CTX-M-type Extended-Spectrum β-Lactamase Producing Enterobacteriaceae Isolated from Urine in a Tertiary Care Hospital, Kathmandu, Nepal

2021 ◽  
Vol 19 ◽  
Author(s):  
Mahesh Acharya ◽  
Prabhu Raj Joshi ◽  
Kamal Thapa ◽  
Saroj Paudel ◽  
Prativa Poudel ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Hospital Setting ◽  
Urine Samples ◽  
High Rate ◽  
Care Hospital ◽  
E Coli ◽  
Extended Spectrum ◽  
Genes Encoding ◽  
Global Increase ◽  
Tract Infections

Background: Despite the global increase of CTX-M type extended-spectrum-β-lactamases (ESBLs) in recent years among Enterobacteriaceae isolates from urinary tract infections, little data is available from Nepal. Objective: This study was conducted to detect the genes encoding extended-spectrum β-lactamases among Enterobacteriaceae isolated from the urine samples in Nepal. Methods: A total of 148 Enterobacteriaceae isolates were collected in Annapurna Neurological Institute and Allied Sciences from urine samples from July 2016 to June 2017. ESBLs production was detected according to the Clinical and Laboratory Standards Institute (CLSI) recommended methods. PCR and sequencing were used for the detection of ESBL genes. Results: Overall 24.3% (36/148) of the study isolates were positive for ESBL production. E. coli was the predominant ESBL-producing organism (28.8%). ESBL-producing organisms showed a high rate of resistance to ceftazidime (58.4%), cefepime (91.7%), aztreonam (83.4%), and ciprofloxacin (80.6%). Also, 30.6% of ESBL-producing organisms were multi-drug resistant. All ESBL producers were CTX-M positive; other ESBL genes were not detected. The majority of the ESBL positive organisms produced CTX-M-15 (n= 31) and few organisms (n= 5) were CTX-M-27 producers. Conclusion: The present study shows that the predominant CTX-M type ESBL in our hospital setting is CTX-M-15.

scholarly journals Epidemiology and Resistance Levels of Enterobacteriaceae Isolates from Urinary Tract Infections Expressed as Multiple Antibiotic Resistance (MAR) Indices

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Márió Gajdács
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Urine Samples ◽  
Diffusion Method ◽  
Care Hospital ◽  
Multiple Antibiotic Resistance ◽  
E Coli ◽  
Positive Urine ◽  
Tract Infections

Aims: To assess the epidemiology of UTIs affecting inpatients and outpatients and the antibiotic resistance levels, expressed as multiple antibiotic resistance (MAR) indices from the isolated species at a tertiary-care hospital in Hungary, during a 10-year study period. Study Design: Retrospective microbiological study. Place and Duration of Study: 1st of January 2008 - 31st of December 2017 at the University of Szeged, which is affiliated with the Albert Szent-Györgyi Clinical Center, a primary- and tertiary-care teaching hospital in the Southern Great Plain of Hungary. Methodology: Antimicrobial susceptibility testing (AST) was performed using disk diffusion method and when appropriate, E-tests on Mueller–Hinton agar (MHA) plates. The multiple antibiotic resistance (MAR) index of the isolates was determined. Results: During the 10-year study period, the Institute of Clinical Microbiology received 21,150 urine samples from outpatient clinics and 19,325 samples from inpatient departments that turned out to be positive for a significant urinary pathogen. Out of the positive urine samples, E. coli represented the overwhelming majority of all positive urine samples. The resistance levels in inpatient isolates were higher than in the outpatient isolates (average MAR indices: 0.347 vs. 0.410, 0.267 vs. 0.435 and 0.318 vs. 0.473 for the E. coli/Klebsiella, CES and Proteae group, respectively). Conclusion: As the therapeutic options are becoming increasingly limited in the current antibiotic resistance climate, more effort should be put into the prudent use of antibiotics and the development of novel antimicrobial agents.

scholarly journals Phenotypic Detection of Extended Spectrum Beta-Lactamases in Uro-pathogens. An Experience from Qazi Hussain Ahmed Medical Complex, Nowshera

2020 ◽  
pp. 40-45
Author(s):  
Hamzullah Khan ◽  
Fazli Bari ◽  
Adnan Masood ◽  
Fazli Ghani ◽  
Zahid Khan ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Proteus Mirabilis ◽  
Tertiary Care ◽  
Klebsiella Pneumonia ◽  
Care Hospital ◽  
Pathology Laboratory ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Tract Infections

