Prevalence of extended spectrum beta lactamase production among urinary isolates in a tertiary care setup ... a bitter truth about the superbugs

• Published in: Journal of evolution of medical and dental sciences Vol. 6; no. 11; p. 867
• Main Authors: Gangurde, Nita, Bajaj, Preeti, Pawar, Rupali, Sope, Varsha
• Format: Journal Article
• Language: English
• Published: Akshantala Enterprises Private Limited 06.02.2017
• Subjects: Care and treatment; Development and progression; Escherichia coli; Health aspects; Microbial drug resistance; Testing; Urinary tract infections
• ISSN: 2278-4748; 2278-4802
• DOI: 10.14260/jemds/2017/187

BACKGROUND Urinary Tract Infection (UTI) occurs as a result of interaction between bacterial virulence and host biological and behavioural factors. Worldwide, about 150 million people are diagnosed with UTI each year, which costs the global economy. UTI although treatable, is now becoming increasingly tough to control, because of rampant antimicrobial resistance in the Enterobacteriaceae family, particularly in E. coli. ESBL (Extended Spectrum Beta Lactamase) producing organisms are distributed worldwide and their prevalence is increasing. Organisms responsible for UTI such as E. coli, Klebsiella species and Enterobacter species have the ability to produce ESBLs in large quantities. The World Health Organisation (WHO) has called antibiotic resistance an emerging disease. In almost all cases of UTI, empirical antimicrobial treatment initiated before the laboratory results of urine culture are available, thus, antibiotic resistance may increase in uropathogens due to frequent use of antibiotics. Therefore, the present study was conducted to study the bacterial spectrum causing UTI in our Institute and to find out the antibiotic response to these organisms with special emphasis on ESBL production by these organisms. Aims and Objectives--1) To study the bacterial spectrum causing UTI in our Institute; 2) To study the prevalence of drug resistance in Gram negative organisms to different urinary antibiotics with special emphasis on ESBL production. MATERIALS AND METHODS The prospective study was conducted over a period of three months (From October 2016 to December 2016) at Department of Microbiology, Dr. Vasantrao Pawar Medical College and Hospital, Nashik, Maharashtra, India. Total 955 urine samples received at Microbiology Laboratory were included in the study. Antibiotic Sensitivity Testing (AST) was performed using Kirby-Bauer Disc diffusion method on Mueller-Hinton agar by following the guidelines given by CLSI 2012. The antibiotic panel used for AST included--Gentamycin, Amikacin, Piperacillin, Cefotaxime, Cotrimoxazole, Ampicillin, Polymyxin B, Ceftazidime, Cefadroxil, Amoxiclav, Norfloxacin, Nitrofurantoin, Cefuroxime, Cefepime, Piperacillin-Tazobactam and Imipenem. All the isolates which showed resistance to third generation cephalosporins were further tested for confirmation of beta-lactamase production by phenotypic methods. Confirmation of ESBL production was done by using E-test (Hi-Media Laboratory, Mumbai). Screening of ESBL production--This was done by two methods, a) Phenotypic Confirmatory Disc Diffusion Test (PCDDT); b) Double Disc Synergy Test (DDST). Confirmation of ESBL production--This was done by using Ezy-MIC strips (Hi-Media Laboratories Pvt. Ltd.). RESULTS Total 955 urine samples were processed. Out of 955 samples, Gram Negative bacilli were isolated from 433 samples and Gram positive organisms were isolated from 54 samples. Out of 433 Gram negative organisms, 205 (47.3%) were E. coli and 82 (18.9%) were Klebsiella pneumonia, 50 (11.5%) were Proteus species, 55 (12.7%) were pseudomonas species and 41 (9.4%) were Enterobacter species. Out of 433 Gram negative organisms, 158 were ESBL producers. Out of 158 ESBL producers E. coli were 45.5%, Klebsiella pneumonia were 30.4%, Proteus species were 24%, Pseudomonas species were 25.45% and Enterobacter species were 31.7%. Most of the organisms were resistant to third generation cephalosporins. ESBL producers showed resistance to Cefotaxime (81.01%), Cefoperazone (82.2%) and Ceftazidime (81.01%). Resistance to aminoglycosides such as Amikacin (24.05%) was found to be on lower side as compared to Gentamicin (62.02%). Also resistance to Tetracycline was found to be on higher side (77.8%). Sensitivity towards Piperacillin, Polymyxin B, Cefepime, Piperacillin + Tazobactam and Imipenem turned out to be satisfactory. E. coli shows higher percentage of resistance to third generation cephalosporins, Cefotaxime (85.1%), Ceftazidime (88.2%) and Cefoperazone (87.2%). Klebsiella pneumoniae shows unsatisfactory results as compared to E. coli. Also, Klebsiella pneumoniae show higher amount of resistance to third generation cephalosporins such as Cefotaxime (96%), Ceftazidime (96%) and Cefoperazone (92%). But resistance to higher antibiotics like Cefepime, Piperacillin + Tazobactam and Imipenem shows satisfactory level of sensitivity among all ESBL producers. CONCLUSION Increasing prevalence of ESBL producers among Gram negative organisms is nowadays becoming a great threat. This has become a major clinical problem in treating infections caused by ESBL producers. Increasing rate of resistance to commonly used antibiotics is an alarming sign for future of healthcare sector. Our study reveals that commonly used antibiotics are almost of no use for treatment of UTI patients. But special drugs like Cefepime, Piperacillin + Tazobactam and Imipenem could be kept as reserved drugs to treat infections. If not used rationally resistance to these reserved drugs will emerge, which will ultimately take us to situation like "NO ANTIBIOTIC ERA"...and which is a bitter truth about the Superbugs...!!! KEYWORDS Urinary Tract Infections (UTI), ESBL, Drug Resistance.