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Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia

Year 2014, Volume: 4 Issue: 02, 50 - 54, 01.06.2014
https://doi.org/10.5799/ahinjs.02.2014.02.0126

Abstract

Objective: To estimate the prevalence and associated risk factors of extended-spectrum β-lactamase producing Enterobacte­riaceae (ESBL) in King Khaled General Hospital, Saudi Arabia. Methods: A twelve -month retrospective study for the presence of ESBL producing Enterobacteriaceae infection was per­formed by using the Microbiology and Infection Control Departments\' database. For all the collected specimens, microbiologi­cal identification and antimicrobial sensitivity testing were done using MicroScan WalkAway system and then confirmed by API 20E and E-test respectively. Results: The prevalence of ESBL producing Enterobacteriaceae infection among studied patients was 22%. The most common types of infections were urinary tract infections representing 59.2%. Previous use of antibiotics, urinary catheter, mechanical ventilation, previous hospitalization, previous intensive care unit admission and nosocomial origin of infection were significant risk factors for acquiring infection. Amikacin had the highest activity against ESBL producing isolates, whereas 20% of isolates were resistant to carbapenems Conclusions: The study revealed that prevalence of ESBL producing Enterobacteriaceae infection was relatively high. Our findings suggest that invasive devices, the use of antibiotics, prolonged hospitalization especially in the intensive care unit in­creases the risk of acquiring such infections. A strict antibiotic policy should be addressed especially with observed emergence of carbapenem resistance. Continuous review of need to invasive devices and strict compliance with basic infection control measures are mandatory to limit the spread of ESBL Enterobacteriaceae.

