Epidemiological Profile of Uropathogenic Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae

The global spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) represents a major challenge for the management of urinary tract infections (UTIs), limiting therapeutic options and increasing the risk of treatment failure. This study aimed to characterize the epidemiological profile and antimicrobial resistance patterns of ESBL-producing uropathogenic Enterobacteriaceae in a Moroccan hospital setting.

A retrospective descriptive study was conducted in the bacteriology department of the Moulay Ismail Military Hospital in Meknes, Morocco, over a 2-year period (2021-2023). Data were extracted from archived urine cytobacteriological examinations. Bacterial identification was performed using chromogenic media and biochemical methods, while antimicrobial susceptibility testing was carried out using the disk diffusion method according to CA-SFM guidelines. ESBL production was detected using the double-disk synergy test.

Among 9867 urine samples analyzed, 1676 cases of UTIs were identified, corresponding to a prevalence of 17%. Enterobacteriaceae accounted for 56.8% of isolates, among which ESBL-producing strains represented the majority of multidrug-resistant bacteria. Escherichia coli was the predominant species (69.9%), followed by Klebsiella pneumoniae (17.6%) and Klebsiella oxytoca (11%). High resistance rates were observed to third-generation cephalosporins (up to 96% for ceftriaxone) and fluoroquinolones (93% for ciprofloxacin). In contrast, carbapenems, amikacin, and fosfomycin retained good activity, with resistance rates below 10%.

This study highlights the increasing burden of ESBL-producing Enterobacteriaceae in UTIs and the alarming levels of resistance to commonly used antibiotics. These findings underscore the need for continuous surveillance, rational antibiotic use, and strengthened antimicrobial stewardship programs to limit the spread of multidrug-resistant bacteria and preserve the effectiveness of available treatments.