Antibiotic susceptibility pattern of ESBLs-producing uropathogens in kidney transplant recipients in northern Iran

Due to the increasing global prevalence of extended-spectrum beta-lactamase (ESBL)-producing uropathogenic strains, ongoing surveillance is required to monitor drug-resistant organisms causing urinary tract infections (UTIs) in kidney transplant recipients (KTRs). This study aimed to evaluate the antibiotic resistance profiles of uropathogenic isolates in KTRs with UTIs caused by ESBL-producing strains.

A total of 96 urine samples collected from KTRs were cultured on selective media and analyzed using phenotypic characterization and PCR methods. Antibiotic resistance patterns among uropathogenic isolates were evaluated using the disk diffusion and E-test methods. Data were analyzed using SPSS Version 21, and the level of significance was set at 0.05.

Among the 26 uropathogenic isolates, uropathogenic Escherichia coli (UPEC) was the most prevalent (15, 57.7%), followed by Klebsiella pneumoniae (10, 38.5%) and Enterococcus faecalis (1, 3.8%). The rate of ESBL-producing isolates was 72% among UPEC and K. pneumoniae isolates. Antibiotic susceptibility testing revealed that ESBL-producing uropathogens exhibited significantly higher resistance rates (p < 0.05) than non-ESBL-producing strains to cefuroxime, cefepime, trimethoprim-sulfamethoxazole, ciprofloxacin, and levofloxacin. E. faecalis showed susceptibility to vancomycin, penicillin, and ampicillin and resistance to ciprofloxacin and levofloxacin.

The rate of ESBL-related UTIs among KTRs was notable in this study. Based on the in vitro results, fosfomycin appears to be a promising oral therapeutic option for UTIs caused by ESBL-producing uropathogens in KTRs in the study region. In addition, the high prevalence of ESBL-producing isolates underscores the potential value of targeted prophylactic strategies for high-risk patients.