Prevalence of Extended Spectrum Beta-Lactamases among Escherichia coli and Klebsiella spp isolates in Manipal Teaching Hospital, Pokhara, Nepal

Yıl 2015, , 69 - 75, 16.07.2015

Shristi Raut Shishir Gokhale Bipin Adhikari

https://doi.org/10.5799/ahinjs.02.2015.02.0179

Cited By: 16

Öz

Objective: To isolate, identify and phenotypically characterize extended spectrum beta-lactamase (ESBL)-producing Escherichia coli andKlebsiella spp in Manipal Teaching Hospital.

Methods: Cross sectional study was conducted among E. coli and Klebsiella spp recovered from patients’ various samples to establish the prevalence of organisms producing ESBL in Manipal Teaching Hospital, Pokhara, Nepal between October 2011 and April 2012. ESBL production was detected by Clinical laboratory Standards Institute (CLSI) recommendations.

Results: E. coli (n=285) and Klebsiella spp (n=55) were isolated from various clinical samples. The specimens were urine 255 (75%), blood 18 (5.3%), pus 48 (14.1%), sputum 17 (5.1%), and body fluid 2 (0.6%). Seventy six (22.4%) were ESBL producing organisms by phenotypic confirmatory test with double disk diffusion method. ESBL group of organisms showed 100% resistance to ampicillin and cefotaxime. All the organisms in this study were 100% sensitive to imipenem and 95.6% sensitive to cefoperazone+sulbactam combination. ESBL producing isolates showed high rate of resistance to ciprofloxacin (90.7%), ceftriaxone (89.4%), ceftazidime (89.4%), cotrimoxazole (90.4%) and norfloxacin (88.1%) as com­pared to non-ESBL group.

Conclusion: ESBL producing E. coli and Klebsiella spp showed high prevalence in Nepal. Routine laboratory testing for ESBL in Nepalese hospitals is needed in order to optimize antibiotic management and reduce the risk of spread of infec­tions caused by ESBL producers. J Microbiol Infect Dis 2015;5(2): 69-75

Anahtar Kelimeler

Extended spectrum beta-lactamase, ESBL, E. coli, Klebsiella spp, Prevalence, Nepal

