Prevalence of extended spectrum beta-lactamase producing uropathogens and their antibiotic resistance profile in patients visiting a tertiary care hospital in central India: Implications on empiric therapy

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Date: July-September 2014
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 3,604 words
Lexile Measure: 1740L

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Byline: Trupti. Bajpai, Maneesha. Pandey, Meena. Varma, Ganesh. Bhatambare

Context: Antimicrobial resistance showed by different uropathogens is one of the barricades that might hinder a successful treatment. Detection of extended spectrum beta-lactamase (ESBL) production among uropathogens is an important marker of endemicity. Aims: The present prospective study was done to identify the trends of uropathogens, to find the prevalence of ESBL isolates and to study the antibiotic resistance profile of the ESBL and non-ESBL uropathogenic isolates. Materials and Methods: This study was conducted in the Department of Microbiology of a teaching tertiary care hospital from July 2013 to September 2013. All the uropathogenic isolates were identified up to species level by conventional methods. The prevalence of potential ESBL producers was explored. Antibiotic resistance test of the urinary isolates was done by disc-diffusion method and the results were interpreted according to Clinical Laboratory Standards Institute-2013 guidelines. Results: A total of 670 urine samples from male and female patients visiting the outpatient department (OPD) and inpatient department (IPD) of our hospital were collected. A significantly higher number of IPD and OPD males (55.1% and 55.5%) were found to be culture positive. Escherichia coli (55.3%) was the most frequently isolated uropathogen followed by Klebsiella pneumoniae (23%). However, strains of Escherichia coli (41.6%) were the highest ESBL producing isolates followed by Pseudomonas aeruginosa (36.1%). ESBL producing isolates were found to be multidrug-resistant when compared to non-ESBL producers. However, excessive drug-resistance among non-ESBL producing isolates can't be ignored. Conclusion: Our study confirms a global trend toward increased resistance to beta-lactam antibiotics. We emphasize on the formulation of antibiotic policy for a particular geographical area.

INTRODUCTION

Extended spectrum beta-lactamase (ESBL) producing organisms are those that hydrolyze the oxyimino beta-lactams and monobactams, but have no effect on the cephamycins and carbapenems. [sup][1] They are increasing rapidly and becoming a major problem in the area of infectious diseases. Problems associated with ESBL producing isolates are difficult to be detected or treated, thereby causing increased mortality of patients. [sup][2] The prevalence of ESBL producing organisms among clinical isolates vary greatly worldwide and is rapidly changing over time. ESBL producers have been steadily increasing after their initial detection in the mid 1980's in Western Europe. The outbreaks of infection in various hospitals globally have been supplanted by endemicity of ESBL producers. This may lead to increased patient mortality when antibiotics inactive against ESBL producers are used. [sup][3] Unfortunately, the ESBL producers often also have resistance determinants to other antibiotic groups, leaving an extremely limited range of effective agents. A delay in appropriate therapy can cause severe complications. [sup][1] Detection of ESBL producers from sample such as urine may be of utmost importance because this represents an epidemiologic marker of colonization and therefore there is potential for transfer of such organisms to other patients. [sup][3] The rapid increase of resistance to broad spectrum beta lactams among uropathogens has recently become a major problem globally. It leads to antibiotic ineffectiveness, increased severity of illness and cost of treatment. [sup][4] The serious increase...

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Gale Document Number: GALE|A379888858