Prevalence and antimicrobial resistance of beta-lactamase-producing Gram-negative isolates from outpatient clinical and environmental samples in the Zenica-Doboj Canton, Bosnia and Herzegovina (original) (raw)
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Background: Extended-spectrum β-lactamase producing bacteria (ESBL) poses an increasing challenge to both public health and hospital infection control services. Objective: To determine the prevalence of ESBL producing bacteria, types of infection they cause and their susceptibility patterns to antibiotics in hospital and community settings. Settings and Design: This is a cross-sectional study that was conducted at a Medical City in Riyadh. Methods: All clinical specimens with positive culture for Gram-negative bacteria were collected from the microbiology laboratory for the year 2013. When bacteria are identified as ESBL strain, the antimicrobial susceptibility is analyzed. Demographic data were collected from patients' records. Results: Overall, 763/6993 (10.9%) were ESBL producing strains from all gram negative bacteria. The highest detection of ESBL bacteria were from specimens of patients over sixty years (34.2%), and 23.7% were from 0-<15 year old. The most frequently detected bacteria was E.coli (76.5%) (Significantly higher among outpatients 54.5%) with highest detection from urine, skin swab, blood, wound and ulcer specimens, followed by K .pneumonia (23.1%) (Significantly higher among inpatients 69.3%) with highest detection from respiratory specimens including sputum. The resistance pattern to antimicrobials was (75.5%, 81.3%) to trimethoprim/sulfamethoxazole, (69.7%, 42.6%) to ciprofloxacin, (38.9%, 58.5%) to gentamicin and (8.7%, 30.7) to piperacillin/tazobactam (E.coli, K. pneumonia respectively). However, very high sensitivity to imipenem and meropenem was reported for both bacteria. Generally, ESBL bacteria isolated from outpatients showed significantly higher resistance to ciprofloxacin than the isolates from inpatients (p=0.02), conversely is detected with piperacillin/tazobactam (p<0.0001). Conclusion: Currently, carbapenems and amikacin are the first line antibiotics that can be used for the treatment of ESBL bacterial infections in both settings. Since ESBL bacterial resistance pattern is increasing, periodical monitoring of antimicrobial susceptibility of isolated ESBL bacteria, and rotating the use of the effective antimicrobial drugs according to guidelines of antimicrobial stewardship programs should always be considered.
Open Journal of Medical Microbiology
Extended-spectrum β-lactamase producing E. coli and K. pneumoniae is a serious threat to the patients. These organisms are major extended spectrum beta lactamase (ESBL) producers. The objective of this study was to determine the prevalence of Extended spectrum β-lactamase producing strains of Escherichia coli and Klebsiella spp isolates from the urine sample of children visiting International Friendship Children Hospital. During the seven months, between June 2016 to December 2016, 1018 midstream urine samples(MSU) were collected from patients suspected of having UTI. The samples were investigated by conventional semi-quantitative culture technique and identification of E. coli and Klebsiella spp. was done by microscopy and biochemical test. Antibiotic susceptibility test of isolates was performed by modified Kirby Bauer Disc diffusion test. ESBL screening test was done by using 3 rd generation Cephalosporin and confirmation done by combination disc diffusion method. Out of total 1018 MSU samples investigated, 200(19.64%) isolates of E. coli and 28(2.7%) isolates of Klebsiella spp. making a total of 228(22.39%) were found to cause significant bacteriuria. 76(33.33%) isolates, from those causing significant bacteriuria, were Multi-drug resistant organisms. Out of 228 isolates, 54(23.68%) were ESBL producers, that includes 51(25.5%) Escherichia coli and 3(12.5%) Klebsiella pneumoniae. ESBL producers were more common in in-patient (36.17%) than outpatient (20.44%). Most of the ESBL producers were resistance to amoxicillin, followed by Cotrimoxazole and Ciprofloxacin respectively. They were highly sensitive to Imipenem, Tigecycline, Amikacin, Piperacillin-Tazobactam, and Nitrofurantoin. High prevalence of ESBL producing E. coli and Klebsiella pneumoniae was found among children. Regular and routine monitoring of ESBL producing isolates is essential.
