Prevalence Of Extended-spectrum Beta-lactamase Production Research Articles

Genetic diversity and prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in aquatic environments receiving untreated hospital effluents.

The spread of extended-spectrum beta-lactamase (ESBL)-producing bacteria in the environment has been recognized as a challenge to public health. The aim of the present study was to assess the occurrence of ESBL-producing Escherichia coli and Klebsiella pneumoniae from selected water bodies receiving hospital effluents in Kerala, India. Nearly 69.8% of Enterobacteriaceae isolates were multi-drug resistant by the Kirby-Bauer disc diffusion method. The double disc synergy test was used to detect the ESBL production and the genes responsible for imparting resistance were detected by PCR. Conjugation experiments confirmed the mechanism of plasmid-mediated transfer of resistance. The prevalence of ESBL production in E. coli and K. pneumoniae was 49.2 and 46.8%, respectively. Among the ESBL-encoding genes, blaCTX-M was the most prevalent group followed by blaTEM, blaOXA, blaCMY, and blaSHV. The results suggest that healthcare settings are one of the key contributors to the spread of ESBL-producing bacteria, not only through cross-transmission and ingestion of antibiotics but also through the discharge of waste without a proper treatment, leading to harmful effects on the aquatic environment. The high prevalence of ESBL-producing Enterobacteriaceae with resistance genes in public water bodies even post-treatment poses a serious threat.

HEALTHCARE-ASSOCIATED TUBO-OVARIAN INFECTIONS IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2020-2022).

The aim: To determine the current prevalence of healthcare-associated tubo-ovarian infections in female and antimicrobial resistance of the responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on healthcare-associated infections surveillance data. Definitions of health¬care-associated tubo-ovarian infections were used from the CDC/ NHSN. The susceptibility to antibiotics was determined by disk diffusion method according to the EUCAST. Results: Among all the 1,528 of women in this study, the prevalence of healthcare-associated tubo-ovarian infections was 31.2%. Of these cases, Salpingitis, Oophoritis, and tubo-ovarian abscess were 47.5%, 34% and 18.5%, respectively. Of all cases tubo-ovarian infections in female, 74.7% were detected after hospital discharge. The predominant pathogens were: Escherichia coli (27.7%), Enterobacter spp. (12.2%), Klebsiella pneumoniae (9.6%), Staphylococcus aureus (8.2%), Pseudomonas aeruginosa (8.1%), and Enterococcus faecalis (7.5%), followed by Proteus mirabilis (5.1%), Streptococcus spp. (4.5%), Staphylococcus epidermidis (4.4%), and Acinetibacter spp. (4%). Methicillin-resistance was ob¬served in 16.8% of S. aureus (MRSA). No strains S.aureus and E. faecalis resistant to vancomycin. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 24.7%. The prevalence of ESBL production among E. coli isolates was 28.6% and among K. pneumoniae 12.8%. Resistance to third-generation cephalosporins was observed in 14.9% E.coli and 11.3% K. pneumoniae isolates. Carbapenem resistance was identified in 11.3% of P.aeruginosa isolates. Conclusions: A healthcare-associated tubo-ovarian infections of the female in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics.

PREVALENCE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF EXTENDED SPECTRUM ?-LACTAMASE (ESBL) PRODUCING GRAM NEGATIVE BACILLI (KLEBSIELLA PNEUMONIA) IN A TERTIARY CARE TEACHING HOSPITAL, IN SOUTHERN-WEST KOTA DISTRICT OF RAJASTHAN (INDIA).

