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Occurence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL and AmpC type) in patients with community acquired urinary tract infection
JÍROVÁ, Jessica
Antibiotic resistance is a global problem and is increasing every year. As urinary tract infections are one of the most common causes for prescribing antibiotics, the incidence of bacteria resistant to commonly used antimicrobials is increasing. Representatives of Enterobacteriaceae, a gramnegative bacteria, are among the most common pathogens causing UTIs. They are producers of beta-lactamases, that break down and inactivate beta-lactam antibiotics, that are commonly used therapeutics to treat UTIs. The theoretical part of the bachelor thesis deals with the characteristics of community-acquired urinary tract infections, especially their diagnosis, therapy and prevention. General properties and laboratory diagnostics of the Enterobacteriaceae family are described here. The final part outlines the content of antibiotic policy and centers in the Czech Republic. The description of the action of antimicrobial substances, specifically beta-lactam antibiotics, follows. The following is a division of the mechanisms of antibiotic resistance. Attention is focused on the description of beta-lactam resistance, the production of beta-lactamase enzymes (especially of the ESBL and AmpC types), which inactivate beta-lactam antibiotics. The theoretical part ends with a description of laboratory diagnostics of beta-lactamases (ESBL and Ampc types). The practical part deals with urine sample processing in a microbiology laboratory and the detection of enterobacteria producing extended-spectrum beta-lactamases. The process involves urine collection, transport and culture process of the sample on the appropriate diagnostic medium. This is followed by microscopy of the microbes and isolation of a pure colony of microbes from the family Enterobacteriaceae. Enterobacteria is diagnosed by using biochemical properties of a microbe grown on a special Švejcar medium and by changing colors by reagents in the INDOL test. A set of tests is used to demonstrate the production of beta-lactamases, ESBL and AmpC types. Disk diffusion test shows whether the strain is sensitive or resistant to the relevant antimicrobial agent. The DDST test is used to detect Enterobacteria producing ESBL and AmpC beta-lactamases. Chromogenic ESBL medium identifies strains producing extended-spectrum beta-lactamase. The research was performed in the Stafila microbiological laboratory for a period of 3 months. The frequency of individual representatives of enterobacteria causing community-acquired urinary tract infections was compared here, depending on the age and type of urine collected. Another comparison was in terms of the percentage of ESBL and AmpC positivity in polyresistant Enterobacteriaceae, also depending on the age and type of urine collected. Escherichia coli is the most common pathogen diagnosed in the urine of patients with urinary tract infections, with up to 60.67%. Proteus mirabilis and Klebsiella pneumoniae should not be overlooked either. The average age of patients with urinary tract inflammation is 54 years. ESBL positive samples were 9% of the total number of processed urine. AmpC positive urine was slightly less, 4% of the total urine count. According to the results, the most vulnerable group of patients are the elderly in care facilities, with an permanent catheter or one-time catheterisation. The final part of the bachelor thesis points to possible solutions to the problem of poly-resistant bacteria in patients with community-acquired urinary tract infections.
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