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Category: Volume 06 Issue 04 April 2018
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Title: Antimicrobial resistance pattern of ESBLs producing uropathogenic E. coli (UPEC) in hospitalized patients from a tertiary care hospital of central India

Authors: Dr Arvind Khodare, Dr Manish Purohit, Dr Anita Mutha

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.131

Abstract

Detection of ESBLs producing organisms from samples such as urine represents an epidemiologic marker of colonization. Thus the present study was aimed to know the antimicrobial resistance pattern among ESBL producing urinary isolates of E. coli which will helps in deciding empiric antibiotic therapy and identifying measures to reduce increasing resistance trends. 106 consecutive non repeating uropathogenic E. coli included in the study. All specimens were cultured using a calibrated loop. Identification of E. coli was done by standard biochemical tests. Antimicrobial susceptibility testing was done by Kirby-Bauer’s disc diffusion method, isolates were screened for ESBLs production and confirmation by combination disk method as per CLSI 2014 guidelines. E. coli ATCC 25922 and Klebsiella pneumonia ATCC 700603 were used as a negative control and positive control respectively. Out of 106 uropathogenic E. Coli, 99(93.4%) strains identified by ESBL screening and 48 (45.2%) were confirmed for ESBLs production. Minimum resistance to Imipenem (1%) followed by Meropenem (2%) and Nitrofurantoin (4%), and maximum resistance to Piperacillin(100%) followed by Cefipime (96%), Ciprofloxacin (96%) and Norfloxacin (91%) were seen. Thus Imipenem followed by Nitrofurantoin and Amikacin remains the drug of choice for ESBL producers with the highest sensitivity depending on severity and risk factors.

Keywords: HAI, UTI, beta-lactamase.