Background and Objectives: The resistance to broad spectrum ?-lactams which is mediated by the extended spectrum beta lactamase (ESBL) enzyme is an increasing problem now-a-days. This resistance mechanism has been responsible for nosocomial outbreaks, serious therapeutic failure if it is not detected on time and the outbreak of multidrug resistant, gram negative pathogens that need expensive control measures. Aim: To know the prevalence of ESBL production in klebsiella pneumoniae and antibiotic sensitivity pattern to 3rd generation of cephalosporins in Govt. Medical College Kota. Material and Methods: The study was conducted in Department of Microbiology, Kota Medical College, Kota, Rajasthan, from dec.2018 to dec.2019. Due permission from institutional ethical committee was obtained. This is descriptive observational study. All data were collected and analyzed with the help of suitable statistical parameters. A total of 101 consecutive, nonrepetitive, gram negative isolates, which were resistant to one of the third generation cephalosporins (cefotaxime,ceftriaxone or ceftazidime) were selected as “Suspicious for ESBL production” as recommended by the Clinical and Laboratory Standards Institute (CLSI). These isolates were confirmed for ESBL production by the double disc synergy test (DDST) and the phenotypic confirmatory disc diffusion test (PCDDT) and they were further confirmed by the E-test ESBL strip randomly. Result: Out of the 101 isolates by double disc synergy test (DDST) 45.54% (46) of Klebsiella pneumoniae isolates were ESBL producers, while PCDDT detected 58.41% (59) Klebsiella pneumoniae isolates as ESBL producers (p value<0.05). Randomly selected isolates were further confirmed by the E-test ESBL strip, which showed a highly significant correlation with PCDDT. Key words: Antimicrobial Susceptibility, Klebsiella pneumoniae, Gram Negative bacilli, Cephalosporins

HEALTHCARE ASSOCIATED DEEP PELVIC TISSUE INFECTION AND OTHER INFECTIONS OF THE FEMALE REPRODUCTIVE TRACT IN UKRAINE

The aim: To obtain the first estimates of the current prevalence of healthcare-associated deep pelvic tissue infection and other infections of the female reproductive tract (vagina, ovaries, uterus) including chorioamnionitis, and antimicrobial resistance of causing pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population included 3,053 women's who underwent gynecological surgery or other procedures from 2017 to 2019 in 7 women hospitals in Ukraine. Definitions of healthcare-associated reproductive tract infection were used from the CDC/ NHSN. Results: The prevalence of healthcare-associated deep pelvic tissue infection and other infections of the female reproductive tract was 26.3%. Incidence of infection was: 13.3% Pelvic abscess or cellulitis, 14.6% Adnexa utery, 9.5% Salpingitis, 7.1% Oophoritis, 12.2% Parametritis, 4.6% Chorioamnionitis, and 38.8% Bacterial Vaginitis. The predominant pathogens were: Escherichia coli (25.6%), Enterobacter spp. (11.4%), Klebsiella pneumoniae (10.6%), Staphylococcus aureus (8.5%), Enterococcus faecalis (7.2%) and Pseudomonas aeruginosa (7.1%). Methicillin-resistance was observed in 14.3% of S. aureus (MRSA). The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 20.8%. The prevalence of ESBL production among E. coli isolates was 24.7% and among K. pneumoniae 11.9%. Resistance to thirdgeneration cephalosporins was observed in 12.8% E.coli and 9.2% K. pneumoniae isolates. Carbapenem resistance was identified in 8.5% of P.aeruginosa isolates. Conclusions: Healthcare associated deep pelvic tissue infection and other infections of the female reproductive tract in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics.

ONE HEALTH: ANTIBIOTIC-RESISTANT BACTERIA CONTAMINATION IN FRESH VEGETABLES SOLD AT A RETAIL MARKETS IN KYIV, UKRAINE

The aim: To obtain the first estimates data on the occurrence of antibiotic-resistant bacteria in a wide range of fresh vegetables available in the Kyiv city markets. Materials and methods: We performed a multicenter study. Fresh vegetables samples were collected of the six different commodity groups from eleven of retail stores locatedin Kyiv, Ukraine. Samples were tested for up to eight bacteria of concern. The susceptibility to antibiotics was determined by disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing. Results: The antibiotic-resistant bacteria contamination in the fresh vegetables was 24.3%. The contamination among organic produce was significantly higher than in conventionally products. Contamination was found to be higher in leafy vegetables. The predominant contaminated bacteria were: Escherichia coli, Enterobacter spp. And Enterococcus faecalis, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, E. faecium, Staphylococcus aureus and Acinetobacter spp. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 36.8% and of methicillin-resistance in S. aureus (MRSA) 10.7%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae. Vancomycin resistance was observed in 3.1% of isolated enterococci (VRE). Carbapenem resistance was identified in 35.3% of P.aeruginosa isolates and 66.8% of Acinetibacter spp. isolates. Resistance to third-generation cephalosporins was observed in 9.7% K. pneumoniae and E.coli in 14.2% isolates. Conclusions: Research has shown that the majority of fresh vegetables available in Kiev markets is contaminated with antibiotic-resistant bacteria and is a potential vehicle for the transmission of these pathogens to consumers.

