issn 0975 -8542
journal of global pharma technology
available online at www.jgpt.co.in
research article
©2009-2017, jgpt. all rights reserved. 120
antimicrobial resistance among escherichia coli causing utis in
women
hawraa wahab aziz, israa adnan ibraheam, hawraa sabah almusawi, zeana
alhindi, tsahel h. al-dulaimi
university of babylon, college of science for women/hilla-iraq.
abstract
urinary tract infections (utis) are common bacterial infections, particularly in women. e. coli is one of
the most frequently isolated bacteria in (utis), , it also caused of childhood diarrhea, severe anemia,
,kidney failure, pneumonia, sinusitis and endocarditis. the current study tried to detecting
antimicrobial resistance among escherichia coli causing utis in women. of the total 48 isolates of
escherichia coli, very high rates of resistance was seen with ticarcillin 48 (100%), piperacillin48 (100%),
aztreonam 46 (95.8%), cefepime and 44 (91.6%) ceftazidime 44 (91.6%) . high rates of sensitive was
seen with imipenem 48 (100%), meropenem 48 (100%), amikacin 46(95.8%) , gentamicin 32 (66.6%) ,
piperacillin\tazobactam 32(66.6%), tobramycin 28 (58.3%) and ciprofloxacin 26(54.1%) , while of
minocycline 8 (16.6 %) has intermediate susceptibility to antibiotics study .according to the last results
the most effective antibiotics were meropenem , imipenem and amikacin so they are considered the best
drugs used for treatment of utis which caused by escherichia coli.
keywords: antibiotics, e. coli, urinary tract infection, vitek, antimicrobial susstebility.
introduction
urinary tract infection (uti) is an infection
of one or more structures in the urinary
system( 1) .this disease affects people of all
age groups, being more common in
women.(2). acute urinary tract infections are
common, occurring in 10% to 20% of
otherwise healthy women during their
lifetimes (3). uti in males, though not rare,
occurs in much less frequency (4).
antibiotic resistance patterns vary in
different areas (5) the prevalence of
antimicrobial resistance in urinary
pathogens is increasing worldwide.
escherichia coli is the most common cause of
utis. e. coli urinary tract infections are
sometimes called bladder infections, an e.
coli uti is the inflammation of any part of
the urinary system. e. coli is a common
bacteria that is found in the lower intestines
and stool of many mammals. the bacterium
when enter into urinary system, it multiplies
and move up to urinary tract.(6) when that
bacteria gets into the urinary system, it
multiplies and travels up the urinary tract.
as it does, the e. coli attaches to the lining of
the urinary tract, causing inflammation and
irritation along the way. it can get into the
urinary system through the urethra, the
passage that carries the urine out of the
body. females have very short urethra s so
they tend to have more problems with uti s [
urinary tract infections].
after urinating it is important that women
wipe from top to bottom so that they don t get
e-coli which are more numerous near the
anus into their urethra they can migrate
from the adjoining large intestine, travel up
the urethra or may be introduced during
catheterization uncommonly blood can be a
cause e-coli bacteria could be present in
urine if there is a fistula present.
a fistula is an abnormal connection between
organs, such as bowel and bladder .the e.
coli accounts for approximately 85% of
community acquired utis and 50% of
hospital acquired utis (7). microorganisms
use various mechanisms to develop drug
hawraa wahab aziz et. al., journal of global pharma technology. 2017 07(9):120-123
©2009-2017, jgpt. all rights reserved. 121
resistance, such as recombination of foreign
dna in bacterial chromosome, horizontal
gene transfer and alteration in genetic
material (8). detection of uti causing
pathogens and resistance of these pathogens
to commonly prescribed antibiotics in clinical
set ups is essential and helpful in improving
the efficacy of empirical treatment (9). in
women between the ages of 16-35 years, the
prevalence of urinary tract infection is
approximately 20%.in addition, there are
special considerations in the management of
uti among selected populations, including
postmenopausal and pregnant women, and
for women with frequent recurrent utis the
persistence of e. coli in bladder "biofilms" or
in the fecal reservoir could explain recurrent
infections in young women.
material and methods
a number total of 48 clinical specimens was
collected in al- hashmiya and al-hilla
hospital. the samples were collected under
sterile conditions include sterile test tubes
and swabs then transported immediately to
the microbiology laboratory to do
bacteriological study which includes
culturing of urine specimens with selective
and differential media for e.coli such as
eosin methylene blue agar and mac conkey
agar media, after that we have done
microscopically, morphologically biochemical
investigations were done for bacteria
identification (10, 11).