References

  1. Khodare A, Mutha A, Purohit M. Prevalence of extended-spectrum β-lactamases producing Escherichia coli in urinary specimens and their phenotypic detection by modified three-dimensional enzyme extract tesh: Comparison with the Phenotypic confirmatory disc diffusion test. Indian J Microbiol Res 2017;4(3):244-247.
  2. Foman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Dis Mon 2003;49:53-70.
  3. Stamm WE. Scientific and clinical challenges in the management of urinary tract infections. Am J Med 2002; 113:1S–4S.
  4. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the Microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24:584–602.
  5. Pfaller MA, Jones RN. MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) results from the Americas: resistance implications in the treatment of serious infections. J Antimicrob Chemother; (2000) 46 (Suppl):25–37.
  6. Goossens H. (MYSTIC) Meropenem Yearly Susceptibility Test Information Collection) results from Europe: comparison of antibiotic susceptibilities between countries and centre types. J Antimicrob Chemother; (2000).(46 (suppl):39–52.
  7. Monica Österblad, Antti Hakanen, Raija Manninen, Tiina Leistevuo, Reijo Peltonen, Olli Meurman et al. A between species comparison of antimicrobial resistance in enterobacteria in fecal flora. J Antimicrob Agents Chemother. 2000 Jun; 44(6): 1479–1484.
  8. Performance Standards for Antimicrobial Susceptibility Testing, Twenty fourth Informational Supplement, CLSI Document M100-S24, Wayne, PA: Clinical and Laboratory Standards Institute, 2014 .
  9. Nathisuwan S, Burgess DS, Lewis II JS. ESBLs : Epidemiology, Detection and Treatment. Pharmacotherapy 2001;21(8): 920-928.
  10. Jacoby GA, Sutton L. (1991) Properties of plasmids responsible for production of extendedspectrum β-lactamases. Antimicrob Agents Chemother 35: 164-69
  11. Chessbrough, M 2006, District laboratory practice in tropical countries, Part-2, Newyork, USA: Cambridge university. pp. 105-115.
  12. Hsueh PR, Hoban DJ, Carmeli Y, Chen SY, Desikan S, Alejandria M et al. Consensus review of the epidemiology and appropriate antimicrobial therapy of complicated urinary tract infections in Asia-Pacific region. J. Infect. 2011 Aug; 63(2): 114-23.
  13. Ravinder Pal Singh, Sonali Jain, Amit Kumar Singh, Nikunj Gupta,. Dinesh Kumar. 1 and Hitesh Bhatt. Comparative study of ESBL producing Escherichia coli in OPD and IPD patients of urinary tract infections. J.Curr.Microbiol.App.Sci (2013) 2(12): 45-50
  14. Bedenic, B., N. Beader, and Z. Zagar. 2001. Effect of inoculum size on the antibacterial activity of cefpirome and cefepime against Klebsiella pneumonia strains producing SHV extended-spectrum beta-lactamases. Clin. Microbiol. Infect. 7:626–635.
  15. Padmini S B, Raju B A, Mani K R. Detection of Enterobacteriaceaeproducing CTX-M extended spectrum β-lactamases from a tertiary care hospital in south India. Indian J Med Microbiol 2008;26:163-6
  16. Metri Basavaraj C., Jyothi P., Peerapur Basavaraj V. The Prevalence of ESBL among Enterobacteriaceae in a Tertiary Care Hospital of North Karnataka, India. Journal of Clinical and Diagnostic Research. 2011 June, Vol-5(3): 470-475
  17. Sharma S, Bhat GK, Shenoy S. Virulence factors and drug resistance in Escherichia coli isolated from extraintestinal infections. Indian J Med Microbiol.2007 Oct; 25(4):369-73
  18. Livermore DM, Hawkey PM. CTX M Changing The Face Of ESBLs in UK. J Antimicrob Chemother.2005;56:451–4.
  19. Priyadharsini RI, Kavitha A, Rajan R, Mathavi S, Rajesh KR. Prevalence of bla CTX MExtended Spectrum Beta Lactamase Gene in Enterobacteriaceae from Critical Care Patients. J Lab Physicians. 2011 Jul-Dec; 3(2): 80–83
  20. Singh S., Kumar S., Sandhu R., Devi R. and Yadav A.K.Prevalence of drug resistance in ESBL producing Escherichia coli causing UTI in rural tertiary care hospital from Haryana, India. International Journal of Basic and Applied Medical Sciences 2015 Vol. 5 (3) September-December, pp. 1-7.
  21. Kumar D, Singh AK, Ali MR, Chander Y. Antimicrobial Susceptibility Profile of Extended Spectrum β-Lactamase (ESBL) Producing Escherichia coli from Various Clinical Samples. Infectious Diseases: Research and Treatment 2014:7 1–8 doi:10.4137/IDRT.S13820
  22. Livermoore DM and Paterson DL (2006). Pocket Guide to Extended Spectrum Β-Lactamases in Resistance (New Delhi: Springer (India) Private Limited).
  23. Sasirekha, B, Manasa, R, Ramya, P, and Sneha, R, 2010, Frequency and Antimicrobial Sensitivity Pattern Of Extended Spectrum β-Lactamases Producing coli And Klebsiella Pneumoniae Isolated In A Tertiary Care Hospital, Al Ameen journal Medical science, vol.3, no.4, pp. 265-271.
  24. Eshwar Singh, M. Veena, K.G. Raghukumar, G. Vishwanath, P.N. Sridhar Rao and B.V. Murlimanju. ESBL production: resistance pattern in Escherichia coli and Klebsiella pneumoniae, a study by DDST method. International Journal of Applied Biology and Pharmaceutical Technology Volume: 2: Issue-4: Oct - Dec -2011
  25. H Ejaz, K ul-Haq, A Zafa, S Mahmood, MM Javed. Urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumonia. AJB 10(73), pp. 16661-16666, 21 November, 2011
  26. Nair T Bhaskaran, Bhat G Kishore, Pai Vidya, Shantharam Manjula. Extended spectrum β-lactamases (ESBL) in uropathogenic escherichia coli, prevalence and susceptibility pattern in a south indian city. IJRAP 2011, 2(6), 1756-1757.

Corresponding Author

Dr Manish Purohit

Associate Prof, Microbiology, MGM Medical College, Indore

Mob: 8109671170, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.