This study investigated the urinary tract infection in Assiut university hospitals to evaluate the rate
of infection, and the prevalence of extended spectrum β-lactamase producing Klebsiella pneumoniae to
define the magnitude of the problem and may help to implement appropriate infection control measures.
Methods: This study was conducted from January 2014 to June 2014. Urine samples were collected from
urinary tract infected patients to detect the causative organisms. After antimicrobial susceptibility testing,
resistant strains to β-lactam antibiotics were selected for detection of ESBLs. In addition PCR was done
to determine the most common group of β-lactamase genes responsible for resistance. Results: The study
included 340 patients presented to urology department at Assiut University Hospitals. The rate of
community and hospital acquired UTI were 41 % (140/340) and 59 % (200/340) respectively. For
community patients the commonest isolate was E. coli (54.28%) followed by Klebsiella pneumoniae
(29.28%) then Staphylococcus aureus (7.14%), Pseudomonas aeruginosa (1.42%), Coagulase-negative
Staphylococcus (3.57%), and Candida species (4.28%).While the pattern of nosocomial isolates was
Klebsiella pneumoniae (51%) followed by E. coli (30%) whereas, Staphylococcus aureus (4%),
Pseudomonas aeruginosa (11%), Coagulase-negative Staphylococcus (3%), Candida species (1%).
Antibiotics sensitivity of K. pneumoniae isolates showed that these organisms were mostly sensitive to
meropenem (100%). Phenotypic confirmatory tests (combined disc method, double disc method and
ESBL-E-Test) were done to test K. pneumoniae isolates for ESBL production. It was concluded that
60.97% (25/41) of community isolates and 81.37% (83/102) of nosocomial isolates were ESBLs
producers. PCR was done to determine the responsible ESBL gene; it revealed that the common ESBL
gene was CTX-M followed by TEM then SHV. Further analysis of CTX-M positive isolates showed that
CTX-M-group-1 was the predominant type. Conclusion: ESBLs is a neglected healthcare crisis in Egypt
that needs strategies to treat, prevent and control the rising rate. In addition, rapid and clinically relevant
antibiotic testing service is always required to provide services. Besides, the controlled use of 3rd
generation cephalosporin along with implementation of infection control measures are the most effective
means of controlling and decreasing the spread of ESBL isolates.