Comparison of extended spectrum β-lactamases-producing Escherichia coli with non-ESBLs-producing E.coli: drug-resistance and virulence

Occurrence and Characteristics of Extended-Spectrum β-Lactamase-Producing Escherichia coli from Dairy Cattle, Milk, and Farm Environments in Peninsular Malaysia

The emergence and spread of antimicrobial resistance genes and resistant bacteria do not recognize animal, human, or geographic boundaries. Addressing this threat requires a multidisciplinary approach involving human, animal, and environmental health (One Health) sectors. This is because antimicrobial agents used in veterinary medicine have been reported to be the same or similar to those in human medicine use. Extended-spectrum β-lactamase (ESBL) E. coli is a growing public health problem worldwide, and the agri-food industry is increasingly becoming a source of clinically important ESBL bacteria. Accordingly, the aim of this study was to investigate the occurrence and characteristics of ESBL-producing E. coli from dairy cattle, milk, and the farm environment. E. coli isolates were identified by their 16sRNA, and their ESBL production was confirmed using ESBL–CHROMagar media and the double disk diffusion method. Genotypes of ESBL producers were characterized using multiplex polymerase chain reaction (mPCR) assay. It was found that 18 (4.8%) of the total samples were positive for ESBL-producing E. coli. Of these, 66.7% were from milk, and 27.8% and 5.5% were from the farm environment and faecal samples, respectively. Predominant ESBL genotypes identified were a combination of both TEM and CTX-M in eight out of 18 (44.4%) isolates. Four (22.2%) isolates produced the CTX-M gene, two (11.1%) isolates produced the TEM gene, and four (22.2%) remaining isolates produced the ESBL genes other than TEM, SHV, CTX-M, and OXA. The SHV and OXA gene were not detected in all 18 isolates. In all, there were four profiles of genetic similarity. The occurrence of these genotypes in indicator organisms from dairy cattle, milk, and the farm environment further re-enforced the potential of food-animals as sources of ESBL-producing E. coli infection in humans via the food chain. Thus, there is the need for the adoption of a tripartite One Health approach in surveillance and monitoring to control antimicrobial resistance.

Effect of dithiocyano-methane on hexose monophosphate pathway in the respiratory metabolism of Escherichia coli

This paper studied the inhibitory effects of dithiocyano-methane (DM) on the glucose decomposition pathway in the respiratory metabolism of Escherichia coli. We investigated the effects of DM on the activities of key enzymes (ATPase and glucose-6-phosphate dehydrogenase, G6PDH), the levels of key product (nicotinamide adenosine denucleotide hydro-phosphoric acid, NADPH), and gene expression in the hexose monophosphate pathway (HMP). The results showed that the minimum inhibitory concentration (MIC) and the minimum bactericide concentration (MBC) of DM against the tested strains were 5.86 mg/L and 11.72 mg/L, respectively. Bacteria exposed to DM at MIC demonstrated an increase in bacterial ATPase and G6PDH activities, NADPH levels, and gene expression in the HMP pathway compared to bacteria in the control group, which could be interpreted as a behavioral response to stress introduced by DM. However, DM at a lethal concentration of 10 × MIC affected glucose decomposition by inhibiting mainly the HMP pathway in E. coli.

Adherence to Hospital Antibiotic Policy for Treatment of Escherichia coli ESBL in Urine

INTRODUCTION

Escherichia coli are the most common uropathogen worldwide accounting for 80% of the Urinary Tract Infections (UTIs). Nosocomial infections caused by Multi-drug resistant Gram negative bacteria expressing Extended Spectrum β Lactamase enzyme, pose a serious therapeutic challenge to clinicians due to limited therapeutic options. Stringent adherence to Hospital Antibiotic Policy in treating Urinary Escherichia coli ESBLs is a borne necessity.

AIM

A clinical audit was undertaken in the form of a cross-sectional study to evaluate the compliance on appropriate antibiotic prescription and strict adherence to Hospital Antibiotic Policy for therapeutic management of the patients infected with urinary Escherichia coli ESBL producers.

MATERIALS AND METHODS

A cross-sectional medical audit on adherence to treatment of Escherichia coli ESBL producers from in-patients diagnosed to have urinary tract infections for a duration of 7 months was conducted as a prospective study. Clinical data, culture and sensitivity reports of the patient diagnosed with urinary Escherichia coli ESBLs were compared with the treatment chart to ensure strict adherence to hospital antibiotic policy for appropriate therapy by physicians. Data were analysed using IBM SPSS version 20 software.

RESULTS

The incidence of uncomplicated cystitis, pyelonephritis and complicated pyelonephritis cases were 65.24% (107 out of 164), 20.7% (34 out of 164) and 14.02% (23 out of 164) respectively. Resistance to individual fluoroquinolones like norfloxacin, ciprofloxacin and ofloxacin were found to be 60%, 59% and 47.5% respectively. As per hospital antibiotic policy, fluoroquinolones were prescribed in only 23% of the patients for the treatment of urinary Escherichia coli ESBLs.

CONCLUSION

Irrational utilization of antibiotics and non-adherence to antibiotic policy could have been the significant risk factors for drug resistance. Optimized antibiotic use, Microbiology laboratory support and periodic antibiotic audit led by effective infection control team would hasten the development of drug resistance.