Frequency Of ESBL Research Articles

A worrisome prevalence of extended-spectrum β-lactamase producers in patients with biliary obstruction and cholangitis: Phenotypic and molecular characterization of biliary Escherichia coli and Klebsiella pneumoniae isolates

Background & aimsThe alarming rise of antibiotic resistance presents a substantial and worrisome issue within the context of biliary obstruction, specifically in the treatment of cholangitis. This abovementioned scenario underscores the critical importance of addressing extended spectrum β-lactamase (ESBL) producers in the biliary system to adequately tackle cholangitis using third-generation cephalosporins. Hence, we aimed to determine the frequency of ESBL and carbapenemases among biliary Escherichia coli and Klebsiella pneumoniae isolated from patients with biliary obstruction. MethodsIn this cross-sectional study, bile samples were collected via aspiration from patients diagnosed with biliary obstruction during the endoscopic retrograde cholangiopancreatography (ERCP) procedure. Subsequent culturing of these samples was performed, followed by phenotypic and molecular assessments for the detection of ESBL- and carbapenemase-producing strains of E. coli and K. pneumoniae. ResultsApproximately 23.5 % of patients with biliary obstruction harbored biliary ESBL-producers, with the majority (70.2 %) being diagnosed with cholangitis. Moreover, 2.1 % of patients had biliary carbapenemase-producing K. pneumoniae strains. Molecular analysis confirmed the high prevalence of blaCTX-M and blaTEM in E. coli, and blaTEM and blaSHV in K. pneumoniae. Additionally, the presence of biliary K. pneumoniae harboring blaKPC, blaNDM, and blaIMP was observed. ConclusionOur study reveals a noteworthy observation that over half of patients experiencing biliary obstruction harbor ESBL-producing bacteria in their biliary tract. Notably, we discovered a significant link between ESBL producers and the risk of cholangitis. These findings raise important concerns regarding the suitability of employing third-generation cephalosporins as initial treatment for cholangitis and other similar biliary infections.

Extended-Spectrum Beta-Lactamase- and Plasmidic AmpC-Producing Enterobacterales among the Faecal Samples in the Bulgarian Community.

The aim of the present work was to genetically characterise cefotaxime-resistant enterobacteria isolated from community carriers in Bulgaria. In total, 717 faecal samples from children and adults in five medical centres in Sofia, Pleven and Burgas were examined. Antimicrobial susceptibility was evaluated by the disk diffusion method. blaESBL or plasmidic AmpC (pAmpC) genes were detected by PCR and sequencing. MLST and ERIC-PCR were used to detect clonal relatedness. Among the faecal samples, 140 cefotaxime-resistant enterobacteria were found. The most frequently detected species was Escherichia coli (77.9%, 109/140 samples), followed by Klebsiella pneumoniae (7.9%, 11/140). Among the isolates, blaCTX-M-15 (37.1%) was predominant, followed by blaCTX-M-3 (19.2%), blaCTX-M-14 (10%), and blaCTX-M-27 (4.3 %). Genes encoding pAmpC were observed in 11.4% (blaDHA-1, 16/140) and in 1.4% (blaCMY-2, 2/140). The frequency of ESBL and pAmpC producers among the subjects was 14.6% and 2.5%, respectively. No carbapenem-resistant isolates were found. Four main clonal complexes (CC131, CC10, CC38, and CC155) were detected among E. coli isolates. The most common type was ST131, phylogroup B2 (16.5%). The increased frequency of ESBL- and pAmpC-producing enterobacteria in the community is a prerequisite for treatment failures of the associated infections and a good background for further studies.

Antimicrobial activity of cefepime-tazobactam combination against extended spectrum beta-lactamase and/or AmpC beta-lactamase- producing gram-negative bacilli

BackgroundThe problem of resistance to beta-lactam antibiotics, which is caused by ESBL and AmpC β-lactamases, is getting worse globally. Infections caused by bacterial isolates harboring these enzymes are difficult to treat with carbapenems being the sole effective treatment option for such infections. The objective of this study was to determine the frequency of ESBLs and AmpC-producing Gram-negative bacilli isolated from clinical specimens and to evaluate the sensitivity of cefepime-tazobactam combination against them.MethodsThis is an observational cross-sectional study carried out on 100 Gram-negative bacilli at Theodor Bilharz Research Institute Hospital during the period from February 2015 to January 2016. ESBL production was screened by using the disc diffusion test followed by confirmation by the combined disc confirmatory test, the screening for AmpC production was conducted using the cefoxitin disc test, which was subsequently confirmed by the AmpC disc test. Isolates confirmed positive for ESBL and/ or AmpC production were investigated for their susceptibility to antibiotics.ResultsAmong 100 Gram-negative bacilli, 44 isolates were confirmed as ESBL producers by the combined disc confirmatory test out of 56 isolates that tested positive for ESBL production through the disc diffusion test. The presence of AmpC production was assessed using the cefoxitin disc test, 32 isolates were screened to be AmpC producers, and the AmpC disc test confirmed AmpC production in 9 isolates of them. Using the Mast® D68C set, 32 isolates were ESBL producers, 3 were AmpC producers, and 4 isolates were ESBL/AmpC co-producers. The highest sensitivity was to cefepime-tazobactam (91.48%) followed by the carbapenems.ConclusionCefepime-tazobactam showed remarkable activity against ESBL and/or AmpC-producing Gram-negative bacilli and may be considered as a therapeutic alternative to carbapenems.

