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

Author(s):  
Anju Saxena ◽  
Sujata Singh ◽  
Rahul Goyal ◽  
Sumit Saxena

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.

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Aryatara Shilpakar ◽  
Mehraj Ansari ◽  
Kul Raj Rai ◽  
Ganesh Rai ◽  
Shiba Kumar Rai

Abstract Background The existence of multidrug-resistant organisms, including extended-spectrum beta-lactamases (ESBLs), is on rise across the globe and is becoming a severe problem. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to study the prevalence of Gram-negative isolates exhibiting ESBL at a tertiary care hospital and study their antibiogram profile. Methods A cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal, from June 2018 to November 2018. A total of 770 clinical samples were collected and identified using the conventional biochemical tests following the Clinical and Laboratory Standard Institute (CLSI) guidelines. Antimicrobial susceptibility testing (AST) was performed using the standardized Kirby-Bauer disk diffusion method. The screening test for ESBL producers was performed as recommended by the CLSI and the confirmatory test was performed phenotypically using the E-test. Results Out of the 92 isolates, 84 (91.3%) were multidrug-resistant, and 47 (51.1%) were found to be potential ESBL producers. Of these, 16 isolates were confirmed ESBL producers by the E-test. Escherichia coli and Klebsiella pneumoniae were the predominant isolates and were also the major ESBL producers. Besides polymyxin B (100% sensitive), meropenem and imipenem showed high efficacy against the ESBL producers. Conclusion Multidrug resistance was very high; however, ESBL production was low. Polymyxin B and carbapenems are the choice of drugs against ESBL producers but should be used only as the last line drugs.


2017 ◽  
Vol 10 (1) ◽  
pp. 8-12
Author(s):  
Shikha Paul ◽  
Sanya Tahmina Jhora ◽  
Prashanta Prasun Dey ◽  
Bilkis Ara Begum

Detection of Extended spectrum beta lactamase (ESBL) enzyme producing bacteria in hospital settings is vital as ESBL genes are transmissible. This study was carried out to determine the distribution of ESBL producing gram negative isolates at a tertiary care hospital in Dhaka city which deals with the patients hailing from relatively low socioeconomic status.Onehundred and twenty four gram negative bacteria isolated from different clinical specimens from outpatient and inpatient departments of Sir Salimullah Medical College and Mitford Hospital (SSMC & MH) were tested for ESBL by E test ESBL method in the department of microbiology of Sir Salimullah medical college (SSMC) from March 2013 to August 2013.Out of 124 gram negative bacteria 69 (55.65%) were positive for ESBL. Among the ESBL producers, Esch.coli was the highest (46.38%) which was followed by Serratia spp (11.59%), Enterobacter spp (10.14%), Proteus spp, (8.70%), Acinetobacter spp.(7.24%) and Klebsiella spp.(5.79%). Out of 32 Esch.coli isolated from outpatient department, 10 (31.25%) were positive for ESBL. On the other hand out of 27 Esch. coli isolated from inpatient department, 22 (81.48%) were positive for ESBL. The difference was statistically significant (p<0.001).So the present study reveals that the distribution of ESBL producers is more among the hospitalized patients than the patients of the community.Bangladesh J Med Microbiol 2016; 10 (1): 8-12


2021 ◽  
Vol 3 (5) ◽  
pp. 46-54
Author(s):  
Mona Ahmed Babiker Ahmed ◽  
Atif Elamin Abdelgadir ◽  
Hayfa Mohammed Ismail

