Detection of Extended-Spectrum Beta Lactamases and AmpC Beta Lactamases Producing Uropathogenic Escherichia coli in a Tertiary Care Hospital


Rupinder Bakshi
Vijay Kumar Sehgal
Perbhat Kansal
Sarjiwan Kaur


Background: The multidrug resistant among uropathogenic E. coli has become a potential threat to global health. The aim of the current study to evaluate the antimicrobial activities of nitrofurantoin and fosfomycin along with other antimicrobials against Extended Spectrum β-Lactamases (ESBL) and AmpC producer isolates from the most common organism E. coli. Methods: A total of 6046 clean catch midstream urine samples were collected and processed in Microbiology department of tertiary care hospital. The antimicrobial susceptibility of E. coli isolates was initially screened by Kirby-Bauer disk diffusion method. The resistant isolates were confirmed to be ESBL and AmpC producers by their respective phenotypic confirmatory tests of combined disc method. Results: Out of 6046 patients there were 1855 E. coli positive patients. Maximum patients in the age group of 21-30 years were 51.5% followed by 31-40 years where patients were 26%. 64.4% E. coli were isolated from female patients and 35.6% from male patients. E. coli showed higher sensitivity towards, fosfomycin (100%), imipenem (100%), nitrofurantoin (84.1%), piperacillin and tazobactam (77.3%), amikacin (76.1%) and while they showed high degree resistance pattern against Penicillin, cotrimoxazole, ciprofloxacin, norfloxacin and 2nd and 3rd generation cephalosporin. Out of 1855 E. coli, multi drug resistance was seen in 520 E. coli isolates. ESBL production was observed among 50% of E. coli isolates by combined disk method. Out of 520 isolates, 150 isolates showed resistance to one or more extended-spectrum cephalosporins and cefoxitin by Kirby-Bauer disk diffusion method. These were selected and screened for ESBL and AmpC production. Among 150 cefoxitin-resistant isolates, AmpC phenotype was detected in 100 isolates (66.6%) by AmpC disc method. The overall occurrence of AmpC in the study was found to be 19.2%. Susceptibility of ESBL and AmpC producers to fosfomycin, imipenem, nitrofurantoin and amikacin were found to be 100%, 98.5%, 89% and 75% respectively. Conclusions: There is increased prevalence of ESBL and AmpC producing E. coli. Thus, early detection of ESBL and AmpC producer E. coli by simple phenotypic methods is necessary to avoid treatment failure, where molecular techniques are not available.


How to Cite
Bakshi, R., Sehgal, V. K., Kansal, P., & Kaur, S. (2019). Detection of Extended-Spectrum Beta Lactamases and AmpC Beta Lactamases Producing Uropathogenic Escherichia coli in a Tertiary Care Hospital. International Journal of Medical and Dental Sciences, 1783–1792.


