Title: Prevalence of ESBL Producing Enterobacteriaceae in Patients with UTI in A Rural Tertiary Care Hospital

Authors: Priyanka Kumari, Dr Nilesh Chavan, Dr Babli Basu, Dr Prashant Peshattiwar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.223

Abstract

Background and Objective: Urinary tract infection (UTI) is the most common bacterial infection in human population leading to significant morbidity and health care costs. Expanded spectrum beta lactamase producing enterobacteriaceae hydrolyse expanded spectrum cephalosporins like ceftazidime, cefotaxmie. They play a significant role in UTI primarily in hospital admitted patients causing morbidity and mortality all over the world. Appropriate diagnosis and treatment are always challenging. An attempt was made to study retrospectively in the Department of Microbiology, Index Medical College about the prevalence of ESBL producing uropathogens belonging to enterobacteriaceae, isolated from patients with suggestive symptoms of urinary tract infection.

Method: Urinary isolates from symptomatic UTI cases were identified by conventional methods. A total of 1244 enterobacteriaceae isolated during October 2015 to October 2017. Antimicrobial susceptibility testing was done by Kauber-Bauer Disc Diffusion method following CLSI guidelines. Isolates resistant to cefotaxime (<_19mm) were tested for ESBL production by double disc synergy method.

Result: The most common isolated species was E.coli 943(76%) followed by Klebsiella spp. 227(18%) and other enterobacteriaceae 74(6%). Of all enterobacteriaceae, 673 (57%) among 1244 were ESBL producer. ESBL production was detected in 564(84%) E.coli, 92(14%) Klebsiella spp. and other enterobacteriaceae17(2%). More than 90% of the isolates were sensitive to amikacin, cefoperazone-sulbactam, imipenem and 36% isolates were sensitive to norfloxacin.

Conclusion:  In the present study a large number of uropathogens were found to be ESBL producer. Monitoring ESBL production and antimicrobial susceptibility testing are necessary to avoid treatment failure in patients with urinary tract infection.

Keywords: Antibiotic susceptibility, ESBL, Urinary tract infection, Uropathogens.

