Antibiotic Resistance: Investigating the Prevalence of Antibiotic Resistance in E. Coli Infections among Patients Treated with Ciprofloxacin versus Amoxicillin : Antibiotic Resistance in E. Coli Infections among Ciprofloxacin versus Amoxicillin Patients

Suhail Marfani; Nadiya Khan; Muhammad Ali Zubair; Syed Liaquat Ali; Khawar Anwar; Ayesha Islam

doi:10.54393/pjhs.v6i5.3085

Authors

Suhail Marfani Department of Medicine, Prime Health Care Group, Al-Qasimia, United Arab Emirates
Nadiya Khan Department of Pharmacology, Ameer Ud Din Medical College, Lahore, Pakistan
Muhammad Ali Zubair Department of Pharmacology, Shahida Islam Medical and Dental College, Lodhran, Pakistan
Syed Liaquat Ali Department of Biochemistry, Shahida Islam Medical and Dental College, Lodhran, Pakistan
Khawar Anwar Department of Biochemistry, Shahida Islam Medical and Dental College, Lodhran, Pakistan
Ayesha Islam Department of Family Medicine, Shahida Islam Medical and Dental College, Lodhran, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i5.3085

Keywords:

Anti-microbial Resistance, Bacteremia, Drug Sensitivity, Escherichia coli

Abstract

Among all gram-negative organisms that cause bacteremia, the most frequent one is Escherichia coli. Objectives: To determine the prevalence of antibiotic resistance towards E. coli infections in patients treated with ciprofloxacin and amoxicillin. Methods: This cross-sectional descriptive study was carried out at the Shahida Islam Medical College and Hospital for six months from July 2024 to December 2024. Isolates of specimens from various samples, such as blood, urine, stool, pus of the ear and skin were included. Isolates positive for Escherichia coli were included, while isolates from other organisms were excluded. Antibiotic sensitivity towards Ciprofloxacin and Amoxicillin was tested. SPSS version 25.0 was used for data analysis. Chi-square test was applied for statistical analysis, keeping p<0.05 as statistically significant. Results: The study analyzed 208 E. coli isolates, mostly from patients over 55 years and presenting with outpatient infections. Antibiotic resistance was significantly higher to amoxicillin (68.75%) compared to ciprofloxacin (41.35%) (p<0.001). Only 9.62% of isolates were sensitive to amoxicillin, while 44.71% were sensitive to ciprofloxacin. These findings highlight a concerning prevalence of resistance, particularly against amoxicillin, among E. coli infections. Conclusions: The results of this study reported a higher prevalence of antibiotic resistance to Amoxicillin when compared with the resistance towards Ciprofloxacin. Further, multicenter studies with a greater sample size would be better able to authenticate the findings observed in this research.

References

Holmes CL, Anderson MT, Mobley HL, Bachman MA. Pathogenesis of Gram-Negative Bacteremia. Clinical Microbiology Reviews. 2021 Jun; 34(2): 10-128. doi: 10.1128/CMR.00234-20.

Poirel L, Madec JY, Lupo A, Schink AK, Kieffer N, Nordmann P et al. Antimicrobial Resistance in Escherichia Coli. Microbiology Spectrum. 2018 Aug; 6(4): 10-128. doi: 10.1128/microbiolspec.ARBA-0026-2017.

Nasrollahian S, Graham JP, Halaji M. A review of the Mechanisms That Confer Antibiotic Resistance in Pathotypes of E. coli. Frontiers in Cellular and Infection Microbiology. 2024 Apr; 14: 1387497. doi: 10.3389/fcimb.2024.1387497.

Fleckenstein JM, Kuhlmann FM. Enterotoxigenic Escherichia Coli Infections. Current Infectious Disease Reports. 2019 Mar; 21: 1-9. doi: 10.1007/s11908-019-0665-x.

Urban-Chmiel R, Marek A, Stępień-Pyśniak D, Wieczorek K, Dec M, Nowaczek A et al. Antibiotic Resistance in Bacteria—A Review. Antibiotics. 2022 Aug; 11(8): 1079. doi: 10.3390/antibiotics11081079.

Begier E, Rosenthal NA, Gurtman A, Kartashov A, Donald RG, Lockhart SP. Epidemiology of Invasive Escherichia Coli Infection and Antibiotic Resistance Status among Patients Treated in US Hospitals: 2009–2016. Clinical Infectious Diseases. 2021 Aug; 73(4): 565-74. doi: 10.1093/cid/ciab005.

Stracy M, Snitser O, Yelin I, Amer Y, Parizade M, Katz R et al. Minimizing Treatment-Induced Emergence of Antibiotic Resistance in Bacterial Infections. Science. 2022 Feb; 375(6583): 889-94. doi: 10.1126/science.abg9868.

Karademir D, Kaskatepe B, Erol HB, Yalcin S, Cevik YN. The Study of Escherichia coli as Antimicrobial‐Resistant Sentinel Microorganism Isolated in the Farms of Three Districts of Ankara by MALDI‐TOF MS and Genomic Analysis. Veterinary Medicine and Science. 2025 May; 11(3): e70209. doi: 10.1002/vms3.70209.

