Abstract
To assess the prevalence of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella strains in nosocomial and community-acquired infections. 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. 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 out-patients (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 out-patients (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 out-patients (182/4,074; 4.4%); 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 out-patients (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 out-patients (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. 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.
Highlights
In 1983, the first outbreak involving extended spectrum beta-lactamase (ESBL) producing organisms was reported in Germany [1]
During the study period, 6,750 Gram negative organisms comprised of 5,503 (82%) E. coli; 1,180 (17%) K. pneumoniae; and 67 (1%) K. oxytoca were assessed for ESBL phenotype
56% of ESBL isolates were identified in patients older than 60years, this age group constituted of only 16.2% (1,094/6,750) of the total number of patients from whom E. coli and Klebsiella were isolated during the study period
Summary
In 1983, the first outbreak involving extended spectrum beta-lactamase (ESBL) producing organisms was reported in Germany [1]. ESBLs arise because of mutations in the TEM-1, TEM-2, or SHV1 genes, commonly found in the Enterobacteriaceae family [2,3] While these enzymes are found predominantly in Klebsiella species and Escherichia coli, they have been described in other genera of Enterobacteriaceae including Citrobacter, Serratia, Proteus, Salmonella, and Enterobacter [2]. In the Arabian Peninsula, reported ESBL detection rates range from 8.5-38.5% in data from the Kingdom of Saudi Arabia [4,5,6,7,8] and (31.7%) in Kuwait [9]; the highest level of 41% is from the United Arab Emirates [10] This variation is perhaps reflective of the fact that these studies focused on hospital-acquired infections or particular sites of infection (e.g. urine, blood). To assess the prevalence of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella strains in nosocomial and community-acquired infections. This has significant implications for patient management, and indicates the need for increased surveillance and molecular characterization of these isolates
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