Extended spectrum beta-lactamase and metallo beta-lactamase production among Escherichia coli and Klebsiella pneumoniae isolated from different clinical samples in a tertiary care hospital in Kathmandu, Nepal

Abstract

BackgroundExtended spectrum beta-lactamase (ESBL) and metallo beta-lactamase (MBL) production in Klebsiella pneumoniae and Escherichia coli are the commonest modes of drug resistance among these commonly isolated bacteria from clinical specimens. So the main purpose of our study was to determine the burden of ESBL and MBL production in E. coli and K. pneumoniae isolated from clinical samples. Further, the antimicrobial susceptibility patterns of E. coli and K. pneumoniae were also determined.MethodsA cross-sectional study was conducted at Om Hospital and Research Centre, Kathmandu, Nepal by using the E. coli and K. pneumoniae isolated from different clinical samples (urine, pus, body fluids, sputum, blood) from May 2015 to December 2015. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion technique. Extended spectrum beta-lactamase production was detected by combined disc method using ceftazidime and ceftazidime/clavulanic acid discs and cefotaxime and cefotaxime/clavulanic acid discs. Similarly, metallo beta-lactamase production was detected by combined disc assay using imipenem and imipenem/ethylenediaminetetracetate discs. Bacteria showing resistance to at least three different classes of antibiotics were considered multidrug resistant (MDR).ResultsOf total 1568 different clinical samples processed, 268 (17.1%) samples were culture positive. Among which, E. coli and K. pneumoniae were isolated from 138 (51.5%) and 39 (14.6%) samples respectively. Of the total isolates 61 (34.5%) were ESBL producers and 7 (4%) isolates were found to be MBL producers. High rates of ESBL production (35.9%) was noted among the clinical isolates from outpatients, however no MBL producing strains were isolated from outpatients. Among 138 E. coli and 39 K. pneumoniae, 73 (52.9%) E. coli and 23 (59%) K. pneumoniae were multidrug resistant. The lowest rates of resistance was seen toward imipenem followed by piperacillin/tazobactam, amikacin and cefoperazone/sulbactam.ConclusionsHigh rate of ESBL production was found in the E. coli and K. pneumoniae isolated from outpatients suggesting the dissemination of ESBL producing isolates in community. This is very serious issue and can’t be neglected. Regular monitoring of rates of ESBL and MBL production along with multidrug resistance among clinical isolates is very necessary.

Extended-spectrum Beta-lactamase and AmpC Beta-lactamase producing gram negative bacilli isolated from clinical specimens at International Clinical Laboratories, Addis Ababa, Ethiopia

“…However, our result was lower than studies done in Sierra Leone (85.7 %) [24], Gondar (87.4%) [16], Bahir Dar (93.1%) [28], Nepal (96.8%) [29].The difference in magnitude of MDR isolates might be due to patient condition, definition for MDR and empirical treatment trend. In addition, our result was higher when compared to a previous study done in Jimma (59.3%) [30], Nepal (54.2%) [27], another study in Nepal by Lamichhane et al [31] reported (33.14%). However, the increased proportion of MDR seen in this study was considered as alarming because only a few treatment options remain for infections.…”

“…In the present study, the overall magnitude of MDR among all GNB isolate was 73.7%. There were also similar findings from studies conducted in Gondar (68.0%) [25], Dessie (74.6%) [26], Debre Markos: (72.2%) [21] and Nepal (64.0%) [27]. However, our result was lower than studies done in Sierra Leone (85.7 %) [24], Gondar (87.4%) [16], Bahir Dar (93.1%) [28], Nepal (96.8%) [29].The difference in magnitude of MDR isolates might be due to patient condition, definition for MDR and empirical treatment trend.…”

A study of bacteriological and antibiotic susceptibility profile of urinary tract infection

“…We observed 17.5% of the Escherichia coli and 21% of Klebsiella pneumoniae to be ESBL producers. In our study, both cefotaxime-clavulanic acid and ceftazidimeclavulanic acid identified ESBL producers equally, whereas in other studies cefotaxime-clavulanic acid identified more number of ESBL producers compared to ceftazidime-clavulanic acid [19,21,22]. ESBL strains apart from being resistant to third generation cephalosporins also showed more than 50% resistance to ampicillin/sulbactum, amikacin, gentamcin, ofloxacin and cotrimoxazole.…”

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

“…We also aimed to identify risk factors related to food. We focused on the recent five years because of the increasing prevalence of multiple mechanisms of resistance among Gramnegative bacteria causing extraintestinal and intestinal infections during this period, including mechanisms such as ESBL [25,26], carbapenemase [27], and metallo-betalactamase production [26], and plasmid-mediated colistin resistance [28].…”