VAGINAL CUFF INFECTION AFTER HYSTERECTOMY IN UKRAINE

The aim: To obtain the first estimates of the current prevalence of vaginal cuff infection after hysterectomy and antimicrobial resistance of causing pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population consisted of women who had an abdominal, vaginal or laparoscopic hysterectomy from 2017 to 2019 in 7 women hospitals of Ukraine. Definitions of vaginal cuff infections were used from the Centers for Disease Control and Prevention's National Healthcare Safety Network, USA. Results: Total 12.6% women's after hysterectomy had vaginal cuff infections. Of these cases, 20.3% after abdominal, 15.5% vaginal and 4.1% laparoscopic hysterectomy were identified. The predominant pathogens of VCUF infections were: Escherichia coli (18.6%), Enterobacter spp. (12.4%), Staphylococcus aureus (10.8%), Streptococcus spp. (9,7%), Klebsiella pneumoniae (8.2%), Pseudomonas aeruginosa (7.6%), Enterococcus faecalis (7,0%) and Proteus spp. (7.0%). Methicillin-resistance was observed in 12.9% of S. aureus (MRSA) and 9.7% CoNS. Carbapenem resistance was identified in 7.3% of P.aeruginosa isolates. Resistance to thirdgeneration cephalosporins was observed in 8.9% K. pneumoniae and E.coli 11.9% isolates. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 22.7%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (32.6%, vs 12.3%). Conclusions: Vaginal cuff infections in women after hysterectomy are common in Ukraine and most of these infections caused by antibiotic-resistant bacteria. The incidence of VCUF infections after hysterectomy differs depending on the type of surgical procedure.

Prevalence of Extended-Spectrum Beta-Lactamases Production in Escherichia coli Isolated from Urinary Tract Infection Samples in Zanjan Hospitals, Iran

Prevalence of Extended-Spectrum Beta-Lactamases Production in Escherichia coli Isolated from Urinary Tract Infection Samples in Zanjan Hospitals, Iran

EPISIOTOMY INFECTIONS IN THE PUERPERIUM AND ANTIMICROBIAL RESISTANCE OF RESPONSIBLE PATHOGENS IN UKRAINE

The aim: To obtain the first estimates of the current prevalence rate of episiotomy infections in the puerperium and antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population consisted of all women who had a vaginal delivery in 7 Regional Women's Hospitals of Ukraine. Definitions of episiotomy infections were used from the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC/NHSN). Results: Total 35.6% women after vaginal delivery had episiotomy done. The prevalence rate of episiotomy infections was 17.7%. The predominant pathogens were: Escherichia coli (49.2%), Enterobacter spp. (11.1%), Streptococcus spp. (9.1%), Enterococcus faecalis (6.5%), Klebsiella spp. (8.1%), followed by Pseudomonas aeruginosa (4.7%), Staphylococcus aureus (4.2%), Proteus spp.(2.9%) and Staphylococcus epidermidis (2.8%). The overall proportion of methicillin-resistance was observed in 17.3% of Staphylococcus aureus (MRSA). Vancomycin resistance was observed in 6.8% of isolated enterococci. Carbapenem resistance was identified in 8% of P.aeruginosa isolates. Resistance to third-generation cephalosporins was observed in 15.2% Klebsiella spp. and E.coli 16.4% isolates. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 26.4%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (31.4%, vs 12.5%). Conclusions:Episiotomy infections in the puerperium are common in Ukraine and most of these infections caused by antibiotic-resistant bacteria. Optimizing the management and empirical antimicrobial therapy may reduce the burden of episiotomy infections, but prevention is the key element.

