Table 1 Antibiotic susceptibility pattern of MDR E. coli isolates (n=170)
Antibiotics used
|
Sensitive (%)
|
Resistant (%)
|
First line of antibiotics
|
Amoxycillin
|
0
|
170 (100)
|
Cefixime
|
0
|
170 (100)
|
Cefotaxime
|
0
|
170 (100)
|
Ceftriaxone
|
0
|
170 (100)
|
Ciprofloxacin
|
7 (4.12)
|
163 (95.88)
|
Cotrimoxazole
|
24 (14.12)
|
146 (85.88)
|
Levofloxacin
|
24 (14.12)
|
146 (85.88)
|
Nitrofurantoin
|
147 (86.47)
|
23 (13.53)
|
Second line of antibiotics
|
Amikacin
|
158 (92.94)
|
12 (7.05)
|
Cefoperazone/Sulbactam
|
91 (53.53)
|
79 (46.47)
|
Ceftazidime
|
0
|
170 (100)
|
Doxycycline
|
61 (35.88)
|
109 (64.12)
|
Gentamycin
|
146 (85.88)
|
24 (14.12)
|
Imipenem
|
160 (94.12)
|
10 (5.88)
|
Meropenem
|
21 (12.35)
|
149 (87.65)
|
Piperacillin/Tazobactam
|
108(63.53)
|
62 (36.47)
|
Table 2 Antibiotic resistance pattern of clinical isolates of MDR E. coli isolates
Resistance phenotype (RP)
|
Resistance Pattern
|
No. of isolates showing the pattern % (n=170)
|
RP-1
|
AmxCtxCtrCfmCazCipLevCotCfsPitMrpDox
|
26(15.29%)
|
RP-2
|
AmxCtxCtrCfmCazCipLevCotMrpDox
|
25 (14.71%)
|
RP-3
|
AmxCtxCtrCfmCazCipLevCotNitCfsPitMrpDox
|
14 (8.24%)
|
RP-4
|
AmxCtxCtrCfmCazCipLevCotMrp
|
14 (8.24%)
|
RP-5
|
AmxCtxCtrCfmCazCipLevCotDox
|
11 (6.47%)
|
RP-6
|
AmxCtxCtrCfmCazCipLevMrp
|
10 (5.88)
|
RP-7
|
AmxCtxCtrCfmCazCipLevCotCfsMrp
|
9 (5.29%)
|
RP-8
|
AmxCtxCtrCfmCazCipMrp
|
8 (4.71%)
|
RP-9
|
AmxCtxCtrCfmCazCipLevCotGenCfsMrpDox
|
7 (4.12%)
|
RP-10
|
AmxCtxCtrCfmCazCot
|
7 (4.12%)
|
RP-11
|
AmxCtxCtrCfmCazCipLevCotAkGenCfsPitMrpIpmDox
|
7 (4.12%)
|
RP-12
|
AmxCtxCtrCfmCazCipCotMrpDox
|
6 (3.53%)
|
RP-13
|
AmxCtxCtrCfmCazCipLevCfsPitMrpDox
|
6 (3.53%)
|
RP-14
|
AmxCtxCtrCfmCazCipLevCotNitMrp
|
5 (2.94%)
|
RP-15
|
AmxCtxCtrCfmCazCipCot
|
4 (2.35%)
|
RP-16
|
AmxCtxCtrCfmCazCipLevCotGenMrp
|
4 (2.35%)
|
RP-17
|
AmxCtxCtrCfmCazCipLevCotAkGenCfsPitMrpDox
|
4 (2.35%)
|
RP-18
|
AmxCtxCtrCfmCazCipLevCotNitAkGenCfsPitMrpIpmDox
|
3 (1.76%)
|
Note: Amx-Amoxycillin, Ctx-Cefotaxime, Ctr-Ceftriaxone, Cfm- Cefixime, Caz-Ceftazidime, Cot-Cotrimoxazole,Nit-Nitrofurantoin, Lev-Levofloxacin, Ak-Amikacin, Gen- Gentamycin, Cfs-Cefoperazone/Sulbactam, Pit-Piperacillin/Tazobactam, Mrp-Meropenem, Ipm-Imipenem, Dox-Doxycycline.
