Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae from companion animals and horses and their putative impact on public health (original) (raw)

Extended spectrum beta-lactamases (ESBL) in Escherichia coli and Klebsiella pneumoniae: trends in the hospital and community settings

The Journal of Infection in Developing Countries, 2009

Background: To assess the prevalence of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella strains in nosocomial and community-acquired infections. Methodology: The study was conducted at a centralized microbiology laboratory in the Eastern Province of Saudi Arabia. Laboratory records (January 2004-December 2005) were assessed. Associated resistance to a panel of antibiotics was determined. Results: A total of 6,750 Gram-negative organisms were assessed for ESBL-phenotype. ESBL was detected in 6% (409/6,750) of isolates, the majority of which were E. coli (83%). ESBL producers were significantly higher among isolates from in-patients 15.4% (143/927) versus outpatients (4.5%; 266/5,823); p < 0.05. Old age (older than 60 years) represented a significant risk for having an ESBL-producing pathogen. Urine was the major source of ESBL isolates in in-patients (46.1%) and outpatients (74.4%). The proportion of urinary E. coli isolates which were ESBL producers was significantly higher among in-patients (53/506; 10.4%) compared to outpatients (182/4,074; 4.4%); p < 0.05. Among in-patients, 60% of the ESBL associated infections were nosocomial. All were sensitive to imipenem but high levels of resistance to gentamicin, amikacin, amoxicillin-clavulanic acid and ciprofloxacin was shown. Conclusion: The findings document evidence of the spread of multiresistant ESBL-producers into the community. This has significant implications for patient management, and indicates the need for increased surveillance and molecular characterization of these isolates.

Multivariate analysis of risk factors for ESBL and AmpC producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care Hospital in Karnataka: A case control study

IP Innovative Publication Pvt. Ltd., 2018

Introduction: Extended spectrum β-lactamase (ESBL) and AmpC producing organisms pose unique challenges to clinical microbiologists, clinicians, infection control professionals. The objective of the present study was to analyze the risk factors that will help in identifying those at risk of acquiring infection by ESBL and/or AmpC producing organisms thereby making appropriate changes in the choice of antimicrobial therapy and minimizing treatment failures. Materials and Methods: Risk factors were evaluated using a retrospective Case control design. 100 patients with infections due to ESBL and/ or AmpC producing E.coli or K. pneumoniae were employed as cases. These were matched with 100 patients with non ESBL- non AmpC producing organisms (Controls). Univariate and Multivariate logistic regression analysis was performed to identify variables associated with becoming a case. Results: Out of the total 100 cases, E.coli 61 (61%) was the predominant ESBL and/or AmpC producer, followed by Klebsiella pneumonia 39 (39%). In the multivariate analysis, we found that duration of hospital stay for more than 5 days (OR=0.16, P=0), stay in ICU (OR=2.98, P=0.02) and prior treatment with antibiotics (OR=2.81, P=0.003) were statistically significant risk factors associated with acquisition of ESBL/AmpC producers. We also found invasive procedures like usage of urinary catheter (OR=3.34, P<0.005), central venous catheter (OR=3.35, P=0.018), intravenous catheter (OR=7.38, P<0.005) and other surgical procedures (OR=3.14, P=0.0002) contributed significantly to the spread of ESBL/AmpC producers. Conclusion: ESBL and AmpC producing strains were found to show higher rates of resistance to various class of antibiotics when compared to non ESBL and AmpC producers. Knowledge on risk factors of infection helps physicians in framing appropriate empirical antibiotic policies. Keywords: AmpC resistance, Case control, Extended spectrum beta lactamases, Risk factors.

The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae among clinical isolates from a general hospital in Iran

Acta Microbiologica et Immunologica Hungarica, 2009

This study was conducted at a 900+ bed general teaching hospital, from May to September 2007, in Iran. The aim of this study was to determine the prevalence of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae and their antimicrobial pattern. The Kirby-Bauer disk diffusion method and the phenotypic disk confirmatory test were performed for each isolate. The total of 206 isolates including 106 E. coli and 100 K. pneumoniae were collected of which 122 isolates (59.2%) were ESBL positive. The prevalence of ESBL-producing strains was 59.2% (122/206). All the isolates were susceptible to imipenem. Among the ESBLproducing isolates, the sensitivity was from 3.3% to 61.5% for ampicillin to aztreonam. From female isolates (136), 59.5 % and from male isolates (70), 58.6% were ESBL-producers. Ratios of isolates from hospitalized patients to out-patients were 94/28 in the ESBL-producing group. The number of ESBL-producing isolates according to the isolation sites showed a significant difference between ESBL-producers and non producers in blood samples (P <0.05). This study shows that the prevalence of ESBL strains in Iran is high. It seems necessary for clinicians and medical community personnel to be fully aware of ESBL-producing microorganisms.