Genotypic detection of extended spectrum beta lactamases from selected bacterial isolates in the Specialist Hospital Sokoto, Nigeria

There are numerous reported cases of extended spectrum beta lactamases (ESBLs) producing Enterobacteriaceae in Nigeria, with little effort done on the molecular detection. Epidemiological studies around the world have investigated the prevalence of ESBL-producing enterobacteriaceae and they have seen multiple mechanisms of drug-resistance. Our study was designed to detect ESBLs genes such as CTX-M, SHV, and TEM using PCR from clinical isolates in a tertiary hospital in Sokoto metropolis. Clinical isolates from the Microbiology laboratory of the tertiary hospital was collected for 3 months. These isolates were identified using standard microbiological methods. They were tested against 8 antibiotics using the modified Kirby Bauer disc diffusion method. Multidrug resistant isolates were screened for ESBL production, and further confirmed by the Double Disc Synergy Test (DDST). Genotypic confirmation was carried out using multiplex Polymerase Chain Reaction (PCR). A total of 47 isolates made up of 21 E. coli (44.6%), 13 Klebsiella spp (27.6%), 7 Salmonella spp (14.9%), 5 Proteus mirabilis (10.6%), and 1 Enterobacter spp (2.1%) were obtained from urine, stool, and wound swab. Out of the 47 isolates, (45) 95.7% were multidrug resistant. Twenty-five (53.2%) were potential ESBL producers, while only 5 (20.0%) were confirmed phenotypically using a DDST. PCR results revealed 4 out of 5 of the isolates were possessing ESBL genes. It also revealed that 3 isolates co-produce TEM and SHV at 403bp and 293bp respectively. Only 1 isolate produced CTX-M gene at 569bp. The prevalence of ESBL production in the Gram negative enterobacteriaceae in our study did not indicate a high prevalence as reported by some studies in Sokoto and Northwest Nigeria.Keywords: Molecular detection, ESBLs, Clinical isolates, PCR

Neonatal sepsis: Aetiological agents and risk factors

Introduction: India accounts for 30% of neonatal deaths globally. Bacterial sepsis is a major cause of morbidity and mortality in newborns. Prompt detection of microorganisms and early institution of therapy are of paramount importance. Materials and Methods: The study was conducted in the Department of Microbiology over a period of one year. Two samples of blood were collected under aseptic precautions, 1 ml each was added to conventional blood culture bottle with biphasic media and paediatric BacT/ALERT bottle. Microorganisms were identified by Gram staining, standard biochemical tests and appropriate antibiograms. The common microorganisms responsible for early- and late-onset neonatal sepsis were identified, and the resistant strains were studied in detail. The main clinical presentations and maternal and neonatal risk factors associated with neonatal sepsis were identified and statistically correlated. Results: Of the 233 newborns, 44 (18.9%) were culture positive, with higher incidence of sepsis in low birthweight male babies. Of the 44 isolates, 31 (70.5%) were Gram-negative organisms, with Klebsiella pneumoniae subspecies pneumoniae (45.5%) being the most common isolate. The prevalence of extended-spectrum beta-lactamase production in this study was 54.8%. Screening for AmpC production showed that 25.8% of the isolates were positive. The maternal risk factor of premature rupture of membrane of more than 18 h was seen in the case of 74 babies (31.8%), and 138 (59.2%) babies had prematurity as neonatal risk factor leading to sepsis. Conclusion: As the aetiological agents in neonatal sepsis vary in different circumstances and antimicrobial resistance due to different mechanisms is prevalent, antibiotic usage should be based on culture and sensitivity results.

Extended-Spectrum Beta-Lactamase (ESBL)–Producing Gram-negative Isolates from Urine and Wound Specimens in a Tertiary Health Facility in Southern Nigeria

Purpose : To determine the prevalence of extended spectrum beta lactamase (ESBL) producing Gram negative bacteria causing wound and urinary tract infections among in- and out-patients in a tertiary health facility. Methods : The presence of ESBL was determined among 230 Gram negative bacilli isolated from wound (105) and urine (125) specimens from in- and out-patients who attended University of Benin Teaching Hospital (UBTH) for treatment using the double disc synergy method. Disc susceptibility test was performed on all isolates using standard techniques. Results : There was no significant difference in the prevalence of ESBL production between isolates from wound (47.6 %) and urine (41.6 %) as well as between in-patients (48.8 %) and out–patients (39.38 %). Enterobacter species were the most prevalent producers of ESBL from both wound and urine specimens as well as from both in- and out–patients. Bacterial isolates that produced ESBL were more resistant to amoxicillin-clavulanate, ceftazidime, ceftriaxone, cefotaxime, gentamicin, ciprofloxacin and ofloxacin compared to non-ESBL producers. Conclusion : A high prevalence (44.3%) of ESBL producing Gram–negative bacteria was observed among the patients, with Enterobacter species being the most prevalent. Prudent use of antibacterial agents is advocated to stem the tide. Keywords : Extended-spectrum beta-lactamase, Enterobacter species, Wound, Urine, Gram negative bacteria