Table 3 Resistance to different class of antibiotics among β-lactamase producer and non-producer MDR isolates
No. of class of antibiotic resistant
|
Antibiotics resistance Pattern
|
No. of strain
|
ESBL (n=95)
|
AmpC (n=15)
|
MBL (n=11)
|
ESBL+ AmpC (n=33)
|
ESBL+MBL
(n=5)
|
MBL+AmpC (n=2)
|
MBL+KPC
(n=1)
|
Non-producer
(n=8)
|
3
|
AmxCtxCtrCfmCazCot
|
7
|
7
|
--
|
--
|
--
|
--
|
--
|
--
|
--
|
4
|
AmxCtxCtrCfmCazCipLevMrp
|
22
|
7
|
1
|
--
|
--
|
--
|
--
|
--
|
2
|
AmxCtxCtrCfmCazCipMrp
|
7
|
--
|
--
|
1
|
--
|
--
|
--
|
--
|
AmxCtxCtrCfmCazCipCot
|
2
|
--
|
--
|
2
|
--
|
--
|
--
|
--
|
5
|
AmxCtxCtrCfmCazCipLevCotMrp
|
25
|
14
|
--
|
--
|
--
|
--
|
--
|
--
|
--
|
AmxCtxCtrCfmCazCipLevCotDox
|
9
|
--
|
--
|
2
|
--
|
--
|
--
|
--
|
6
|
AmxCtxCtrCfmCazCipLevCotMrpDox
|
49
|
18
|
--
|
--
|
7
|
--
|
--
|
--
|
1
|
AmxCtxCtrCfmCazCipLevCotCfsMrp
|
6
|
--
|
--
|
1
|
--
|
--
|
--
|
2
|
AmxCtxCtrCfmCazCipCotMrpDox
|
5
|
--
|
--
|
1
|
--
|
--
|
--
|
--
|
AmxCtxCtrCfmCazCipLevCotNitMrp
|
4
|
--
|
--
|
1
|
--
|
--
|
--
|
--
|
AmxCtxCtrCfmCazCipLevCotGenMrp
|
3
|
--
|
--
|
1
|
--
|
--
|
--
|
--
|
7
|
AmxCtxCtrCfmCazCipLevCfsPitMrpDox
|
6
|
2
|
3
|
--
|
1
|
--
|
--
|
--
|
--
|
8
|
AmxCtxCtrCfmCazCipLevCotCfsPitMrpDox
|
33
|
4
|
5
|
--
|
9
|
3
|
2
|
--
|
3
|
AmxCtxCtrCfmCazCipLevCotGenCfsMrpDox
|
5
|
1
|
--
|
1
|
--
|
--
|
--
|
--
|
9
|
AmxCtxCtrCfmCazCipLevCotAkGenCfsPitMrpDox
|
28
|
--
|
1
|
1
|
2
|
--
|
--
|
--
|
--
|
AmxCtxCtrCfmCazCipLevCotNitCfsPitMrpDox
|
3
|
4
|
2
|
4
|
1
|
--
|
--
|
--
|
AmxCtxCtrCfmCazCipLevCotAkGenCfsPitMrpIpmDox
|
--
|
--
|
7
|
--
|
--
|
--
|
--
|
--
|
10
|
AmxCtxCtrCfmCazCipLevCotNitAkGenCfsPitMrpIpmDox
|
3
|
--
|
--
|
1
|
--
|
1
|
--
|
1
|
--
|
Amx-Amoxycillin, Ctx-Cefotaxime, Ctr-Ceftriaxone, Cfm- Cefixime, Caz-Ceftazidime, Cot-Cotrimoxazole,Nit-Nitrofurantoin, Lev-Levofloxacin, Ak-Amikacin, Gen- Gentamycin,Cfs-Cefoperazone/Sulbactam, Pit-Piperacillin/Tazobactam,Mrp-Meropenem, Ipm-Imipenem, Dox-Doxycycline
Table 4 Plasmid profile of MDR E. coli isolates
No. of plasmid
|
Type
|
Molecular Weight (Kb)
|
Plasmid
profile
|
No. of isolates
Showing Profile (%)
|
Total number (%)
|
1
|
1a
|
>33.5
|
1
|
20 (11.76)
|
20 (11.76)
|
2
|
2a
|
>33.5, 33.5
|
2
|
19 (11.17)
|
67
(39.41)
|
2b
|
>33.5(2)
|
3
|
12 (7.1)
|
2c
|
>33.5, 15.0
|
4
|
10 (5.88)
|
2d
|
>33.5, 9.4
|
5
|
9 (5.29)
|
2e
|
>33.5, 10.1
|
6
|
8 (4.71)
|
2f
|
>33.5, 6.0
|
7
|
5 (2.94)
|
2g
|
>33.5, 4.8
|
8
|
4 (2.35)
|
3
|
3a
|
>33.5, 15.0, 2.0
|
9
|
6 (3.53)
|
29
(17.05)
|
3b
|
>33.5(2), 3.0
|
10
|
5 (2.94)
|
3c
|
>33.5, 6.7, 2.4
|
11
|
4 (2.35)
|
3d
|
>33.5, 14.0, 1.5
|
12
|
3 (1.76)
|
3e
|
>33.5(2), 33.5
|
13
|
2 (1.17)
