Abstract
Objective: The aim of present study was to determine the prevalence of Extended Spectrum Beta Lactamase (ESBLS) mediated resistance among Escherichia coli and klebsiella pneumoniae in clinical sample and their Antimicrobial Resistance (AMR) Pattern, and also to compare chromogenic agar and combined disc diffusion method in identification of these enzymes in routine clinical laboratories.
Materials and Methods: A total of 2640 patient were referred from different OPD and IPD were included in study. From all the patients 2640 clinical specimens like Urine, Pus, CSF, Sputum, Wound swab, discharge from fistula, peritoneal, aspiration, fluid were received in sterilized container by aseptic methods. Any Medical, surgical and drug history were noted. Isolation and Identification of Micro-organism were carried out by Gram’s staining culture character, motility and by standard biochemical procedures according to CLSI guidelines. Antimicrobial susceptibility tests was done by Kirby - baur disc diffusion method. Resistance to at least one of the antibiotics (cephalosporin) was considered as positive in the screening test for possible ESBL production. Isolates of E. Coli and Kl. pneumoniae that were considered to be positive for ESBL production by screening tests were subjected to combined disc diffusion methods and Isolated were also tested for chromogenic ESBL Agar. All the test were performed according to CLSI 2017 guidelines and all the Media, biochemical reagents and Antimicorbial disc are supplied by Hai Media (Mumbai).
Result: Out of 2640 clinical specimens 165 Isolates were isolated. Escherichia coli were obtained predominantly from Urine (94.1%) samples, where as klebsiella pneumoniae, isolates were obtained from sputum (46.2%), the screening test for ESBL production, 78 (42.47%) isolates were found to be resistant to at least one of the cephalosporins disc. Out of 78 isolates that were positive in the screening test, ESBL production was confirmed by combined Disc diffusion method in 62 (79.48%) isolates. ESBL producers were isolated from Urine (33.78%), sputum (80%) and pus (57.14%). ESBL E. coli were predominantly isolated from Urine samples (92%), whereas ESBL-KP were isolated from sputum samples (62.5%), conformation of ESBL positive organism by combined disc diffusion method, E. coli and Klebsiella Spp. Showed Maximum ESBLS production in CTX & CEC combination. Out of 78 isolates that were positive in the screening test, ESBL production was confirmed by chromogenic ESBL Agar in 77 (98.71%) isolates.
Conclusion: Good infection control practices and antibiotic management interventions are instrumental in preventing the emergence of outbreaks due to ESBL producing isolates, especially in high risk areas such as the medical ICU, pediatric wards and surgical wards. Clinical microbiology laboratories need not only use proper phenotypic testing methods but they also need to implement molecular detection protocols. Furthermore, the vigilant surveillance and appropriate infection control programme must be implemented in each hospital setting.
Keywords: Escherichia coli, klebseilla spp, ESBL, Agar, Antimicorbial agent, prevalence.
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Corresponding Author
Dr Satyendu Sagar
Assistant Professor, Department of Microbiology, Nalanda Medical College, Patna, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i9.02
