Multidrug Resistant CTX-M-ProducingEscherichia coli: A Growing Threat among HIV Patients in India

Abstract

Extended Spectrumβ-Lactamases (ESBLs) confer resistance to third-generation cephalosporins and CTX-M types have emerged as the most prominent ESBLs worldwide. This study was designed to determine the prevalence of CTX-M positive ESBL-producing urinaryE. coliisolates from HIV patients and to establish the association of multidrug resistance, phylogeny, and virulence profile with CTX-M production. A total of 57 ESBL producers identified among 76E. colistrains isolated from HIV patients from South India were screened forblaCTX-M, AmpC production, multidrug resistance, and nine virulence associated genes (VAGs),fimH,pap,afa/dra,sfa/foc,iutA,fyuA,iroN,usp,andkpsMII.The majority (70.2%) of the ESBL producers harboredblaCTX-Mand were AmpC coproducers. Among the CTX-M producers, 47.5% were found to be UPEC, 10% harbored as many as 7 VAGs, and 45% possessedkpsMII. Multidrug resistance (CIPRSXTRGENR) was significantly more common among the CTX-M producers compared to the nonproducers (70% versus 41.2%). However, 71.4% of the multidrug resistant CTX-M producers exhibited susceptibility to nitrofurantoin thereby making it an effective alternative to cephalosporins/fluoroquinolones. The emergence of CTX-M-producing highly virulent, multidrug resistant uropathogenicE. coliis of significant public health concern in countries like India with a high burden of HIV/AIDS.