This study was conducted to evaluate the current implementation level of Hazard Analysis and Critical Control Point (HACCP) prerequisites adopted in poultry meat production and processing in Khartoum State, Sudan. To achieve the goal, a cross sectional study was conducted. Data and samples were collected from January to September 2018 from 12 close system broiler slaughterhouses according to Non-Probability Multistage Cluster Sampling Method in Khartoum, Khartoum North (Bahri), and Omdurman localities (4 farms from each). A standardized questionnaire was conducted for slaughterhouses (12 for each) to investigate the current status of implemented HACCP prerequisites. One hundred and eighty swab samples were taken from different sites in the slaughterhouses’ halls (surfaces, workers’ hands, boots, water, and chillers) followed by 240 swab samples collected from broiler carcasses after 4 process steps (defeathering, evisceration, washing and chilling). After bacterial culturing, isolation, and identification, all collected Data were subjected to descriptive and analytical statistic such as Chi square and ANOVA using SPSS. Low level of good practices in slaughterhouses was shown regarding programmed documented personal hygiene staff training and qualification for responsibilities 50.0% (n=6), preventative maintenance 41.7% (n=5), and appropriate use of personal facilities 58.3% (n=7). In addition to that, 66.7% (n=8) of examined premises showed difficulty in cleaning, inadequate ventilation and 33.3% (n=4) showed lack of sanitary facilities (dispensers, personnel changing rooms, toilets, washing basins). Unhealthy practices and habits were observed in majority of workers during work such as not washing hands before entering production areas, smoking, and eating and drinking in processing areas, beside low level of medical check in two thirds of them 66.7% (n=8). Bacterial growth was shown in 60.0% (n=108) and 58.80% (n=141) of slaughterhouses’ halls samples and meat samples respectively. There was significant difference between state of growth of slaughterhouses’ halls sample and farm location (χ2=7.22 and P-value = 0. 027) while a high significant difference in association between state of growth of meat samples and slaughterhouses’ location (χ2=43.02 and P-value=0. 000) was revealed. The Gram positive and Gram negative isolates were mostly detected in workers’ hands 19.60% (n=56) and 4.36% (n=12) respectively. The difference between growth state of bacteria in slaughterhouses’ halls samples and sample sites was highly significant (χ2=30.92 and P-value=0.000) and the highest growth was shown in workers’ hands. On the other hand, most of Gram positive and Gram negative bacteria in processing steps were detected after defeathering 14.40% (n=41) and evisceration 2.49% (n=7) steps. However, there was no significant difference resulting from association of state of bacterial growth of poultry meat samples and different process steps (χ2=5.14 and P-value=0.162). Slaughterhouses’ halls samples and meat samples were found contaminated with harmful pathogenic bacteria such as Salmonella spp. 1.41% (n=4), Escherichia coli 9.51% )n=27(, Staphylococcus aureus 7.75% (n=22), Citrobacter frundi 1.41% (n=4), and Micrococcus kristanae 8.75% (n=24). In conclusion, effective adoption of HACCP PRPs and biosecurity measures in Khartoum State has not been given serious attention beside lack of knowledge, resources, and absence of official authority’s role. Absence of proper “Farm to Table” hygiene policy in broiler production negatively affects poultry meat hygiene and consequently threatens public health. Therefore, formulation of suitable procedures and regulations by official authorities for implementing HACCP PRPs and biosecurity measures are needed to ensure poultry meat hygiene from primary stages of production till the end product.


2019 ◽  
Vol 11 (03) ◽  
pp. 253-258 ◽  
Author(s):  
Suryarashmi Sahoo ◽  
Sarita Otta ◽  
Bichitrananda Swain ◽  
Subrat Kumar Kar

Abstract BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing organisms inactivate extended beta-lactam antibiotics and monobactams and also exhibit coresistance to many other classes of antibiotics. The present study was carried out to assess the prevalence of the ESBLs and to determine the most prevalent genotype in our hospital. MATERIALS AND METHODS: All clinically significant Gram-negative isolates were identified, and their antimicrobial susceptibility testing was done by Kirby–Bauers' disc diffusion method. ESBL detection was confirmed by minimal inhibitory concentration method using agar dilution technique for those who screened positive by ceftazidime (30 μg) disc. Further, the established ESBL-positive isolates were subjected to genotyping for bla TEM, bla CTX-M, and bla SHV genes by using conventional polymerase chain reaction. RESULTS: Escherichia coli was the most common (28.84%) Gram-negative bacillus followed by Klebsiella pneumoniae (18.07%), while Pseudomonas spp. (9.61%) was the most commonly identified nonfermenter. ESBL production was detected in 160 (30.8%) isolates. Klebsiella oxytoca (46.7%) followed by E. coli (44%) were the common ESBL producers. Most predominant ESBL gene was bla TEM, found in 122 (76.25%) isolates. Combinations of two genes were seen in 109 (68.1%) isolates, the most common (43.12%) combination being blaTEM and blaCTX-M. In this study, 16 (10%) strains had all the three types of genes. Most of the isolated Gram-negative bacilli (GNB) were sensitive to amikacin, imipenem, and colistin. CONCLUSION: In our study, the 30.8% of GNB were ESBL producers. This is the only study that shows that TEM is the most prevalent ESBL genotypes in our area. Of concern is a good number of isolates showing all three patterns of genes (TEM, SHV, and CTX-M). Amikacin, imipenem, and colistin were the most useful antibiotics in our setup.


