1887

Abstract

Introduction:

Urinary tract infections (UTIs) are the most common bacterial infections in women of all ages. The emergence of resistance to newer classes of antibiotics, including third generation cephalosporins, has limited the drug choices for treatment of UTI. We report here a recurrent UTI due to co‐infection with multiple‐antibiotic‐resistant (MAR) pathotypes.

Case presentation:

A 73‐year‐old woman with diabetes mellitus type 2 presented with fever, nausea, vomiting, burning sensation, painful and frequent urination. She was diagnosed with recurrent UTI (RUTI) due to co‐infection with pansensitive enteroaggregative (EAEC) and MAR extended spectrum ‐lactamase (ESBL)‐producing uropathogenic E. coli (UPEC) and treated with azithromycin and levofloxacin (each for 10 days). Unfortunately, she did not respond. Plasmid profile analysis showed that the MAR strain harboured multiple plasmids including ∼38 and ∼80 MDa plasmids. PCR for detection of ‐lactamase genes showed that the isolate was negative for blaTEM, blaSHV, blaOXA and blaCTX‐M. To the best of our knowledge, this is the first report of co‐infection with an EAEC and MAR ESBL‐producer UPEC in Bangladesh.

Conclusion:

We recommend that all pathotypes of as well as the other more common uropathogens should be considered in the diagnosis of RUTI and multiple antibiotics should be prescribed only in severe conditions.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.001404
2014-09-01
2019-10-22
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/1/3/jmmcr001404.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.001404&mimeType=html&fmt=ahah

