p.p1 ESBL pathogens poses challenges for health care providers

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Abstract Title:  Urinary Bacterial Profile and Antibiotic Susceptibility Pattens among patients presenting to the emergency department of King Abdulaziz Medical City, Riyadh, Saudi Arabia 

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1) Problem 
Urinary tract infections are among the most prevalent infections in ED patients. Changes in pathogen profile and susceptibility patterns isolated from urinary tract infections accentuate the need for regional review to generate information that can guide antimicrobial therapy.  

2) Background/context
Knowledge on the current status of antimicrobial resistance in uropathogens, and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy formulations and encourage prudent use of antimicrobials.

3) Methods
This was a retrospective review of culture results from urine samples sent from our ED in a period of 3 months (February – March – April 2016). 

4) Results
Total of 2128 urinary cultures sent from ER with 504 positive culture (=23.7%), 125 contaminated culture (=5.9%), and 1499 negative culture (=70.4%). The highest rate of positive cultures is among females older than 45 (ranging between 28.41% to 35.8%). The lowest rate of positive cultures is among males younger than 45 (=10%). 
The predominant organism identified was E. coli accounting for 54% of all positive cultures including E coli ESBL identified in 15% of positive cultures. The predominance of E coli was observed among both genders and across all age groups. Common organisms following E coli varied widely according to age and gender. 
Organisms resistant to commonly prescribed outpatient antibiotics were present in almost 25% of positive cultures (E coli ESBL 15%, K pneumonia 2%, Carbapenem Res. K. pneumonia 1.5%, Vancomycin Resistant Enterococci 1%, P. aeruginosa 3%, MDR P. aeruginosa 1%,  MDR P. Mirabilis <0.5%) with variable sensitivity to Meropenem, Imepenem, Vancomycin, Colisitin.  5) Conclusion/Lessons learned The increased prevalence of multidrug resistant ESBL pathogens poses challenges for health care providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialized tests for detection of ESBL producing pathogens from isolates obtained from in-patients. Further studies on the mechanisms and pathways utilized by these bacteria to cause UTI will highlight other avenues in patient management.