Extended spectrum beta-lactamase producing Escherichia coli in animals: do we have to face new emerging multiresistant clones?

Background : Extended spectrum ß Lactamases (ESbL) producing Escherichia coli (Ec) and Klebsiella pneumoniae (KP) has increased in recent years leading to limitations of treatment options. The present study was undertaken to determine the prevalence of ESbL production among nosocomial isolates of Ec and KP and their impact on clinical outcome Methods : One hundred and one isolates of Ec and KP obtained from patients hospitalized for > 48 hours were included in the study. They were tested for ESbL production by double disc synergy test (ddST) and E test . coresistance to fluoroquinolones, aminoglycosides , trimethoprim -sulphamethoxazole, aztreonam and ß lactamase inhibitor combinations and susceptibility to carbapenems were determined by disc diffusion method. Production of Ampc was screened using cefoxitin discs. They were designated as colonizers or pathogens using clinical data and laboratory parameters. risk factors assessed were variables related to hospital stay and antibiotics used. The outcome was followed up.

ESBL-Producing E.Coli and Klebsiella among Patients Treated at Minia University Hospitals

Journal of Ancient Diseases & Preventive Remedies

Background: Extended spectrum beta-lactamases (ESBLs) are group of bacteria producing enzymes which can destroy one or more antibiotics. ESBL producing organisms are resistant to many types of antibiotics which would normally be used to treat such infections thus considered as multi-drug resistant (MDR). The emergence and spread of ESBL is a public health threat as it is usually associated with an increase of morbidity, mortality and healthcare costs. Aim of the work: Detecting the prevalence of nosocomial infections caused by ESBL-producing E.coli and Klebsiella species among patients treated at Minia University Hospitals. Methods: Eighty-five isolates from nosocomial infections at Minia university hospital due to E.coli and klebsiella species were screened for ESBL production phenotypically and by PCR Results: Out of 85 isolates causing nosocomial infections at Minia university hospitals during the period of April 2014-April 2015, the prevalence of E.coli was 52 isolates (61.1%) while Klebsiella spp. was 33 isolates (38.9%). The prevalence of ESBL among all the isolates of E.coli and Klebsiella species was 32.8% (28/85); with a prevalence of 16.4% among E.coli and 16.4% among Klebsiella spp. Isolates. Conclusions: The prevalence of ESBL in Minia University Hospitals was 32.8% among the nosocomial infections. The predictors for the nosocomial acquired ESBL-EK infections were; old age, long hospital stay, mechanical ventilation, diabetes mellitus and prior antibiotics intake.

ESBL-producing Escherichia coli and Klebsiella pneumoniae at a tertiary care hospital in Saudi Arabia

The Journal of Infection in Developing Countries, 2014

Introduction: The increasing frequency and antibiotic resistance among extended-spectrum β-lactamases (ESBLs)-producing bacteria are posing a serious threat. This study sought to investigate the frequency and antibiotic susceptibility of ESBL-producing E. coli and K. pneumoniae at a tertiary care hospital. Methodology: Data were collected from samples sent to the microbiology laboratory between 2006 and 2010 at King Khalid University Hospital, Riyadh. ESBLs were confirmed using Etest strips of cefotaxime/cefotaxime + clavulanic acid, ceftazidime/ceftazidime + clavulanic acid, and cefepime/cefepime + clavulanate. Results: Out of 17,105 samples, 1,076 (6.3%) ESBL-producing isolates of E. coli (808) and K. pneumoniae (268) were confirmed. Among these, 680 (63.2%) isolates were found in urine samples, followed by 287 (26.7%) in superficial swabs, deep wounds swabs, tissues and sterile body fluids, 71 (6.6%) in respiratory, and 38 (3.5%) in blood samples. The overall frequency rates of ESBL E. coli and K. pneumoniae were 6.6% and 5.5%, respectively. The frequency of ESBL-producing E. coli and K. pneumoniae increased significantly during the study period. E. coli resistance against cotrimoxazole was 71.1%, followed by ciprofloxacin (68.2%) and gentamicin (47%). Similarly, 62.7% of K. pneumoniae isolates were resistant to gentamicin, 59.5% to cotrimoxazole, and 49.8% to ciprofloxacin. There was no statistically significant change in antimicrobial resistance over the study period. Conclusions: Although the frequency rates of ESBL-producing E. coli and K. pneumoniae increased, no change in the anti-microbial susceptibility was observed over the study period.

