Shristi RAUT, Shishir GOKHALE, Bipin ADHİKARİ

Prevalence of Extended Spectrum Beta-Lactamases among Escherichia coli and Klebsiella spp isolates in Manipal Teaching Hospital, Pokhara, Nepal

Amaç: Manipal Eğitim Hastanesi’nde genişlemiş spektrumlu beta-laktamaz (GSBL) üreten Escherichia coli and Klebsiella spp izolatlarını tanımlamakYöntemler: Nepal Pokhara’da yer alan Manipal Eğitim Hastanesi’nde hastaların çeşitli klinik örneklerinden izole edilen E. coli and Klebsiella spp. suşlarında GSBL sıklığını belirlemek için Ekim 2011 ve Nisan 2012 arasında kesitsel bir çalışma yapıldı. GSBL üretimi “Clinical laboratory Standards Institute” (CLSI) önerilerine gore belirlendi.Bulgular: Çeşitli klinik örneklerden izole edilen 285 E. coli ve 55 Klebsiella spp (n=55, % 16,2) çalışmaya dahil edildi. Örnekler in 255’i (% 75) idrar, 18’i (% 5,3) kan, 48’i (% 14,1) püy, 17’si (% 5,1) balgam ve 2’si (% 0,6) vücut sıvısı idi. Çift disk difüzyon ile yapılan fenotipik konfirmasyon testine göre 76 (% 22.4) izolat GSBL üretiyordu. GSBL üreten mikroorganizmaların hepsi (% 100) ampisilin ve seftriaksona dirençli idi. Çalışmaya dahil edilen izolatların % 100’ü karbapenemlere, % 95,6’sı ise sefaperazon-sulbaktama duyarlı idi. GSBL üreten izolatlar siprofloksasin (% 90,7), seftriakson (% 89,4), seftazidim (% 89,4), kotrimaksazol (% 90,4) ve norfloksasin (% 88,1) GSBL üretmeyen gruba göre daha yüksek oranda dirençli idiler. Sonuç: Nepal’de GSBL üreten E. coli and Klebsiella spp. prevalansı yüksek bulundu. Nepal hastanelerinde antibiyotik tedavisinin optimize edilmesi ve GSBL üreten mikroorganizmaların yayılımının engellenmesi için laboratuarda rutin olarak GSBL belirlemeye yönelik testler uygulanmalıdır

Objective: To isolate, identify and phenotypically characterize extended spectrum beta-lactamase (ESBL)-producing Escherichia coli andKlebsiella spp in Manipal Teaching Hospital.Methods: Cross sectional study was conducted among E. coli and Klebsiella spp recovered from patients’ various samples to establish the prevalence of organisms producing ESBL in Manipal Teaching Hospital, Pokhara, Nepal between October 2011 and April 2012. ESBL production was detected by Clinical laboratory Standards Institute (CLSI) recommendations.Results: E. coli (n=285) and Klebsiella spp (n=55) were isolated from various clinical samples. The specimens were urine 255 (75%), blood 18 (5.3%), pus 48 (14.1%), sputum 17 (5.1%), and body fluid 2 (0.6%). Seventy six (22.4%) were ESBL producing organisms by phenotypic confirmatory test with double disk diffusion method. ESBL group of organisms showed 100% resistance to ampicillin and cefotaxime. All the organisms in this study were 100% sensitive to imipenem and 95.6% sensitive to cefoperazone+sulbactam combination. ESBL producing isolates showed high rate of resistance to ciprofloxacin (90.7%), ceftriaxone (89.4%), ceftazidime (89.4%), cotrimoxazole (90.4%) and norfloxacin (88.1%) as compared to non-ESBL group.Conclusion: ESBL producing E. coli and Klebsiella spp showed high prevalence in Nepal. Routine laboratory testing for ESBL in Nepalese hospitals is needed in order to optimize antibiotic management and reduce the risk of spread of infections caused by ESBL producers. J Microbiol Infect Dis 2015;5(2): 69-75Key words: Extended spectrum beta-lactamase, ESBL, E. coli, Klebsiella spp, Prevalence, Nepal

Keywords:

Extended spectrum beta-lactamase, ESBL, E. coli Klebsiella spp, Prevalence, Nepal,

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