The Bacterial Isolates and Plasmid Profile of Extended Spectrum Beta-Lactamases Producers Causing Urinary Tract Infection among Pregnant Women in Uyo, Nigeria

Ifeanyi Abraham Onwuezobe, Florence Effiong Orok

Department of Microbiology, University of Uyo, Uyo, Nigeria.

DOI: 10.4236/jbm.2015.37004                

Abstract

Background: Extended spectrum beta-lactamases (ESBLs) are enzymes that compromise the efficacy of all beta-lactams and are spread by plasmids. They are of public health importance the world over; however, in Nigeria in general and Uyo in particular, tests for their detection are not routinely done in hospital laboratories despite increase in treatment failures observed for common clinical conditions like urinary tract infection. Objective: To isolate ESBLs producing uropathogens and the plasmid underlying their resistance to antibiotics. Materials and Methods: Three hundred urine specimens (n = 300) were collected from pregnant women attending antenatal clinics at St. Lukes Hospital, Anua, cultured and incubated according to accepted standard. Identification of isolates was done using Microbact 24E (Oxoid, UK) system. The predominant bacterial pathogens were Escherichia coli (42%) followed by Klebsiella pneumonia (21%), Klebsiella oxytoca (12%), Citrobacter spp. (5%), Proteus mirabilis (7%), Enterobacter spp. (12%) and Acinetobacter baumanii (1%). The isolated bacteria were tested for their antibiotic susceptibility using Clinical Laboratory Standard Institute (CLSI) recommended disc diffusion method. A Double Disk Synergy Test (DDST) and Phenotypic Disk Confirmatory Test (PDCT) were performed to determine ESBL production. Chromagar ESBL was also used to test for the presence of ESBL producing isolates. The plasmid content of ESBL producing isolates and their participation in drug resistance were investigated. Results: Of the 80 bacterial isolates causing urinary tract infection in these women, the ESBL producers were found to be 16 (20%). Out of these 16 ESBL producing urogenital isolates Klebsiella pneumonia (8, 50%) was the most prevalent. Others include Escherichia coli (38%), Klebsiella oxytoca (6%) and Enterobacter cloacae (6). Plasmid content of ESBL producing isolates was found to be 87.5%. Conclusion: The Extended Spectrum Beta-lactamase producing uropathogens mainly of plasmid origin are increasingly responsible for the cause of community acquired urinary tract infections in pregnant women in Uyo.