Molecular characterization of extended-spectrum beta-lactamases and carbapenemases producing Enterobacteriaceae isolated from North Eastern region of India

Objectives: This study is aimed to investigate the prevalence of genes encoding extended-spectrum β-lactamases (ESBLs) and carbapenemases production among Enterobacteriaceae isolated from North East India. Materials and Methods: A total of 210 non-duplicate multi-drug resistant Enterobacteriaceae (MDRE) strains were included in this investigation. The isolates were resistant to third-generation cephalosporins, aminoglycosides, and fluoroquinolones. First, the strains were subjected to phenotypic assays to determine ESBLs and carbapenemases production; then, multiplex polymerase chain reaction (mPCR) assays were done to detect ESBLs and carbapenemases genes. In addition, efflux pump activity was determined by phenylalanine-arginine b-naphthylamide assay. Statistical Analysis: The frequency of ESBLs and carbapenemase genes among MDRE strains was shown as percentages. The data analysis was done using Microsoft Excel computer software. Results: Among 210 MDRE clinical isolates, ESBLs production was observed in 72.86% (153) isolates. During mPCR assay, gene encoding ESBLs were detected in 55.24% (116) MDRE strains beta-lactamase Temoniera (blaTEM) (26.67%, 56), beta-lactamase Cefotaxime-Munich (blaCTX-M) (19.52%, 41), and beta-lactamase sulfhydryl reagent variable (blaSHV) (9.05%, 19)]. In addition, 55 (26.2%) and 53 (25.26%) strains were found to be meropenem and imipenem resistant, respectively. Carbapenemase nordmann-poirel (Carba-NP) test for carbapenemases activity was found to be positive in 18.58% (39) MDRE strains. The genes encoding carbapenemases production was observed in 18.58% (39) MDRE [beta-lactamase New Delhi metallo-β-lactamases-1(blaNDM-1) (8.10%, 17), beta-lactamase oxacillinase-48 (blaOXA-48) (2.86%, 6), beta-lactamase Verona imipenemase (blaVIM) (1.43%, 3), and blaOXA-48 and blaVIM (6.19%, 13)]. Efflux pump activity was observed in 5 (2.3%) of Carbapenem-resistant Enterobacteriaceae isolates. Conclusions: For the first time in this region, we have detected the presence of blaOXA-48 and blaVIM in a single MDRE isolate as high as 6.1%. Therefore, clinicians need to detect the ESBLs and carbapenemases producing Enterobacteriaceae on priority in hospital settings for therapeutic options as well as stringent infection control strategies to be adopted as precautions.

Extended Spectrum B-Lactamase (ESBL) and Metallo B-Lactamase (MBL) Production in Gram-Negative Bacteria isolated from Urinary Tract Infection Patients.

Background: The rate of infections caused by Morganella species is reported to be affected by difficulties in their isolation. Enterobacter, species, Citrobacter freundii, Serratia marcescens, and Morganella morganii are the major pathogens involved in hospital acquired infections. All of them are extensively reported in the infections of urinary tract, respiratory tract, cutaneous disorders, catheter associated infections and infections of the central nervous system.Objective: To investigate the frequency of ESBL producing bacteria in Urinary Tract Infection. Material and Methods: A cross-sectional study of 200 urine samples was collected from the outdoor patient departments of Khyber Teaching Hospital Peshawar through consecutive sampling technique during April, 2019 to June 2019. The urine samples were collected and then cultured on selective media i.e., Cysteine Lactose Electrolyte Deficient Agar (CLED) and on MacConkey agar plates. Isolates were identified by conventional morphological and biochemical tests while antibiotic susceptibility was analyzed by “Agar disc diffusion method” using different antibiotics and their zone of inhibition was measured. Results: Total 200 samples processed, 125 (62.5%) isolates, including 67 (53.6%) females, tested positive for the growth of Gram-negative bacteria. Among the identified species, 76 (60.8%) isolates produced ESBLs, with Escherichia coli accounting for 32.6%, Enterobacter for 23.2%, and Morganella species for 12.0%. Moreover, 77 (61.6%) of the isolates were found to be MBL positive, with 30 (24.0%) of them being E. coli, 28 (22.4%) being Enterobacter, and 19 (15.2%) being Morganella spp. The isolates formed a zone of inhibition like a clover leaf and demonstrated a sensitivity of 85 (68%) to antibiotics in the carbapenem class, such as imipenem and meropenem. Cefoparazone/Sulbactam 80 (64.0%), Ofloxacin 79 (63.2%), and Amikacin 78 (62.4%) were the next three antibiotics with high sensitivity. Ampicillin 106 (84.8%) showed the highest resistance, followed by Nitrofurantoin 84 (67.2%) and Ceftriaxone 79 (63.2%), in that order. Conclusion: The study indicated that ESBL-producing bacteria were present frequently among UTI patients. Most of the isolates exhibited strong carbapenem class antibiotic sensitivity. The findings of this study may contribute to the formulation of tactics to lower the incidence of ESBL-producing UTI.Keywords: Antibiotics resistance, Gram Negative bacteria, Plasmid-mediated enzymes, UTI.