Extended-spectrum beta-lactamases producing Escherichia coli and Klebsiella pneumoniaei: A Multi-centric Study Across Karnataka

Background:There are sporadic reports on detection of extended-spectrum beta-lactamases (ESBL) producers from Karnataka; hence, this is a first multicentric study across Karnataka state to determine the prevalence of ESBL production among clinical isolates of Escherichia coli and Klebsiella pneumoniae.Aims and objectives:To determine the prevalence of ESBL producing clinical isolates of E. coli and K. pneumoniae from five geographically distributed centers across Karnataka, to study the susceptibility of ESBL producing isolates to other beta-lactam and beta-lactam-beta-lactamase inhibitors and to demonstrate transferability of plasmids coding for ESBL phenotype.Materials and Methods:Two hundred isolates of E. coli and K. pneumoniae each were collected from each of the five centers (Bellary, Dharwad, Davangere, Kolar and Mangalore). They were screened for resistance to screening agents (ceftazidime, cefotaxime, ceftriaxone, aztreonam) and positive isolates were confirmed for ESBL production by test described by Clinical and Laboratory Standards Institute. Co-production of ESBL and AmpC beta-lactamase was identified by using amino-phenylboronic acid disk method. Susceptibility of ESBL producers to beta-lactam antibiotics and beta-lactamase inhibitors was performed. Transferability of plasmids was performed by conjugation experiment.Results:Overall prevalence of ESBL production among E. coli and K. pneumoniae across five centers of the state was 57.5%. ESBL production was found to be 61.4% among E. coli and 46.2% among K. pneumoniae. ESBL production was significantly more among E. coli than K. pneumoniae. Significant variations in distribution of ESBL across the state was observed among E. coli isolates, but not among K. pneumoniae isolates. All ESBL producers demonstrated minimum inhibitory concentration levels ≥2 μg/ml towards cefotaxime, ceftazidime and ceftriaxone.Conclusion:Overall prevalence of ESBL production among clinical isolates of E. coli and K. pneumoniae across Karnataka state was high. The prevalence of ESBL production was significantly higher with E. coli than K. pneumoniae isolates. Higher rates of resistance to ceftriaxone and cefotaxime than to ceftazidime suggests the possibility of presence of CTX-M type ESBLs. Of all the beta-lactam/beta-lactamase inhibitor combinations tested, cefepime-tazobactam demonstrated highest in-vitro activity against ESBL producers. There was no statistical difference in the transferability of plasmids among E. coli and K. pneumoniae.

Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome.

To determine the epidemiologic features and clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae isolates, cases of bacteremia caused by these organisms in children were analyzed retrospectively. Among the 157 blood isolates recovered from 1993 to 1998 at the Seoul National University Children's Hospital, the prevalence of ESBL production was 17.9% among the E. coli isolates and 52.9% among the K. pneumoniae isolates. The commonest ESBLs were SHV-2a and TEM-52. A novel ESBL, TEM-88, was identified. Pulsed-field gel electrophoresis analysis of the ESBL-producing organisms showed extensive diversity in clonality. The medical records of 142 episodes were reviewed. The risk factors for bloodstream infection with ESBL-producing organisms were prior hospitalization, prior use of oxyimino-cephalosporins, and admission to an intensive care unit within the previous month. There was no difference in clinical severity between patients infected with ESBL-producing strains (the ESBL group) and those infected with ESBL-nonproducing strains (the non-ESBL group) at the time of presentation. However, the overall fatality rate for the ESBL group was significantly higher than that for the non-ESBL group: 12 of 45 (26.7%) versus 5 of 87 (5.7%) (P = 0.001). In a subset analysis of patients treated with extended-spectrum cephalosporins with or without an aminoglycoside, favorable response rates were significantly higher in the non-ESBL group at the 3rd day (6 of 17 versus 33 of 51; P = 0.035), the 5th day (6 of 17 versus 36 of 50; P < 0.05), and the end of therapy (9 of 17 versus 47 of 50; P < 0.001). In conclusion, the ESBL production of the infecting organisms has a significant impact on the clinical course and survival of pediatric patients with bacteremia caused by E. coli and K. pneumoniae.