# Prevalence, Demographic Distribution, and Antimicrobial Resistance Patterns of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Urinary Tract Infections: A Cross-Sectional Study in a Tertiary Care Hospital in Manipur, India

## TL;DR

This study found a high rate of drug-resistant E. coli causing urinary tract infections in Manipur, India, highlighting the need for better treatment strategies.

## Contribution

The study provides new local data on ESBL-producing E. coli in UTIs, including demographic and resistance patterns in Manipur.

## Key findings

- 74.3% of E. coli isolates were ESBL-positive, with 56.7% confirmed by CDT.
- Females and young adults (16-25 years) were most affected, with a 1:4.1 male-to-female ratio.
- ESBL producers showed high resistance to cefpodoxime and ciprofloxacin but remained fully sensitive to imipenem.

## Abstract

Background: Urinary tract infections (UTIs) are among the most common bacterial infections globally, with Escherichia coli as the predominant uropathogen. The emergence of extended-spectrum beta-lactamase (ESBL)-producing strains has significantly complicated treatment due to widespread multidrug resistance (MDR).

Objectives: This cross-sectional study aimed to determine the prevalence of ESBL-producing E. coli in UTIs, describe its demographic distribution, and evaluate antimicrobial susceptibility patterns among isolates from patients at a tertiary care hospital in Imphal, Manipur, India.

Methods: From September 2015 to August 2017, 230 non-repetitive E. coli isolates from urine samples of symptomatic patients were collected, and antimicrobial susceptibility testing was done by Kirby-Bauer disk diffusion methodology. Isolates were then screened for ESBL production using Clinical and Laboratory Standards Institute (CLSI) guidelines. Screening employed disk diffusion with indicator cephalosporins, and confirmation for ESBL production was done via the combined disk test (CDT) (ceftazidime ± clavulanic acid).

Results: Of the 230 isolates, 171 (74.3%) were screened positive and 97 (56.7%) were confirmed as ESBL producers by CDT. Female patients predominated with 185 (80.4%) cases; the male-to-female ratio was 1:4.1, with the highest prevalence in the 16-25 years age group, accounting for 44 (19.1%) cases. Community-acquired isolates represented 172 (74.8%) cases, with 68 (70.1%) showing ESBL positivity versus 29 (29.9%) in inpatient isolates. All isolates retained 100% sensitivity to imipenem. ESBL producers exhibited complete resistance to cefpodoxime, 7 (7.2%) to gentamicin, and high co-resistance to ciprofloxacin. Non-producers showed significantly lower resistance rates (p < 0.05).

Conclusions: This study demonstrates a high prevalence of ESBL-producing E. coli in both community and hospital settings in Manipur, underscoring the urgent need for routine screening, enhanced antimicrobial stewardship, ongoing surveillance, and evidence-based empirical therapy guidelines to curb escalating resistance and improve patient outcomes.