Abstract
Background: ESBL producing GNB causing blood stream infections (BSI), skin and soft tissue (SSTI) and respiratory tract infection (RTI) are widely prevalent in Indian medical centers. We compared the in-vitro activity of five commonly used antimicrobials to treat such infections against the recently introduced carbapenem - ertapenem (ERT). Methods: From a collection of 776 clinically significant isolates prospectively collected (2005–2007) from seven medical centers, 238 GNB isolates (Escherichia coli [EC], = 122, Klebsiella spp. [KS], = 107 and Enterobacter spp. [ES] = 9) obtained from RTI (n = 75), BSI (n = 74), SSTI (n = 70) and urinary tract (n = 19) were tested. ESBL screen was performed by disc diffusion using cefotaxime (CTX) and ceftazidime (CZD), confirmed using CTX and CZD discs with and without clavulanic acid and Etest ESBL strips. Antimicrobial resistance to levofloxacin (LEV), amikacin (AMK), piperacillin/tazobactam (P/T), imipenem (IMP), meropenem (MER) and ERT was determined by agar dilution and Etest. Isolates were considered multi-drug resistant (MDR), if resistant to >2 classes. Polymerase Chain Reaction (PCR) was done to determine beta lactamases (bla)TEM, SHV and CTX-M among 120 isolates. Results: In this study, 221(93%) GNB were confirmed ESBL producers (range between centers, 74 to 99%) of which 94% were nosocomial in origin. ESBL in intensive care unit (ICU) and non-ICU patients was 86% and 98% respectively. Among ESBLs in ICU, 13.5% were community acquired. Resistance to LEV was 73.3% > P/T 27.3% and > AMK 12.3%. No resistance to IMP and MER seen. Overall 61% were MDR. Four KS (1.7%) isolates were resistant to ERT. PCR showed blaCTX-M in 73%, blaTEM in 56% and blaSHV in 38%. Multiple genes were present in 60%. Conclusion: Prevalence of ESBL among GNB causing infections continues to be high in Indian medical centers. ERT shows good activity equivalent to the tested Group 2 carbapenems and may be considered for treatment of such infections.
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