moreover, colonies were stained by gram
stain, in addition isolates were also identified
by using commercially available api 20 e kit
(bio merieux, france). finally vitek2
susceptibility test was used to determine
susceptibility of escherichia coli to antibiotics
by using vitek2 technique according to the
product company (bio meriux).
results and discussion
in the present study (48) patients out of 80
were shown to be urine culture positive
(females).
although e. coli was responsible for more
than half of the uti, its antimicrobial
resistance was significantly lower than that
presented by the other bacteria (12).
approximately 1 in 3 women will require
antimicrobial treatment for a uti before age
24, and 40% to 50% of women will have a
uti during their lifetime (13). e. coli strains
were the most common cause of uti, which is
in accordance with findings from other
studies faro (14).
the information of antibiotics resistance by
e.coli is important because this pathogen
associated with urinary tract infection, which
is selecting as a guide for antimicrobial
therapy (6) in addition other antibiotic
resistance genes may also be present in the
cassette rendering resistance to multiple
antibiotics( 15).
antimicrobial resistant isolates, especially
those that are fluoroquinolone resistant and
those producing extended-spectrum ?-
lactamases have increased significantly
during the 2000’s and in certain areas many
nosocomial and community-acquired, e. coli
are now resistant to the several important
antimicrobial classes (16).
in spain, the proportion of e. coil resistant to
ampicillin in urine specimens reaches 50%
and that resistance to tm-sm ranges from 27
to 49% (17) .increasing resistance among
community-acquired escherichia coli to tmpsmx
worldwide has led to a reassessment of
the most appropriate empiric therapy for
these infections.
the elevated incidence of infection between
the male and female genitourinary systems
in anatomy and microflora (18).the results
showed the age group (14-23) gives high
percentages (41.6%),table 2.because this
ages are sexually active and the infection
may be resulted from transmission from their
husbands.
based on results obtained from susceptibility
testing (table), the bacteria recovered from
uti showed the highest degree of resistance
to ticarcillin 48 (100%), piperacillin48
(100%), aztreonam 46 (95.8%), cefepime and
44 (91.6%) ceftazidime 44 (91.6%). high
rates of sensitive was seen with imipenem 48
(100%), meropenem 48 (100%), amikacin 46
(95.8%), gentamicin 32 (66.6%),
piperacillin\tazobactam 32(66.6%),
tobramycin 28 (58.3%) and ciprofloxacin
26(54.1%), while of minocycline 8 (16.6 %)
has intermediate susceptibility to antibiotics
study. the sensitivity to imipenem (100%) in
our results were similar to another study of
gautametal (19) which (100%).
hawraa wahab aziz et. al., journal of global pharma technology. 2017 07(9):120-123
©2009-2017, jgpt. all rights reserved. 122
figure 1: the resistant results of escherichia coli isolates to the antibiotics
table 1: the resistant results of escherichia coli isolates to the antibiotics
antibiotics resistance intermediate sensitive
no. % no. % no. %
ticarcillin 48 100 00 00.0 00 00.0
piperacillin 48 100 00 00.0 00 00.0
piperacillin\tazobactam 04 08.4 12 25 32 66.6
ceftazidime 44 91.6 02 04.2 02 04.2
cefepime 44 91.6 02 04.2 02 04.2
aztreonam 46 95.8 02 04.2 00 00.0
imipenem 00 00.0 00 00.0 48 100
meropenem 00 00.0 00 00.0 48 100
amikacin 00 00.0 02 04.2 46 95.8
gentamicin 12 25 04 08.4 32 66.6
tobramycin 06 12.6 14 29.1 28 58.3
ciprofloxacin 18 37.5 04 08.4 26 54.1
minocycline 18 37.5 08 16.6 22 45.9
trimethoprime\sulfament 32 66.6 00 00.0 16 33.4
table 2: distrebution the rite of infection according to age groups
age \year no. percentage %
14-23 20 41.6%
24-33 12 25%
34-43 12 25%
44-53 4 8.4%
total 48 100
conclusions
? the percent of antibiotic sensitivity to
impanel and meropenen 100%
? young women in the age 14-23 are more
exposed to urinary tract infection than
other age groups.
acknowledgments
? conduct an extensive study involving other
governorates in iraq to show the spread
urinary tract infection in women aand the
role of vitek2 system in detection of
antimicrobail suscebtibility of bacteria.
? the current study suggests vitek2
technique as a important and differential
test in some critical cases of urinary tract
infections.
? conduct other academic studies, including
escherichia coli strains.
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