Emerging Perils of Extended Spectrumβ-Lactamase Producing Enterobacteriaceae Clinical Isolates in a Teaching Hospital of Nepal

Abstract

Introduction. Infections due to extended spectrum β-lactamase producing Enterobacteriaceae are on the rise. They pose serious public health problems due to their resistance to large number of antibiotics. However, little is known about the genotypes of ESBL from Nepal. Therefore, the study presents results of phenotypic and molecular characterization of ESBL producing Escherichia coli and Klebsiella spp. isolated from various clinical specimens in a tertiary care teaching hospital of Nepal. Methods. A total of 172 Enterobacteriaceae clinical isolates recovered from various clinical specimens were analyzed for their antibiotic susceptibility test. Detection of ESBLs was carried out using combination disk test and multiplex PCR for their genotypes (CTX-M, SHV, and TEM). Results. Out of 172 clinical isolates, 70 (40.6%) of them were found ESBL producers. The major source of ESBL producers was urinary tract samples and the highest ESBL production was observed in Escherichia coli (46.5%). Among ESBL genotypes, CTX-M (91.4%) was most predominant, followed by TEM (65.7%) and SHV (11.4%) in both of the isolates. Conclusions. High level of drug resistance and ESBL production was observed among the clinical isolates. There is a need for longitudinal and nationwide surveillance for drug resistance in clinical isolates and antimicrobial stewardship is necessary to guide the appropriate and judicious antibiotic use.

Biofilm formation and antimicrobial resistance in Klebsiella pneumoniae isolated from patients visiting a tertiary care center of Nepal

“…The data of ESBL producing K. pneumoniae in Nepal ranges from 18.4%-30.0% [27,28]. Our study showed higher percentage of ESBL (43.3%) than the previous studies from Nepal, however, was similar to data of another study from South East Asia (46.7%) [29].…”

Higher prevalence of ESBL producing uropathogenic Escherichia coli among Diabetic patients from a Tertiary Care Hospital of Kathmandu

“…The incidence of ESBL producing E. coli among the outpatients (89.1%) was higher than inpatients (63.64%) which were in contrast to the ndings [43], which revealed that incidence of ESBL producing E. coli among the inpatients was higher than in outpatients. In this study, the ESBL producing E. was found comparatively higher in number than in the studies by Parajuli et al and Seyedjavadi et al [48,49]. Pokhrel et al, 2014, andChander andShrestha 2013 [44, 50] revealed even less ESBL producing E. coli.…”

Extended-Spectrum β-Lactamase (ESBL) Genotypes among Multidrug-Resistant Uropathogenic Escherichia coli Clinical Isolates from a Teaching Hospital of Nepal

“…However, the bla-CTX-M gene has been described as the most common genotype of ESBL among enterobacteriaceae in several literatures [40][41][42]. In our previous report too, we found the dominance of the bla-CTX-M gene among ESBLproducing enterobacteriaceae from various clinical specimens [22]. Moreover, multiple occurrences of genes in a same organism were also noted, where bla-TEM + bla-CTX-M (54.8%) was common.…”

“…Polymerase chain reaction-(PCR-) based amplification of ESBL genes was carried out as the method previously described [22]. For instance, multiplex PCR was carried out to detect the plasmid genes for SHV and CTX-M, while conventional linear PCR was used for TEM-type ESBL genes.…”