References

  • Kang CI, Wi YM, Lee MY, et al. Epidemiology and risk factors of community onset infections caused by Extended-Spec- trum B-Lactamase-Producing Escherichia coli strains. J Clin Microbiol 2012;50:312–317.
  • Pitout JD , Nordmann P, Laupland KB , Poirel L. Emergence of Enterobacteriaceae producing extended-spectrum b-lac- tamases (ESBLs) in the community. Antimicrob Agents Che- mother 2005;52:56–59.
  • Paterson DL. Recommendation for treatment of severe in- fections caused by Enterobacteriaceae producing extend- ed-spectrum b-lactamases (ESBLs). Clin Microbiol Infect 2000;6:460–463.
  • Paterson DL , Bonomo RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657–686.
  • Fennell J, Vellinga A, Hanahoe B, et al. Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: an observational study. BMC Infectious Diseases 2012;12:116-123.
  • Rubio-Perez I, Martin-Perez E, Garcia DD, et al. Extended- spectrum β lactamase producing bacteria in a tertiary care hospital in Madrid: epidemiology, risk factors and antimi- crobial susceptibility patterns. Emerg Health Threats J 2012;5:11589.
  • Kader AA, Kumar A. Prevalence and antimicrobial susceptibili- ty of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a general hospital. Ann Saudi Med 2005;25:239-242.
  • Bilal NE, Gedebou M. Clinical and community strains of Klebsiella pneumoniae: multiple and increasing rates of an- tibiotic resistance in Abha, Saudi Arabia. Br J Biomed Sci 2000;57:185-191.
  • Babay HA. Detection of extended-spectrum β lactamases in members of the family Enterobacteriaceae at a teaching hospital, Riyadh, Kingdom of Saudi Arabia. Saudi Med J 2002;23:186-190.
  • Nguyen QV. Hospital-Acquired Infections. J Hosp Infect 2004;43:85-100.
  • Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing:18th infor- mational supplement. 2008; M100-S18.Wayne,PA.
  • Babypadmini S, Appalaraju B. Extended spectrum lactamase in urinary isolates of E. coli and Klebsiella pneumoniae – prevalence and susceptibility pattern in a Tertiary care hospi- tal. Indian J Med Microbiol 2004;22:172-174.
  • Coque T, Baquero F, Canton R. Increasing prevalence of ESBL producing Enterobacteriaceae in Europe . Eurosurveil lance.2008;13(47):pii=19044.
  • Zhanel GG, DeCorby M, Laing N, et al. Anti-microbial-resis- tant pathogens in intensive care units in Canada: results of the Canadian National Intensive Care Unit (CAN-ICU) study, 2005-2006. Antimicrob Agents Chemother 2008;52:1430- 1437.
  • Jones RN. Summation: Β-lactam resistance surveillance in the Asia-Western Pacific region. Diagn Microbiol Infect Dis 1999;35:333-338.
  • Jamal W, Rotimi VO, Khodakhast F, et al. Prevalence of extended-spectrum β-lactamases in Enterobacteriaceae, Pseudomonas and Stenotrophomonas as determined by the VITEK 2 and E test systems in a Kuwait teaching hospital. Med Prin Pract 2005;14:325-331.
  • Al-Zarouni M, Senok A, Rashid F, et al. Prevalence and antimicrobial susceptibility pattern of extended-spectrum β-lactamase-producing Enterobacteriaceae in the United Arab Emirates. Med Prin Pract 2008;17:32-36.
  • El-Khizzi NA, Bakheshwain SM. Prevalence of extended spectrum β-lactamases among Enterobacteriaceae isolated from blood culture in a tertiary care hospital. Saudi Med J 2006;27:37-40.
  • Ben-Ami R, Rodrı´guez-Ban J, Arslan H, et al. A Multinational Survey of Risk Factors for Infection with Extended-Spectrum b-Lactamase–Producing Enterobacteriaceae in Nonhospi- talized Patients. Clin Infect Dis 2009;49:682–690.
  • Memon J, Rehmani R, Ahmed M, Elgendy, A.Nizami I. Ex- tended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae bacteremia. Risk factors and outcome in the eastern region of Saudi Arabia. Saudi Med J 2009; 30:803-8.
  • Hernandez J, Pascual A, Canton R, Martinez- Martinez L and Grupo de Estudio de Infeccion Hospitalaria (GEIH). Esch- erichia coli y Klebsiella pneumoniae productores de espectro extendido en hospitales espanoles (Proyecto GEIH-BLEE 2000). Enferm Infect Microbiolo Clin 2003;21:177-182.
  • Luzzaro F, Mezzatesta M, Mugnaioli C, et al. Trends in pro- duction of extended-spectrum β-lactamases among entero- bacteria of medical interest: report of the second Italian na- tionwide survey. J Clin Microbiol 2006;44:1659-1664.
  • Aly M, Balkhy H. The prevalence of antimicrobial resistance in clinical isolates from Gulf Corporation Council countries. Antimicrobial Resistance and Infection Control 2012;1:26- 30.
  • Gupta N, Limbago B, Patel J, Kallen J. Carbapenem-resis- tant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60–67.
  • Nair PK, Vaz MS. Prevalence of carbapenem resistant En- terobacteriaceae from a tertiary care hospital in Mumbai, In- dia. J Microbiol Infect Dis 2013;3:207-210.
  • Kang CI, Kim SH, Kim DM, et al. Risk factors for and clinical outcomes of bloodstream infections caused by extended- spectrum β-lactamase-producing Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2004;25:860-867.
  • Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: A case control study. 2010;4:717-722.
  • Paterson DL, Ku WC, von Guttberg A, et al. Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of pro- duction of extended spectrum b-lactamases. Clin Infect Dis 2003;39:31-37.
  • Rodriguez-Bano J, Navarro MD, Romero L, et al.: Epidemiol- ogy and clinical features of infections caused by extended- spectrum β-lactamase-producing Escherichia coli in non- hospitalized patients. J Clin Microbiol 2004;42:1089–1094.
  • Bisson G, Fishman NO, Patel JB, et al. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spe- cies: risk factors for colonization and impact of antimicrobial formulary interventions on colonization prevalence. Infect Control Hosp Epidemiol 2002;23:254-260.

Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia

Year 2014, Volume: 4 Issue: 02, 50 - 54, 01.06.2014
https://doi.org/10.5799/ahinjs.02.2014.02.0126

Abstract

Amaç: Suudi Arabistan Kral Halid Hastanesi’nde genişlemiş spektrumlu β-laktamaz (GSBL) üreten Enterobacteriaceae prevalansı ve enfeksiyon gelişmesinde risk faktörlerinin belirlenmesi Yöntemler: Mikrobiyoloji ve Enfeksiyon Kontrol Birimleri’nin veri tabanı kullanılarak 12 aylık dönemde geriye yönelik olarak GSBL üreten Enterobacteriaceae ile enfeksiyon görülme oranı belirlendi. Bu sürede içerisinde elde edilen örneklerde mikrobiyolojik tanımlama ve antibiyogram testleri MicroScan WalkAway sistemi kullanılarak yapıldı. Sonuçlar API 20E ve E-test yöntemi ile doğrulandı. Bulgular: Çalışmaya alınan hastalarda GSBL üreten Enterobacteriaceae prevelansı % 22 olarak bulundu. En sık karşılaşılan enfeksiyon % 59,2 ile üriner sistem enfeksiyonu idi. Antibiyotik kullanımı, üriner kateterizasyon, mekanik ventilasyon, daha önce hastanede yatış, yoğun bakım ünitesinde tedavi görme ve enfeksiyonun hastane kaynaklı olması GSBL üreten Enterobacteriaceae ile enfeksiyon gelişmesi için risk faktörleri olarak bulundu. GSBL üreten bakterlere karşı en etkin antibiyotik amikasinken, izolatların % 20’sinde karbapenemlere karşı direnç saptandı. Sonuçlar: Bu çalışmanın sonuçları GSBL üreten Enterobacteriaceae oranının yüksek olduğunu göstermektedir. Bulgular; antibiyotik kullanımı, invaziv işlemler ve özellikle yoğun bakım ünitesine olmak üzere uzamış hastane yatışının GSBL üreten bakterilerle enfeksiyon gelişme riskini artırdığını göstermektedir. Gözlenen yüksek karbapenem direnç oranı antibiyotik kullanımıyla ilgili etkin politikalar oluşturulması gerektiğini ortaya koymaktadır. GSBL üreten Enterobacteriaceae yayılmasının engellenmesi için kullanılan invaziv cihazlara ihtiyacın sürekli olarak değerlendirilmesi ve temel enfeksiyon kontrol önlemlerine etkin şekilde uyulması gerekmektedir