The frequency of ESBL producing bacterial infections and related antimicrobial susceptibility in ICU patients: A five-year longitudinal study

The frequency of ESBL producing bacterial infections and related antimicrobial susceptibility in ICU patients: A five-year longitudinal study

Study of Applications of E-Test for the Detection of Beta Lactamase Producing Bacteria

The term antimicrobial resistance refers to the ability to resist the effects of drugs formally used to treat them and this term relates only to bacteria becoming resistant. Microorganisms which are resistant to multiple drugs are known as multidrug resistant bacteria. Methods: Most of the experimental work to study the application of E-Test for detection of lactamase producing bacteria was carried out at Pathology Laboratory of Sir Ganga Ram Hospital Lahore. While the remaining research work was done in Microbiology Laboratory of Govt. Post Graduate Islamia College Cooper Road Lahore during the study period from December 2019 to March 2020. Total 60 samples of different patients were collected from Sir Ganga Ram Hospital Lahore and most of the samples were urine (n=25), followed by Blood (n=14), Pus (n=14), and sputum (n=7). Oxidase, indole, citrate utilization, sugar fermentation (Kligler iron agar medium) and urease tests were performed for the identification bacterial strains. Results: In all of 60 samples frequency of occurrence of E. coli, Enterobacter and Klebsiella strains were 59%, 23%, 18% respectively. Most of them (n=36) were ESBLs positive and about (n=24) were ESBLs negative and their percentage were 60% and 40% respectively. Extended spectrum β-lactamase (ESBL) producing strains of Enterobacteriaceae have now become as a significant issue in hospitalized and community patients. These microorganisms are liable for many diseases, for example, urinary tract infection, septicemia, hospitalized-acquired pneumonia, intra-abdominal abscess, brain abscess and device related infections. Conclusions: The frequency of ESBL producing bacteria in most hospitals is very high especially in the hospitals where broad spectrum antibiotics are generally recommended. Among gram negative bacteria, the emergence of resistance to expanded spectrum cephalosporins has been a major concern. Many of ESBL producing bacteria showed multidrug resistance.

Pathogenic features of urinary Escherichia coli strains causing asymptomatic bacteriuria during pregnancy

Urinary tract infection (UTI) during pregnancy is often correlated with complications. As the main objective of this study, we investigated the prevalence of antimicrobial susceptibility, resistance genes, virulence genes and its relationship with different phylogenetic groups among Uropathogenic E. coli strains isolated from pregnant women with asymptomatic bacteriuria who referred to Hafez hospital, Shiraz, Iran. Our results revealed that among 300 urine samples, 105 (35%) were positive for E. coli. The data demonstrated that the highest and the lowest resistance rates were observed against nalidixic acid (82.1%), and imipenem (2.8%), respectively. The frequency of ESBLs and AmpC-β-lactamase, in the Uropathogenic E. coli isolates was 41% and 9.5% respectively. blaCTXM was the commonest genotype (93%). Phylogenetic group distribution was as follow: B1 2.8%, A 14.2%, B2 61.9% and D 4.6%. Our result showed that most of the virulence genes belonged to group B2 and also several virulence genes such as hlyA, cnf-1 and papGII genes were positively associated with group B2. Among E. coli strains isolated from patients with UTIs, different features phylogroups, with special virulence factors, could cause severe infection. Awareness about the virulence patterns distribution among phylogenetic groups of UPEC could greatly aid in confine and prevent the development of lethal infection caused by these strains.

