Isolation Frequency of Uropathogenic Strains and Search for ESBL Producing Enterobacteriaceae Isolated from Patients with UTI in Bechar (Algeria)
Authors: Benyagoub Elhassan , Alkhudhairy Miaad K. , Benchaib S. Mohamed , Zaalan Abdelmadjid , Mekhfi Youcef , Teyebi Nasreddine , Razni Dalila , Bendada Farah 
Published: December 2020

Background:
The emergence of multidrug-resistant uropathogenic strains, mainly the global
spread of extended-spectrum beta-lactamase (ESBL) genes accompanied both by the uncontrolled
use of antibacterial agents and a considerable decrease in their activities, makes the monitoring of the
resistance pattern one of the necessary means that could help the medical practitioners to choose the
best treatment. For this purpose and during four months from March 1 to June 30 (2019), an experimental
study has been carried out on urine specimens of 123 inpatients (IP) and outpatients (OP) at
infectious disease service Boudjemaa TOURABI Public Hospital of Bechar (Algeria), aiming the detection
of ESBL-producing Enterobacteriaceae uropathogenic strains.

Methods:
Firstly, the antibiotic susceptibility testing has been carried out by using the disk diffusion
method to determine not only the multidrug resistance patterns, but also the multiple antibiotic resistance
MAR indexes of uropathogenic strains that were isolated from clinical IP and OP samples.
Secondly, the ESBL detection was done using the following methods: synergy tests based on the synergy
between a third-generation cephalosporin and clavulanate, double-disc synergy test (DDST) and
phenotypic tests on a cloxacillin-containing agar.

Results:
As a result, 56 patients had a urinary tract infection (UTI) in overall 123 patients; thus, a frequency
of 45,52%. Through a UTI’s frequency of 64,7%, the female gender was the most affected. All
age groups were affected by UTI, with a mean age of 38,47±19,97 years old. Knowing that UTIs’ patients
aging from 16 to 49 years old were the most affected compared to other ages’ groups, with a
frequency of 66,6 and 50% for female and male gender, respectively. The microbial strains represented
by the bacteria group were predominant, i.e. (98,22%) followed by yeasts (1,78%), where Gramnegative
bacilli showed (96,36%) of the uropathogenic agents, so (3,64%) were Gram-positive bacteria.
The antibiotic resistance profile of isolated Enterobacteriaceae showed very high resistance rates
for the species of Escherichia coli, Klebsiella spp, and Proteus spp to aminopenicillins, cephalosporins,
and less against carbapenems and other drug groups. E. coli had presented the highest multidrug
resistance followed by Klebsiella spp with a MAR index ranged from 0,53 to 0,82. Within this range,
a total of 28 isolate (25 E. coli, 2 Klebsiella spp, and 1 Proteus mirabilis) had shown resistance against
9 to 14 out of the 17 tested antibiotics. The rate of ESBL-producing Enterobacteriaceae strains was
23,07 and 55,26% for inpatients and outpatients, respectively, where E. coli was the most important
ESBL producers out of all isolated strains.

Conclusion:
An alarming ESBLs rate for outpatients is usually higher among inpatients with UTI, who
receive several classes of antibiotics. Such conditions should be considered as a major public health concern,
and measures must be taken to establish the sources and drivers of this issue. Thus, the findings of
this research push the health sector stakeholders as well as the scientific communities to act on reducing
the transmission of the multidrug-resistant strains that threaten several classes of life-saving antibiotics.