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Epidemiology and Antimicrobial Resistance of Extended-Spectrum β-Lactamase-Producing Escherichia coli in Urinary Tract Infections: Implications for Antibiotic Stewardship

Year: 2026

Type: article

Abstract: Urinary tract infections (UTIs) caused by Extended-Spectrum Beta-Lactamase (ESBL)-producing Escherichia coli represent a growing therapeutic challenge due to their multidrug-resistant nature. The rising prevalence of ESBL-producing uropathogens, particularly in developing countries, necessitates routine detection and updated antimicrobial surveillance. This study aimed to determine the prevalence of ESBL-producing E. coli among UTI patients and evaluate their antimicrobial resistance profile at a tertiary care centre in Bareilly, India. A retrospective study was conducted in the Department of Microbiology, SRMS Institute of Medical Sciences, over six months (November 2023 – May 2024). One hundred urine samples (midstream, catheter, and suprapubic aspirate) from clinically suspected UTI patients were processed. Semi-quantitative culture on CLED agar, biochemical identification, and VITEK-2 automated confirmation were performed. Antibiotic susceptibility testing followed the Kirby–Bauer disk diffusion method per CLSI 2023 guidelines. ESBL detection was confirmed phenotypically using the Double Disc Synergy Test (DDST). Culture positivity was 72%. Escherichia coli was the predominant isolate (63.9%), of which 45.7% were confirmed ESBL producers. ESBL-positive strains showed 100% resistance to third-generation cephalosporins (cefotaxime, ceftazidime, ceftriaxone), high resistance to fluoroquinolones (ciprofloxacin 81%, levofloxacin 76%) and cotrimoxazole (85%). Carbapenems (imipenem and meropenem) retained 100% sensitivity in both ESBL and non-ESBL groups. Female patients accounted for 62% of ESBL-positive cases. ESBL-producing E. coli constitutes a significant proportion of UTI isolates with extensive multidrug resistance. Carbapenems remain the most reliable therapeutic option. Routine ESBL screening, antimicrobial stewardship, and continuous resistance surveillance are essential to limit further spread of resistant strains.

Source: International Journal of Current Microbiology and Applied Sciences

DOI: 10.20546/ijcmas.2026.1506.008