Prevalence Of Extended-spectrum Beta-lactamase Producers Research Articles

Phenotypic characterization of ESBL-producing urinary isolates of E. coli and Klebsiella spp. in a tertiary care children's hospital in Nepal

BackgroundThe production of extended-spectrum beta-lactamases (ESBLs) among uropathogens, particularly E. coli and Klebsiella spp., poses a severe public health concern. This study explored the epidemiology of ESBL-producing E. coli and Klebsiella spp. isolated from urine samples obtained at a tertiary care children's hospital in Nepal.MethodsA cross-sectional study was conducted from August 2016 to February 2017. A total of 745 clean catch urine samples were obtained from pediatric patients under the age of 13 and subjected to semiquantitative culture. E. coli and Klebsiella spp. were identified using standard laboratory protocols. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and ESBL producers were phenotypically identified using the combined disk method.ResultsAmong the bacterial isolates, E. coli predominated, accounting for 139 (81.8%) positive cases. Notably, E. coli showed high susceptibility to nitrofurantoin, with 117 (84.2%) isolates being susceptible. Meanwhile, K. pneumoniae showed high susceptibility to gentamicin, with 21 (91.3%) isolates being susceptible. Of the 163 isolates of E. coli and Klebsiella spp., 62 (38.0%) were identified as multidrug-resistant (MDR), with 42 (25.8%) confirmed as phenotypic ESBL producers. Remarkably, all 41 (100%) ESBL-producing E. coli isolates were susceptible to imipenem.ConclusionsThe prevalence of ESBL producers among E. coli and K. pneumoniae isolates from pediatric patients underscores the importance of antimicrobial stewardship. Nitrofurantoin and gentamicin emerge as effective empirical treatment choices against these pathogens in children. However, the high rates of multidrug resistance and ESBL production highlight the necessity for routine surveillance, and early detection strategies to manage such infections effectively.

Extended Spectrum Beta Lactamase Profile of Citrobacter Species Isolated from Various Samples in the North East Coast of Tamil Nadu, India: A Cross-sectional Study

Introduction: Citrobacter species play a significant role in causing hospital-acquired infections, especially those affecting the urinary and respiratory systems, and they are commonly present in faeces. Healthcare systems are facing a major challenge due to the rise of antibiotic-resistant Gram-negative infections resistant to antibiotics. Aim: To identify the genotypic characterisation of the resistant gene blaTEM-1 in Citrobacter spp. obtained from a range of clinical samples. This investigation seeks to provide insights into the patterns of antibiotic resistance exhibited by these bacteria. Materials and Methods: This cross-sectional study was conducted between August 2021 and February 2022. Preliminary examinations included screening as well as confirmatory tests for Extended Spectrum Beta Lactamase (ESBL) production, which were confirmed by the combination disk method and double disc synergy test. Genotypic detection of the blaTEM-1 gene was done using the Polymerase Chain Reaction (PCR) technique. Demographic parameters like gender and age were assessed. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Software version 21.0. Results: Citrobacter koseri (66 isolates, 54.5%) was found to be the predominant species among the Citrobacter spp., followed by Citrobacter freundii (55 isolates, 45.5%). Urine samples were the primary source of Citrobacter spp. isolates, comprising 52 isolates (43%) of the total. In this study, the prevalence of ESBL producers was reported to be 49 isolates (77.8%) identified as ESBL producers. Tigecycline demonstrated a 100% effectiveness rate, followed by Piperacillin-Tazobactam (96% sensitivity) and Amikacin (95% sensitivity). Out of the 20 Citrobacter spp. isolates that tested positive for ESBL, 15 isolates (75%) were found to be positive for blaTEM-1. Conclusion: The results of this study provide insight into the changing patterns of antibiotic resistance in Citrobacter spp., with particular emphasis on ESBL profiles. Thus, it is imperative to implement intervention techniques to reduce the ongoing selection and spread of these more resistant bacteria, as well as efficient infection-control measures to manage epidemics. These results advance the comprehension of antibiotic resistance patterns and guide initiatives to combat the increasing threat of antibiotic resistance.

