Download PDF
Open Access
CC BY 4.0 · Libyan International Medical University Journal
DOI: 10.1055/s-0045-1814412
Original Article

Clinical Significance of Extended-Spectrum β-Lactamase (ESBL) and AmpC β-Lactamase (AmpC) Coproduction among Uropathogenic Escherichia coli from Diabetic and Nondiabetic Patients: Implications for Antimicrobial Resistance and Treatment Outcomes

Authors

  • Mohanned Mohamed Alwashaish 

    1   Microbiology Department, Faculty of Pharmacy, Misurata University, Misurata, Libya

  • Fathia Muftah Elmeheishi

    2   Microbiology Department, Faculty of Science, Misurata University, Misurata, Libya

  • Asma Abdellatif Abbas

    1   Microbiology Department, Faculty of Pharmacy, Misurata University, Misurata, Libya
Further Information
Also available at
  Permissions and Reprints


Graphical Abstract

Abstract

Background

Urinary tract infections (UTIs) caused by Escherichia coli remain a major global health burden, particularly among diabetic patients who are prone to recurrent and complicated infections.

Aim

This article determines the prevalence, antimicrobial resistance patterns, and clinical predictors of extended-spectrum β-lactamase (ESBL) and AmpC β-lactamase coproduction among uropathogenic E. coli isolates.

Methods

Cross-sectional study was conducted on 300 adult patients with culture-confirmed E. coli UTIs at Misurata Medical Center, including 150 people living with diabetes (PLWD) and 150 nondiabetic participants. Midstream urine specimens were collected and cultured on standard media. Antimicrobial susceptibility testing followed the Clinical and Laboratory Standards Institute 2024 guidelines, while ESBL and AmpC β-lactamases were phenotypically detected using the double-disk synergy and inhibitor-based disk tests. Data were analyzed using SPSS v27 and R v4.3.2. Categorical and continuous variables were compared using chi-square/Fisher's exact and Mann–Whitney U tests, respectively. Predictors of coproduction and its impact on treatment failure were identified via multivariate logistic regression; a p-value of < 0.05 was considered statistically significant.

Results

The total prevalence of ESBL, AmpC, and ESBL + AmpC coproduction was 58.3, 14.3, and 14.0%, respectively. While the prevalence of ESBL-only and AmpC-only phenotypes did not differ significantly between PLWD and nondiabetic patients, coproduction was significantly higher in PLWD (22%) compared with nondiabetic patients (6%; p < 0.001) and was associated with extensive multidrug resistance (93%). Diabetes mellitus (adjusted odds ratio [OR] = 3.64; p = 0.001) and prior antibiotic exposure (adjusted OR = 2.18; p = 0.041) were independent predictors of coproduction.

Conclusion

ESBL + AmpC coproduction in uropathogenic E. coli represents an emerging therapeutic and epidemiological concern, particularly among PLWD. Routine AmpC screening and rational antibiotic policies are urgently required to mitigate treatment failure and limit resistance.

Keywords

Escherichia coli - extended-spectrum β-lactamase (ESBL) - ampC β-lactamase - antimicrobial resistance - diabetes mellitus - urinary tract infection - Libya


