AUTHOR=Mwakyoma Adam A. , Kidenya Benson R. , Minja Caroline A. , Mushi Martha F. , Sandeman Alison , Sabiti Wilber , Holden Mathew T. G. , Mshana Stephen E. 

TITLE=Allele distribution and phenotypic resistance to ciprofloxacin and gentamicin among extended-spectrum β-lactamase-producing Escherichia coli isolated from the urine, stool, animals, and environments of patients with presumptive urinary tract infection in Tanzania

JOURNAL=Frontiers in Antibiotics

VOLUME=2

YEAR=2023

URL=https://www.frontiersin.org/journals/antibiotics/articles/10.3389/frabi.2023.1164016

DOI=10.3389/frabi.2023.1164016

ISSN=2813-2467

ABSTRACT=<sec><title>Background</title><p>Additional antimicrobial resistance to extended-spectrum β-lactamase (ESBL)-producing <italic>E. coli</italic> exhausts treatment options. We investigated allele distribution and resistance to ciprofloxacin and gentamicin among ESBL-producing <italic>E. coli</italic> isolates from the urine, stool, animals, and environments of presumptive urinary tract infection (UTI) patients, in order to gain a crucial insight toward devising prevention and control measures and treatment guidelines.</p></sec><sec><title>Methods</title><p>Archived ESBL-producing <italic>E. coli</italic> isolates from the urine, stool, animals, and surrounding environments of presumptive UTI patients were retrieved. Antimicrobial susceptibility profiles for ciprofloxacin and gentamicin were done followed by multiplex Polymerase chain reaction (PCR) for <italic>bla<sub>CTX-M</sub></italic>, <italic>bla<sub>TEM</sub></italic>, and <italic>bla<sub>SHV</sub></italic>, to determine ESBL allele distribution. Data were analyzed using STATA version 17.</p></sec><sec><title>Results</title><p>A total of 472 confirmed ESBL-producing <italic>E. coli</italic> isolates from Mwanza 243 (51.5%), Kilimanjaro 143 (30.3%), and Mbeya 86 (18.2%) were analyzed. Of these, 75 (15.9%) were from urine, 199 (42.2%) from stool, 58 (12.3%) from rectal/cloaca swabs of animals, and 140 (29.7%) from surrounding environments. Out of the 472 ESBL-producing <italic>E. coli</italic>, 98.9% (467) had at least one ESBL allele. The most frequent allele was <italic>bla<sub>CTX-M</sub></italic>, which was detected in 88.1% (416/472) of isolates, followed by the <italic>bla<sub>TEM</sub></italic> allele, which was detected in 51.5% (243/472) of isolates. A total of 40.7% (192/472) of isolates harbored dual <italic>bla<sub>CTX-M</sub></italic> + <italic>bla<sub>TEM</sub></italic>alleles and only 0.2% (1/472) of isolates had dual <italic>bla<sub>CTX-M</sub></italic> + <italic>bla<sub>SHV</sub></italic>alleles, whereas 2.3% (11/472) of isolates had a combination of all three alleles (<italic>bla<sub>CTX-M</sub></italic> + <italic>bla<sub>TEM</sub></italic> + <italic>bla<sub>SHV</sub></italic>). None of the isolates harbored a combination of <italic>bla<sub>TEM</sub></italic> + <italic>bla<sub>SHV</sub></italic>only. Resistance to ciprofloxacin and gentamicin was observed in 70.8% (334/472) and 46.0% (217/472) of isolates, respectively. There was a significant difference in the distribution of resistance to ciprofloxacin as well as gentamicin among ESBL-producing <italic>E. coli</italic> isolated from various sources (<italic>p</italic>-value &lt; 0.001 and 0.002, respectively).</p></sec><sec><title>Conclusion</title><p>Almost all ESBL-producing <italic>E. coli</italic> isolates carry <italic>bla<sub>CTX-M</sub></italic>, <italic>bla<sub>TEM</sub></italic>, and <italic>bla<sub>SHV</sub></italic> either alone or in combination, with the most common allele being <italic>bla<sub>CTX-M.</sub></italic>The resistance to ciprofloxacin and gentamicin, which are frontline antibiotics for UTIs among ESBL-producing <italic>E. coli</italic>, is high. This implies the need to continually revise the local guidelines used for optimal empirical therapy for UTIs, and for continual research and surveillance using one health approach.</p></sec>