Incidence of Multi-Drug Resistant Escherichia
Coli Isolates from Blood and Urine in Kerbala,
Iraq.
Abstract
Escherichia coli is a common cause of urinary tract infection (UTI) and septicemia/
bactriemia. With the increase of antibiotic resistance among E. coli isolates, monitoring of the
incidence of drug resistance became critical for appropriate empiric selection of antibiotic therapy.
The aims of this study are to explore the drug resistance patterns among E. coli isolates from urine
and blood in Kerbala, and to identify the antibiotics that might be considered appropriate for
empirical treatment for UTI and Septicemia caused by E. coli in the study region. A total of 1637
culture results of urine (n=410) and blood (n=1227) were reviewed and analyzed for isolation and
identification of bacteria , antimicrobial susceptibility testing, in addition, patients age and sex.
Only single isolate per patients were considered in the study analyses. E. coli was isolated from 105
patients (62 from urine and 43 from blood samples). High resistance rates were documented to
Ampicillin (95.7%), Cephalothin (94.0%), Amoxicillin-Clavulanic acid (89.09%), Cefixime
(82.7%), Ceftriaxone (78.4%) and Cefotaxime (76.9%). In contrast, high degrees of sensitivity were
detected to Imipenem (100%), Nitrofurantoin (90.2%), Chloramphenicol (81.8%) and Amikacin
(76.0%). No significant differences were seen in susceptibility patterns among isolates from blood
versus urine. Overall, 67 isolates (63.8%) were multi-drug resistant (MDR), that are resistant to
more than 2 classes of antibiotics. Proportion of MDR isolates among urine samples was higher
than among blood samples (69.4% versus 55.8%). In conclusion: E. coli displayed high resistance
rates to several antibiotics. However, Imipenem, Nitrofurantoin, chloramphenicol and amikacin are
appropriate for empirical treatment for UTI and Septicemia caused by E. coli inKerbala.
Continuous surveillance of drug –resistance is highly recommended.