References

  1. Ahmed D. , Hoque A. , Mazumder R. , Nahar K. , Islam N. , Gazi S.A. , Hossain A. . ( 2012; ). Extended‐spectrum‐β‐lactamases producing Salmonella enterica serovar Typhi strain in Dhaka, Bangladesh. . J Med Microbiol 61:, 1032–1033.[CrossRef]
    [Google Scholar]
  2. Anderson G.G. , Palermo J.J. , Schilling J.D. , Roth R. , Heuser J. , Hultgren S.J. . ( 2003; ). Intracellular bacterial biofilm‐like pods in urinary tract infections. . Science 301:, 105–107.[CrossRef]
    [Google Scholar]
  3. Azap O.K. , Arslan H. , Serefhanoglu K. , Colakoglu S. , Erdogan H. , Timurkaynak F. , Senger S. . ( 2010; ). Risk factors for extended‐spectrum β‐lactamase positivity in uropathogenic Escherichia coli isolated from community‐acquired urinary tract infections. . Clin Microbiol Infect 16:, 147–151.[CrossRef]
    [Google Scholar]
  4. Boll E.J. . ( 2012; ). A new understanding of enteroaggregative Escherichia coli as an inflammatory pathogen. . Cell Adh Migr 6:, 413–418.[CrossRef]
    [Google Scholar]
  5. DeBusscher J. , Zhang L. , Buxton M. , Foxman B. , Barbosa C.C. . ( 2009; ). Persistent extended‐spectrum β‐lactamase urinary tract infection. . Emerg Infect Dis 15:, 1862–1864.[CrossRef]
    [Google Scholar]
  6. Falagas M.E. , Kastoris A.C. , Kapaskelis A.M. , Karageorgopoulos D.E. . ( 2010; ). Fosfomycin for the treatment of multidrug‐resistant, including extended‐spectrum β‐lactamase producing, Enterobacteriaceae infections: a systematic review. . Lancet Infect Dis 10:, 43–50.[CrossRef]
    [Google Scholar]
  7. Foxman B. . ( 2010; ). The epidemiology of urinary tract infection. . Nat Rev Urol 7:, 653–660.[CrossRef]
    [Google Scholar]
  8. George D. , Manges A. . ( 2010; ). A systematic review of outbreak and non‐outbreak studies of extraintestinal pathogenic Escherichia coli causing community‐acquired infections. . Epidemiol Infect 138:, 1679–1690.[CrossRef]
    [Google Scholar]
  9. Harrington S.M. , Sheikh J. , Henderson I.R. , Ruiz‐Perez F. , Cohen P.S. , Nataro J.P. . ( 2009; ). The Pic protease of enteroaggregative Escherichia coli promotes intestinal colonization and growth in the presence of mucin. . Infect Immun 77:, 2465–2473.[CrossRef]
    [Google Scholar]
  10. Herzog K. , Dusel J.E. , Hugentobler M. , Beutin L. , Sagesser G. , Stephan R. , Hächler H. , Nüesch‐Inderbinen M. . ( 2013; ). Diarrheagenic enteroaggregative Escherichia coli causing urinary tract infection and bacteremia leading to sepsis. . Infection, 1–4.
    [Google Scholar]
  11. Huang D.B. , Okhuysen P.C. , Jiang Z‐D. , DuPont H.L. . ( 2004; ). Enteroaggregative Escherichia coli: an emerging enteric pathogen. . Am J Gastroenterol 99:, 383–389.[CrossRef]
    [Google Scholar]
  12. Huppertz H.I. , Rutkowski S. , Aleksic S. , Karch H. . ( 1997; ). Acute and chronic diarrhoea and abdominal colic associated with enteroaggregative Escherichia coli in young children living in western Europe. . Lancet 349:, 1660–1662.[CrossRef]
    [Google Scholar]
  13. Larsson M. , Kronvall G. , Chuc N. , Karlsson I. , Lager F. , Hanh H. , Tomson G. , Falkenberg T. . ( 2000; ). Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community. . Trop Med Int Health 5:, 711–721.[CrossRef]
    [Google Scholar]
  14. Lee N.Y. , Lee C.C. , Huang W.H. , Tsui K.C. , Hsueh P.R. , Ko W.C. . ( 2012; ). Carbapenem therapy for bacteremia due to extended‐spectrum‐β‐lactamase‐producing Escherichia coli or Klebsiella pneumoniae: implications of ertapenem susceptibility. . Antimicrob Agents Chemother 56:, 2888–2893.[CrossRef]
    [Google Scholar]
  15. Li D. , Liu B. , Chen M. , Guo D. , Guo X. , Liu F. , Feng L. , Wang L. . ( 2010; ). A multiplex PCR method to detect 14 Escherichia coli serogroups associated with urinary tract infections. . J Microbiol Methods 82:, 71–77.[CrossRef]
    [Google Scholar]
  16. Olesen B. , Scheutz F. , Andersen R.L. , Menard M. , Boisen N. , Johnston B. , Hansen D.S. , Krogfelt K.A. , Nataro J.P. . other authors ( 2012; ). Enteroaggregative Escherichia coli O78: H10, the cause of an outbreak of urinary tract infection. . J Clin Microbiol 50:, 3703–3711.[CrossRef]
    [Google Scholar]
  17. Rasko D.A. , Webster D.R. , Sahl J.W. , Bashir A. , Boisen N. , Scheutz F. , Paxinos E.E. , Sebra R. , Chin C‐S. . other authors ( 2011; ). Origins of the E. . . coli strain causing an outbreak of hemolytic–uremic syndrome in Germany. N Engl J Med 365:, 709–717.
    [Google Scholar]
  18. Russo T.A. , Johnson J.R. . ( 2000; ). Proposal for a new inclusive designation for extraintestinal pathogenic isolates of Escherichia coli: ExPEC. . J Infect Dis 181:, 1753–1754.[CrossRef]
    [Google Scholar]
  19. Talukdar P.K. , Rahman M. , Rahman M. , Nabi A. , Islam Z. , Hoque M.M. , Endtz H.P. , Islam M.A. . ( 2013; ). Antimicrobial resistance, virulence factors and genetic diversity of Escherichia coli isolates from household water supply in Dhaka, Bangladesh. . PloS One 8:, e61090.[CrossRef]
    [Google Scholar]
  20. Yamamoto S. . ( 2007; ). Molecular epidemiology of uropathogenic Escherichia coli . . J Infect Chemother 13:, 68–73.[CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.001404
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.001404
Loading

Data & Media loading...

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error