Objectives: To determine the phenotype and frequency of Extended Spectrum Beta-Lactamase in Uro-pathogens in a tertiary care hospital of Nowshera. Material and methods: This Prospective cohort study was performed in the clinical pathology laboratory of Qazi Hussain Ahmed Medical Complex (QHAMC) Nowshera from 1st Jan 2019 to 30th May 2019. Relevant information was recorded on a predesigned proforma prepared as per CLSI Recommendation for data collection. Results: A total of 192 urine samples were received for Culture and sensitivity. Out of which 56 cases were ESBL phenotypically positive (29.16%). 39(69.9%) were females and 17(30.4%) were males. The age range of the patient was from 3 months to 63 years of age, with a mean age of 30 years with +5.4 SD Frequency of ESBL producing uro-pathogens was; 51(91%) E-Coli, 4(7.1%) Klebsiella pneumonia and 1(1.8%) Proteus mirabilis. Out of 39 ESBL producing uro-pathogen in Female gender, E Coli-ESBL producing strains were isolated in 35 patients, Klebsiella Pneumonia in 3 patients and one case was of Proteus mirabilis-ESBL. In the male gender, 17 cases with E Coli-ESBL were reported and one case of Kliebsilla Pneumonia ESBL. Conclusion: The prevalence of ESBL producers in the present study was quite alarming and challenging to the clinician in treating urinary tract infections. These types of resistant infections are a challenge to treat and a public health threat that needs accumulative response through advocacy, communication, and social mobilization. Keywords: ESBL, Urinary Tract Infection, antibiotic resistance.

ANTIBIOTIC SUSCEPTIBILITY PATTERN OF MICROBIAL ISOLATES OBTAINED FROM OBSTETRICS PATIENTS IN TERTIARY CARE HOSPITAL IN NORTHERN INDIA

2021 ◽  
pp. 34-35
Author(s):  
Shruti Sharma ◽  
Aditya Rana ◽  
Subhash Chand Jaryal ◽  
Anuradha Sood ◽  
Daaman Thakur ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Bacterial Infections ◽  
Tertiary Care ◽  
Empiric Therapy ◽  
Urine Samples ◽  
Care Hospital ◽  
E Coli ◽  
Northern India ◽  
Tract Infections ◽  
Susceptibility Patterns

BACKGROUND: Urinary tract infections (UTI) are one of the most frequent clinical bacterial infections in women. They are at higher risk to acquire UTI during pregnancy. The emergence and spread of antimicrobial resistance is a cause of increasing concern. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for empiric therapy of UTIs. Retrospective study was conducted in the Department of Microbiology of DRPGM MATERIALS AND METHODS: C Kangra at Tanda. Study was conducted for the period of one years ie. from July 2020 to June 202. Urine samples were collected and sent to the laboratory for identication and antimicrobial susceptibility of bacterial isolates. RESULTS: During the 12-month study period, out of the 1266 samples screened, 977(77.2%) were sterile, 224(17.698%) samples showed signicant growth of >10฀CFU/ml and 65(5.1%) were contaminanst or insignicant growth, which were excluded from the study. E. coli alone accounted for 66.9% of the urinary isolates followed by Klebsiella spp 12.9%. Among the Gram-positive cocci, Enterococcus isolated from a single sample and Methicillin resistant staphylococcus aureus were seen in two urine samples. Signicantly high susceptibility was seen with fosfomycin(90%) and nitrofurantoin(84%). Resistance was quite high against the noroxacin(30.3%) and cefazolin(17.8%). The susceptibility patterns seen in our study see CONCLUSION: m to suggest that it is necessary to obtain sensitivity reports before initiation of antibiotic therapy in cases of suspected UTI

scholarly journals The prevalence of the iutA and ibeA genes in Escherichia coli isolates from severe and non-severe patients with bacteremic acute biliary tract infection is significantly different

Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mahoko Ikeda ◽  
Tatsuya Kobayashi ◽  
Fumie Fujimoto ◽  
Yuta Okada ◽  
Yoshimi Higurashi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Tract Infection ◽  
Biliary Tract ◽  
Iron Acquisition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Biliary Tract Infection ◽  
E Coli ◽  
Severe Group ◽  
Tract Infections

