Abstract
Aim : The emergence of multidrug-resistant (MDR) bacteria is the most dangerous threat for the treatment of infectious diseases. The aim of this study was to detect and characterize extended spectrum beta-lactamases (ESBLs) and carbapenemaseproducing Klebsiella pneumoniae and Escherichia coli among patients and environment of intensive care units (ICUs) of three tertiary care hospitals in Pakistan. Materials and Methods : A total of 82 samples from ICU's patients and inanimate environment (injection trays, wash basins, door handles, hand swabs of professionals, and ICU fridges) were screened for ESBL by culturing on CHROMagar-ESBL. ESBL and carbapenemases production were confirmed by double disc synergy test and modified Hodge's test, respectively. Polymerase chain reaction was used to detect ESBL encoding genes bla cefotaxime (CTX-M), bla CTX-M-1, bla CTX-M-2, bla CTX-M-9, bla TEM, blaSHV and carbapenemase genes bla KPC, bla New Delhi metallo-beta-lactamase-1, bla OXA-48 and bla VIM. Results : Overall, ESBL production was found high 30/82 (36.5%) among isolates of which 15.8% K. pneumoniae and 20.7% E. coli were identified. All the K. pneumoniae and majority of E. coli isolates were MDR, i.e., resistance to three or more antimicrobial categories. Molecular characterization showed the bla CTX-M-1 as the predominant genotype found in 17/21 (80%) of the isolates. None of the strains was found positive for carbapenemase-encoding genes. Conclusion : In conclusion, this study demonstrates the emergence of MDR ESBL producing strains among ICU patients and hospital environment, posing a serious threat for the control of nosocomial infections.
Highlights
The antimicrobial resistance poses a serious public health problem and immense economic losses worldwide
In conclusion, this study demonstrates the emergence of MDR Extended spectrum beta-lactamases (ESBLs) producing strains among intensive care units (ICUs) patients and hospital environment, posing a serious threat for the control of nosocomial infections
The β-lactam group of antibiotics is the most common drugs used for the treatment of Gramnegative bacteria, and the ESBL mediated resistance has become a global challenge in infection control
Summary
The antimicrobial resistance poses a serious public health problem and immense economic losses worldwide. The irrational use of antimicrobial agents in human medicine has led to rapid increase in bacterial resistance toward antimicrobial drugs [1]. Resistance to beta-lactam antibiotics, especially to 3rd generation cephalosporins has become a global dilemma in infection control. Extended spectrum beta-lactamases (ESBLs) are a group of enzymes produced mostly by Gram-negative bacilli which are responsible for resistance to all ß-lactam antibiotics except cephamycins and carbapenems [2]. Hospitalacquired infections (HAIs) or nosocomial infections are a source of diseases that may pose a threat to public health.
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