Prevalence, antibiotic susceptibility and associated risk factors for Extended Spectrum Beta-lactamase producing Enterobacteriaceae among patients suspected with urinary tract infection

Abstract Background Nowadays, increasing extended-spectrum beta-lactamase-producing Enterobacteriaceae, which were a common cause of urinary tract infection, have become a global concern because they induce resistance to most of the antimicrobial classes and make treatment difficult. Objective This study aimed to determine the prevalence of extended spectrum beta-lactamase producing Enterobacteriaceae, antibiotic susceptibility and its associated factors among patients suspected with urinary tract infection at Wachemo University Nigist Eleni Mohammed memorial Comprehensive Specialized Hospital, Hosanna, Ethiopia. Methods A cross-sectional study design was conducted among 287 patients suspected of having urinary tract infection. Data on socio-demographic information, clinical data and possible risk factors were collected using a Kobo toolbox. Mid-stream and catheter urine samples were collected and processed to characterize the Enterobacteriaceae isolates. Urine specimens were mixed well and aseptically inoculated Mac-Conkey agar and CLED agar using a standard calibrated loop. Kirby Bauer disk diffusion technique was employed to determine antibiotic susceptibility. The presence of extended spectrum beta-lactamase confirmed by double disk synergy test and data was analyzed by statistical package for social science (SPSS) version 26. Results The proportion of Enterobacteriaceae UTI was 33% (95% CI: 27.7; 38.9%). 95 Enterobacteriaceae were identified with Escherichia coli predominating (62.11%), followed by Klebsiella spp. (23.2%). The overall prevalence of extended spectrum beta-lactamase producing Enterobacteriaceae was 26.32% (95% CI: 17.8; 36.4%) with E. coli accounting (64%), followed by Klebsiella spp. 6(24%). ESBL-producers showed resistant rate of (100%) to cefotaxime and ceftriaxone. The resistance rate to norfloxacillin, naldixic acid, ciprofloxacin, clavulanic acid, gentamicin, and amikacin were 80%, 68%, 60%, 48%, 36%, and 28% respectively. Meropenem and nitrofurantoin has the resistance rate of (8%) and (20%). In multivariable logistic regression, a presence of previous history of urinary tract infections with AOR = 8.002, presence of previous history of urinary tract catheterization AOR = 3.385, and presence of history of urinary tract surgery AOR = 4.535 were identified as independently associated risk factors. Conclusion In our study that 26.32% of the Enterobacteriaceae tested phenotypically were identified as ESBL-producers. In antibiotic resistance test ESBL-producers showed 100% resistance to ceftriaxone and cefotaxime. Conversely, the isolates have resistant rate of (8%) and (20%) to meropenem and nitrofurantoin. Presence of a previous history of UTI, presence of history of urinary tract catheterization, and presence of previous history of urinary tract surgery were identified as independently associated risk factors for ESBL producing Enterobacteriaceae associated UTI.