Genotypic Identification of ESBL Producing Urinary Tract Infections In Leicestershire Area, UK

Background: Uropathogenic E. coli is one of the highest producers of extended-spectrum β-lactamases (ESBLs), a major public health concern. Many studies have described the epidemiology and prevalence of ESBL-producing E.coli. (1) Plasmids can transfer between different species of bacteria, carrying resistance genes with them, facilitating the spread of resistance. This study aimed to investigate the prevalence of ESBL genes and plasmid types in Leicestershire, UK. Methods: 380 uropathogenic E. coli ESBL-producing isolates were collected from the Leicester Royal Infirmary in Leicestershire, UK. Isolates were confirmed to be ESBL producers using the MAST ESBL detection kit. This study investigated the presence of ESBL-producing genes (blaCTX-M, blaSHV, blaTEM and blaOXA) by multiplex PCR.A second multiplex PCR assay identified blaCTX-M-1, blaCTX-M-2, blaCTX-M-8, blaCTX-M-9 and blaCTX-M-25. To investigate the relationship between plasmid type and ESBLs, a multiplex PCR-based replicon typing assay was designed to detect IncFIA, IncI1, IncL/M, IncN and IncFII. Results: Prevalence of ESBL genes was as follows: blaCTX-M (37%) blaOXA (5%), blaTEM and blaSHV (2.4%). Multiple resistance genes were detected in 10.2% of isolates. In the second multiplex assay, the order of prevalence of CTX-M genes was as follows: blaCTX-M-1 (56%), blaCTX-M-9 (11%), blaCTX-M-25 (6%), blaCTX-M-8 (0.5%) and blaCTX-M-2 (0.2%). Multiple resistance genes were detected in 3 isolates. blaCTX-M was found to be associated with all the replicon genes other than incL/M. Conclusions: To our knowledge, this is the first study to analyse the prevalence of uropathogenic ESBLs in Leicestershire. Our findings are in line with other authors findings in Europe. Bacteria use plasmids to transfer genes, including those that cause antibiotic resistance. It was found that CTX-M producing E.coli are associated with multiple plasmids, which can be linked to its rapid spread across the world. Epidemiology and prevalence studies help to inform policy about antibiotic stewardship, with the aim to reduce resistance levels in the future.