2018 ◽  
Vol 12 (1) ◽  
pp. 32-36
Author(s):  
Mili Rani Saha ◽  
Sanya Tahmina Jhora

Background and objectives: Emergence of extended spectrum beta-lactamase (ESBL) producing bacteria is a major public health concern. Detection of multi drug resistant (MDR) ESBL producing organisms is necessary to prevent its spread and effective treatment. The purpose of the present study was to determine the magnitude of ESBL producing organism in hospital setting and to compare the suitability of double disc synergy test (DDST) and cefepime-clavulanate E-test method for the detection of ESBL producing organisms in routine microbiology laboratory.Materials and methods: The study was carried out in the Department of Microbiology, Sir Salimullah Medical College, Dhaka from January 2011 to December 2011. Clinical samples included urine and pus from patients with suspected urinary tract and wound infections respectively. Standard microbiological methods were employed for isolation and identification of the organisms. DDST and E-test were used to detect ESBL producing Gram negative organisms.Results: A total of 186 Gram-negative organisms were isolated from various samples. Among the 186 Gram negative bacteria, 120 (64.5%) were Esch. coli while 33 (17.7%), 20 (10.8%) and 11 (5.9%) were Pseudomonas sp, Klebsiella sp and Proteus sp respectively. Out of total 186 isolates, 77 (41.4%) and 73 (39.2%) isolates were found ESBL producers by DDST and E-test method (p=0.674) respectively. Compared to Escherichia coli, Pseudomonas and Proteus, significantly high (p<0.01) proportion of Klebsiella were ESBL positive by both DDST and E-test methods. The detection rate of ESBL producing organisms was not significantly different by DDST and E-test (41.4% vs 39.2%). Non-determinable result was obtained for 4 (2.2%) isolates by E-test method.Conclusion: In our present study, a substantially large number of clinical isolates were found ESBL producers. Compared to E-test, DDST was found as a reliable, convenient and inexpensive method for detection of ESBL producing organism in routine microbiology laboratory practice.IMC J Med Sci 2018; 12(1): 32-36


2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)


KYAMC Journal ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 171-175
Author(s):  
Tania Rahman ◽  
Momtaz Begum ◽  
Sharmeen Sultana ◽  
SM Shamsuzzaman

Background: In recent years, Extended-spectrum beta-lactamase (ESBL) producing microorganisms have complicated treatment of infections due to resistance of ESBL producing strains to a wide range of antimicrobials. Objective: Target of this study was to determine the prevalence of ESBL producing gramnegative bacteria in neonatal sepsis cases and to reveal the antimicrobial susceptibility pattern of those isolated ESBL producers. Materials and Methods: This cross sectional study was carried out in Dhaka Medical College Hospital (DMCH) over a period of 12 months from January to December in 2016. Following isolation and identification of gram-negative bacteria from blood samples of suspected septicemic neonates, antimicrobial susceptibility test was performed by Kirby Bauer disk-diffusion method and ESBL producers were detected by Double Disk Synergy (DDS) test. Results: Among 52 Gram-negative bacteria isolated from 106 blood samples, 34.61% ESBL producers were detected and Enterobacter spp. (45%) was predominant followed by Klebsiella pneumoniae (33.33%). None of the ESBL producers was resistant to colistin and tigecycline. All ESBL producing Acinetobacter baumannii, 77.78% and 66.67% of ESBL producing Enterobacter spp and Klebsiella spp. respectively showed resistance to meropenem. All ESBL producers were resistant to piperacillintazobactam. Conclusion: Appropriate measures should be taken to prevent the spread of ESBL producing strains by combining strategies for infection prevention, control and rational use of antibiotics. KYAMC Journal Vol. 11, No.-4, January 2021, Page 171-175


2019 ◽  
Vol 6 (5) ◽  
pp. 2091
Author(s):  
Parima Dalal ◽  
Rekha Thaddanee ◽  
Arun Parikh ◽  
Hasmukh Chauhan ◽  
Shamim Morbiwala