References

  • Kang CI, Wi YM, Lee MY, et al. Epidemiology and risk factors of community onset infections caused by Extended-Spec- trum B-Lactamase-Producing Escherichia coli strains. J Clin Microbiol 2012;50:312–317.
  • Pitout JD , Nordmann P, Laupland KB , Poirel L. Emergence of Enterobacteriaceae producing extended-spectrum b-lac- tamases (ESBLs) in the community. Antimicrob Agents Che- mother 2005;52:56–59.
  • Paterson DL. Recommendation for treatment of severe in- fections caused by Enterobacteriaceae producing extend- ed-spectrum b-lactamases (ESBLs). Clin Microbiol Infect 2000;6:460–463.
  • Paterson DL , Bonomo RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657–686.
  • Fennell J, Vellinga A, Hanahoe B, et al. Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: an observational study. BMC Infectious Diseases 2012;12:116-123.
  • Rubio-Perez I, Martin-Perez E, Garcia DD, et al. Extended- spectrum β lactamase producing bacteria in a tertiary care hospital in Madrid: epidemiology, risk factors and antimi- crobial susceptibility patterns. Emerg Health Threats J 2012;5:11589.
  • Kader AA, Kumar A. Prevalence and antimicrobial susceptibili- ty of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a general hospital. Ann Saudi Med 2005;25:239-242.
  • Bilal NE, Gedebou M. Clinical and community strains of Klebsiella pneumoniae: multiple and increasing rates of an- tibiotic resistance in Abha, Saudi Arabia. Br J Biomed Sci 2000;57:185-191.
  • Babay HA. Detection of extended-spectrum β lactamases in members of the family Enterobacteriaceae at a teaching hospital, Riyadh, Kingdom of Saudi Arabia. Saudi Med J 2002;23:186-190.
  • Nguyen QV. Hospital-Acquired Infections. J Hosp Infect 2004;43:85-100.
  • Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing:18th infor- mational supplement. 2008; M100-S18.Wayne,PA.
  • Babypadmini S, Appalaraju B. Extended spectrum lactamase in urinary isolates of E. coli and Klebsiella pneumoniae – prevalence and susceptibility pattern in a Tertiary care hospi- tal. Indian J Med Microbiol 2004;22:172-174.
  • Coque T, Baquero F, Canton R. Increasing prevalence of ESBL producing Enterobacteriaceae in Europe . Eurosurveil lance.2008;13(47):pii=19044.
  • Zhanel GG, DeCorby M, Laing N, et al. Anti-microbial-resis- tant pathogens in intensive care units in Canada: results of the Canadian National Intensive Care Unit (CAN-ICU) study, 2005-2006. Antimicrob Agents Chemother 2008;52:1430- 1437.
  • Jones RN. Summation: Β-lactam resistance surveillance in the Asia-Western Pacific region. Diagn Microbiol Infect Dis 1999;35:333-338.
  • Jamal W, Rotimi VO, Khodakhast F, et al. Prevalence of extended-spectrum β-lactamases in Enterobacteriaceae, Pseudomonas and Stenotrophomonas as determined by the VITEK 2 and E test systems in a Kuwait teaching hospital. Med Prin Pract 2005;14:325-331.
  • Al-Zarouni M, Senok A, Rashid F, et al. Prevalence and antimicrobial susceptibility pattern of extended-spectrum β-lactamase-producing Enterobacteriaceae in the United Arab Emirates. Med Prin Pract 2008;17:32-36.
  • El-Khizzi NA, Bakheshwain SM. Prevalence of extended spectrum β-lactamases among Enterobacteriaceae isolated from blood culture in a tertiary care hospital. Saudi Med J 2006;27:37-40.
  • Ben-Ami R, Rodrı´guez-Ban J, Arslan H, et al. A Multinational Survey of Risk Factors for Infection with Extended-Spectrum b-Lactamase–Producing Enterobacteriaceae in Nonhospi- talized Patients. Clin Infect Dis 2009;49:682–690.
  • Memon J, Rehmani R, Ahmed M, Elgendy, A.Nizami I. Ex- tended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae bacteremia. Risk factors and outcome in the eastern region of Saudi Arabia. Saudi Med J 2009; 30:803-8.
  • Hernandez J, Pascual A, Canton R, Martinez- Martinez L and Grupo de Estudio de Infeccion Hospitalaria (GEIH). Esch- erichia coli y Klebsiella pneumoniae productores de espectro extendido en hospitales espanoles (Proyecto GEIH-BLEE 2000). Enferm Infect Microbiolo Clin 2003;21:177-182.
  • Luzzaro F, Mezzatesta M, Mugnaioli C, et al. Trends in pro- duction of extended-spectrum β-lactamases among entero- bacteria of medical interest: report of the second Italian na- tionwide survey. J Clin Microbiol 2006;44:1659-1664.
  • Aly M, Balkhy H. The prevalence of antimicrobial resistance in clinical isolates from Gulf Corporation Council countries. Antimicrobial Resistance and Infection Control 2012;1:26- 30.
  • Gupta N, Limbago B, Patel J, Kallen J. Carbapenem-resis- tant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60–67.
  • Nair PK, Vaz MS. Prevalence of carbapenem resistant En- terobacteriaceae from a tertiary care hospital in Mumbai, In- dia. J Microbiol Infect Dis 2013;3:207-210.
  • Kang CI, Kim SH, Kim DM, et al. Risk factors for and clinical outcomes of bloodstream infections caused by extended- spectrum β-lactamase-producing Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2004;25:860-867.
  • Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: A case control study. 2010;4:717-722.
  • Paterson DL, Ku WC, von Guttberg A, et al. Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of pro- duction of extended spectrum b-lactamases. Clin Infect Dis 2003;39:31-37.
  • Rodriguez-Bano J, Navarro MD, Romero L, et al.: Epidemiol- ogy and clinical features of infections caused by extended- spectrum β-lactamase-producing Escherichia coli in non- hospitalized patients. J Clin Microbiol 2004;42:1089–1094.
  • Bisson G, Fishman NO, Patel JB, et al. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spe- cies: risk factors for colonization and impact of antimicrobial formulary interventions on colonization prevalence. Infect Control Hosp Epidemiol 2002;23:254-260.
There are 30 citations in total.