Antibiotic Susceptibility Patterns of Bacteria Isolated from Hospital Surfaces and Environment in Kenya

Objective: Control of hospital environment is key to success of healthcare quality. Increasing emergence and spread of pathogenic bacteria is of great concern and continues to challenge infection prevention and epidemiology practice. This study aimed at providing information about the management of hospital environment and wastes in selected hospitals in Kenya, determine prevalence of pathogenic bacteria and their antibiotic susceptibility.
 Methods: A cross sectional study was conducted at Kenyatta National Hospital (KNH) (public) and Kikuyu Mission Hospital (KMH) (private) in Kenya from May 2015 to April 2017. In microbiological analysis, a total of 246 samples from each of the two hospitals was obtained using sterile cotton swabs from random sampling of hospital different surfaces, drainages, hands of healthcare givers and hospital waste dump site among others.
 Results: A total of 471 bacterial isolates were recovered, and were distributed as follows; Providentia spp, Staphylococcus aureus spp, Escherichia coli spp (E. coli), other Gram negative bacteria were, Pseudomonas spp, coagulase negative Staphylococcus (CONS), Serratia spp, Klebsiella spp, Proteus spp and Enterobacter spp. Susceptibility test revealed that Escherichia coli isolates were the most sensitive isolate to antibiotics. Imipenem drug showed 100% sensitivity for Gram negative, while Gram-positive isolates, linezolid antibiotic was the most sensitive drug.
 Discussion: There is need for stringent review of hospital waste management system in Kenya. The frequency of ESBL producing strains among clinical isolates has been steadily increasing.
 Conclusion: Continued drug resistance surveillance of ESBL isolates is necessary to guide the appropriate and judicious antibiotic use.

Antibiotic resistance pattern and frequency of some beta lactamase genes in Klebsiella pneumoniae isolated from raw milk samples in Iran

Klebsiella pneumoniae have become an important cause of mastitis in dairy cows. Resistance to beta lactam antibiotics resulted from beta lactamases enzyme production. The aim of this study was to investigate the antibiotic resistance pattern and frequency of some beta lactamase genes in Klebsiella pneumoniae isolated from raw milk samples in Iran. 200 raw cow milk samples were collected from different villages of north west of Iran. The samples were cultured and biochemical tests were performed for phenotypic diagnosis. Then, antibiotic resistance pattern was determined by antibiogram test. Finally, the presence of CTX, SHV and TEM genes in Klebsiella pneumoniae isolates was found by PCR method. Of total 200 raw cow milk samples, 80 samples (40%) contained Klebsiella pneumoniae. The frequency of CTX, SHV and TEM genes in Klebsiella pneumoniae isolates was 50 (62.5%), 34 (42.5%) and 70 (87.5%), respectively. 14 Klebsiella pneumoniae isolates (17.5%) possessed all three intended genes simultaneously. All strains of Klebsiella pneumoniae (100%) were resistant to ampicillin. The most strains were resistant to ceftriaxone (75%), gentamicin (70%) and nitrofurantoin (70%). 4 Klebsiella pneumoniae strains (5%) were resistant to all of tested antibiotics. The results showed high frequency of ESBLs and antibiotic resistance in Klebsiella pneumonia samples isolated from raw milk. It may occur exchange of resistance genes within and across species and with commensal bacteria of the human and animals.

Molecular characterization of extended-spectrum β-lactamase-producing Escherichia coli isolated from postpartum uterine infection in dairy cattle in India.

Background and Aim:Selection and dissemination of plasmid-encoded extended-spectrum β-lactamase (ESBL) among Enterobacteriaceae confers resistance to beta-lactam antibiotics. The purpose of this study was to determine the prevalence and molecular characteristics of ESBL-producing organisms isolated from dairy cattle with a uterine infection.Materials and Methods:Bacterial isolates (n=62) were characterized by biochemical test for genus and species determination. Antimicrobial susceptibility tests were performed by Kirby–Bauer disk diffusion method using panel of antibiotics for initial screening of ESBL organism. Phenotypic confirmation of ESBL-suspected strains was done by combination disk method and double-disk method. Multiplex polymerase chain reaction (PCR) was carried out for phylogrouping of Escherichia coli isolates as well as for genotyping ESBL genes. Enterobacterial repetitive intergenic consensus-PCR method was used for genotypic characterization of isolates.Results:Antibiotic susceptibility profile of E. coli (n=40) isolates showed high rates of resistance for ampicillin (95.0%), cefpodoxime (97.5%), cefotaxime (87.5%), and ceftriaxone (70%). However, low rates of resistance were observed for cefoxitin (25%), amoxicillin/clavulanic acid (20%), ceftazidime (17.5%), gentamicin (10%), and ertapenem (7.5%). A total of 39/40 E. coli isolates were confirmed as ESBL with Epsilometer test as well as the genotypic method and 28 (70%) of them were multidrug-resistant. Genotype blaCTX-M was observed as a predominant beta-lactamase type with the preponderance of CTX-M Group 1. The following combinations were observed: blaTEM+ blaCTX-M in 15 (36.2%) isolates, blaTEM/blaSHV in 8 (5.2%) isolates, and blaCTX-M/blaSHV in 6 (5.2%) isolates. The phylogenetic grouping of E. coli strains revealed the highest prevalence for B1 (22.0%) followed by A (20%).Conclusion:This report shows a high frequency of ESBL E. coli from cattle with postpartum uterine infections. These isolates showed reduced susceptibility to common antibiotics used for the treatment of uterine infections greater affecting the therapeutic outcome.

