Epidemiology, antibiotic resistance, and molecular detection of blaOXA and blaCTX-M Genes in ESBL-Producing Escherichia coli from urinary tract infections in Jordanian hospitals.

Abstract

Background: Urinary tract infections (UTIs) impose significant challenges among patients infected with multidrug-resistant Escherichia coli (E. coli). The emergence of the extended-spectrum beta-lactamase (ESBL) strains complicates the treatment and exacerbates life-threatening infections. The comprehensive analysis of the resistance mechanisms combined with identifying the relevant genes amend the implications encountered with the devastating effects generated by the pathogenic microorganisms. This study sought about the prevalence of ESBL-producing E. coli in UTIs patients in Jordan, focusing on the prevalence of blaOXA and blaCTX-M resistance genes.

Methods: A total of 500 urine samples were compiled from patients diagnosed with UTIs between November 2023 and May 2024. The samples were collected from five governmental hospitals distributed in three districts in Jordan (North, Middle, and South). Urine samples were cultured in the microbiology lab and the percentage of E. coli isolates was explored. Later on, isolates were tested for ESBL production using the double disk synergy test. Thus, molecular detection of the blaOXA and blaCTX-M genes was performed using polymerase chain reaction (PCR) assays. Statistical analysis was conducted to assess the prognostic correlation between the prevalence of resistance genes and variables such as location, age, and gender.

Results: In the current study, we investigated the prevalence of ESBL-producing E. coli in UTIs across Jordanian hospitals, focusing on the prevalence of the blaOXA and blaCTX-M genes with the correlation with the epidemiological factors. Our findings revealed an overall prevalence of 18% for ESBL- E. coli isolates, with the highest prevalence in the Northern governorates exhibiting 50% (OR = 1.67, 95% CI: 1.103-2.519). Females showed a higher prevalence of the blaOXA gene (62.29%) compared to males (37.7%) (p = 0.008). Moreover, the blaCTX-M gene was universally present in all samples with a prevalence of 98%. The multinomial regression analysis has revealed a significant correlation (p = 0.001) between location on the distribution of the blaOXA gene among the study population.

Conclusion: The findings of the current study highlight alarming rates for the prevalence of ESBL-producing E. coli in UTIs across Jordan in general and in the northern districts as specific. Emphasizing the crucial need for effective surveillance, antibiotic stewardship, and infection control strategies. The significant regional variations in resistance rates suggest that localized factors, such as antibiotic misuse and environmental influences combined with the widespread of blaCTX-M and blaOXA genes point to the need for targeted antibiotic resistance surveillance in Jordan.