Antibiotic resistance profiles and risk factors of multidrug-resistant Escherichia coli in a large tertiary care hospital in a low- and middle-income country.

Escherichia coli is a significant member of the Enterobacteriaceae family, a group of gram-negative rods that are normally found in the human gastrointestinal tract. The global rise of antimicrobial resistance presents a major and escalating threat to public health. In this context, our study sought to evaluate the patterns of antibiotic resistance and the risk factors associated with E. coli pathogens including multidrug-resistant (MDR) strians. We also aimed to determine the prevalence of MDR E. coli strains isolated from hospitalized patients to provide healthcare professionals with essential information for managing these infections. A retrospective hospital-based study was carried out at a major tertiary care facility between January 2022 and December 2023. Data on E. coli were obtained from the hospital's information system. The inclusion criteria were as follows: (1) patients of all ages, (2) both male and female, and (3) all types of E. coli isolated from any sample. Patients from outpatient clinics and hemodialysis centers, as well as 20 individuals whose medical records were incomplete, were excluded. As a result, the final sample consisted of 423 patients. The demographic, clinical, and microbiological characteristics of patients with E. coli infections were examined in this study. The mean age of the patients was 50.3 years, with no significant differences among the three subgroups of E. coli. The CR-E. coli group was more prevalent among males (64.4%, p = 0.031). Comorbidities, such as cardiovascular disease (43.8%), solid malignancies (32%), and diabetes (24.8%), did not significantly differ among the groups, with the exception of hematological malignancies (p = 0.016). In the CR-E. coli group, intubation was more prevalent (p = 0.006), indicating that there were substantial differences in medical procedures. The E. coli group presented the highest prevalence of urine cultures (47.9%), with substantial variations in resistance patterns among the species. The rates of resistance to cephalosporins and ciprofloxacin increased (67.7%). Renal disease (p = 0.035) was associated with MDR E. coli acquisition. The findings of this study revealed a considerable prevalence of MDR E. coli species causing various infections. As a result, antimicrobial stewardship programs that thoroughly assess the need for antibiotic use can help reduce the risk of resistance. Furthermore, implementing infection control measures is crucial in lowering the risk of cross transmission.