Keywords

ESBL, Plasmid Content, Uropathogens

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Giraldo, P.C., Araujo, E., Junior, R., Amaral, R., Passos, M. and Goncalves, A. (2012) The Prevalence of Urogenital Infections in Pregnant Women Experiencing Pretem and Full Term Labour. Infectious Diseases in Obstetrics and Gynecology, 2, 878.
[2]	Guerra, G., Costa, B.F., Nascimento, F., Amaral, M. and Serafim, A. (2012) Urine Test to Diagnose Urinary Tract Infection in High-Risk Pregnancy Women. Revista Brasileira de Ginecologia e Obstetrícia, 34, 488-493. http://dx.doi.org/10.1590/S0100-72032012001100002
[3]	John, E.D. and Michael, L.L. (2000) Urinary Tract Infections during Pregnancy. American Family Physician, 61, 713- 721.
[4]	Loh, K.Y. and Silvalingam, N. (2007) Urinary Tract Infections in Pregnancy. Malaysian Family Physician, 2, 54-57.
[5]	Onuh, S.O., Umeora, O.U.J., Igberase, G., Azikem, M.E. and Okpere, E.E. (2006) Microbiological Isolates and Sensitivity Pattern of Urinary Tract Infection in Pregnancy in Benin City, Nigeria. Ebonyi Medical Journal, 5, 48-52.
[6]	Livermore, D.M. (2003) Bacterial Resistance: Origins, Epidemiology and Impact. Clinical Infectious Diseases, 36, 11- 23. http://dx.doi.org/10.1086/344654
[7]	Coque, T.M., Baquero, F. and Canton, R. (2008) Increasing Prevalence of ESBL. Eurosurveillance, 13, 347-349.
[8]	Johnson, T.J. and Nolan, L.K. (2009) Plasmid Replicon Typing. Methods of Molecular Biology, 51, 27-35. http://dx.doi.org/10.1007/978-1-60327-999-4_3
[9]	Bradford, P.A. (2001) Extended-Spectrum Beta-Lactamases in the 21st Century: Antimicrobial Agents and Chemotherapy, 32, 2227-2238.
[10]	Rodriguez, B.J., Alcala, J.C. and Cisneros, J.M. (2009) Community Infections Caused by Extended Spectrum Beta- Lactamases Producing Escheria coli. Archives of Internal Medicine, 168, 1897-1902. http://dx.doi.org/10.1001/archinte.168.17.1897
[11]	Glupczynski, Y., Berhin, C., Bauraing, C. and Bogaerts, P. (2007) Evaluation of a New Selective Chromogenic Agar Medium for Detection of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae. Journal of Clinical Microbiology, 45, 501-505. http://dx.doi.org/10.1128/JCM.02221-06
[12]	Meyers, J.A., Sanchez, D., Elwell, L.P. and Falkow, S. (1976) Simple Agarose Gel Electrophoretic Method for the Identification and Characterization of Plasmid Deoxyribonucleic Acid. Journal of Bacteriology, 20, 1529-1537.
[13]	Aiyegoro, O.A., Igbinosa, O.O., Ogunmwonyi, I.N., Odjadjare, E.E., Igbinosa, O.E. and Okoh, A.I. (2007) Incidence of Urinary Tract Infections among Children and Adolescents in Ille-Ife, Nigeria. African Journal of Microbiology Research, 15, 13-19.
[14]	Pondei, K., Langley, O. and Pondei, J. (2012) Current Microbial and Culture Sensitivity Pattern of Urinary Tract Infection in a Private Setting in Bayelsa State, Nigeria. International Research Journal of Microbiology, 3, 393-398.
[15]	Alemu, A.T., Moges, S.W., Shiferaw, S.T., Tafess, S.T., Kassu, T.S., Anagaw, S.V. and Agegn, G.S. (2012) Recent Development in the Diagnosis and Treatment of Urinary Tract Infections. Nigeria British Journal of Obstetrics and Gynaecology, 11, 23-30.
[16]	Agarawal, P., Ghosh, A.N., Kumar, S., Basl, B. and Rapila, K. (2008) Prevalence of Extended-Spectrum β-Lactamases among E. coli and Klebsiella pneumonia Isolates in Tertiary Care Hospital. Indian Journal of Pathology and Microbiology, 13, 139-142. http://dx.doi.org/10.4103/0377-4929.40428
[17]	Ejikuegwu, P.C., Ikegbunam, N.M., Ugwu, C.M., Iroha, I.R. and Esimone, C.O. (2012) Extended-Spectrum β-Lactamase Producing E. coli Isolatesfrom Suspected Community Acquired Urinary Tract Infections. European Journal of Scientific Research, 84, 565-571.
[18]	Ramazanz, R. (2010) Etiologic Agents and Extended-Spectrum β-Lactamase Production in Urinary Tract Infections in Sanandaj, Iran. Eastern Journal of Medicine, 15, 57-62.
[19]	Mumtaz, S., Ahmad, M., Aftab, I., Akhtar, N., ul Hassan, M. and Hamid, A. (2007) Extended Spectrum β-Lactamases in Enteric Gram-Negative Bacilli: Related to Age and Gender. Journal of Ayub Medical College Abbottabad, 19, 107- 111.
[20]	Omar, B., Aifadel, O.O., Atif, H.A. and Mogahid, M. (2013) Increasing Prevalence of ESBL Producing Enterobacteriaceae. Life Science Journal, 13, 556-559.
[21]	Marhova, K., Kostadinova, T. and Stoitos, M. (2009) ESBL: An Increasing Threat. Antimicrobial Agent and Chemotherapy, 15, 375-379.