ESBL Production Among E. coli and Klebsiella spp. Causing Urinary Tract Infection: A Hospital Based Study

Abstract

Introduction:Increase in extended-spectrum β-lactamases (ESBL) producing microbes in recent years has led to limitations of treatment options. This study aimed to assess the prevalence of ESBL producing E. coli and Klebsiella spp. at a tertiary hospital in Nepal.Methods:A total of 2209 non-repetitive mid-stream urine (MSU) samples were collected during the study period (March to September 2014). Identification of the isolates was done by Gram's staining followed by biochemical tests. Antibiotic susceptibility testing was done by modified Kirby-Bauer disc diffusion method and interpretation was done following Clinical and Laboratory Standard Institute (CLSI) guidelines, 2013. ESBL screening among E. coli and Klebsiella spp. isolates were done using ceftriaxone, cefotaxime, ceftazidime and cefpodoxime. The confirmation was done by phenotypic disc diffusion test (combined disc method) using ceftazidime (30µg) and ceftazidime plus clavulanic acid (30/10µg), and cefotaxime (30µg) and cefotaxime plus clavulanic acid (30/10µg) disc as per CLSI guidelines.Results:A total of 451 samples showed significant bacteriuria with 365 (80.9%) E. coli, 17 (3.8%) Klebsiella pneumoniae and 3 (0.7%) Klebsiella oxytoca. Of 451 isolates, 236 (52.3%) were found MDR strains. By combined disk test, 33 (91.7%) E. coli and 3 (8.3%) Klebsiella spp. were found ESBL producers.Conclusion:Higher prevalence of ESBL producing E. coli and Klebsiella spp. was observed warranting prompt need of surveillance for effective management of such MDR strains.

Prevalence of Extended Spectrum Beta- Lactamase Producers among Various Clinical Samples in a Tertiary Care Hospital: Kurnool District, India

“…Maximum resistance was seen for Ampicillin, all 4-generations of . This susceptibility and resistance pattern is in accordance with other studies (Pooja Shakya et al, 2017;Akila et al, 2016 andDinesh Kumar, 2014 …”

In-vitro Antibacterial activity of Rhus javanica Against Multidrug-Resistant Uropathogens

“…In present study, the prevalence of bacterial infection among study subjects is found to be 35.3%, in which Escherichia coli is the predominant organism and followed by Enterococcus faecalis and Klebsiella pneumoniae. AST showed that, out of total isolates, 53.2% were MDR.Similar finding was reported by Shakya et al,where 52.3% of the total isolates were MDR, in which the main pathogens are Escherichia coli 79.7%, Providencia species 5.1%,and Klebsiella pneumoniae 3.4% [4]. A study from eastern Nepal also showed that, 43.98 % of urine samples showed significant growth and pathogens were resistant to amoxycillin, co-trimoxazole, flouroquinolones and third-generation cephalosporins [12].…”

“…In Nepal the mortality rate is high due to diarrheal diseases, respiratory tract infection, blood stream infection, urinary tract infection, tuberculosis and sexually transmitted diseases [3]. The evidence of multidrug resistant pathogens is reported from the various studies conducted in different part of Nepal [4,5]. The major culprits include pathogens like extended-spectrum β-lactamaseproducing Escherichia coli and Klebsiella pneumonia, carbapenemresistant Enterobacteriaceae, Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), Pseudomonas aeruginosa and Acinetobacter baumannii.…”

Antibiotic sensitivity pattern for non-beta lactam antibiotics and carbapenems in extended-spectrum beta-lactamase (ESBL) producing uropathogens versus non-ESBL producing uropathogens

“…According to a study conducted in 2012 in a tertiary care hospital of Sri Lanka, 13% of all community-acquired UTIs were due to ESBL producers. 21 The antibiotic sensitivity of the ESBL producers in the present study demonstrated relatively higher resistance rates against commonly used empirical antibiotics [ciprofloxacin (20.5%), norfloxacin (21.1%) and nalidixic acid (14.8%)] in the primary care setting. These findings suggest that empiric therapy with commonly used antibiotics is questionable in a background with an increased ESBL prevalence.…”