Antibiotic Therapy for ESBL and NDM producing Escherichia coli and Klebsiella pneumoniae isolates in a Tertiary Care Center

Abstract

Objective: Antibiotic resistance is a global phenomenon wherein
 physicians face the most challenging decision to make for the right kind of
 drug, and its combinations, to tackle the ever growing ESBL and NDM on
 pathogens. The aim of the study is to understand outcome of hospitalized
 patients undergoing antibiotic therapy for bacterial infections. These patients
 are from Kamrup District of Assam, India. 
 
 Materials
 and methods: A total of 185 clinical isolates of Escherichia coli and Klebsiella
 pneumoniae were collected from hospitalized patients of a tertiary care
 centre presenting symptoms of infection. Upon biochemical identification, their
 antibiotic susceptibility were assessed; isolates resistant to 3rd or 4th
 generation cephalosporins or carbapenem were phenotypically and genotypically
 determined for the production of extended spectrum β-lactamase (ESBL) and
 carbapenemase. PCR was carried out for CTX-M, TEM, SHV, OXA-48 and New Delhi
 Metallo-β-lactamase (NDM). 
 
 Results:
 Bacterial infection is ubiquitous among male and female patients, with high
 isolation rate of Escherichia coli
 among female patients with urinary infection. The highest resistance against E. coli isolates was nalidixic acid
 (82.9%; p≤0.005) and cefixime (81.4%; p≤0.005). The highest resistance against K. pneumoniae was cefotaxime (77.7%;
 p≤0.005) and ceftazidime (73%; p≤0.005). Imipenem was the most effective
 antibiotic while ertapenem was the least. Antibiotic therapy included
 piperacillin (alone or in combination with tazobactam) for both E. coli and K. pneumoniae infections. 
 
 Conclusions: Ceftriaxone, amikacin, cefepime, ceftriazone and
 imipenem were chosen as treatment options; isolates showed intermediate to
 negligible resistance to these drugs. Tigecycline was administered to patients
 infected with NDM producing pathogens.  J Microbiol Infect Dis 2018; 8(4): 153-157.