  1. Babypadmini S, Appalaraju B. Extended spectrum beta lactamases in urinary isolates of Esch. coli and K.
  2. pneumoniae prevalence and susceptibility pattern in tertiary care hospital. Ind. J. Med. Microbiol. 2004; 22:172-74.
  3. Ebbing Lautenbach, Jean Baldus Patel, Warren B. Bilker, Paul H. Edelstein, Neil O Fishman. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Risk factors for infection and impact of resistance on outcomes, Clin. Infect. Dis. 2001 Apr; 15;32(8):1162-71. PMid: 11283805.
  4. Gupta V, Yadav A, Joshi RM. Antibiotic resistance pattern in uropathogenes. Indian Journal of Med. Microbial. 2008; 20(2):96-98.
  5. Jabeen K, Zafir A, Hassan R. Comparison of double disc and combined disc method for the detection of extended spectrum β-Lactamases in Enterobacteriaceae, Department of Pathology, Aga Khan University, Karachi. J. Pak. Med. Assoc. 2003; 53(11):510.
  6. Livermore DM. B-Lactamases in laboratory and clinical resistance. Clin. Microbiol. Rev. 1995; 8:557-84. https:// PMid: 8665470, PMCid: PMC172876.
  7. Paterson DL, Bonomo RA. Extended spectrum β-lactamses: A clinical update. Clin. Microbiol. Rev. 2005; 18(4):657-86. PMid: 16223952, PMCid: PMC1265908.
  8. Rupp M, Fey PD. Extended Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae: Considerations for diagnosis, prevention and drug treatment. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA. Drugs. 2003; 63(4):35365. PMid: 12558458.
  9. Neeraj Kumar Tulara. Nitrofurantoin and Fosfomycin for extended spectrum beta lactamases producing E. coli and Klebsiella pneumoniae. J. Glob. Infect. Dis. 2018 JanMar; 10(1):19-21. PMid: 29563719, PMCid: PMC5850758.
  10. Azap Ö, et al. Risk factors for extended‐spectrum β‐ lactamase positivity in uropathogenic Escherichia coli isolated from community‐acquired urinary tract infections. Clinical Microbiology and Infection. Feb. 2010; 16(2); 147:151. PMid: 19689464.
  11. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twenty fifth informational supplement. CLSI document M100-S25. Wayne PA: CLSI; 2015.
  12. Naveen Grover, Col AK, Sahni Brig, Bhattacharya S. Therapeutic challenges of ESBLS and AmpC betalactamase producers in a tertiary care center. Med. J. Armed. Forces. India. 2013 Jan; 69(1):4-10. https:// PMid: 24532926, PMCid: PMC3862620.
  13. Chervet D, et al. Antimicrobial resistance in communityacquired urinary tract infections in Paris. Medecineet Maladies Infectieuses. 2017.
  14. Fahad A, et al. Incidence and molecolar characterization of the extended spectrum beta lactamase-producing Escherichia coli isolated from urinary tract infections in Eastern Saudi Arabia. Saudi. Med. J. 2017; 38(8):81115. PMid: 28762433, PMCid: PMC5556297.
  15. Smita Sood, Ravi Gupta. Antibiotic resistance pattern of community acquired uropathogens at a Tertiary Care Hospital in Jaipur, Rajasthan. Indian J. Community Med. 2012; 37(1):39-44. PMid: 22529539, PMCid: PMC3326806.
  16. Black JA, Moland ES, Thomson KS. AmpC disc test for detection of plasmid-mediated AmpC β-Lactamases in Enterobacteriaceae lacking chromosomal AmpC β-Lactamases. Journal of Clinical Microbiology. 2005; 43(7):3110-13. PMid: 16000421, PMCid: PMC1169113.
  17. Yashavanth R, Ronald R, Anita K, Narendra N, Faseela T. Uropathogens and their antimicrobial susceptibility pattern in a tertiary care hospital. Journal of Evolution of Medical and Dental Sciences. Oct. 2012; 1(4):467.
  18. Umadevi S, Kandha Kumari G, Joseph NM, Kumar S, Easow JM. Prevalence and antimicrobial susceptibility pattern of ESBL producing gram negative Bacilli. J. Clin. Diag. Res. 2011; 5(2):236-39.
  19. Soha A, el -hady, Lamiaa A Adel. Occurnec and detection of AmpC β-lactamses among Entrobacteriaceae isolates from patients at Ain Shans University Hospital. The Egyptian Journal of Medical Human Genetics. 2015; 16:239-44.
  20. Gupta V, Garg R, Chander J. Detection of AmpC β-lactamses in gram negative bacilli - A study from North India. Int. J. Infect. Dis. 2008; 12(1):e121.
  21. Mana Baziboroun, Masomeh Bayani, Zahara Poormonstaseri, Mehran Shokri, Tahmineh Biazar.
  22. Prevalence and antibiotic susceptibility patteren of extended spectrum beta lactamses producing Escherchia coli isolated from outpatients with Urinary tract infections in Babool, Northern of Iran. Curr. issues in Pharma Med. Sci. 2018; 31(2):61-64.
  23. Rajendra Karadiya, saroj Hooja, Nital Pal, Rajni Sharma, Rakesh Maheswari, Ramesh Mishra. Prevalence and antimicrobial susceptibility of ESBL and AmpC β-lactamases producing Escherichia coli and Klebsiella pneumoniae from various clinical samples: An emerging threat. Journal of Evolution of Medical and Dental Sciences. 2016; 5(32):172934.
  24. Bhola Shankar Sah, Manita Aryal, Dipak Bhargava, Amrullah Siddique. Drug resistance pattern of bacterial pathogens of Enterobacteriaceae family. Tribhuvan University Journal of Microbiology. 2017; 4(1).
  25. Manchanda V, Singh NP. Occurrence and detection of AmpC beta-lactamases among Gram-negative clinical isolates using a modified three-dimensional test at Guru Tegh Bahadur Hospital, Delhi, India. J. Antimicrob. Chemother. 2003 Feb; 51(2):415-18. PMid: 12562713.
  26. Chakrawarti A, Dongol P, Khanal H, Subba P, Banerjee JJ. Extended spectrum beta lactamases detection and multiple antibiotic resistance indexing of Escherichia coli from urine samples of patients from a referral hospital of eastern Nepal. Int. J. Appl. Sci. Biotechnol. 2015; 3(3):423-26.
  27. Vellanki Naga Madhavi, Puppala Subbulu. Prevalence and antibacterial susceptibility testing pattern of bacterial pathogens causing urinary tract infections in community. Journal of Evolution of Medical and Dental Sciences. 2016; 5(30):1528-31.
  28. Rupinder Bakshi, Geeta Walia, Anita Gupta. Microbiological profile of UTI along with their antibiotic sensitivity pattern with special reference to Nitrofurantoin. World Academy of Science, Engineering and Technology International Journal of Medical. Health, Biomedical, Bioengineering and Pharmaceutical Engineering. 2015; 9(9).

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