Multidrug resistant Enterobacteriaceae and extended spectrum β-lactamase producing Escherichia coli: a cross-sectional study in National Kidney Center, Nepal

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.

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“…This accords with other studies [21, 22, 24, 28-34]. However, discords with following studies [35-38]. …”

Section: Discussionsupporting

confidence: 80%

“…The findings are in agreement with the study [11], however, contrary to the findings of other study [47] of 365 E. coli isolates, 33 (9.0%) were ESBL producers. This accords with the other studies [33, 35, 41, 48], however, discords with following studies [22, 24, 29-32, 36-38]. Likewise, of 20 Klebsiella spp.…”

Section: Discussionsupporting

confidence: 76%

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

Shakya¹,

Shrestha²,

Maharjan³

et al. 2017

TOMICROJ

108

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“…Misappropriation of antibiotic is liable for the higher incidence of antibiotic resistance among bacteria(Neupane et al, 2016). In this study, 65% E. coli isolates were multidrug resistant which are in agreement with a number of studies, 95.52%(Yadav et al, 2015), 73.68%(Thakur et al, 2013), 57.3%(Nairoukh et al, 2018) and 40.7% isolates in Tehran(Ghadiri et al, 2014). In this study, E. coli isolates exhibited variable rates of susceptibility and resistance to 10 different types of antibiotics.…”

supporting

confidence: 90%

“…In this study, E. coli isolates exhibited variable rates of susceptibility and resistance to 10 different types of antibiotics. The highest percentage of resistant to CEX (89.1%) and Jena et al, 2017), 7.37%(Yadav et al, 2015), 22% isolates of E. coli…”

mentioning

confidence: 94%

Detection of Metallo-?-Lactamasesencoding Genes Among Clinical Isolates of Escherichia Coli in a Tertiary Care Hospital, Malaysia

Fazlul¹,

Najnin²,

Yasmin³

et al. 2019

IJPR

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The multidrug resistant Escherichia coli strains causes multiple clinical infections and has become a rising problem globally. The metallo-β-lactamases encoding genes are very severe in gram-negative bacteria especially E. coli. This study was aimed to evaluate the prevalence of MBLs among the clinical isolates of E. coli. A total of 65 E. coli isolates were collected from various clinical samples of Malaysian patients with bacterial infections. The conventional microbiological test was performed for isolation and identification of E. coli producing MBLs strains in this vicinity. Multidrug Resistance (MDR) of E. coli isolates were assessed using disk diffusion test. Phenotypic methods, as well as genotypic-PCR methods, were performed to detect the presence of metallo-β-lactamase resistance genes (blaIMP, blaVIM) in imipenem resistant strains. Out of 65 E. coli isolates, 42 isolates (57.3%) were MDR. The isolates from urine (19) produced significantly more MDR (10) isolates than other sources. Additionally, 19 (29.2%) imipenemresistant E. coli isolates contained 10 MBLs gene, 7(36.8%) isolates contained blaIMP and 3(15.7%) isolates contained blaVIM genes. This study revealed the significant occurrence of MBL producing E. coli isolates in clinical specimens and its association with health risk factors indicating an alarming situation in Malaysia. It demands an appropriate concern to avoid failure of treatments and infection control management.

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“…Chander and Shrestha from nearby hospital reported the ESBL prevalence rate to be 13.5% [18] whereas, recently, Neupane et al have reported 33.2% of ESBL producers in their study [19]. Similarly, Ansari et al [20], Khanal et al [21], Pokhrel et al [10], Yadav et al [22], and Pant et al [23] have reported 24%, 25%, 25.8%, 26.8%, and 31.3% ESBL producers, respectively. These findings correlated well with those of our study.…”

Section: Discussionmentioning

confidence: 99%

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

Parajuli

Maharjan

Joshi

et al. 2016

BioMed Research International

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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.

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Multidrug resistant Enterobacteriaceae and extended spectrum β-lactamase producing Escherichia coli: a cross-sectional study in National Kidney Center, Nepal

Cited by 78 publications

References 20 publications

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

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

Detection of Metallo-?-Lactamasesencoding Genes Among Clinical Isolates of Escherichia Coli in a Tertiary Care Hospital, Malaysia

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

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