598. A 3-Year Evaluation of Antibiotic Resistance Patterns in Gram-Negative Genitourinary Tract Infections Treated in Outpatient Infusion Centers (POICs)

BackgroundResistant Gram-negative pathogens (GNP) are common causes of genitourinary tract infections (GUI) often requiring outpatient parenteral antibiotic therapy (OPAT). Data are sparse regarding antibiotic resistance of GNP in patients (pts) treated with OPAT. We analyzed GNP of GUI pts treated in Infectious Disease OICs over a 3-year period stratified by location prior to OPAT.MethodsRecords from 18 POICs were queried for GUI pts with ≥1 GNP receiving OPAT from 2018 to 2020. Demographics, pt location prior to OPAT, infection type, year of therapy, and GNP were recorded. Antibiotic resistance patterns were defined as extended-spectrum beta-lactamase (ESBL) or multi-drug resistant (MDR). Chi Square and Fisher’s exact test were used to determine if ESBL status was associated with GNP or location prior to OPAT (hospital vs. community). The Cochran-Armitage test was used to analyze temporal trend in ESBL expression. Statistical significance was defined as P< 0.05 for all tests. ResultsA total of 634 GNP were identified in 601 pts (mean age: 64±16, 58% female). Infections were 75% complicated urinary tract infection, 20% pyelonephritis, and 5% prostatitis/other. Overall, 56% (n=339) were treated directly from the community and 44% (n=262) following hospital discharge. GNP isolated were 56% E. coli, 19% Pseudomonas spp., 16% Klebsiella spp. and 9% others. Of the 611 GNP with potential to express ESBL, 43% (n=265) were ESBL producers (Table 1). Significantly more ESBL-producing GNP occurred in pts discharged from a hospital prior to OPAT compared to the community (53% vs. 36%, P< 0.001). Overall, the incidence of MDR constituted 36% (n=231) of GNP, which did not differ by location prior to OPAT. Evaluation of ESBL incidence by year showed a significant increase from 2018 to 2020 (P=0.03). Although a slight increase in MDR was noted from 2018 to 2020, this was not significant (Figure 1).Table 1. Frequency of ESBL and MDR by Location prior to OPAT Figure 2. Prevalence of ESBL producers and MDR Pathogens by Year ConclusionResistant GNP were observed in the OPAT setting for GUI with both ESBL and MDR pathogens. We saw a significantly higher rate of ESBL with GNP from hospital discharged pts compared to community-acquired infections and an increase in the overall incidence of ESBL over time. Management of Gram-negative genitourinary infections in the OPAT setting requires close monitoring of emerging resistance patterns. Disclosures Kimberly A. Couch, PharmD, MA, FIDSA, FASHP, AbbVie (Speaker's Bureau) Lucinda J. Van Anglen, PharmD, Merck & Co. (Research Grant or Support)

The Incidence, Aetiology and Antimicrobial Susceptibility of Central Line-Associated Bloodstream Infections in Intensive Care Unit Patients at a Private Tertiary Care Hospital in Mumbai, India

AbstractBackground: There is a need to generate accurate data on temporal trends in incidence rates, aetiology and antimicrobial susceptibility of central line-associated bloodstream infections (CLABSIs) in the Indian setting. Aim: To study the incidence, aetiology and antimicrobial susceptibility of CLABSI in adult, paediatric and neonatal intensive care units (NICUs) in a tertiary care private hospital in Mumbai, India. Materials and Methods:This is a prospective observational study conducted at the adult, paediatric and NICUs of tertiary care private hospital from 2011 to 2018. CLABSI was defined as per the Centers for Disease Control criteria. Surveillance of CLABSI in the intensive care units (ICUs) was conducted using a form adapted from the International Nosocomial Infection Control Consortium surveillance system. The incidence rates of CLABSI (per 1000 central line days), crude mortality, aetiology and antimicrobial susceptibility were calculated and reported. Results: Six hundred and eighty-six episodes of CLABSI were recorded, and the overall incidence of CLABSI was 5/1000 catheter days, 4.1 in the adult ICU, 5 in the paediatric ICU and 9 in the newborn ICU. Crude mortality in patients with CLABSI in the adult, paediatric and NICUs was 45%, 30% and 7%, respectively. Of the 752 isolates, 80% were Gram negative, 10% Gram positive and 10% yeast. The prevalence of extended-spectrum beta-lactamase producers was 80%, and rates of carbapenem resistance were on an average 50%. Conclusions: The CLABSI rates at a well-equipped tertiary care hospital are still significantly higher than the USA benchmarks. Alarming rates of drug resistance in Gram-negative pathogens were seen.