Phenotypic Detection of Extended Spectrum Beta-Lactamases in Uro-pathogens. An Experience from Qazi Hussain Ahmed Medical Complex, Nowshera

Objectives: To determine the phenotype and frequency of Extended Spectrum Beta-Lactamase in Uro-pathogens in a tertiary care hospital of Nowshera. Material and methods: This Prospective cohort study was performed in the clinical pathology laboratory of Qazi Hussain Ahmed Medical Complex (QHAMC) Nowshera from 1st Jan 2019 to 30th May 2019. Relevant information was recorded on a predesigned proforma prepared as per CLSI Recommendation for data collection. Results: A total of 192 urine samples were received for Culture and sensitivity. Out of which 56 cases were ESBL phenotypically positive (29.16%). 39(69.9%) were females and 17(30.4%) were males. The age range of the patient was from 3 months to 63 years of age, with a mean age of 30 years with +5.4 SD Frequency of ESBL producing uro-pathogens was; 51(91%) E-Coli, 4(7.1%) Klebsiella pneumonia and 1(1.8%) Proteus mirabilis. Out of 39 ESBL producing uro-pathogen in Female gender, E Coli-ESBL producing strains were isolated in 35 patients, Klebsiella Pneumonia in 3 patients and one case was of Proteus mirabilis-ESBL. In the male gender, 17 cases with E Coli-ESBL were reported and one case of Kliebsilla Pneumonia ESBL. Conclusion: The prevalence of ESBL producers in the present study was quite alarming and challenging to the clinician in treating urinary tract infections. These types of resistant infections are a challenge to treat and a public health threat that needs accumulative response through advocacy, communication, and social mobilization. Keywords: ESBL, Urinary Tract Infection, antibiotic resistance.

Phenotypic Characteristics of <i>Klebsiella pneumoniae</i> Extended Spectrum β-Lactamases Producers Isolated in Hospitals in the Littoral Region, Cameroon

Background: the resistance of enterobacteriaceae to antibiotics is experiencing a worrying worldwide development with an increasing impact of β-lactamases. Klebsiella pneumoniae is one of the bacteria responsible for nosocomial infections. Hence the need to look for these enzymes in the hospitals of the Littoral region, Cameroon. Method: cross-sectional and descriptive study during 2016 and early 2017, isolates of intermediate sensitivity or resistant to third generation cephalosporins (C3G) collected in the laboratories of the Littoral referral hospitals and in Diagmed laboratory. Confirmation of the strains made by the API 20E™ gallery, the study of antibiotic sensitivity by the method of diffusion of discs on agar (Mueller Hinton). The double synergy test for the search of extended spectrum β-lactamases (ESBL), and confirmation by the Eurobio ™ kit (France). Results: a total of 412 strains of klebsiellasp (species) were isolated and 122 Klebsiella pneumoniae included. The majority age group is that ≤1 year with 26.0%, the germs were isolated in the urine at 54.6% and in neonatology and pediatrics at 35.8%. Klebsiella pneumoniae pneumoniae identified at 82.4%. The production of BLSE was 86.9%, against that of AmpC at 3.30%. The sensitivity to imipenem and amikacin was 96.2% and 98.1%, respectively. Conclusion: the study shows a high frequency of ESBL and a low presence of ampC in the Littoral region, Cameroon; practitioners must make a rational prescription from a correctly performed antibiogram.

1467. Antimicrobial Susceptibility and Molecular Characterization of Extended-Spectrum β-Lactamase of Escherichia coli and Klebsiella pneumoniae of Urine Samples Isolated from Community Patients in South Brazil