Details

Primary Language English
Journal Section ART
Authors

Amina Yousef Kandeel This is me

Publication Date June 1, 2014
Published in Issue Year 2014 Volume: 4 Issue: 02

Cite

APA Kandeel, A. Y. (2014). Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia. Journal of Microbiology and Infectious Diseases, 4(02), 50-54. https://doi.org/10.5799/ahinjs.02.2014.02.0126
AMA Kandeel AY. Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia. J Microbil Infect Dis. June 2014;4(02):50-54. doi:10.5799/ahinjs.02.2014.02.0126
Chicago Kandeel, Amina Yousef. “Prevalence and Risk Factors of Extended-Spectrum B-Lactamases Producing Enterobacteriaceae in a General Hospital in Saudi Arabia”. Journal of Microbiology and Infectious Diseases 4, no. 02 (June 2014): 50-54. https://doi.org/10.5799/ahinjs.02.2014.02.0126.
EndNote Kandeel AY (June 1, 2014) Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia. Journal of Microbiology and Infectious Diseases 4 02 50–54.
IEEE A. Y. Kandeel, “Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia”, J Microbil Infect Dis, vol. 4, no. 02, pp. 50–54, 2014, doi: 10.5799/ahinjs.02.2014.02.0126.
ISNAD Kandeel, Amina Yousef. “Prevalence and Risk Factors of Extended-Spectrum B-Lactamases Producing Enterobacteriaceae in a General Hospital in Saudi Arabia”. Journal of Microbiology and Infectious Diseases 4/02 (June 2014), 50-54. https://doi.org/10.5799/ahinjs.02.2014.02.0126.
JAMA Kandeel AY. Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia. J Microbil Infect Dis. 2014;4:50–54.
MLA Kandeel, Amina Yousef. “Prevalence and Risk Factors of Extended-Spectrum B-Lactamases Producing Enterobacteriaceae in a General Hospital in Saudi Arabia”. Journal of Microbiology and Infectious Diseases, vol. 4, no. 02, 2014, pp. 50-54, doi:10.5799/ahinjs.02.2014.02.0126.
Vancouver Kandeel AY. Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia. J Microbil Infect Dis. 2014;4(02):50-4.