A total of 120 urine samples were collected Tiruchengode private hospitals, among that 100 isolates were studied for the existence of beta- lactamases. Susceptibility tests were carried out according to the criteria of national committee for clinical laboratory standards. MICs were obtained by agar diffusion method. Existence of extended spectrum of beta-lactamases were assessed by double disc synergy test [DDST].Out of 120 samples,100 isolates showed growth on the nutrient agar medium and 20 showed no growth. Among the 120 isolates, 62 isolates were Gram negative and the remaining 38 showed other than Gram negative organisms. The distribution of Gram negative bacterial isolates, Klebsiella pneumoniae was predominate (24.2%) followed by Escherichia coli (15%), Proteus mirabilis (12.5%). Antibiotic sensitivity pattern showed, out of 100 isolates, (19.4%) isolates resistant and (80.6%) isolates were sensitive. Presence of beta- lactamase enzyme was done by DDST. (17.74%) isolates showed positive results for DDST among the 62 Gram negative isolates. Routine diagnosis of ESBL producing strain should be done in hospital. The most important in avoiding misuse and overuse of antibiotics may reverse the undesired effects of multi drug resistance and ESBL producing Gram negative organism.
Journal of Pure and Applied Microbiology, 2021
Extended Spectrum beta lactamase producing pathogens are reported in many clinical samples and pose an emerging threat health. To find the prevalence of ESBL producing Enterobactriacea pathogens isolated from inpatients (Medical and Surgical Wards; Hospital stay > 72 h) admitted to Prince, Mutib, Hospital Sakaka, Jouf. A total of 1043 Enterobactriacea were isolated during April 2015 to October 2016 study period. Vitek -2 compact (biomeriux Leon, France) was used for identification and antimicrobial sensitivity (AST) test. A Total of 115/1043 (11.02%) ESBL producing pathogens were isolated from urine 15.07% (n=242), sputum 13.6 % (n=220), wound 10.8% (n=287) and blood 5.4 % (n=294). Klebsiella pneumonia is most dominant followed by E coli and Proteus miribilis. Cephamycins and carbapenems were found most effective (100% sensitivity) against the pathogens isolated. The aminoglycosides, beta lactams and Fluroquinolnes class of antibiotics, microorganisms have gained the resistance o...
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.
Journal of Infection in Developing Countries, 2023
Introduction: Enterobacteriaceae that produce extended-spectrum beta-lactamase (ESBL) are quickly spreading, posing a threat to world healthcare. Methodology: 138 gram-negative bacteria were collected from different samples (stool, urine, wound, blood, tracheal aspirate, catheter tip, vaginal swab, sputum, and tracheal aspirate) from hospitalized patients. Samples were subcultured and identified in accordance with their biochemical reactions and culture characteristics. Against all the isolated Enterobacteriaceae, an antimicrobial susceptibility test was performed. VITEK®2 system, phenotypic confirmation, and Double-Disk Synergy Test (DDST) had been utilized to identify the ESBLs. Results: Of the 138 samples studied, the prevalence of ESBL-producing infections among the clinical samples of the present study was 26.8 % (n = 37). E. coli was the commonest ESΒL producer at 51.4% (n = 19) followed by K. pneumoniae at 27% (n = 10). The potential risk factors for the ESBL development that produces bacteria were as follows, patients with the presence of indwelling devices, previous history of hospital admission, and usage of antibiotics. ESBL is statistically (p ≤ 0.05) higher among the patients with indwelling devices, ICU admission, who had a previous hospital admission in the last 6 months as well as who was given antibiotics (quinolones and/or cephalosporins) in the last 6 months. One hundred thirty-two (95.7%) of ESBL isolates were resistant to amoxicillin, while the lowest resistance was for fosfomycin (15.2%). Conclusions: ESBL-producing Enterobacteriaceae are highly prevalent in Turaif General Hospital setting with some potential risk factors. A strict policy to be made available on the usage of antimicrobials in hospitals and clinics should be established.
