IJCRR - 5(11), June, 2013
INCREASING PREVALENCE OF EXTENDED SPECTRUM BETA LACTAMASES (ESBLS) PRODUCING E.COLI AND KLEBSIELLA SPP IN OUTPATIENT DEPARTMENTS (OPDS) PATIENTS IN URINARY TRACT INFECTIONS (UTIS) IN TERTIARY CARE HOSPITAL
Author: Gopal Kashyap, Sweta Gupta, Ved Prakash Mamoria, Pushpa Durlabhji, Dinesh Jain
Background: Extended-spectrum β-lactamases (ESBLs) are plasmid-mediated group of fast growing enzymes synthesized by the Gram negative bacteria that are causing medicinal crisis. At present, ESBLs has been increasing as a serious pathogen having the property multidrug resistance. So, The present study was undertaken to find out the prevalence of ESBLs positive E. coli and Klebsiella in urinary isolates obtained from various In-patient Departments (IPDs) , Outpatient Departments (OPDs) and Intensive Care units (ICUs). Methods: Processing of 251 non- repetitive urine samples received during a period of about one year for detection of ESBLs positive Escherichia coli and Klebsiella spp. was done. All suspected isolates of ESBLs producers were confirmed by the Double Disc potentiating discs test, Double disc synergy test and E-Test. Results: Out of Two fifty one urinary isolates of Escherichia coli and Klebsiella spp. 93 (37.1%) were confirmed as ESBLs producers and 158(62.9%) were non ESBL producers by all the three tests of confirmation. 61 out of 93 (65.6%) were from OPDs and in all IPDs maximum ESBLs producing urinary isolates were obtained from Medicine wards 12/93 (12.9%). Conclusion: Results indicate that now ESBL producers are increasing in community. So, routine ESBL detection should be made mandatory not only in indoor patient but also in outdoor also. Appropriate use of third generation cephalosporins must be encouraged to reduce the risk of multidrug resistant bacteria and to make an antibiotic policy.
Keywords: Extended-spectrum ?-lactamases, Gram negative bacteria, E. coli
Gopal Kashyap, Sweta Gupta, Ved Prakash Mamoria, Pushpa Durlabhji, Dinesh Jain. INCREASING PREVALENCE OF EXTENDED SPECTRUM BETA LACTAMASES (ESBLS) PRODUCING E.COLI AND KLEBSIELLA SPP IN OUTPATIENT DEPARTMENTS (OPDS) PATIENTS IN URINARY TRACT INFECTIONS (UTIS) IN TERTIARY CARE HOSPITAL International Journal of Current Research and Review. 5(11), June, 87-93
1. Nachimuthu R ,Chethpalayam SS,Balasubramanium V,Ravichandran Palamappam K,Kannan VR.,2008.Urinary tract Infection and Antimicrobial susceptibility patternof Extended Spectrum Beta Lactamase producing Clinical isolates,Adv in Biol Research.,2(5-6):78- 82.
2. Bailey and Scott?s Diagnostic Microbiology.12th Edition .
3. Walter E. Stamm, Urinary Tract Infection,Pyelonephritis,and Prostatitis. Harrison’s Principle of Internal Medicine.17th Edition(Vol 2):1820-1827
4. Paterson, D.L., W.C. Ko, Von Gottberg, et al., 2001.Outcome of cephalosporin for serious infection due to apparently susceptible organisms producing extended spectrum Beta-lactamases: implications for the clinical microbiology laboratory, J.Clin Microbiol.,39:2206-2212.
5. Knothe H, Shah P,Kremery V et al.(1983).Transferable resistance to cefotaxime,Cefoxitin,Cefamandole and Cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens.Infection II(6):315-317
6. Quinn JR,Miyashiro D,Sahm D et al.Novel plasmid-mediated beta-lactamase (TEM10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae.Antimicrob Agents Chemother 1989;33:1451-6.
7. Jacoby GA ,Medeiros AA,O Brien TF, et al. Broad spectrum transferable beta lactamases.N Eng J Med 1988;319:723-4
8. Phillipon A,Arlet B,Jacoby GA.2002.Plasmid-Determined AmpC-Type β-Lactamases.Antimicrob Agents Chemother.,2002;46:1-11.
9. Matsumoto, Y., and M. Inoue. 1999. Characterization of SFO-1, a plasmidmediated inducible class A beta-lactamase from Enterobacter cloacae. Antimicrob. Agents Chemother. 43:307-31.
10. Rosenthal VD, Maki DK, Jamulitrat S, et al. International Nosocomial Infection Control Consortium report ,data summaryfor2003-2008,issued June 2009.Am J Infect Contr2010;38:95-106.
11. Jerome Fennell, Akke Vellinga et al (2012) “Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: an observational study”; BMC Infectious Diseases 2012, 12:116
12. Babypadmini S, Appalaraju B. Extendedspectrum β-lactamases in the urinary isolates of Escherichia coli and Klebsiella pneumoniae – prevalence and susceptibility pattern in a tertiary care hospital. Indian J Med Microbiol 2004; 22(3): 172-74.
13. Tada Dharmishtha G, Gandhi Paragi J, Patel Kiran N.A study on antibiotic related resistance in UTI patients: a comparison between community acquired and hospital acquired E. Coli. National Journal of Community Medicine. Vol 3 Issue 2 AprilJune 2012 Page 255.
14. Subha A, Ananthan S. Extended-spectrum β-lactamase (ESBL) mediated resistance to the third generation cephalosporins among Klebsiella pneumoniae in Chennai. Indian J Med Microbiol 2002; 20:92-95
15. Joseph Gangoue P, Branka bedenic et al . Extended spectrum β-lactamases producingEnterobacteriaceae in Yaunde,Cameroon.J Clin Microbio,july 2005,3273-77.
16. Ananthan S, Subha A. Cefoxitin resistance mediated by loss of porin in clinical strains of Klebsiella pneumoniae and Escherichia coli. Indian J Med Microbio, (2005) 23(1):20-23
17. MS Kumar, V Lakshmi, R. Rajagopalan. Occurrence of Extended –spectrum β- lactamases among Enterobacteriaceae ssp. Isolated at a tertiary care institute. Indian J Med Microbio, (2006) 24(3): 208-211
18. Shila Jalalpour (2011) “ Survey frequency of extended spectrum beta-lactamases (ESBLs) in Escherichia coli and Klebsiella pneumonia strains isolated from urinary tract infection in Iran”; African Journal of Microbiology Research vol 5(22) pp. 3711- 3715, 16, December 2011.
19. Husam S. Khanfar, Khalid M. Bindayna, Abiola C. Senok, and Giuseppe A. Botta. Extended spectrum beta-lactamases (ESBL) in Escherichia coli and Klebsiella pneumoniae: trends in the hospital and community settings. J Infect Dev Ctries 2009; 3(4):295-299.
20. S. Meier, R Weber et al “Extendedspectrum β-lactamase-producing gramnegtive pathogens in community acquired urinary tract infections: an increasing challenge for antimicrobial therapy”; Infection(2011) 39:333-340.
21. Shakti Rath, Debasmita Dubey , Mahesh C. Sahu,et al.Surveillance of multidrug resistant Escherichia coli in a hospital in India.
22. Agrawal P, Ghosh A N, Kumar S, Basu B, Kapila K. Prevalence of extended-spectrum β-lactamases among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital. Indian J Pathol Microbiol 2008;51:139-42
23. Chaudhary, U, Aggarwal, R.Extended spectrum beta lactamases(ESBL)- An emerging threat to clinical theraputics, Indian Journal of Medical Microbiology,2004;.22(2): 75-80.