
NS |
Table 4Distribution of virulence patterns of UPEC in relationship with clinical symptoms.
Patterns |
Phenotypic markers
|
No. of isolates |
Clinical symptoms
|
ESBL |
Biofilm |
Hemolysin |
MRHA |
MSHA |
Acute cyctitis |
Acute pyelonephritis |
Asymptomatic bacteriuria |
UP 1 |
+ |
+ |
+ |
+ |
− |
9 |
3 |
6 |
0 |
UP 2 |
+ |
+ |
+ |
− |
+ |
13 |
7 |
4 |
2 |
UP 3 |
+ |
+ |
− |
+ |
− |
5 |
4 |
0 |
1 |
UP 4 |
+ |
+ |
− |
− |
+ |
9 |
7 |
0 |
2 |
UP 5 |
+ |
− |
+ |
+ |
− |
1 |
0 |
1 |
0 |
UP 6 |
+ |
− |
+ |
− |
+ |
1 |
1 |
0 |
0 |
UP 7 |
+ |
− |
− |
+ |
− |
2 |
1 |
0 |
1 |
UP 8 |
+ |
− |
− |
− |
+ |
2 |
0 |
0 |
2 |
UP 9 |
− |
+ |
+ |
+ |
− |
6 |
2 |
3 |
1 |
UP 10 |
− |
+ |
+ |
− |
+ |
14 |
8 |
3 |
3 |
UP 11 |
− |
+ |
− |
+ |
− |
31 |
22 |
2 |
7 |
UP 12 |
− |
+ |
− |
- |
+ |
46 |
37 |
1 |
8 |
UP 13 |
− |
− |
+ |
+ |
− |
3 |
1 |
2 |
0 |
UP 14 |
− |
− |
+ |
− |
+ |
6 |
6 |
0 |
0 |
UP 15 |
− |
− |
− |
+ |
− |
1 |
0 |
0 |
1 |
UP 16 |
− |
− |
− |
− |
+ |
7 |
4 |
0 |
3 |