Clinical and microbiological observational study on AmpC β-lactamase-producing Enterobacteriaceae in a hospital of Nepal

Abstract

Limited information is available regarding AmpC β-lactamase (ABL)-producing Enterobacteriaceae compared to extended-spectrum β-lactamase-producing enterobacteria. Since ABL-producing organisms are often resistant to multiple antimicrobial agents, therapeutic options against these pathogens are limited. Among 230 clinical Enterobacteriaceae isolates, 64 (27.8%) were found to produce ABL in our study. Escherichia coli (83.9%) was a predominant pathogen, followed by Citrobacter freundii (5.2%). A significant proportion of ABL-producing isolates (81.3%) were found to be multidrug resistant against commonly used antibiotics. Univariate analysis showed that prior history of taking antibiotics (odds ratio [OR], 5.278; confidence interval [CI], 2.838-9.817; p<0.001) and being inpatients (OR, 4.587; CI, 2.132-9.9; p<0.001) were associated with ABL positivity. Regular antimicrobial resistance surveillance for ABL-producing Enterobacteriaceae is warranted for proper antimicrobial treatment strategy and policy making due to ABL-positive infections.

Multivariate analysis of risk factors for ESBL and AmpC producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care Hospital in Karnataka: A case control study

“…Prior treatment with antibiotics was identified as a significant risk factor for infection with ESBL producing strains in different studies done by Santhi M et al [5] , Pena C et al, 1 Baral P et al, 3 Ozgunes I et al 13 and Tumbarello M et al 9 It was correlating with our present study. Similarly longer duration of hospital stay was identified as independent risk factor in various studies conducted by Santhi M et al, 5 Baral P et al 3 and Tumbarello M et al 9 Furthermore, Foley's catheter, intravenous catheter, central venous catheter, intubation, surgery and mechanical ventilation were identified as risk factors associated with ESBL production by the study done by Ozgunes I et al 13 which correlated with our study.…”

“…Similarly longer duration of hospital stay was identified as independent risk factor in various studies conducted by Santhi M et al, 5 Baral P et al 3 and Tumbarello M et al 9 Furthermore, Foley's catheter, intravenous catheter, central venous catheter, intubation, surgery and mechanical ventilation were identified as risk factors associated with ESBL production by the study done by Ozgunes I et al 13 which correlated with our study.…”

“…2 High rates of AmpC β-lactamase (ABL) producing Enterobacteriaceae have been reported-36.5% in India, 35.6% in Pakistan and 26.2% in China. 3 Infections with ESBL-producing Enterobacteriaceae originally emerged primarily in the hospital setting. Patients at high risk for developing infection with ESBL-producing organisms are often seriously ill, have (had) a prolonged hospital stay and in whom invasive medical devices are present (urinary catheters, endotracheal tubes, central venous lines) for a prolonged duration, have had prior antibiotics or have severe underlying disease.…”

Multidrug resistant Enterobacteriaceae from blood stream infections at a tertiary care hospital of Eastern Nepal

“…Out of these, 5 isolates were positive by con rmatory test ( Table 2). The rate of AmpC production was less compared to other study done in Nepal suggesting lesser spectrum of resistance among our isolates [24].…”

High burden of antimicrobial resistance among gram negative bacteria causing healthcare associated infections in a critical care unit of Nepal

“…Furthermore, we detect 27.5% AmpC producing isolates, including Acinetobacter spp. (42.3%) followed by Escherichia coli (38.7%) and Klebsiella pneumoniae (32.4%) which is comparative to the previous reports of Baral et al [47] and Khanal et al [36] from nearby hospital. However, in an Indian study lower rate (14.2%) of AmpC producing isolates were documented [48].…”