Prevalence and antibiotic susceptibility pattern of quinolones and cephalosporins resistant uropathogenic Escherichia coli in the north Iran

Saman Shalibeik, Hossein Ghafori, Kourush Delpasand, Nafiseh Zamani, Zaman Darvish, Hasan Pourmoshtagh


Escherichia coli is a Gram-negative bacillus of the Enterobacterales order that is considered an opportunistic pathogen. One of the places they can enter is the urinary tract, which is called the Uropathogenic E. coli (UPEC) strains and the infections that result from it are called urinary tract infection (UTI). The aims of this study was to obtain new information about the antibiotic susceptibility pattern of quinolones and cephalosporins resistant E. coli. In this retrospective cross-sectional study, all cases of urinary tract infections caused by E. coli isolates referred to Razi Hospital in Rasht, the North of Iran over a period of three years were evaluated. Antimicrobial susceptibility patterns were evaluated using disk diffusion method. The total number of E. coli bacteria isolated from urine samples of patients with UTIs from 2016 to 2018 was 1224 cases. Totally, 382 out of 612 tested E. coli isolates were ciprofloxacin resistant (62.4%). While, 251 out of 446 tested E. coli isolates were cephalosporins (56.3%). Among the tested isolated, 206 cases were resistant to both antibiotics (cephalosporin and ciprofloxacin), of which 71 (34.5%) were recovered from male and 135 (65.5%) from female samples. The highest antibiotic susceptibility to E. coli was related to amikacin (74.8%) and followed by nitrofurantoin (67.5%). The results showed an alarming rate of cephalosporin and ciprofloxacin resistance among E. coli causing UTI in our region. These findings suggest optimizing local stewardship programs and infection control policy. 


Escherichia coli; Urinary tract infection; Quinolone; Cephalosporin; Antibiotic resistance

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Gómez-De Rueda F, Martinez-Nogueras R, Tena-Sempere ME, Elosegui-Horno I, Robles-Rodríguez L, Horno-Ureña F. Epidemiological aspects and prevalence study of nosocomial infections in a general hospital of specialties: retrospective analysis 2012-2017. Eur J Hosp Pharm. 2019; 26(6):339-42.

Willyard C. The drug-resistant bacteria that pose the greatest health threats. Nature. 2017; 543(7643):15.

Rajabi M, Abdar ME, Rafiei H, Aflatoonia MR, Abdar ZE. Nosocomial Infections and Epidemiology of Antibiotic Resistance in Teaching Hospitals in South East of Iran. Glob J Health Sci. 2015; 8(2):190-7.

Ghashghaee A, Behzadifar M, Azari S, Farhadi Z, Luigi Bragazzi N, Behzadifar M, et al. Prevalence of nosocomial infections in Iran: A systematic review and meta-analysis. Med J Islam Repub Iran. 2018; 32:48.

Spatenkova V, Bradac O, Fackova D, Bohunova Z, Suchomel P. Low incidence of multidrug-resistant bacteria and nosocomial infection due to a preventive multimodal nosocomial infection control: a 10-year single centre prospective cohort study in neurocritical care. BMC Neurol. 2018; 18(1):23.

Li D, Liu B, Chen M, Guo D, Guo X, Liu F, et al. A multiplex PCR method to detect 14 Escherichia coli serogroups associated with urinary tract infections. J Microbiol Methods. 2010; 82(1):71-7.

Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis. 2009; 13(2):140-4.

Chin BS, Kim MS, Han SH, Shin SY, Choi HK, Chae YT, et al. Risk factors of all-cause in-hospital mortality among Korean elderly bacteremic urinary tract infection (UTI) patients. Arch Gerontol Geriatr. 2011; 52(1):e50-5.

Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014; 28(1):1-13.

Nikokar I, Tishayar A, Flakiyan Z, Alijani K, Rehana-Banisaeed S, Hossinpour M, et al. Antibiotic resistance and frequency of class 1 integrons among Pseudomonas aeruginosa, isolated from burn patients in Guilan, Iran. Iran J Microbiol. 2013; 5(1):36-41.

Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother. 1995; 39(6):1211-33.

Zhao L, Chen X, Zhu X, Yang W, Dong L, Xu X, et al. Prevalence of virulence factors and antimicrobial resistance of uropathogenic Escherichia coli in Jiangsu province (China). Urology. 2009; 74(3):702-7.

Kawamura-Sato K, Yoshida R, Shibayama K, Ohta M. Virulence genes, quinolone and fluoroquinolone resistance, and phylogenetic background of uropathogenic Escherichia coli strains isolated in Japan. Jpn J Infect Dis. 2010; 63(2):113-5.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; 30th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2020.

Alizade H. Escherichia coli in Iran: An Overview of Antibiotic Resistance: A Review Article. Iran J Public Health. 2018; 47(1):1-12.

Haghighatpanah M, Mojtahedi A. Characterization of antibiotic resistance and virulence factors of Escherichia coli strains isolated from Iranian inpatients with urinary tract infections. Infect Drug Resist. 2019; 12:2747-54.

Mortazavi-Tabatabaei SAR, Ghaderkhani J, Nazari A, Sayehmiri K, Sayehmiri F, Pakzad I. Pattern of Antibacterial Resistance in Urinary Tract Infections: A Systematic Review and Meta-analysis. Int J Prev Med. 2019; 10:169.

Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother. 2012; 56(4):2181-3.

Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis. 2012; 2012:976273.

Stapleton AE, Wagenlehner FME, Mulgirigama A, Twynholm M. Escherichia coli Resistance to Fluoroquinolones in Community-Acquired Uncomplicated Urinary Tract Infection in Women: a Systematic Review. Antimicrob Agents Chemother. 2020; 64(10).

Jafari A, Falahatkar S, Delpasand K, Sabati H, Sedigh Ebrahim-Saraie H. Emergence of Escherichia coli ST131 Causing Urinary Tract Infection in Western Asia: A Systematic Review and Meta-Analysis. Microb Drug Resist. 2020; 26(11):1357-64.


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