Risk factors and molecular typing in urinary tract infections due to extended-spectrum beta-lactamase (ESBL) positive e. coli and klebsiella species in hospitalized patients

Objective: Investigation of inpatients who were treated in Hafsa Sultan Hospital of Celal Bayar University for urinary tract infection (UTI) due to Escherichia coli and Klebsiella species, their comparison with respect to their ability to produce extended-spectrum beta-lactamases (ESBLs) for various risk factors such as age, gender, underlying disease, as well as determination of molecular type of isolated ESBL (+) species in origin. Method: The inpatients who were older than 18 years of age and non-pregnant and positive urine cultures for Escherichia coli and Klebsiella species in Hafsa Sultan Hospital of Celal Bayar University in the period between March 2013 and November 2014 were enrolled in the study. A total of 100 patients with ESBL (+) strains constituted the experiment group, whereas 100 patients with ESBL (-) strains constituted the control group. The patients were given a pre-prepared questionnaire. Based on questionnaire results obtained from the subjects of the two groups, data were analyzed by using SPSS 15 software package. Stock plates were inoculated from ESBL (+) Escherichia coli and Klebsiella spp culture positive plates. The plates were stored in a refrigerator at + 4 ° C. After 100 samples were collected, inoculation was performed from stock cultures to EMB agar plates to increase the number of samples. ESBL typing by PCR was performed from the strains isolated from plaques. Results: Most of the patients of both ESBL (+) and ESBL (-) groups were from the internal medicine department. Mean age of patients was 65 in ESBL (+) group, and 63 in ESBL (-) group. E. coli was determined as the most common causative bacteria of UTI in both groups. Possible risk factors for the production of ESBL were determined as nephrostomy, frequently recurring UTI history, urinary operation history, urinary system anomaly (the most common anomaly was neurogenic bladder in both groups), foreign bodies in urinary tract, antibiotic use and UTI history within the last six months. In both groups, the most common clinical symptom was dysuria, and physical examination finding was fever. As a laboratory finding, increased creatinine was significant in favor of the ESBL producing group. PCR typing revealed CTX- M type, and its subtype CTX-M-15 subtype at most. Conclusion: Significant studies should be conducted as soon as possible, in order to prevent worldwide spread of ESBL-producing microorganisms and determine relevant control measures. Keywords: Urinary tract infections, ESBL, PCR, Klebsiella spp, Escherichia coli