Prevalence of ESBL and MBL producing gram negative uropathogens

Abstract

Background: Antimicrobial resistance in bacterial pathogens reduces the effectiveness of antibiotics leading to increased morbidity, mortality and financial cost. Urinary tract infection is one of the most common public health problem in Nepal. This study was aimed to determine the distribution and antibiotic susceptibility patterns of Gram negative uropathogens producing extended spectrum beta lactamases and metallo-beta lactamases. Methods and materials: This was cross-sectional study was conducted at National Public Health Laboratory over the period of six month. A total of 1446 mid stream urine samples were processed for isolation and identification of bacteria by conventional culture techniques. The identified gram negative pathogens were subjected to antibiotic susceptibility testing by modified Kirby Bauer disc diffusion method. Screening and Confirmation of ESBL and MBL production was done by phenotyping methods following CLSI guideline 2017 Results: Of the 155 (10.72%) Gram negative uropathogens, 53.8% were isolated from male patients and 46.2% were isolated from female patients.40 (25.8%) were ESBL producers, predominantly Escherichia coli 25 (62.5%) followed by Klebsiella pneumoniae 7 (17.5%), Pseudomonas spp 3 (7.5%), Proteus vulgaris 1 (2.5%), Citrobacter koseri 1 (2.5%) Morganella morganii 2 (5%) and Acinetobacter spp 1 (2.5%). 14 (9.03%) were MBL producers predominantly 5 E.coli (35.71%) followed by Pseudomonas spp 4 (28.57%), K. pneumoniae 3 (21.43%), Proteus vulgaris1 (7.14%) and Proteus mirabilis1 (7.14%). 6 (3.8%) were both ESBL and MBL producers. The maximum activity was seen in E.coli 3 (50%) followed by Pseudomonas spp1 (16.7%) and K. pneumoniae1 (16.7%) and Proteus mirabilis1 (16.7%). Most ESBL producers showed higher sensitivity towards Imipenem (20%), Amikacin (20%) followed by Piperacillin tazobactam (20%) whereas MBL producers showed sensitivity towards Amikacin (50%) only and resistant to almost all drugs. Conclusion: The prevalence of ESBL and MBL producing gram negative bacteria was found to be high in urinary tract infection in Nepal. Routine laboratory testing for ESBL and MBL is needed in order to optimize antibiotic management and reduce the risk of spread of infections caused by ESBL and MBL producers. Further, to control the emergence of drug resistance strict policy to rationalize the use of antibiotics is necessary.