Multidrug resistant, extensively drug resistant and pan drug resistant gram negative bacteria at a tertiary care centre in Bhubaneswar

Background: Multidrug resistance has emerged as a challenge in health care settings. Again increasing prevalence of multidrug resistant (MDR), extensively drug resistant (XDR) and pan drug resistant (PDR) gram negative bacteria is making the condition more critical because of limited options of antibiotics, increasing morbidity, mortality and hospital stay of the patients. The present study is carried out with an aim to estimate the prevalence of MDR, XDR, PDR gram negative bacteria in a tertiary care hospital.Methods: Total of 912 gram negative bacterial isolates obtained from various samples of indoor patients in a tertiary care hospital, were studied over a period of six months. The bacteria were identified by conventional methods. Antibiotic sensitivity testing was done by Kirby Bauer disc diffusion method. Minimum inhibitory concentration (MIC) of antibiotics for the resistant isolates were detected by Vitek-2 automated method. MDR, XDR and PDR were determined according to the definitions suggested by European Centre for Disease Prevention and Control (ECDC), and Centers for Disease Control and Prevention (CDC). Prevalence of extended spectrum beta lactamase (ESBL) producers was estimated.Results: Out of 912 isolates, prevalence of MDR, XDR and PDR were 66.12%, 34.32% and 0.98% respectively. Prevalence of MDR and XDR were higher in ICUs than clinical wards (p&lt;0.0001). Prevalence of ESBL producers was 48.4%.Conclusions: The study highlights increased prevalence of multidrug resistant and extensively drug resistant strains in our hospital. Stringent surveillance, proper implementation of hospital infection control practices and antimicrobial stewardship will help in limiting the emergence and spread of drug resistant strains.

MP23-12 A CONTEMPORARY VIEW OF ANTIBIOTIC RESISTANCE IN UROLOGY IN THE UNITED KINGDOM

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-12 A CONTEMPORARY VIEW OF ANTIBIOTIC RESISTANCE IN UROLOGY IN THE UNITED KINGDOM Emma Coleman, Hugo Donaldson, and Ranan DasGupta Emma ColemanEmma Coleman More articles by this author , Hugo DonaldsonHugo Donaldson More articles by this author , and Ranan DasGuptaRanan DasGupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.744AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Antibiotic resistance is a growing public health concern globally; the rise of extended spectrum beta lactamase (ESBL)-producing organisms and the emergence of carbapenem-resistance is now recognised. Antibiotic choices for urinary tract infection (UTI) treatment as well as for prophylaxis before urological procedures mean that all units should know their local resistance patterns. In our busy tertiary unit, we aimed to determine the prevalence of ESBL across all Urology patients, and to rationalise our antimicrobial regimes based on this. METHODS We examined positive urine culture results among all Urology inpatients and outpatients, collected over an 8-month period during 2017. The prevalence of ESBL producers (defined as resistance to cephalexin, ceftazidime or cefotaxime) and carbapenem resistance were analysed, and also the resistance rates to commonly used antibiotics. RESULTS During the 8-month period, the Microbiology laboratory cultured 468 positive urine samples from the Urology department. The number of ESBL producers was 75 (16%). Of the ESBL producers, 78% were identified as multi drug resistant (defined as resistance to at least one agent in three or more antibiotic categories). The number of carbapenem resistant organisms was 4 (0.85%). Resistance rates to commonly used antibiotics in the treatment of UTIs were examined. Trimethoprim resistance was the highest at 24%, ciprofloxacin 15.6%, nitrofurantoin 11.8% and gentamicin 8.1%. Escherichia Coli was found to be the most common causative organism, representing 44.2 % of all positive urine cultures, and accounting for 50.7 % of ESBL producers. CONCLUSIONS The prevalence of ESBL remains significant, particularly the high proportion of these that have become multi drug-resistant. The choice of oral agent for UTI treatment, and use of aminoglycosides for procedure prophylaxis, requires close liaison between the laboratory and surgical staff. The high rates are in line with published data from our city a decade ago, though the development of ESBL is a newer concern, and the emergence of carbapenem resistance may continue to follow a similar trajectory in the next few years. Tighter controls of peri-operative and treatment antibiotic regimes may play a part in slowing down this inexorable rise in resistance. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e285-e286 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Emma Coleman More articles by this author Hugo Donaldson More articles by this author Ranan DasGupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Antibiotic Susceptibility Pattern of Extended Spectrum Betalactamase (ESBL) Producers and other Bacterial Pathogens in Kano, Nigeria