|
3f
|
>33.5, 14.0, 9.0
|
14
|
2 (1.17)
|
3g
|
>33.5(2), 2.2
|
15
|
2 (1.17)
|
3h
|
>33.5, 33.5, 2.1
|
16
|
2 (1.17)
|
3i
|
>33.5, 9.0, 4.0
|
17
|
2 (1.17)
|
3j
|
>33.5, 2.0, 1.5
|
18
|
1 (0.58)
|
4
|
4a
|
>33.5, 15.0, 4.0, 2.0
|
19
|
9 (5.29)
|
29
(17.05)
|
4b
|
>33.5, 33.5, 4.8, 4.0
|
20
|
6 (3.53)
|
4c
|
>33.5, 15.0, 4.0, 2.5
|
21
|
3 (1.76)
|
4d
|
>33.5, 15.0, 7.0, 5.0
|
22
|
3 (1.76)
|
4e
|
>33.5, 33.5, 6.3, 3.1
|
23
|
3 (1.76)
|
4f
|
>33.5(2), 2.6, 2.0
|
24
|
1 (0.58)
|
4g
|
>33.5, 33.5, 14.8, 11.8
|
25
|
1 (0.58)
|
4h
|
>33.5, 33.5, 2.0, 1.0
|
26
|
2 (1.17)
|
4i
|
>33.5(2), 33.5, 4.4
|
27
|
1 (0.58)
|
5
|
5a
|
>33.5(2), 5.0, 3.1, 2.4
|
28
|
3 (1.76)
|
9
(5.29)
|
5b
|
>33.5(3), 33.5, 1.2
|
29
|
1 (0.58)
|
5c
|
>33.5, 33.5, 2.0, 1.5, 1.0
|
30
|
1 (0.58)
|
5d
|
>33.5, 33.5, 3.1, 2.0, 1.6
|
31
|
1 (0.58)
|
5e
|
>33.5(2), 33.5, 3.0, 2.0
|
32
|
1 (0.58)
|
5f
|
33.5, 10.0, 7.4, 4.0, 3.0
|
33
|
1 (0.58)
|
5g
|
>33.5, 15.0, 5.0, 4.4, 0.8
|
34
|
1 (0.58)
|
6
|
6a
|
>33.5, 10.6, 4.0, 3.0, 1.5, 1.2
|
35
|
4 (2.35)
|
|
|
6b
|
>33.5(2), 6.0, 3.0, 2.0, 1.5
|
36
|
3(1.76)
|
|
|
6c
|
>33.5(2), 12.7, 9.0, 5.0, 2.5
|
37
|
1 (0.58)
|
|
|
6d
|
>33.5(2), 5.0, 4.8, 2.4, 2.1
|
38
|
1 (0.58)
|
|
|
6e
|
>33.5(3), 33.5, 3.0, 1.0
|
39
|
1 (0.58)
|
|
|
6f
|
>33.5, 12.0, 5.5, 2.5, 1.9, 1.2
|
40
|
1 (0.58)
|
|
|
6g
|
>33.5, 33.5, 4.0, 3.0, 2.0, 1.6
|
41
|
1 (0.58)
|
|
|
6h
|
>33.5, 33.5, 7.0, 5.0, 4.0, 2.0
|
42
|
2 (1.17)
|
|
|
6i
|
>33.5,33.5,12.7,15.0, 3.0, 1.5
|
43
|
1 (0.58)
|
|
7
|
7a
|
>33.5,33.5,9.4,3.0,2.2,2.0,1.0
|
44
|
1 (0.58)
|
1 (0.58)
|
* Parentheses ( ) represents times of mol. weight of plasmid repeated among the isolates
Table 5: Plasmid profiling in relation to β-lactamase production in MDR E. coli isolates
Plasmid Number
|
Molecular weight
|
No. of isolate
|
ESBL
|
AmpC
|
MBL
|
ESBL/
AmpC
|
ESBL/
MBL
|
MBL/ AmpC
|
MBL/
KPC
|
Non -producer
|
1
|
>33.5
|
20
|
13
|
2
|
--
|
3
|
--
|
--
|
--
|
2
|
2
|
>33.5, 33.5, 15.0, 10.1, 9.4, 6.0, 4.8
|
67
|
32
|
6
|
7
|
14
|
--
|
2
|
1
|
5
|
3
|
>33.5, 33.5, 15.0,14.0,9.0,6.7,4.0,3.0,2.4,2.2, 2.1,2.0, 1.5
|
29
|
16
|
4
|
2
|
6
|
1
|
--
|
--
|
--
|
4
|
>33.5,33.5,15.0,14.8,11.8,7.0,6.3,5.0,4.8,4.4, 4.0,3.1,2.5,2.6,2.0,1.0,
|
29
|
21
|
--
|
1
|
5
|
2
|
--
|
--
|
--
|
5
|
>33.5,33.5,15.0,10.0,7.4,5.0,4.4,4.0,3.8,3.1, 3.0,2.4,1.6,1.5,1.2,1.0,0.8
|
9
|
5
|
1
|
1
|
1
|
--
|
--
|
--
|
1
|
6
|
>33.5,33.5,12.7,10.6,9.0,7.0,6.0,5.0,4.8,4.0, 3.0, 2.5,2.4,2.1,2.0,1.9,1.6, 1.5, 1.2,1.0
|
15
|
7
|
2
|
--
|
4
|
2
|
--
|
--
|
--
|
7
|
>33.5, 33.5, 9.4, 3.0, 2.2, 2.0, 1.0
|
1
|
1
|
--
|
--
|
--
|
--
|
--
|
--
|
--
|
Total isolates
|
170
|
95
|
15
|
11
|
33
|
5
|
2
|
1
|
8
|