ISSN: 0973-7510

E-ISSN: 2581-690X

Research Article | Open Access
Shanmugapriya Thiagarajan1, Selvaraj Stephen2, Sarangapani Kanagamuthu1, Stanley Ambroise3, Pragasam Viswanathan4, Palanivel Chinnakali5 and Rajesh Nachiappa Ganesh6
1Department of Microbiology, Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry – 605 001, India.
2Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Puducherry – 607403, India.
3Department of Medicine, Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry – 605 001, India.
4School of Biosciences and Technology, Vellore Institute of Technology, Vellore – 632 014, Tamil Nadu, India.
5Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry – 605006, India.
6Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry – 605 006, India.
J Pure Appl Microbiol. 2021;15(4):2085-2097 | Article Number: 7199
https://doi.org/10.22207/JPAM.15.4.31 | © The Author(s). 2021
Received: 26/07/2021 | Accepted: 06/09/2021 | Published: 29/09/2021
Abstract

Urinary tract infection (UTI) causes significant renal damage and disease severity is compounded by antimicrobial resistance (AMR) and other comorbidities in the patient. Blood group antigens secreted in body fluids (secretor status) are known to play a role in bacterial adhesion and we studied its influence on AMR in UTI. A total of 2758 patients with UTI were studied with urine culture, qualitative and semiquantitative urine microscopy, serum creatinine and secretor status in saliva samples by adsorption-inhibition method. Of these, AMR from 300 patients with E. coli infection were assessed as per CLSI 2019 guidelines and extended-spectrum beta-lactamase (ESBL) genes (bla TEM, bla CTX-M, bla SHV) and NDM1 genes were studied using TaqMan probes in Real-time polymerase chain reaction. Patients with UTI were followed up for two weeks. Female patients had higher predilection (57%) for E. coli infection while patients with diabetes or non-secretors had none. In our study, ESBL producers were seen in 62% of the E. coli isolates and fosfomycin had 100% susceptibility. Non-secretors were significantly associated with acute kidney injury (AKI), AMR and ESBL genes. Multidrug-resistance (MDR) was noted in 127/160 (79.4%) ESBL and 17/18 (94%) NDM1 gene encoding strains. Quantitative urine microscopy scoring predicted AKI both at presentation and at end of follow up. ESBL producers were common in our study population and non-secretors had a significant association with AMR genes. Urine microscopy scoring system may be a useful tool to predict AKI in patients with UTI.

Keywords

Antimicrobial resistance, Escherichia coli, Blood group secretor, extended-spectrum beta-lactamase, Acute Kidney Injury, Quantitative urine microscopy

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