Prevalence and Risk Factors associated with Extended Spectrum Beta Lactamase Producing Escherichia coli and Klebsiella pneumoniae Isolates in Hospitalized Patients in Kashan (Iran)

Electronic physician, 2016

Introduction: Production of extended spectrum beta lactamase (ESBL) is an important mechanism of antimicrobial resistance in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates. This study was performed to determine the prevalence and risk factors associated with ESBL producing strains of E. coli and K. pneumoniae. Methods: In this cross-sectional study, 250 strains (134 E. coli and 116 K. pneumoniae) were obtained, and ESBL producing isolates were detected by the combination disk test in Shahid Beheshti Hospital in Kashan, Iran, from February 2012 to June 2013. Antimicrobial resistance was screened by the disk diffusion method and was confirmed by E-test. Furthermore, risk factors of ESBL producing E. coli and K. pneumoniae microorganisms were determined. Data were analyzed by SPSS version 16, using descriptive statistics, chi-squared, independentsamples t-test, and logistic regression analysis. Results: One hundred and two (40.8%) of all strains were ESBL producers, of which 54 (52.9%) were E. coli and 48 (47.1%) were K. pneumoniae (p = 0.86). Furthermore, 40.3% of E. coli and 41.4% of K. pneumoniae isolates were ESBL producers (p = 0.86). The most antimicrobial resistance was to ampicillin, and no imipenem resistance was detected. Risk factors for ESBL producing E. coli included admission duration exceeding 7 days (p = 0.011) and antibiotic use in the last month (p < 0.001), and the associated risk factor for ESBL producing K. pneumoniae was antibiotic use during the recent month (p = 0.002). Conclusion: This study identified a relatively high prevalence of ESBL production among E. coli and K. pneumoniae strains. Furthermore, anti-bimicrobial use and admission duration were risk factors for ESBL producing isolates. Therefore, more comprehensive investigations are needed for the development of new strategies to control the dissemination of these microbes.

Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: a case control study

The Journal of Infection in Developing Countries, 2010

Introduction: Increased production of extended-spectrum β-lactamases (ESBLs) has become an important issue for treatment of severe Klebsiella pneumoniae (K. pneumoniae) infections. This study aimed to evaluate risk factors of infection from ESBLproducing K. pneumoniae (ESBL-KP). Methodology: Risk factors were evaluated using a retrospective case control design. Fifty-two patients admitted to Firat University Hospital (FUH) with invasive infections from ESBL-KP were employed as cases. Patients admitted to FUH with non-ESBL-producing K. pneumoniae invasive infection were chosen as controls. Potential risk factors of the cases and controls were evaluated using hospital charts. Pulsed-field Gel Electrophoresis (PFGE) was used to show the relatedness of ESBL-KP strains. Results: In univariate analysis, the following factors were found significant for ESBL-KP: pre-infection hospital stay, nosocomial origin, central venous catheterization, surgical intervention, antibiotic use longer than one week, and previous hospitalization. In contrast, stepwise logistic regression analysis showed that two variables, previous antibiotic use (p = 0.000) and surgical intervention (p = 0.006), remained significantly associated with risk for infection with an ESBL-KP. Molecular epidemiology identified several clusters among the ESBL-producing isolates. Conclusions: Antibiotic use and surgical intervention were significant associated factors for infections with ESBL-KP.

Nosocomial blood-stream infections from extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumonia from GB Pant Hospital, New Delhi

2010

Background: Nosocomial septicemia due to extended spectrum beta-(β)-lactamase (ESBL) producing Klebsiella pneumoniae and Escherichia coli are a therapeutic challenge due to resistance. Knowledge of disease burden and resistance patterns is required for proper and timely management. We report the prevalence and antimicrobial susceptibility of ESBL producing E. coli and K .pneumoniae from septicemia at a tertiary care hospital. Methodology: A total of 2,870 blood samples of suspected cases of septicemia were studied between January and December 2009. Antimicrobial susceptibility was determined by Kirby Bauer's disc diffusion method and MICs for imipenem, meropenem, and ertapenem were determined using the E-test. All isolates of E. coli and K. pneumoniae were tested for ESBL production by E-test method. Results: Forty-one (70.7%) K. pneumoniae isolates and ten (41.7%) E. coli isolates were ESBL producers. Two (5%) of ESBL producing K. pneumoniae isolates, but no E. coli isolates, were resistant to carbapenems. In vitro, all ESBL producers were sensitive to tigecycline. Conclusion: Our data indicated that the prevalence of ESBL-producing E. coli and K. pneumonia strains isolated from blood cultures from hospitalized patients is high. ESBL-producing organisms were found to be more susceptible to meropenem than to imipenem and ertapenem. Tigecycline is active against all the ESBL or multidrug resistant (MDR) E. coli and Klebsiella spp. isolates.