Prevalence & antimicrobial resistance pattern of extended spectrum beta-lactamase producing Klebsiella spp isolated from cases of neonatal septicaemia (original) (raw)
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Journal of Laboratory Physicians, 2015
Background: β-lactamases viz., extended spectrum β-lactamase (ESBL), AmpC, and metallo β-lactamase (MBL) production in Klebsiella pneumoniae has led to a serious concern about septicemic neonates in Neonatal Intensive Care Units due to high resistance against commonly used antimicrobials Purpose:To study the prevalence of ESBL, AmpC, and MBL production in K. pneumoniae isolates in neonatal septicemia, to check antimicrobial susceptibility to various drugs including tigecycline; and to assess burden of multiple drug resistance (MDR). Materials and Methods: Total 24 clinical isolates of K. pneumoniae isolated from 318 blood samples of suspected cases of neonatal septicemia were studied. Isolates were screened for ESBL, AmpC, and MBL production by Clinical and Laboratory Standards Institute (CLSI) disk method, AmpC cefoxitin screen, and imipenem, meropenem, ceftazidime disk screen respectively; and confirmation was done by CLSI phenotypic disk confirmatory test, AmpC sterile disk metho...
2015
Introductions: Klebsiella sepsis is the most important nosocomial infection in neonates. The objectives of this study were to review an outbreak in a neonatal unit caused by Klebsiella species, to identify the source of the infections, and to identify infection control measures for eradication and prevention of these infections. Methods: The case notes and investigation reports of all sepsis cases admitted in neonatal units of Patan hospital from July to December 2011 caused by Klebsiella species were retrospectively reviewed. The demographic profile, risk factors along with clinical features and management of sepsis were reviewed. Results: Twenty three out of 37 neonatal blood cultures grew Klebsiella species. Thirty one were K. pneumoniae and six K. oxytoca . Seventeen of the 31 (55%) K. pneumoniae isolates were multidrug resistant and extended spectrum beta lactamase producers. Eighteen of 23 (78%) neonates with Klebsiella sepsis died. After extensive cleaning methods and identif...
Klebsiella pneumoniae is one of the major causes of blood-stream infections in neonatal intensive care units. Treatment has been a challenge due to the development of multidrug resistant strains, which are mainly attributed to the ability of the organism to produce extended spectrum β-lactamases that confer resistance to second and third generation cephalosporins. This laboratory-based cross-sectional study was aimed at determining the extent of extended spectrum β-lactamase production among invasive K. pneumoniae isolates from blood culture specimens at the University Teaching Hospital in Lusaka. The production of the extended spectrum β-lactamases was detected using the combination disc method, and by detecting genes encoding extended spectrum β-lactamases using Polymerase Chain Reaction. The drug resistance profile was determined using the Kirby-Bauer disc diffusion method against tetracycline, chloramphenicol, amikacin, gentamicin, co-trimoxazole, ciprofloxacin, cefotaxime, ceftazidime, cefpodoxime and imipenem. All the 45 isolates were found to be ESBL producers, and out of these 33/45 SHV gene was detected. Antimicrobial susceptibility testing revealed a high frequency of antimicrobial resistance: cefotaxime ..
Journal of International Medical Research, 2002
The present study was designed to determine the antimicrobial resistance and extended-spectrum β-lactamase (ESBL) activities of Klebsiella pneumoniae strains isolated from the neonatal intensive care unit of Atatürk University Hospital, Erzurum, Turkey. Antibiotic susceptibility of 40 isolates was detected by the standard disk diffusion method according to the National Committee for Clinical Laboratory Standards Guidelines. The double-disk synergy method was used to determine ESBL activity, which is associated with resistance to β-lactam antibiotics. Twenty-four (60%) of 40 K. pneumoniae strains were found to produce ESBL. Of the antibiotics tested, meropenem was found to be the most effective (100%), and ampicillin the least effective (0%). With the increasing incidence of antimicrobial resistance, which poses a clinically significant risk to vulnerable patients, it is important that clinical microbiology laboratories have accurate and timely information concerning the strains of b...
National Journal of Community Medicine, 2012
Background & objectives: Clinical laboratories need to develop quick screening methods for detection of Extended Spectrum β-Lactamases (ESBL) & Amplified C (AmpC) β-Lactamase, so that the appropriate medication can be started without delay. Here, we reported the screening & confirmatory methods for detection of ESBL & AmpC in Klebsiella pneumoniae in Neonatal Intensive Care Unit (NICU). Methods: We had tested 600 blood culture samples from the NICU patients. From the positive bacterial isolates, Klebsiella pneumoniae were screened for ESBL & AmpC production followed by confirmatory methods as per Clinical Laboratory Standard Institute (CLSI) guidelines. Results: Out of the 600 blood culture, 266 were positive for microbial growth. Among them, Klebsiella pneumoniae were in 54 patients. Out of 54 Klebsiella pneumoniae, 48 were positive for ESBL in screening method. Out of 48, 41 isolates were ESBL positive & 4 were AmpC positive by Confirmatory test (Modified Three Dimensional Method for AmpC). Interpretation & conclusions: The prevalence of ESBL & AmpC producing Klebsiella pneumoniae in NICU at our institute is 75.92% & 7.4% which is very alarming, and it requires strict implementation of infection control guidelines in NICU by safe hygiene practices, restricted use of broad spectrum antibiotics as empirical therapy in septicemic cases and also formulation of uniform antibiotic policy for such patients based on the current trend of antibiotic resistance. This can be helpful in preventing emergence of multidrug resistance in such organisms.
National Journal of Medical Research, 2012
Background & objectives: Several outbreaks of neonatal septicemia by extended spectrum beta lactamases (ESBL) producing isolates are not uncommon & are associated with increased mortality. Moreover, detection of ESBL in isolates that produce Amp C beta lactamases is problematic. So, clinical laboratories need to develop quick screening methods for detection of ESBL producing strains. Materials & methods: Out of 600 samples of blood culture from neonatal intensive care unit (NICU) patients, 54 Klebsiella pneumoniae were tested for ESBL by screening & confirmatory tests recommended by clinical laboratory standard institute (CLSI). In addition, double disk synergy test (DDST), modified double disk synergy test (MDDST), direct modified three dimensional tests (DMTDT) & indirect modified three dimensional tests (IMTDT) were evaluated for optimum detection of ESBL in Amp C producing isolates. Results: From 54 Klebsiella pneumoniae, 48 were screen positive for ESBL by CLSI criteria. ESBL detection was confirmed in 44 isolates. Phenotypic confirmatory disk diffusion method (PCDDT) by CLSI detected ESBL in 41/48 isolates. DDST using amoxicillin-clavulanic acid detected the same in 36/48 cases. MDDST using cefepime & piperacillin-tazobactam detected ESBL in 44/48 cases, including 3 isolates having Amp C enzyme which was confirmed by modified three dimensional tests for Amp C enzyme. DMTDT detected only 4 isolates with ESBL production. IMTDT detected all 44 ESBL producing isolates. Conclusion: The prevalence of ESBL producing Klebsiella pneumoniae in our NICU was 81.48%. MDDST & DMTDT seem to be superior to PCDDT, DDST & IMTDT for detection of ESBL in Amp C producing isolates