Publication History

Received: 16 November 2025

Accepted: 19 November 2025

Article published online:
04 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Bunduki GK, Heinz E, Phiri VS, Noah P, Feasey N, Musaya J. Virulence factors and antimicrobial resistance of uropathogenic Escherichia coli (UPEC) isolated from urinary tract infections: a systematic review and meta-analysis. BMC Infect Dis 2021; 21 (01) 753
    CrossrefPubMedSearch in Google Scholar
  • 2 Qin X, Li R, Zhang W, Liu J, Chen Z, Li J. Antimicrobial resistance of clinical bacterial isolates in China: a review from 2005 to 2022. JAC Antimicrob Resist 2024; 6 (02) dlae052
    PubMedSearch in Google Scholar
  • 3 Choi JH, Kim YJ, Park YS, Seo KW, Jeon HY, Lim SK. Prevalence and characterization of extended-spectrum β-lactamase and AmpC β-lactamase producing Escherichia coli isolates from diseased dogs and cats in Korea. Antibiotics (Basel) 2023; 12 (04) 745
    CrossrefPubMedSearch in Google Scholar
  • 4 Salvia T, Dolma KG, Dhakal OP, Khandelwal B, Singh LS. Phenotypic detection of ESBL, AmpC, MBL, and their co-occurrence among MDR Enterobacteriaceae isolates. J Lab Physicians 2022; 14 (03) 329-335
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Sun L, Meng N, Wang Z. et al. Genomic characterization of ESBL/AmpC-producing Escherichia coli in stray dogs sheltered in Yangzhou, China. Infect Drug Resist 2022; 15: 7741-7750
    CrossrefPubMedSearch in Google Scholar
  • 6 Das D, Vohra P, Mane P, Shaozae CK. Extended spectrum, AmpC & metallo β-lactamases producing Escherichia coli in urinary isolates: a prospective study in north India. Indian J Med Res 2025; 161 (02) 167-173
    CrossrefPubMedSearch in Google Scholar
  • 7 Nepal K, Pant ND, Neupane B. et al. Extended spectrum beta-lactamase and metallo beta-lactamase production among Escherichia coli and Klebsiella pneumoniae isolated from different clinical samples in a tertiary care hospital in Kathmandu, Nepal. Ann Clin Microbiol Antimicrob 2017; 16 (01) 62
    CrossrefPubMedSearch in Google Scholar
  • 8 Mama M, Manilal A, Gezmu T, Kidanewold A, Gosa F, Gebresilasie A. Prevalence and associated factors of urinary tract infections among diabetic patients in Arba Minch Hospital, Arba Minch province, South Ethiopia. Turk J Urol 2018; 45 (01) 56-62
    CrossrefPubMedSearch in Google Scholar
  • 9 Yenehun Worku G, Belete Alamneh Y, Erku Abegaz W. Prevalence of bacterial urinary tract infection and antimicrobial susceptibility patterns among diabetes mellitus patients attending Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Infect Drug Resist 2021; 14: 1441-1454
    CrossrefPubMedSearch in Google Scholar
  • 10 Magiorakos A-P, Srinivasan A, Carey RB. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18 (03) 268-281
    CrossrefPubMedSearch in Google Scholar
  • 11 Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: 34th Edition (M100). Wayne, PA: CLSI; 2024
    Search in Google Scholar
  • 12 Owusu E, Adjei H, Afutu E. Similarities in bacterial uropathogens and their antimicrobial susceptibility profile in diabetics and their non-diabetic caregivers at a national diabetes management and research centre, Accra-Ghana. Diseases 2022; 10 (04) 124
    CrossrefPubMedSearch in Google Scholar
  • 13 Ben Sallem R, Ben Slama K, Estepa V. et al. Prevalence and characterisation of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolates in healthy volunteers in Tunisia. Eur J Clin Microbiol Infect Dis 2012; 31 (07) 1511-1516
    CrossrefPubMedSearch in Google Scholar
  • 14 Carrillo-Larco RM, Altez-Fernandez C, Acevedo-Ramos A. et al. Type 2 diabetes mellitus and antibiotic-resistant infections: a systematic review and meta-analysis. BMJ 2022; 376: e069780
    PubMedSearch in Google Scholar
  • 15 Arumugam K, Karande GS, Patil SR. Prevalence of extended spectrum b-lactamase and AmpC b-lactamase among Escherichia coli and Klebsiella pneumoniae in urinary tract infections. J Pure Appl Microbiol 2025; 19 (03) 2237-2246
    CrossrefSearch in Google Scholar
  • 16 Hassen B, Abbassi MS, Benlabidi S. et al. Genetic characterization of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolated from wastewater and river water in Tunisia: predominance of CTX-M-15 and high genetic diversity. Environ Sci Pollut Res Int 2020; 27 (35) 44368-44377
    CrossrefPubMedSearch in Google Scholar
  • 17 El-Faitouri A, El-Amin H, Mohamed M. Extended-spectrum β-lactamase production among E. coli isolates from urinary tract infections in Tripoli, Libya. J Infect Dev Ctries 2019; 13 (08) 742-748
    Search in Google Scholar
  • 18 Al-Kesh AH, Abdussalam S, El-Debani H. Antimicrobial resistance patterns of Escherichia coli causing urinary tract infections in Misurata, Libya. Libyan J Med Sci 2020; 4 (03) 115-122
    Search in Google Scholar
  • 19 World Health Organization (WHO). Global Antimicrobial Resistance and Use Surveillance (GLASS) Report 2025. Geneva: WHO; 2025
    CrossrefSearch in Google Scholar
  • 20 Coudron PE. Inhibitor-based methods for detection of plasmid-mediated AmpC β-lactamases in Klebsiella spp., Escherichia coli, and Proteus mirabilis. J Clin Microbiol 2005; 43 (08) 4163-4167
    CrossrefPubMedSearch in Google Scholar
  • 21 Mohammed A, Ahmed S, Ibrahim Y. High prevalence of blaCMY AmpC β-lactamase in ESBL co-producers among Escherichia coli and Klebsiella spp. clinical isolates. J Glob Antimicrob Resist 2020; 21: 205-211
    Search in Google Scholar
  • 22 Shahkolahi S, Shakibnia P, Shahbazi S. et al. Detection of ESBL and AmpC producing Klebsiella pneumoniae ST11 and ST147 from urinary tract infections in Iran. Acta Microbiol Immunol Hung 2022; 69 (04) 303-313
    CrossrefPubMedSearch in Google Scholar
  • 23 Alghamdi SAA, Mir SS, Alghamdi FS, Al Banghali MAMMA, Almalki SSR. Evaluation of extended-spectrum beta-lactamase resistance in uropathogenic Escherichia coli isolates from urinary tract infection patients in Al-Baha, Saudi Arabia. Microorganisms 2023; 11 (12) 2820
    CrossrefPubMedSearch in Google Scholar
  • 24 Abdallah H, Youssef M, El-Gendy A. Co-existence of extended-spectrum β-lactamases and AmpC β-lactamases among uropathogenic E. coli: emerging therapeutic challenge. Antibiotics (Basel) 2022; 11 (10) 1369
    PubMedSearch in Google Scholar
  • 25 Aref M, Fathi J, Ghazanfari P, Malekzadegan Y, Jamali B. Characterization of plasmid-mediated quinolone resistant genes among uropathogenic Escherichia coli isolates in Bushehr, south of Iran. BMC Res Notes 2025; 18 (01) 404
    CrossrefPubMedSearch in Google Scholar