Background: This study was done to know the maternal perception of weight of their children and correlate it with exact weights. We also studied various factors affecting ability of a mother to perceive her child’s weight status.Method: This prospective study was done in Pediatric Department of a tertiary care teaching hospital of Western Gujarat, India, from January 2018 to September 2018. 897 mothers of children < 5 years of age were included. Socio-demographic and anthropometric details of child and mother were recorded. Maternal perception of their child’s weight status was enquired. A correlation between perceived and actual child weight status was estimated.Results: 897 patients <5 years of age had mean (SD) age of 28.66 (±17.04) months, weight 10.17 (±3.5) kg, height 0.81 (±0.15) meters and BMI 15.74 (±15.26) kg/m2. 34.7% of mothers perceived underweight erroneously as compared to actual weight status being normal (p value=0.00001). Misperception (under or over) of the mothers for their children weight status was significant for girls (p=0.011). Significant difference between perceived and actual weight status was seen in birth orders 1 to 4. 34. 6% actual UW children were perceived as NW by < 40 years age mothers (p=0.0018). 78.2% uneducated and 81% of primary or secondary educated mothers from lower SES felt their children were of NW status whereas actually 43.4% and 50.3% children were of NW status respectively (p=0.00001). Surprisingly, 91.3% of graduate or postgraduate mothers of middle SES perceived their children as NW status while actually only 39.1% were of NW and 52.1% of UW (p=0.00001).Conclusion: Half of the mothers were not able to perceive correct weight status of their children. Misperception was significant for girls. Significant difference between perceived and actual weight status was seen for birth orders 1 to 4. Mothers <40 years of age significantly failed to perceive actual UW status of the children. Both educated and uneducated mothers misclassified their children’s weight status significantly.


2013 ◽  
Vol 20 (03) ◽  
pp. 332-340
Author(s):  
ATIF SITWAT HAYAT ◽  
MUHAMMAD ADNAN BAWANY ◽  
JAWAD AHMED QADRI ◽  
Kiran Khalil

Background: Ischemic heart disease is the most common cause for complete heart block (CHB) and sudden death. Heartblocks may occur as complications of acute myocardial infarction (AMI) and are associated with increased mortality. The aim of thisstudy is to determine the frequency of complete heart block (CHB) in acute myocardial infarction at a tertiary care hospital. Place andduration: This study was conducted in Cardiology Department of Liaquat University of Medical and Health Sciences from 1st August2009 to 31st January 2010. Study Design: Cross sectional and descriptive study. Materials and Methods: ST segment elevation equal toor more than 1mm (0.1mv) in two of these leads II, III and aVF. Rise in serum creatinine kinase level (CPK Level) more than twice thenormal value along with CK-MB fraction more than 6% of CPK value. Patients with history of chest pain, shortness of breath, nausea,vomiting and unconsciousness were enrolled in the study. The cardiac enzymes tropinin T was also performed at bed side by venousblood sample. Results: Total of 87 patients were included, prevalence of heart blocks was 27.58%. Anterior wall MI was in 50(57.5%)patients. Of these, 13(54.2%) had complete heart block. Inferior wall MI was in 37(42.5%) cases, of these, 11(45.8%) were found withcomplete heart block. There was no significant difference between anterior wall MI and inferior wall MI with complete heart block (P value> 0.05). Mortality was 2.3% with anterior wall MI. Conclusions: Development of complete heart blocks has important prognosticsignificance. Complete heart block was frequent complication of myocardial infarction.


2022 ◽  
Vol 9 (1) ◽  
pp. 28-32
Author(s):  
Sara Mariyum ◽  
Nazma Saleem ◽  
Amjad Iqbal ◽  
Shama Iqbal ◽  
Munazza Khattak ◽  
...  

OBJECTIVES: The purpose of this study was to compare the Type 2 diabetes mellitus patients and non-diabetics in terms of Papillary bleeding index (PBI) of periodontal disease. METHODOLOGY: This comparative cross-sectional study was conducted during the period of November 2020 to February 2021 in three (3) tertiary care hospitals of Peshawar. The sampling technique was purposive sampling. The sample comprised 105 individuals, 56 participants in Type–2 diabetes group and 49 in non-diabetes group. Male and females, having age between 40-65 years were recruited. Each diabetic and non-diabetic were clinically examined for periodontitis. Age and sex-matched participants suffering from periodontitis without a history of diabetes as well as with good glycemic control (HbA1c) were considered as controls subjects. Glycated hemoglobulin (HbA1c) was carried out for all the participants free of cost by using Human Gmbh-Max-Planck-Ring 21-65205 Wiesbaden-Germany kit. The study was approved by the ethical committee of the Peshawar Medical College. Data was analyzed using software package SPSS version 20. RESULTS: Out of 56  diabetics, 24 subjects brushed once daily, 15  brushed twice daily, 11 brushed occasionally and 6  didn’t brush  whereas in 49 non diabetics, 20 subjects brushed once daily, 13 brushed twice daily, 11  brushed occasionally and 5 didn’t brush. The clinical parameter mean (PBI) was recorded in our study. Score was 2.09 (±0.82) in diabetics and 1.02 (±0.47) in non-diabetics. P-value measured by the chi square test was significant. Spearman correlation test was performed to explore the association between the type 2 diabetes and Papillary bleeding index (PBI). CONCLUSION: We concluded that a significant difference exists between the mean PBI scores of Type 2 diabetics and non-diabetics.


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