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Urinary tract infections (UTIs) are the most common bacterial infections in women of all ages. The emergence of resistance to newer classes of antibiotics, including third generation cephalosporins, has limited the drug choices for treatment of UTI. We report here a recurrent UTI due to co‐infection with multiple‐antibiotic‐resistant (MAR) Escherichia coli pathotypes. Case presentation: A 73‐year‐old woman with diabetes mellitus type 2 presented with fever, nausea, vomiting, burning sensation, painful and frequent urination. She was diagnosed with recurrent UTI (RUTI) due to co‐infection with pansensitive enteroaggregative E. coli (EAEC) and MAR extended spectrum β‐lactamase (ESBL)‐producing uropathogenic E. coli (UPEC) and treated with azithromycin and levofloxacin (each for 10 days). Unfortunately, she did not respond. Plasmid profile analysis showed that the MAR E. coli strain harboured multiple plasmids including ∼38 and ∼80 MDa plasmids. PCR for detection of β‐lactamase genes showed that the isolate was negative for blaTEM, blaSHV, blaOXA and blaCTX‐M. To the best of our knowledge, this is the first report of co‐infection with an EAEC and MAR ESBL‐producer UPEC in Bangladesh. Conclusion: We recommend that all pathotypes of E. coli as well as the other more common uropathogens should be considered in the diagnosis of RUTI and multiple antibiotics should be prescribed only in severe conditions.

jmm case reports

Recurrent urinary tract infection due to co‐infection with extended spectrum β‐lactamase‐producer uropathogenic Escherichia coli and enteroaggregative E. coli