Prevalence of multidrug-resistant and extended-spectrum beta-lactamase producing Gram-negative isolates from clinical samples in a tertiary care hospital of Nepal

Aryatara Shilpakar,Mehraj Ansari,Ganesh Rai,Kul Raj Rai,Shiba Kumar Rai

doi:10.1186/s41182-021-00313-3

Abstract

BackgroundThe existence of multidrug-resistant organisms, including extended-spectrum beta-lactamases (ESBLs), is on rise across the globe and is becoming a severe problem. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to study the prevalence of Gram-negative isolates exhibiting ESBL at a tertiary care hospital and study their antibiogram profile.MethodsA cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal, from June 2018 to November 2018. A total of 770 clinical samples were collected and identified using the conventional biochemical tests following the Clinical and Laboratory Standard Institute (CLSI) guidelines. Antimicrobial susceptibility testing (AST) was performed using the standardized Kirby-Bauer disk diffusion method. The screening test for ESBL producers was performed as recommended by the CLSI and the confirmatory test was performed phenotypically using the E-test.ResultsOut of the 92 isolates, 84 (91.3%) were multidrug-resistant, and 47 (51.1%) were found to be potential ESBL producers. Of these, 16 isolates were confirmed ESBL producers by the E-test. Escherichia coli and Klebsiella pneumoniae were the predominant isolates and were also the major ESBL producers. Besides polymyxin B (100% sensitive), meropenem and imipenem showed high efficacy against the ESBL producers.ConclusionMultidrug resistance was very high; however, ESBL production was low. Polymyxin B and carbapenems are the choice of drugs against ESBL producers but should be used only as the last line drugs.

Highlights

The existence of multidrug-resistant organisms, including extended-spectrum beta-lactamases (ESBLs), is on rise across the globe and is becoming a severe problem
A total of 92 Gram-negative bacteria were isolated from various clinical specimens
Similar culture positivity was seen in both sexes; culture positivity was higher for females than males in the urine sample, and a higher prevalence of E. coli and K. pneumoniae was observed

Summary

Introduction

The existence of multidrug-resistant organisms, including extended-spectrum beta-lactamases (ESBLs), is on rise across the globe and is becoming a severe problem. This study aimed to study the prevalence of Gram-negative isolates exhibiting ESBL at a tertiary care hospital and study their antibiogram profile. Extended-spectrum beta-lactamase (ESBL) producers can confer resistance to beta-lactam antibiotics such as penicillins, cephalosporins, and aztreonam [2]. ESBLs producers exhibit a broad antibiotic resistance which is a great problem in clinical therapeutics [3,4,5] and leads to higher morbidity and mortality owing to improper or delayed antibiotic treatment [6]. ESBLs are becoming more common in Gram-negative isolates [7, 8], and the number of ESBL producers is growing exponentially [9]. ESBL producers have become a major multidrug-resistant pathogen, and several significant changes in ESBL producing isolates have been witnessed worldwide in the last two decades [11]

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