Evaluate Antimicrobial Agents to Treatment of Urine Tract Infection Caused by E. coli and ESBL-Producing E. coli.

Escherichia coli is the most common pathogen of bacterial infections worldwide. As many as 80% of urinary tract infections are caused by E. coli . Infections caused by extended-spectrum β-lactamase (ESBL)–producing gram-negative bacteria are occurring more frequently in hospitalized patients. These organisms can cause a variety of infections including, but not limited to, pneumonia, urinary tract infections, and bacteremia. Carbapenems are considered the drugs of choice for ESBL-producing bacteria. Retrospective study of patients with ESBL-producing E. coli . were taken retrospectively from Phoenix 100. The result shows that the percentage of ESBL-produced E. coli was 27.5% from total E. coli isolation. None of the 59 isolates ( E. coli with no resistant marker and ESBL-producing E. coli ) show resistance to ertapenem, meropenem, or promising made them promising as a therapy for ESBL-producing E. coli. The result shows also a high rate of resistance to quinolons (Ciprofloxacine, Cephalothin, Cefrazidime, Levofoxacin) in ESBL-producing E. coli with a resistance rate of >60% (Table1), must be ruled out as a therapy option for the treatment of UTIs caused by ESBL-producing organisms .


Introduction
Escherichia coli is the most common pathogen of bacterial infections worldwide.As many as 80% of urinary tract infections are caused by E. coli.In 1980, resistance to third class cephalosporines was found for the first time in Enterobacteriaceae showing no chromosomalcoded AmpC overexpression.This newly detected plasmid-encoded resistance was selected by the frequent use of cephalosporines.These bacterial enzymes have been named Extended-Spectrum-Beta-Lactamases (ESBL) due to their capacity to inactivate practically all cephalosporines (Alhambra et al., 2004).ESBL-producing phenotypes of the family of Enterobacteriaceae were primarily considered as multiresistant organisms originating in hospitals.In the recent years, an increase of such ESBL-producers has been observed in outpatient settings, especially related to urinary tract infections (UTI), reducing the treatment options to a limited number of antibiotics (Bradford, 2001;Chaudhary & Aggarwal, 2004;Livermore et al., 2007;Paterson, 2006;and Turner, 2005).Of special concern are associated coresistances to other classes of antimicrobials which aid the spreading of multiresistant isolates (Morosini, 2006).ß-lactamases producing Enterobacteriaceae, which are commonly found in outpatients and isolated from UTIs, are typically also resistant to quinolones, aminoglycosides and sulfonamides such as ciprofloxacine, gentamicin and trimethoprim/sulfamethoxazole, respectively (Machado et al., 2006;and Perez et al., 2007).

Statistic Method
Data were analyzed using SPSS software, version 20.Fisher exact test was used.Significance was set at P<0.05 using two-sided comparisons.

Results and Discussion
E. coli isolates were collected consecutively (2013) from Zliten teaching hospital.Many specimens were submitted by inpatient Zliten teaching hospitals 192 patients recorded as UTI.
In our study we focused just for E. coli with no resistant marker and ESBL-producing E. coli.The result shows that percentage of ESBL prodused E. coli was 27.5% from total E.coli isolation.Limited information was available concerning patients' previous treatment with antibiotics, Patients' ages ranged from 2 months to 90 years, 75% UTI infection from female and 25% from male patients.None of the 59 isolates of (E. coli with no resistant marker and ESBL-producing E. coli) tested against ertapenem, meropenem and Imipenem exhibited resistance to these antimicrobial agents with no different between the two E. coli strains (Figure 1-2) with p value more than 1.The data of Table ( 1) are congruent with data from (Mody et al., 2007;Tamayo et al., 2007;and Alhambra et al., 2004).They reported no resistance of ESBLproducing E. coli to ertapenem (Alhambra et al., 2004;Mody et al., 2007;and Tamayo et al, 2007).The option of using ertapenem once-a-day makes it a useful parenteral antimicrobial agent for the treatment of serious infections of the urinary tract in nursing homes and outpatient healthcare settings (Paterson & Bonomo, 2005).Carbapenems (imipenem and meropenem) are currently considered to be the treatment of choice for serious infections caused by ESBL-producing bacteria (Shah et al., 2008).
Results of Levofoxacin susceptibility rate was 87.5% and 12.5% resistant in E. coli with no resistant marker with reduced susceptibility in ESBL-producing E. coli susceptibility rate 25% and 75% resistant (Table 1), make it not good choice to treat UTI.
Nitrofurantoin is a bactericidal drug.It is reduced by bacterial flavoproteins to reactive intermediates which inactivate or alter bacterial ribosomal proteins and other macromolecules.A 7-day twice-daily administration of 100 mg is recommended (FDA, 2015).
Nitrofurantoin exhibited in E. coli with no resistant marker 93.8% susceptibility and 6.2% were resistant in front of 75% susceptibillity and 25% resistant in case of ESBL-producing E. coli (Figure 1 and 2).Nitrofurantoin comparable to the 94,9% susceptible E. coli isolated from 240 recurrent UTIs in the ARESC study 2009 (Schito et al., 2009).
The study of further resistances by means of the evaluation of antibiograms revealed a susceptibility rate of 50% for gentamycine in both two E. coli strains as presented in Table (1).The results show a high rate of resistance to quinolons (Ciprofloxacine, Cephalothin, Cefrazidime, Levofoxacin) in ESBL-producing E. coli., a resistance rate >60% (Figure 1 and 2), must be ruled out as a therapy option for the treatment of UTIs caused by ESBLproducing organisms.Schwaber et al. (2005), examined 70 ESBL-expressing E. coli and detected >80% resistance to the agents mentioned above.Also the administration of Ampiniilin and Amoxicilin-cavulante with a resistance rate of 100 % is not indicated for the treatment of ESBL-associated UTIs.

Conclusion
27.5% of E. coli isolated was ESBL-producing E. coli.None of E. coli with no resistant marker and ESBL-producing E. coli shows resistant to ertapenem, meropenem or promising made them promising as a therapy of ESBL-producing E. coli.The result show also a high rate of resistance to Quinolons (Ciprofloxacine, Cephalothin, Cefrazidime, Levofoxacin) in ESBL-producing E. coli with resistance rate of >60%, must be ruled out as a therapy option for the treatment of UTIs caused by ESBL-producing organisms.
So, according to this conclusion Patients should not take any antibiotic with no culture and sensitivity test to avoid ineffective antibiotic especially in UTI caused by ESBL-producing E. coli Evaluate Antimicrobial Agents to Treatment of Urine Tract Infection……………Faculty of Marine Resources, Alasmarya Islamic University, Libya.

Table 1 .
Sensitivity and resistant rate of E.coli with no resistant marker Evaluate Antimicrobial Agents to Treatment of Urine Tract Infection…………… Faculty of Marine Resources, Alasmarya Islamic University, Libya.: 2413-5267 and E.coli strain with ESBL resistant marker ISSN