BackgroundEnterobacteriaceae is the main pathogens of UTI. It is important to be aware the local epidemiological data for an appropriate initial treatment. Resistance to antimicrobial agents has increased, especially to first-choice antibiotics in the treatment of cystitis. Our objective is to asses the antimicrobial susceptibility profile from uropathogens isolated in community and evaluated the dissemination of extended-spectrum ß lactamase (ESBL), in E. coli and K. pneumoniae in south of Brazil.MethodsFrom June 2016 to June 2017, all urine samples collected in the Basic Health Units and Emergency Departments were sent to a Central Laboratory. Identification and susceptibility tests were performed on the VITEK® 2 (bioMérieux, France) system. Clinical Laboratory Standards Institute (CLSI) breakpoints were used for the interpretation of susceptibility. Positive cultures were defined as those demonstrating ≥105 CFU / mL (colony-forming units). The presence of ESBL was also subjected to the Chrom ID BLEE® agar plate test (bioMérieux- Marcyl’Etoile, France). PCR technique uses specific primers for genes blaTEM and blaSHV. Detection of the blaCTX-M genes was performed by multiplex PCR.ResultsA total of 56,555 microbiologic tests were performed, 8189 were positive. Women were responsible for 89.4%, and 10% were pregnant. Table 1 shows uropathogens isolated. Graphic 1 shows antimicrobial susceptibility. Extended-spectrum ß lactamase production was present in 6.7% (n = 489). People older than 60 years had ESBL more frequent (P <0.05) as well as being pregnant is not related to ESBL (P <0.05). Table 2 shows the distribution of the bla genotypes. Table 3: Distribution of blaCTX-M. Among blaCTX-M1 genotype, blaCTX-M15 was the most frequent.ConclusionIn this study, the most frequent uropathogen isolated was E. coli followed by K. pneumoniae. Cotrimoxazol had high rates of resistance and nitrofurantoin the lowest. Quinolone resistance is more than 10%. Sensitivity to aminoglycosides and carbapenems remains high.We found relevant frequency of ESBL, CTX-M-1-group most commonly found. Among CTX-M-1, blaCTX-M15 was the most isolated. Disclosures All authors: No reported disclosures.

Phenotypic Characterization and Antibiotic Resistance Patterns of Extended-Spectrum β-Lactamase- and AmpC β-Lactamase-Producing Gram-Negative Bacteria in a Referral Hospital, Saudi Arabia.

Background Emergence of pathogenic bacteria carrying β-lactamase-resistant determinants has become a major health problem in the hospital setting. The study aimed to determine antibiotic-resistant patterns and frequency of extended-spectrum β-lactamase- (ESBL-) producing Gram-negative bacteria (GNB) and AmpC β-lactamase-producing GNB. Methodology A prospective cross-sectional study was conducted during a period from September 2017 to August 2018 at King Abdullah Hospital, Bisha Province, Saudi Arabia. GNB (n = 311) were recovered from patients' clinical specimens including sputum, urine, wound pus, blood, tracheal aspirates and high vaginal swabs, umbilical discharge, eye discharge, and cerebrospinal fluids. Isolates were identified by the Phoenix identification system. Antimicrobial susceptibility was tested by the Kirby–Bauer disk procedure. Phenotypic characterization of ESBLs and AmpC β-lactamases was performed utilizing the double-disk synergy test and inhibitor-based method, respectively. Associations with outcome measures were determined by simple descriptive statistics and a chi-square test. Results Out of 311 GNB isolates, the frequency of ESBL and AmpC β-lactamase producers was 84 (27%) and 101 (32.5%), respectively. Klebsiella pneumoniae and Escherichia coli were common ESBL producers. AmpC β-lactamases predominate among Acinetobacter spp. and Pseudomonas aeruginosa. Coproduction of ESBLs and AmpC β-lactamases was found in 36 (11.6%) isolates, with very close relative frequencies among K. pneumoniae, Acinetobacter spp., and P. aeruginosa. β-Lactamase producers were predominantly found in the surgical department (56.5%) and ICUs (44.2%). ESBL producers revealed high resistance for cefuroxime (96.4%), cefotaxime (92.9%), and trimethoprim/sulfamethoxazole (90.5%). The resistance rates were significantly higher among ESBL producers than nonproducers for cephalosporins (p < 0.001), amoxicillin/clavulanate (p < 0.001), piperacillin/tazobactam (p = 0.010), nitrofurantoin (p = 0.027), aztreonam (p < 0.001), ciprofloxacin (p = 0.002), and trimethoprim/sulfamethoxazole (p < 0.001). Significantly higher (p < 0.05) resistance rates were observed among AmpC β-lactamase producers than nonproducers for all tested antibiotics. Conclusions This finding showed a high prevalence of ESBL- and AmpC β-lactamase-producing GNB in our hospital. Quality control practice and routine detection of β-lactamase producers before deciding on antibiotic therapy are advocated.

Multidrug-resistant Shigella infection in pediatric patients with diarrhea from central Iran.