Kaynakça

• Livermore DM. Bacterial resistance: Origin, Epidemiology and Impacts. Clin Infect Dis 2003;36(Suppl 1)S11-23.
• Finch RG. Antibiotic resistance. J Antimicrob Therap 1998;42:125-128.
• Livermore DM. Current epidemiology and growing resistance of gram negative pathogens. Korean J Intern Med 2012;27:128-142.
• Poirel L, Gniadkowski M, Nordmann P. Biochemical analysis of the ceftazidime hydrolyzing extended spectrum β-lactamase CTX-M 15 and of its structurally related β-lactamase CTX-M
• J Antimicrob Chemother 2002;50:1031–1034.
• Paterson DL. Recommendation for treatment of severe
• infectionscaused by Enterobacteriaceae producing extended spectrum β-lactamases (ESBLs). Clin Microbiol Infect 2000:460-463.
• Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007;20:440-458.
• Koneman EW, Allen SD, Janda WM, et al. The enterobacteriaceae.
• In Color Atlas and textbook of diagnostic microbiology, 5th edition. JB Lippincott Co: Philladelphia; 2006;211-302.
• Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. M100-S21 2011;31:42-46.
• Sharma M, Pathak S, Srivastava P. Prevalence and antibiogram of Extended Spectrum β-Lactamase (ESBL) producing Gram negative bacilli and further molecular characterization of ESBL producing Escherichia coli and Klebsiella spp. J Clin Diagn Res 2013;7:2173-2177.
• Ali AM, Rafi S, Qureshi AH, et al. Frequency of Extended Spectrum β-Lactamases (ESBL) producing nosocomial isolates in a tertiary care hospital in Rawalpindi. Pak Armed Forces Med J 2009(03). http://pafmj.org/showdetails. php?id=241&t=o.
• Thakur S, Pokhrel N, Sharma M. Prevalence of Multidrug Resistant Enterobacteriaceae and Extended Spectrum β-Lactamase Producing E. coli in Urinary Tract Infection.Res J Pharm Biol Chem Sci 2013;4:1615-1624.
• Shrestha S, Amatya R, Dutta R. Prevalence of extended spectrum β-lactamase (ESBL) production in gram negative isolates from pyogenic infection in tertiary care hospital of eastern Nepal. Nepal Med Coll J 2011;13:186-189.
• Poudyal S, Bhatta DR, Shakya G, et al. ESBL producing multi drug resistant clinical bacterial isolates at NPHL, Nepal. Nepal Med Coll J 2011; 13:34-38.
• Agrawal P, Ghosh AN, Kumar S, et al. Prevalence of extended
• spectrum β-lactamases among E. coli and K. pneumoniae isolates in a tertiary care hospital. Indian J Pathol Microbiol 2008;51:139-142.
• Babypadmini S, Appalaraju B. Extended spectrum β-lactamases in urinary isolates of E.coli and K. pneumoniae: Prevalence and susceptibility pattern in a tertiary care hospital. Indian J Med Microbiol 2004;22:172-174.
• Shivaprakasha S, Radhakrishnan K, Gireesh A, et al. Routine
• screening for ESBL Production, A necessity of Today. The Internet J Microb 2006;3:1.
• Sasirekha B, Manasa R, Ramya P, et al. Frequency and Antimicrobial Sensitivity Pattern Of Extended Spectrum β-Lactamases Producing E. coli and K. pneumoniae Isolated In A Tertiary Care Hospital. Al Ameen J Med Sci 2010;3:265-271.
• Sharma S, Gupta A, Arora A. Cefepime Tazobactam: A new β-lactam/ β-lactamase inhibitor combination against ESBL producing gram negative bacilli. Int J Pharm Biomed Sci 2012;3:35-38.
• Ali AM, Rafi S, Qureshi AH. Frequency of extended spectrum β-lactamase producing gram negative bacilli among clinical isolates at clinical laboratories of Army Medical College, Rawalpindi. J Ayub Med Coll Abbottabad 2004;16:35–37.
• Ullah F, Malik SA, Ahmed J. Antimicrobial susceptibility pattern and ESBL prevalence in K. pneumoniae from urinary tract infections in the North West of Pakistan. Afr J Microbiol Res 2009;3:676-680.
• Yusha’u M, Aliyu HM, Kamurya AS, et al. Prevalence of Extended
• spectrum β-lactamases among Enterobacteriaceae in Murtala Mohammed Specialist Hospital, Kano, Nigeria. Bayero Journal of Pure and Applied Sciences 2010;3:169-172.
• Ho PL, Tsang DN, Que TL, et al. Comparison of screening methods for detection of extended spectrum β-lactamases and their prevalence among E. coli and Klebsiella spp in Hong Kong. APMIS 2000;108:237–240.
• Wiegand I, Geiss HK, Mack D, et al. Detection of Extended Spectrum β-Lactamases among Enterobacteriaceae by use of semi-automated Microbiology Systems and Manual Detection Procedures. J Clin Microbiol 2007;45:1167-1174.
• Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial
• resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002). Diagn Microbiol Infect Dis 2004;50:59–69.
• CDC National Nosocomial Infections Surveillance. 2010.Available from: http://www.cdc.gov/ncidod/hip/surveill/nnis.htm
• Denholm JT, Huysmans M, Spelman D. Community acquisition of ESBL producing E. coli: a growing concern. Med J Aust 2009;190:45-46.
• Jabeen K, Zafar A, Hasan R. Frequency and sensitivity pattern of extended spectrum β-lactamase producing isolates in a tertiary care hospital laboratory of Pakistan. J Pak Med Assoc 2005;55:436-439.
• Paterson DL, Bonomo RA. Extended Spectrum β-Lactamases: a Clinical Update. Clin Microbiol Rev 2005;18:657-686.
• Ghatole M, Manthalkar P, Kandle S, et al. Correlation of extended
• spectrum β-lactamases production with cephalosporin resistance in gram negative bacilli. Indian J Pathol Microbiol 2004;47:82-84.