ESBL Production Among E. coli and Klebsiella spp. Causing Urinary Tract Infection: A Hospital Based Study.

Pooja Shakya,Elina Maharjan,Rabin Paudyal,Vijay K Sharma,Dhiraj Shrestha

doi:10.2174/1874285801711010023

Pooja Shakya, Elina Maharjan + Show 3 more

Open Access

https://doi.org/10.2174/1874285801711010023

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Abstract

Introduction:Increase in extended-spectrum β-lactamases (ESBL) producing microbes in recent years has led to limitations of treatment options. This study aimed to assess the prevalence of ESBL producing E. coli and Klebsiella spp. at a tertiary hospital in Nepal.Methods:A total of 2209 non-repetitive mid-stream urine (MSU) samples were collected during the study period (March to September 2014). Identification of the isolates was done by Gram's staining followed by biochemical tests. Antibiotic susceptibility testing was done by modified Kirby-Bauer disc diffusion method and interpretation was done following Clinical and Laboratory Standard Institute (CLSI) guidelines, 2013. ESBL screening among E. coli and Klebsiella spp. isolates were done using ceftriaxone, cefotaxime, ceftazidime and cefpodoxime. The confirmation was done by phenotypic disc diffusion test (combined disc method) using ceftazidime (30µg) and ceftazidime plus clavulanic acid (30/10µg), and cefotaxime (30µg) and cefotaxime plus clavulanic acid (30/10µg) disc as per CLSI guidelines.Results:A total of 451 samples showed significant bacteriuria with 365 (80.9%) E. coli, 17 (3.8%) Klebsiella pneumoniae and 3 (0.7%) Klebsiella oxytoca. Of 451 isolates, 236 (52.3%) were found MDR strains. By combined disk test, 33 (91.7%) E. coli and 3 (8.3%) Klebsiella spp. were found ESBL producers.Conclusion:Higher prevalence of ESBL producing E. coli and Klebsiella spp. was observed warranting prompt need of surveillance for effective management of such MDR strains.

Highlights

Increase in extended-spectrum β-lactamases (ESBL) producing microbes in recent years has led to limitations of treatment options
Urinary tract infection (UTI) is a spectrum of disease caused by microbial invasion of the genitourinary tract that extends from the renal cortex of the kidney to the urethral meatus [1]
The reported positive rate of UTI among Nepalese patients attending general hospitals ranged from 23.1% to 37.4% [3]

Summary

Introduction

Increase in extended-spectrum β-lactamases (ESBL) producing microbes in recent years has led to limitations of treatment options. This study aimed to assess the prevalence of ESBL producing E. coli and Klebsiella spp. at a tertiary hospital in Nepal. Urinary tract infection (UTI) is a spectrum of disease caused by microbial invasion of the genitourinary tract that extends from the renal cortex of the kidney to the urethral meatus [1]. The reported positive rate of UTI among Nepalese patients attending general hospitals ranged from 23.1% to 37.4% [3]. Bacteria are the major causative organisms and are responsible for more than 95% of UTI cases. Escherichia coli is the most prevalent causative organisms of UTI and is solely responsible for more than 80% of the infections [4]

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