Background: Shigella spp. are primary pathogens of diarrhea in children worldwide. Emergence of resistance to fluoroquinolones and third-generation cephalosporins is crucial in the management of pediatric shigellosis. We determined the prevalence and the antibiotic resistance patterns of Shigella species isolated from pediatric patients in central Iran.Materials and methods: Pediatric diarrhea samples (n=230) were cultured on MacConkey and XLD agar media and in GN broth. Genus-specific PCR for ipaH was also used for detection directly from fecal specimens. Antibiotic resistance and the frequency of ESBL and AmpC genes were determined.Results: Out of the 230 samples, 19 (8.2%) cases of Shigella spp. were identified using culture. Twenty-six samples were positive by PCR (11.3%), S. flexneri (4/19; 21%) and S. sonnei (15/19; 78.9%) being the most detected. The highest antibiotic resistance rates were found for cotrimoxazole (19/19; 100%), ampicillin (16/19; 84.2%), cefixime (13/19; 68.4%) and ceftriaxone (12/19; 63.1%). Ten cases showed phenotypic ESBL presence and all these strains were positive for blaTEM, blaCTX-M-1, and blaCTX-M-15. Three strains were AmpC positive, all of which harbored blaCMY-2 and two contained blaCIT. Of the 19 Shigella isolates 5 (26.3%), 2 (10.5%), and 1 (5.2%) were phenotypically resistant to nalidixic acid, ciprofloxacin, and norfloxacin, respectively. Class 1 integron was found in 18 (94.7%) isolates whereas class 2 integron was found in 19 (100%) strains.Conclusion: We found a considerable presence of Shigella species with elevated antibiotic resistance levels. In particular, the resistance to third-generation cephalosporins (ESBL) and ciprofloxacin must be taken seriously.

Antibiotic susceptibility pattern of extended spectrum β-lactamase ESBL producing gram negative bacilli in a tertiary care teaching hospital, Bareilly, India

Background: The increasing prevalence of infections caused by antibiotic-resistant bacteria makes empirical treatment of these infections difficult. Resistance to a wide variety of common antimicrobials has made the proliferation of extended spectrum β-lactamase (ESBL) producing strains a serious global health concern that has complicated treatment strategies and is very alarming. This study was undertaken to identify ESBL production in various gram negative bacilli isolated and to further study the antibiogram of ESBL producers and their contribution towards anti-microbial resistance.Methods: A total of 2008 samples were taken and studied for positive bacterial growth. Presence of ESBL positivity was detected using Kirby-Bauer sensitivity testing method and their antibiogram was studied. Data was analysed using IBM SPSS version 20. Chi-square test was applied wherever applicable to check the significant difference among the different groups. p value of ≤0.05 was considered to be significant.Results: A total of 2008 samples were studied. Out of which 655 gave positive bacterial growth and amongst these 312 were ESBL producers. Resistance to multiple classes of antibiotics was observed among ESBL producers and mostly imipenem, colistin and polymyxin B were the antibiotics which were sensitive to most of the strains.Conclusions: The frequency of ESBL producing strains among clinical isolates has been steadily increasing. Advance drug resistance surveillance and development of newer antibiotics is necessary to guide the appropriate and judicious antibiotic use.

THE PREVALENCE AND PHENOTYPIC CHARACTERIZATION OF EXTENDED-SPECTRUM β-LACTAMASES-PRODUCING ESCHERICHIA COLI STRAINS ISOLATES RECOVERED FROM TERTIARY HOSPITALS IN SANA'A CITY, YEMEN

The emergence of ESBL producing Escherichia coli in clinical isolates is posing a serious threat for treating nosocomial infections. The aim of the study was to determine the frequency of extended spectrum β-lactamase (ESBL) producing Escherichia coli isolated from clinical specimens in several teaching and general hospitals in Sana'a city, Yemen, and to compare the phenotypic methods used for the characterization of ESBL producing strains. This cross sectional observational study was conducted from 1st July to 28th of August 2017, at the Department of Medical microbiology, Faculty of Medicine and Health Sciences, University of Sciences and Technology in Sana'a city, Yemen. A total number of 3500 various clinical samples were analyzed during the study period. Escherichia coli were identified using API 20E system and ESBL detection was carried out using double-disk synergy test (DDST) and CLSI confirmatory test. Escherichia coli were isolated from 100 samples, out of which 63 (63%) were ESBL producers and 37 (37%) were non-ESBL producers. The gender distribution of ESBL producing Escherichia coli was 35/45 (77.8%) in males and 28/55 (50.9%) in females. Highest frequency of ESBL producing Escherichia coli was detected in sputum (100%), wounds (83.3%) and urine (65.7%) samples. Comparison of DDST and CLSI confirmatory test showed that 65 (65%) isolates were characterized by DDST and 63 (63%) using CLSI confirmatory test. All ESBL-positive isolates were susceptible to imipenem, indicating that this agent is the best drug for treating serious infections caused by ESBL-producing E. coli. In conclusion, the present study shows moderately high frequency of ESBL producing Escherichia coli among patients suffering from sepsis in tertiary hospitals in Sana'a city. DDST was found to be less efficient in ESBL detection as compared to CLSI confirmatory test.

Extended-spectrum β-lactamases (ESBL) TEM and SHV in intensive care unit patients with Health-care associated infections, silenced genes?