References

  1. Kunin CM. Urinary tract infections in females. Clin Infect Dis 1994;18:1-12.
  2. Goussard S, Courvalin P. Updated sequcence information for TEM beta lactamase genes. Antimicrob Agents Chemother 1999;43:367-370.
  3. Bush K, Jacoby GA. An updated functional classification of β- lactamases. Antimicrob Agents Chemother 2010;54: 969-976.
  4. Patricia AB. Extended-spectrum β- lactamase in the 21st century: characterization, epidemiology and detection of this important resistance therat. ClinMicrobiol Rev 2001;14:933-51.
  5. Mehrgan H, Rahbar M. Prevalence of extended-spectrum beta- lactamase producing Escherichia coli in a teriary care hospital in Tehran, Iran. Int J Antimicrob Agents 2008;31:1471-1451.
  6. Farrell DJ, Morrissey I, De Rubeis D, Robbins M, Felmingham D. A UK multicentre study of the antimicrobial susceptibility of the bacterial pathogen causing urinary tract infection. J Infect 2003;46:94-100.
  7. Mathai D. Jones RN ,Pfaller MA, SENTRY Participant Group North America. Epidemiology and frequcency of resistance among pathogens causing urinary tract infections in 1,510 hospitalized patients. A report from the SENTRY Anyimicrobial Surveillance Programme (North America). Diagn Microbiol Infect Dis 2001;40:129-36.
  8. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC, editors. The Enterobacteriaceae. In: Color atlas & text book of diagnostic microbiology, 5th Philadelphia: JB Lippincott Co. 1997 p.171-230.
  9. Bauer AW, Kirby WMM, Sherris JC, Tuck M. Antibiotic susceptibility testing by a standardized single disc method. Am J ClinPathol 1966;45:493-6.
  10. National Committee for Clinical Labora-toty Standards. Performance standards for antimicrobial disk susceptibility test, 7th Approved standards, NCCLS Document M2-A7, Vol:20 No1; Wayne PA. 2000.
  11. Jarlier V, Nicolas M, Fournier G, Philippon A. Extended spectrum β-lactamase conferring transferable resistance to newer β-lactam agents in Enterobacteriaceae: Hospital prevalence and susceptibility patterns. Rev Infect Dis 1988;10:867-78.
  12. Grubenberg GN. Antibiotic sensitivities of urinary pathogens:1979-1982. Antimicrob Chemother 1984;14:17-23.
  13. Thomson KS. Controversies about exten-ded spectrum and Amp C β- lactamases. Emerg Infect Dis 2001;7:333-6.
  14. Chaudhary U, Aggrawal R. Extended spectrum β- lactamases (ESBL)- An emerging threat to clinical therapeutics. India J Med Microbiol 2004;22:75-80.
  15. Gunti R, Arava DR and Ramana KV. Prevalence of Extended spectrum β lactamases among Escherichiacoli and Klebsiellapneumoniae in and around Kakinada, Andhra Pradesh, India. J Pharm Biomed Sci 2014;04:773-775.
  16. Selvakumar BN and Jasmine R. Antibiotic susceptibility of ESBL producing urinary isolates at a tertiary care hospital in Tiruchirappalli, South India. J Med Sci 2007;7:443-446.
  17. Babypadmini S, Appalaraju B. Extended spectrum β- lactamases urinary isolates of Escherichia coli and Klebsiella pneumoniae- Prevalence and Susceptibility pattern in a tertiary care hospital. Indian J Med Microbiol 2004;22:172-174.
  18. Tankhiwale SS, Jalgaonkar SV, Ahamad S and Hassani U. Evaluation of extended spectrum β lactamase in Urinary isolates. Indian J Med Res 2004;120:553-556.
  19. Subha A, Ananthan S. Extended -Spectrum β-lactamase (ESBL) mediated resistance to third generation cephalo-sporin among Klebsiellap neumoniae in Chennai. Indian J Med Microbiol 2002;20:92-5.
  20. Wattal C, Sharma A, Oberoi JK, Datta S, Prasad KJ, Raveendr R. ESBL- An emerging threat to antimicrobial therapy. Microbiology NewsletterSir Ganga Ram Hospital ,Vol 10. No. 1:1-8.
  21. Kumar MS, Lakshmi V and Rajagopalan R. Occurrence of Extended spectrum β-lactamase among Enterobacteriacae spp. Isolated at a tertiary care Institute. Indian J Med Microbiol 2006; 24(3):208-11.
  22. Mandal P, Kapil A, Goswami, Das B and Dwivedi SN. UropathogenicEscherichia coli causing urinary tract infections. Indian J Med Res 2001;114:207-211.
  23. Shaky P, ShresthaD, Maharjan E, Sharma KV and Paudyal R. ESBL Production Among coli and Klebsiella spp. Causing UrinaryTract Infection: A Hospital Based Study. The open Microbiol J 2017;11-23-30.
  24. Hassan AS, Jamal AS and Kamal M.Occurrence of Multidrug resistant and ESBL producing colicausing urinary tract infections. J. basic appl. sci. 2011; 7(1):39-43.
  25. Tillekeratne GL, Vidanagama D, Tippalagama R, Lewkebandara R, Joyce M, Nicholson PB, Nagahawatte A, Bodinayake KC, De Silva DA, and  Woods WC. Extended-spectrum ß-Lactamase-producing Enterobacteria-ceaeas a Common Cause of Urinary TractInfections in Sri Lanka. Chemother 2016;48:160-165.
  26. Somashekara CS,Deepalaxmi S, Jagannath N, Ramesh B, Laveesh RM, Govindadas D. Retrospective analysis of antibiotic resistance pattern tourinary pathogens in a tertiary care hospital in South. J. Basic and ClinPharam2014;5:105-108.
  27. Metri Basavaraj C., Jyothi P., Peerapur Basvaraj V. The Prevalence of ESBL among Enterobacteriaceae in a tertiary care hospital of North Karnataka, India. J Clin and Diag. Res 2011;5:470-475.

Corresponding Author

Dr Nilesh Chavan

Associate Professor, Department of Microbiology,

Index Medical College, Hospital and Research Centre, Indore, Madhya Pradesh

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No: 9893095985