Pulse, 2016
Introduction: Extended spectrum β-lactamases (ESBLs) are enzymes that mediate resistance to extended-spectrum (third generation) cephalosporins (e.g., ceftazidime, cefotaxime, and ceftriaxone) and monobactams (e.g., aztreonam) but do not affect cephamycins (e.g., cefoxitin and cefotetan) or carbapenems (e.g., meropenem or imipenem). Though the no. of ESBLs producing organism has been increasing day by day, the detection methods and treatment option for them are extremely limited. Aims & Objective: The present study was undertaken to investigate the rate of ESBLs production and their antibiotic susceptibility pattern. Materials & Method: A total 110 Gram negative isolates from various clinical samples from a tertiary care hospital were studied and ESBLs production was detected by double disc synergy test. Antibiotic susceptibility test was done for commonly used antibiotics. Results: Among the total isolates 66.36% (73) were ESBLs producer, and the rate of ESBLs positivity was 80.32% for E.coli (49 out of 61), 25% for Pseudomonas spp (6 out of 24), 71.42% for Klebsiella spp (10 out of 14), 80% for Enterobacter spp (4 out of 5), 100% for Acinetobacter spp (4 out of 4) and 0% for Proteus spp (0 out of 2). ESBLs producing organisms were resistant to most of the antibiotics but 100% were sensitive to imepenem. Conclusion: Screening for ESBLs production needs to be carried out routinely in every clinical diagnostic laboratory to guide clinicians in proper selection of antibiotics.
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.
2017
DOI: 10.21276/sjams.2017.5.10.44 Abstract: The present study was undertaken to evaluate the prevalence of the extended spectrum βlactamase (ESBL) producing gram negative strains at our tertiary care hospital by using the Modified Double Disc Synergy Test (MDDST) and CLSI phenotypic confirmatory test (PCT). A total of 300 non-repetitive isolates of enterobacteriaceae from various clinical samples of urine, blood, pus, wound swab, sputum, or intravenous catheter were obtained from inpatient units of various wards of our tertiary care teaching hospital. Gram negative isolates having zone size of <=22mm for ceftazidime and <=27mm for cefotaxime (standard disc diffusion method) were selected as suspicious for ESBL production as recommended by CLSI guidelines. These potential ESBL producing strains were further tested by MDDST and CLSI PCT methods. Among the 300 clinical isolates tested 154 gram-negative isolates were considered suspicious of ESBL production by the initial screening...
2017
Extended spectrum beta-lactamase (ESBL) producing bacteria are the cause of widespread infections worldwide, in both hospital and community settings. The presence of ESBLs prevent treatment of the infection with many β-lactam antibiotics. Highly mobile genetic element such as plasmids carrying ESBL genes often also harbour resistance genes to other classes of antimicrobials. To date, susceptibility generally remains high to the carbapenem antibiotics and to the polymyxin colistin and the glycylcycline tigecycline. However rigorous antibiotic stewardship programmes on national and international level will be crucial in maintaining the status of these drugs. This study provides epidemiological and molecular information regarding ESBL-producing bacteria both-in-patients and outpatients at the Saudi Aramco Dhahran Health Center, an acute care facility in the Eastern Province of Saudi Arabia, over four years. Two sampling cohorts (2010-2011 and 2012-2013 gave a total of 385 ESBL-producing isolates dominated by Enterobacteriaceae, mainly from urine cultures, followed by blood cultures. Most patients were from the outpatient setting. The majority of strains were Escherichia coli, followed by K. pneumoniae. Other isolates included members of Enterobacter, Citrobacter, Morganella, Serratia and Proteus families. K. pneumoniae became relatively more common in 2012 compared to 2010. Overall, female gender was identified as a risk factor for ESBL infection. Older age (>60 years) was also a risk factor, particularly for males. Susceptibility of infections to nine β-lactams was tested, namely ampicillin/sulbactam, ceftazidime, ceftriaxone, cefazolin, cefepime, cefoxitin and the carbapenems imipenem, meropenem, and ertapenem. There were high levels of resistance in both 2010 and 2012 for ampicillin/sulbactam, cefazolin, ceftriaxone and ceftazidime. While high percentages of both E. coli and K. pneumoniae were sensitive to cefoxitin in both 2010 and 2012, both E. cloacae and E. aerogenes isolates were uniformly resistant to this drug. For cefepime, sensitivity fell sharply in 2012, attributable to equivalent drops among E. coli and K. pneumoniae. There was consistently high sensitivity in 2010 and 2012 to the carbapenems. Seven non--lactam antibiotics were tested, namely nitrofurantoin, amikacin, ciprofloxacin, trimethoprim/sulfamethoxazole, gentamicin, colistin and tigecycline. There was 100% v