Kot B. Antibiotic Resistance among Uropathogenic Escherichia Coli. Polish Journal of Microbiology. 2019 Dec; 68(4): 403. doi: 10.33073/pjm-2019-048.

Abdullah FE, Memon AA, Bandukda MY, Jamil M. Increasing Ciprofloxacin Resistance of Isolates from Infected Urines of a Cross-Section of Patients in Karachi. BioMed Central Research Notes. 2012 Dec; 5: 1-5. doi: 10.1186/1756-0500-5-696.

Di KN, Tay ST, Ponnampalavanar SS, Pham DT, Wong LP. Socio-Demographic Factors Associated with Antibiotics and Antibiotic Resistance Knowledge and Practices in Vietnam: A Cross-Sectional Survey. Antibiotics. 2022 Mar; 11(4): 471. doi: 10.3390/antibiotics11040471.

Chokshi A, Sifri Z, Cennimo D, Horng H. Global Contributors to Antibiotic Resistance. Journal of Global Infectious Diseases. 2019 Jan; 11(1): 36-42. doi: 10.4103/jgid.jgid_110_18.

Adamus-Białek W, Wawszczak M, Arabski M, Majchrzak M, Gulba M, Jarych D et al. Ciprofloxacin, Amoxicillin, and Aminoglycosides Stimulate Genetic and Phenotypic Changes in Uropathogenic Escherichia Coli Strains. Virulence. 2019 Jan; 10(1): 260-76. doi: 10.1080/21505594.2019.1596507.

Spinei L, Ciobanu E, Balan G, Croitoru C, Tapu L, Ferdohleb A. The Phenomenon of Antibiotic Resistance and People's Knowledge. One Health and Risk Management. 2023 Jun: 43-.

Sakalauskienė GV and Radzevičienė A. Antimicrobial Resistance: What Lies Beneath This Complex Phenomenon? Diagnostics. 2024 Oct; 14(20): 2319. doi: 10.3390/diagnostics14202319.

Bilal H, Khan MN, Rehman T, Hameed MF, Yang X. Antibiotic Resistance in Pakistan: A Systematic Review of Past Decade. BioMed Central Infectious Diseases. 2021 Dec; 21: 1-9. doi: 10.1186/s12879-021-05906-1.

Daneman N, Fridman D, Johnstone J, Langford BJ, Lee SM, MacFadden DM et al. Antimicrobial Resistance and Mortality Following E. Coli Bacteremia. E-Clinical Medicine. 2023 Feb; 56. doi: 10.1016/j.eclinm.2022.101781.

Paitan Y. Current Trends in Antimicrobial Resistance of Escherichia Coli. Escherichia Coli, A Versatile Pathogen. 2018: 181-211. doi: 10.1007/82_2018_110.

Hutinel M, Huijbers PM, Fick J, Åhrén C, Larsson DG, Flach CF. Population-level Surveillance of Antibiotic Resistance in Escherichia Coli Through Sewage Analysis. Euro-surveillance. 2019 Sep; 24(37): 1800497. doi: 10.2807/1560-7917.ES.2019.24.37.1800497.

Ali SQ, Zehra A, Naqvi BS, Shah S, Bushra R. Resistance Pattern of Ciprofloxacin Against Different Pathogens. Oman Medical Journal. 2010 Oct; 25(4): 294. doi: 10.5001/omj.2010.85.

Mohammed EJ, Allami M, Sharifmoghadam MR, Bahreini M. Relationship Between Antibiotic Resistance Patterns and O-Serogroups in Uropathogenic Escherichia Coli Strains Isolated from Iraqi Patients. Jundishapur Journal of Microbiology. 2021 Jan; 14(8): e118833. doi: 10.5812/jjm.118833.

Bonten M, Johnson JR, van den Biggelaar AH, Georgalis L, Geurtsen J, de Palacios PI et al. Epidemiology of Escherichia Coli Bacteremia: A Systematic Literature Review. Clinical Infectious Diseases. 2021 Apr; 72(7): 1211-9. doi: 10.1093/cid/ciaa210.

Bourély C, Cazeau G, Jarrige N, Jouy E, Haenni M, Lupo A et al. Co-Resistance to Amoxicillin and Tetracycline as an Indicator of Multidrug Resistance in Escherichia Coli Isolates from Animals. Frontiers in Microbiology. 2019 Oct; 10: 2288. doi: 10.3389/fmicb.2019.02288.

Peralta G, Sanchez MB, Garrido JC, De Benito I, Cano ME, Martínez-Martínez L, Roiz MP. Impact of Antibiotic Resistance and of Adequate Empirical Antibiotic Treatment in the Prognosis of Patients with Escherichia Coli Bacteraemia. Journal of Antimicrobial Chemotherapy. 2007 Oct; 60(4): 855-63. doi: 10.1093/jac/dkm279.

Sabir S, Anjum AA, Ijaz T, Ali MA, Nawaz M. Isolation and Antibiotic Susceptibility of E. Coli from Urinary Tract Infections in A Tertiary Care Hospital. Pakistan Journal of Medical Sciences. 2014 Mar; 30(2): 389. doi: 10.12669/pjms.302.4289.