Background: The extended-spectrum β-lactamases (ESBL) Ambler's class A are capable of hydrolyze broad spectrum penicillin and cephalosporins, and mostly are codified by plasmidial genes. Health-care associated infections (HAI) are a group of entities with a high frequency worldwide, specially in critical adult patients and children in Intensive Care Units (ICU). The frequency of ESBL in this kind of patients is unknown nowadays in ICU in Cartagena de Indias D.T., Bolívar Colombia. Methods & Materials: The goal of this project was to describe the epidemiology of ESBLS type TEM and SHV in the city of Cartagena de Indias D.T state of Bolívar in Colombia. Clinical samples (blood, urine, LRT secretion, surgical site secretion) were collected from adult patients under HAIs diagnosis (Ventilator Associated Pneumonia, Bloodstream Infection, Urinary Tract Infection, Surgical Site Infection). Phenotypic identification, susceptibility test and antibiotic profile was performed with an automatized method according the current CLSI standards, following of genotypic identification with molecular biology methods as PCR and sequencing to confirm the presence of TEM and SHV genes in susceptible and resistant bacteria. Results: The presence of ESBLS type TEM and SHV was frequent in the samples collected, finding that the presence of TEM/SHV at the same time was found in 43.3% of the samples and TEM ESBL was the most frequent, these findings were observed in susceptible and resistant bacteria. K pneumoniae was the most frequent bacteria (33.3%) follow by P. aeruginosa (28,9%) with TEM and SHV genes in susceptible and resistant samples at the same time. Conclusion: The presence of ESBL type TEM and SHV in susceptible and resistant bacteria in Health-care associated infections (HAI) in Intensive Care Units (ICU) patients has an importance in antibiotic therapy and prognosis of this kind of patients worldwide. Silenced genes in susceptible strains has been described in this kind of isolates, in Cartagena, Colombia this kind of findings are new, and could be part of the reason of the negative outcome on these patients.

Infeções do Trato Urinário da Comunidade da Ilha do Faial, Determinadas no Hospital da Horta EPER - 2016

Introdução: A infeção do trato urinário (ITU) é uma das infeções mais frequentes a nível comunitário, apresentando custos mais elevados para a sociedade e para o sistema de saúde. A publicação de estudos de avaliação epidemiológica dos agentes etiológicos responsáveis pela ITU e o seu perfil de resistências antimicrobianas constitui uma mais-valia para a elaboração de critérios de decisão para antibiótico-terapia empírica, bem como para alertar os responsáveis na área da saúde no que respeita aos benefícios de uma prescrição correta dos antimicrobianos.&#x0D; Material e Métodos: Estudo epidemiológico do tipo transversal, baseado nas uroculturas realizadas aos utentes externos do serviço de Patologia Clínica do Hospital da Horta EPER no ano de 2016. Sobre as uroculturas consideradas positivas foram analisados parâmetros como a idade, sexo, tipo de bactéria e perfil de suscetibilidade a antimicrobianos. Foram excluídos do estudo todos os registos com dados insuficientes para análise, bem como todos os pedidos de uroculturas em duplicado e do mesmo paciente num prazo inferior a 7 dias. Todos os dados utilizados foram disponibilizados pelo Serviço de Patologia Clínica do Hospital da Horta EPER.&#x0D; Resultados: Maior prevalência de uroculturas positivas nas mulheres comparativamente com os homens. Nas mulheres tendência bi-modal com primeiro pico a ocorrer na faixa etária dos 30 aos 39 anos, o segundo pico (mais elevado) na faixa dos 70 aos 79 anos. Nos homens, a tendência de aumento ocorre a partir da faixa etária dos 50 aos 59; a frequência das bactérias isoladas entre sexos é diferente. Predomínio da Escherichia coli como principal causadora de ITU, na mulher é mais alta do que no homem. A segunda e terceira bactéria mais frequentes foram a Klebsiella p. pneumoniae e Proteus mirabilis respetivamente, com maior frequência no homem do que na mulher em ambos os casos; maior frequência de beta lactamases de espectro estendido ocorre no homem; o estudo do perfil antimicrobiano nas estirpes de Escherichia coli apresentou elevada sensibilidade à fosfomicina (&gt; 95%) e nitrofurantoína (&gt; 95%). O timetroprim/sulfametoxazol e as fluoroquinolonas apresentaram resistências elevadas, (próxima dos 20%). A amoxicilina e amoxicilina/ácido clavulânico com resistências muito mais elevadas quando comparadas com a fosfomicina e nitrofurantoína. Excluindo a cefalotina, no grupo das cefalosporinas existe alguma heterogeneidade, mas com sensibilidades sempre superiores a 80%.&#x0D; Conclusão: Este tipo de estudos permite ajudar a determinar as linhas orientadoras para uma elaboração de antibiótico-terapia empírica.