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Multiple-Antibiotic Resistance Mediated by Plasmids and Integrons in Uropathogenic Escherichia Coli and Klebsiella Pneumoniae
Multiple-Antibiotic Resistance Mediated by Plasmids and Integrons in Uropathogenic Escherichia Coli and Klebsiella Pneumoniae
Original Article
Multiple-Antibiotic Resistance Mediated by Plasmids and Integrons in
Uropathogenic Escherichia coli and Klebsiella pneumoniae
Taslima Taher Lina, Sabita Rezwana Rahman and Donald James Gomes*
Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
Antibiotic resistance in urinary tract infection (UTI) is a growing public health problem in the world. In this
study, a total of 182 uropathogens were isolated from patients with symptoms of urinary tract infection (UTI).
Escherichia coli (88%) was the most prevalent isolate, while Klebsiella pneumoniae was recovered from 12%
cases. The male/female ratio was 1:3. About 56% female and 51% male patients belonged to the age group >40
years. The antibiotic resistance rates of the isolates to fifteen different drugs were investigated. E. coli and
K. pneumoniae showed variable pattern of susceptibility. The percentage of resistance to different drugs was
higher in E. coli isolates compared to that of K. pneumoniae. Among the total number of isolates about 87%
were resistant to at least three commonly used antibiotics. All the isolates were sensitive to imipenem.
Analysis of the plasmid DNA had shown that the plasmid pattern was very diverse in both E. coli and
K. pneumoniae. All the isolates contained multiple numbers of plasmid ranging from 1.0 to >140 MDa. Middleranged plasmids (30 to 80 MDa), the transferable resistance plasmids, were found to be present in 86% E. coli
and 85% K. pneumoniae isolates. The strong association observed between plasmid profiles and drug resistance
patterns suggest that plasmids other than the common plasmids may have epidemiological significance. The
presence of class 1 and class 2 integrons were also investigated. A relatively high occurrence of class 1
integrons, that are associated with lateral transfer of antibacterial resistance genes, was observed in
K. pneumoniae (88%) than in E. coli isolates (54%). Class 2 integrons were not found in any of the E. coli and
K. pneumoniae isolates. These results show the high rate of drug resistance and the presence of high rate of
transferable elements in these MDR isolates.
Keywords: Uropathogens, Escherichia coli, Klebsiella pneumoniae, Multidrug-resistant (MDR) bacteria, Plasmid
profiles, Integrons
Introduction
Urinary tract infection (UTI) is a serious health problem affecting
millions of people each year. This is the second most common
type of infection in human. Urinary tract infection is a common
community-acquired bacterial disease, which frequently affects
female than male1. Increasing rates of resistance among bacterial
uropathogens has caused growing concern in both developed
and developing countries2. Escherichia coli, the most common
member of the family Enterobacteriaceae, accounts for 75-90% of
all urinary tract infections in both in-patients and out-patients.
Klebsiella pneumoniae is the second most frequently found
organism in UTI patients2. Antibiotics are the typical treatment
for UTIs. Therefore, multidrug-resistant organisms are frequently
found in urinary tract infection (UTI)3.
The emergence and spread of antibiotic resistance is a cause of
increasing concern2. Antibiotic resistance is the ability of a
microorganism to withstand the effects of an antibiotic. It is one
of the major causes of failure in the treatment of infectious diseases
that results in increased morbidity, mortality, and costs of health
*Corresponding
author:
Dr. Donald James Gomes, Professor, Department of Microbiology, University of Dhaka University, Dhaka 1000, Bangladesh
Tel (Office): (02) 9661920-73 Ext. 7739; Tel (Home): (02) 8362232; Cell: 01817 016815; Fax: +880 (02) 8615583
19
Lina et al.
Oligoneucleotide sequence (5 to 3)
Position of
amplicon
Int 1-F
GGTCAAGGATCTGGATTTCG
786-766
Int 1-R
ACATGCGTGTAAATCATCGTC
303-324
Int 2-F
CACGGATATGCGACAAAAAGGT
219-240
Int 2-R
GTAGCAAACGAGTGACGAAATG
1,007-986
Results
E. coli and K. pneumoniae were isolated from 182 cases, of which
73.6% (n = 134) were from female patients and 26.4% (n = 48) were
from male patients. Among the female and male patients,
respectively 56.0% (n = 75) and 52.1% (n = 25) cases belonged to
the age group >40 years.
PCR was performed for all the MDR isolates. In all the isolates the
PCR products were successfully amplified to the expected 1,900
bp for int1 gene. Class 1 integron was present in 54% E. coli and
88% K. pneumoniae isolates. None of the isolates contain any
int2 gene.
Lina et al.
Discussion
UTI ranks as one of the most important causes of morbidity even
today in the developing countries like Bangladesh17. This may
be attributed to lack of proper research, abuse of chemotherapeutic
agents and most importantly ignorance of people and little or no
preventive measure. There have been several studies on bacterial
cause of UTI in Bangladesh18-19. This study had been designed
to investigate the drug resistance pattern and the frequency of
plasmids as well as the relationship between antibiotic resistance,
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Franklin GA, Moore KB, Snyder JW, Polk HC Jr & Cheadle WG.
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