Prevalence of extended spectrum beta-lactamase production among uropathogens in south Mumbai and its antibiogram pattern.

Abstract

β-lactams are the most widely used group of antimicrobials. However, increasing resistance to these valuable drugs in uropathogens, mediated principally by β-lactamases, has become a major concern. The present study was undertaken to determine the prevalence of Extended Spectrum β-Lactamase (ESBL) producers in clinical isolates of urine specimens, collected from various healthcare centres across south Mumbai. A total of 195 gram negative urine isolates were identified as Pseudomonas aeruginosa (13), Proteus mirabilis (21), Klebsiella pneumoniae (29), Escherichia coli (96), Enterobacter aerogenes (1), Enterobacter cloacae (1), Enterococcus fecalis (1), Morganella morganii (1), Citrobacter diversus (16), Citrobacter amalonaticus (5) and Proteus vulgaris (11). Antimicrobial Susceptibility Testing (AST) by Kirby-Bauer method showed 43.07 % (84/195) of the isolates were resistant to more than 70 % of the antibiotics used. Confirmatory screening using a combination of Double Disk Synergy Test (DDST), Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and E-test revealed the overall prevalence of ESBL producers to be 34.71 % (68/195). The study showed 72.05 % of the ESBL producers to be resistant to fluoroquinolones, highlighting its extensive use in the region of south Mumbai. All ESBL producers were found to be sensitive to Imipenem whereas 82.36 % showed susceptibility to Amikacin making these 2 antibiotics the most effective choice of drug against ESBLs. In order to ensure rational treatment of highly resistant pathogens, the occurrence of ESBL and its primary studies may serve as a base for further research and findings.