Purpose: To evaluate the antibiotic susceptibility pattern of various bacterial pathogens including extended spectrum betalactamase (ESBL) producers in Kano, Nigeria. Method: A total of 604 consecutive clinical samples obtained from Aminu Kano Teaching Hospital (AKTH), Kano between January and July 2010 were analyzed for bacterial pathogens using standard microbiological techniques for the isolation and identification of pathogens. Antibiotics susceptibility tests including, ESBL screening and confirmation, were carried out by disc diffusion technique using Clinical Laboratory Standard Institute (CLSI) criteria. Results: Ten different types of bacteria genera were observed from nine different clinical samples. E. coli was the most frequently isolated bacteria (30.5 %) followed by Staphylococcus aureus (21.3 %). ESBL producers showed high-level resistance against the quinolones, aminoglycoside and cotrimoxazole but were sensitive to carbapenems and levofloxaccin. Non-ESBL organisms showed increased resistance to amoxicillin-clavulanate, ceftazidime, cotrimoxazole, tetracycline and amoxycillin. The prevalence of ESBL producers was 12.8 %. E. coli , Klebsiella pneumonia and Pseudomonas aeruginosa showed ESBL production of 17.3, 14.9 and 10.0 %, respectively. Conclusion: The findings of this study suggest that regular surveys should be carried out in this locality to provide baseline data that would always be of clinical relevance in the treatment of patients and to detect the emergence of multiple antibiotic resistance strains. Keywords: Antibiotic Susceptibility, Multiple antibiotic Resistance, Extended Spectrum Betalactamase, Bacterial Pathogens

Characterization of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae from Riyadh, Saudi Arabia

The objectives of this study were to determine the prevalences, genotypes, and clonal relationships of extended-spectrum beta-lactamase (ESBL)-producing strains in 98 Klebsiella pneumoniae isolates from Riyadh. The prevalence of ESBLs in these strains was 37·75%. All isolates that were confirmed to have ESBLs were completely resistant to amoxicillin/clavulanate, aztreonam, cefotaxime, ceftazidime, cefoxitin, and gentamicin and were susceptible to tigecycline, colistin, and imipenem. In total, 16·6, 77, and 91·6% of isolates were resistant to amikacin, ciprofloxacin, and piperacillin/tazobactam, respectively. The prevalences of isolates producing the beta-lactamases SHV, CTX-M, and TEM were 91·9, 86·5, and 54·05%, respectively. The most frequent ESBL gene detected was blaCTX-M-15, which was observed in 75% of isolates. Other frequent ESBL genes were blaSHV-12 (29·73% of isolates) and blaSHV-5 (5·4% of isolates); additionally, blaCTX-M-3, blaCTX-M-27, blaCTX-M-57, and blaCTX-M-82 were each detected in one isolate. Pulsed-field gel electrophoresis (PFGE) analysis revealed the presence of diverse and unrelated clones. The high prevalence of ESBL producers among the strains examined in our study was not due to the spread of a single clone of bacteria. Clone A was detected in six isolates, indicating intra-hospital spread. Our study documented a high prevalence of the CTX-M-15 product in K. pneumoniae and demonstrated that SHV-12 was also highly prevalent. This study represents the first report of CTX-M-3, CTX-M-27, CTX-M-57, and CTX-M-82 beta-lactamases in K. pneumoniae isolates from Saudi Arabia.

Epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a UK district hospital; an observational study

Extended-spectrum beta-lactamases (ESBLs) are an increasingly important cause of resistance in Gram-negative bacteria throughout the world. We investigated the clinical and molecular epidemiology of infections caused by ESBL-producing Enterobacteriaceae in a UK hospital, to identify the types of ESBL produced and risk factors for acquisition. Between July 2008 and June 2009, all patients yielding ESBL-producing Enterobacteriaceae from any clinical specimen were prospectively investigated using a questionnaire. API20E was used for bacterial identification; susceptibility testing and ESBL production were assessed by BSAC disc diffusion and cefpodoxime-clavulanate synergy tests, respectively. Polymerase chain reaction was used to screen a subset of isolates for bla(CTX-M) genes, to assign Escherichia coli isolates to their phylogenetic groups, and to identify members of the uropathogenic ST131 lineage. The overall prevalence of ESBL producers among clinical samples yielding Enterobacteriaceae was 1%; ESBL producers, obtained from 124 patients, were E.coli (N=105), Klebsiella pneumoniae (N=12), and others (N=7). The main risk factors identified include recent antibiotic use (93%) and presence of a urinary catheter (24%). CTX-M group 1 ESBLs dominated (in 59 of 78, 76%, isolates studied). Most E.coli (35 of 56 tested) were phylogroup B2; of these, 23 belonged to the ST131 clone, 12 were phylogroup D, and four each belonged to phylogroups A and B1. ESBLs are an uncommon but significant problem in north-west Cambridgeshire. CTX-M-type enzymes were found in 75% of ESBL-positive isolates. All but two patients had at least one recognized risk factor. This study supports the requirement for interventions to reduce inappropriate urinary catheterization and antibiotic prescribing.

Bacteriologic Profile and Antibiogram of Blood Culture Isolates in a Pediatric Care Unit

Background / Aims:Septicemia is one of the important causes of mortality and morbidity in neonates and children. Blood culture is the gold standard for the diagnosis. Emergence of multidrug resistant bacterial strains is a major problem in the management of sepsis. Present study was undertaken to identify the common bacterial pathogens associated with pediatric sepsis and to determine their antibiotic susceptibility pattern.Materials and Methods:Blood cultures from 185 suspected cases of sepsis were examined. The growths from the subcultures were identified by conventional biochemical tests. Antibiotic susceptibility testing was performed by modified Kirby-Bauer disk diffusion method and drug resistant strains in primary screening were further processed for extended spectrum beta lactamases (ESBL) and methicillin resistant Staphylococcus aureus (MRSA) status by combination disk method (ESBL) and oxacillin disk diffusion method (MRSA).Results:Out of the 185 cultures obtained from suspected cases, 81 (44%) were culture positive. Fifty-two (35%) of the culture isolates were Gram negative bacilli. Twenty-eight (64%) of the isolates were Gram positive cocci. One case was of mixed infection. The prevalence of MRSA in 41 strains of S. aureus was found to be 29% (12 strains). The overall prevalence of ESBL producers among 28 Gram negative bacterial isolates was found to be 32% (9 strains).Conclusion:This study stresses the need for the continuous screening and surveillance for antibiotic resistance in pediatric care unit.

A 2-year trend of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Thailand: an alert for infection control

A variety of gram-negative bacteria, particularly Enterobacteriaceae, produce extended-spectrum beta-lactamase (ESBL) resulting in resistance to several beta-lactam agents. These bacteria play a major role in nosocomial infections. While the prevalence of ESBL producers appear to be rapidly increasing worldwide, data from Thailand are rarely reported. We analysed the recent trends in prevalence and antimicrobial resistance among ESBL-producing Escherichia coli and Klebsiella pneumoniae over the 2-year period of August 2005 to July 2007 at a major university hospital in Thailand. The results showed that the prevalence of ESBL producers was very high (up to 65.9% among sputum isolates) and continues to increase. These bacteria also demonstrated a significant increase in resistance rates to several non-beta-lactam antibiotics and expressed a multidrug resistance phenotype at a high rate. This study poses a serious concern for infection control in Thailand and indicates the need for immediate action to prevent further spread of these resistant bacteria.