Incidence of ESBL-Producing Gram-Negative Bacteria of Lower Respiratory Tract Infection in Bharatpur Hospital, Nepal

Abstract

Background: Antimicrobial resistance is a global threat in the medical society. Extended-Spectrum β-lactamase (ESBL) producing bacteria are increasing worldwide including Nepal and causing more severe infections because of their continuous mutation and multidrug resistance (MDR) nature. Objective: The objective of this study was to assess Gram-negative bacterial etiology of lower respiratory tract infections (LRTIs) and determine their antibiotic susceptibility pattern with a special focus on MDR including ESBL production. Methods: A total of 109 sputum specimens were analyzed. The bacterial isolates were identified by standard microbiological procedures including Analytical Profile Index (API) 20E test panels for Enterobacteriaceae and subjected to antimicrobial susceptibility testing. Screening of ESBL producers among Gram-negative isolates was done by using third generation cephalosporins (ceftazidime and cefotaxime) and confirmed by the combined disk method as recommended by CLSI (2019). Results: Out of 109 sputum specimens, Gram-negative bacterial etiology was determined in 31(28.4%) cases. The age-wise distribution of LRTIs patient was found to be statistically significant with bacterial incidence (p < 0.05). Altogether, 15(46.9%) isolates were multidrugresistant. ESBL producers were observed only among Klebsiella spp. and Escherichia coli isolates. On the ESBL screening test of 9 isolates (3 of E. coli and 6 of Klebsiella spp.,) 5(55.6%) gave a positive result, and only 3(33.3%) of them were further confirmed as ESBL producers. The majority of ESBL producers were Klebsiella spp. 2(66.7%). Conclusion: The present study revealed that multidrug resistance is prevalent among Gramnegative bacterial pathogens isolated from the patients with lower respiratory tract infections, requiring routine laboratory testing for MDR and ESBL production in clinical isolates for better prophylaxis and reducing the risk of ESBL transmission.

Prevalence of CTX-M β-Lactamases Producing Multidrug Resistant Escherichia coli and Klebsiella pneumoniae among Patients Attending Bir Hospital, Nepal

“…Several studies in Nepal have reported the prevalence of MDR [ 22 , 23 ] and ESBL producers [ 8 – 10 ]. Despite knowing the fact, in Nepal, the literature regarding ESBL production among MDR isolates and their responsible genes are poorly stated than other developed nations; the present study would help to investigate the prevalence of CTX-M β -lactamases producing MDR E. coli and K. pneumoniae among patients.…”

“…Although ESBL was discovered several decades ago, there have been troublesome to sort out organisms that are responsible for ESBL production due to several reasons such as difficulty in its detection and variability during reporting [7]. A large number of studies have reported the presence of ESBL producers in clinical [8][9][10] as well as nonclinical samples [11][12][13]. Nevertheless, some studies concluded E. coli and K. pneumoniae as the most crucial bacteria responsible for ESBL production [14,15].…”

Clinical Specimens are the Pool of Multidrug- resistant Pseudomonas aeruginosa Harbouring oprL and toxA Virulence Genes: Findings from a Tertiary Hospital of Nepal

“…P. aeruginosa has great diversity and is capable of causing life-threatening contagious infections in a multifariousness patients' population [10], causing several diseases such as urinary tract infections (UTIs) [11], respiratory tract infections (RTIs) [12], burn wounds, skin and soft tissue infections [13], bacterial keratitis [14], and swimmer ear infections [15].…”

“…Resistance to the different classes of antibiotics by P. aeruginosa is due to the loss or reduced copy numbers of oprD and overproduction of active efflux pumps, AmpC β-lactamase and extended-spectrum β-lactamases and their resistance mechanism are classified as intrinsic, acquired, and adaptive [6]. In Nepal, the increasing trend of antimicrobial-resistance bacteria in both clincal and nonclinical settings [11,12,[20][21][22][23][24][25][26] is becoming an alarming health issue. ere is no exact observable scheme for marking antibiotic resistance patterns and their use in Nepal.…”