Abstract Background Although Escherichia coli is the most frequently isolated microorganism in acute biliary tract infections with bacteremia, data regarding its virulence are limited. Results Information on cases of bacteremia in acute biliary tract infection in a retrospective study was collected from 2013 to 2015 at a tertiary care hospital in Japan. Factors related to the severity of infection were investigated, including patient background, phylogenetic typing, and virulence factors of E. coli, such as adhesion, invasion, toxins, and iron acquisition. In total, 72 E. coli strains were identified in 71 cases, most of which primarily belonged to the B2 phylogroup (68.1%). The presence of the iutA gene (77.3% in the non-severe group, 46.4% in the severe group, P = 0.011) and the ibeA gene (9.1% in the non-severe group, and 35.7% in the severe group, P = 0.012) was significantly associated with the severity of infection. Among the patient characteristics, diabetes mellitus with organ involvement and alkaline phosphatase were different in the severe and non-severe groups. Conclusions We showed that bacteremic E. coli strains from acute biliary tract infections belonged to the virulent (B2) phylogroup. The prevalence of the iutA and ibeA genes between the two groups of bacteremia severity was significantly different.

scholarly journals Prevalence Of Extended Spectrum Beta-Lactamases (ESBLs)-Producing Escherichia Coli Isolated From UTI Patients Attending some Selected Hospitals In Minna, Nigeria

2021 ◽  
Vol 37 (2) ◽  
pp. 56-73
Author(s):  
F Iseghohi ◽  
J.C Igwe ◽  
M Galadima ◽  
A.F Kuta ◽  
A.M Abdullahi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistance ◽  
Urine Samples ◽  
Antibiotics Resistance ◽  
Healthy Individuals ◽  
Beta Lactamases ◽  
E Coli ◽  
Extended Spectrum ◽  
Extended Spectrum Beta Lactamases ◽  
Tract Infections

Globally, urinary tract infections are one of the most common infections in need of urgent clinical attention. The prevalence of extended spectrum beta-lactamases (ESBL)- producing Escherichia coli isolated from urine samples of some UTI patients and s of apparently healthy individuals in Minna, Nigeria, is investigated. Standard microbiological techniques were used to conduct this study. A total of 170 catch midstream urine samples submitted to the Medical Microbiology Laboratories of 4 different hospitals (and samples from healthy individuals) were randomly collected for 5 months and examined for microbial growths. Female patients (65.9%) submitted more urine samples for UTI test than their male counterpart (34.1%). The age ranges of 21 -30 (26.5%) and 31 - 40 (25.3%) had the highest percentages of infection rate while those within the ages 1- 10 (3.5%) and ≥ 71 (2.3%) were the least infected. This study observed a prevalence of 23.5% of E. coli in Minna metropolis and a significant number (30%) of healthy individuals (HI) was observed to harbor the E. coli in their urine. The isolates were highly susceptible to Gentamicin (65%), Ofloxacin (65%), Tetracycline (62.5%), Cotrimoxazole (62.5%), and Streptomycin (57.5%). Mildly susceptible to Pefloxacin (37.5%), Chloramphenicol (37.5%), and Ciprofloxacin (35%). There were significant resistance to most of the beta-lactames tested [Cefuroxime (80%), Amoxicillin (42.5%), Augmentin (40), Cefotaxime (20%) and Ceftaxidime (7.5%)]. Two of the isolates were resistant to all the 13 antibiotics tested; 70% (28) of the isolates had multiple antibiotics resistance index (MARI) ≥0.3. Multidrug resistance was expressed in 37.5% of the isolates tested. The study showed a vast resistant pool in the environment. Only 25% of the E. coli isolated from the urine samples produced beta-lactamases phenotypically, most of which expressed resistance to more than 5 of the antibiotics tested and had MARI of ≥ 0.5. Further evaluation showed that 25% (10/40) of the E. coli isolated from the UTI patients in Minna, Nigeria, were ESBL- producers and could harbor one or two of the genes. TEM gene was expressed in 70% (7) of the isolates that produced ESBL phenotypically, 60% 6) harbored CTXM gene, 20% (2) had the OXA gene while none of the bacteria harbored the SHV gene. The study established a 5.9% ESBL prevalence among the E. coli isolated from UTI in the environment studied. This study established that E. coli is one of the prevalent bacteri urea majorly isolated from UTI patients in Minna. The prevalent E. coli are multidrug resistant and could harbor more than one ESBL gene . keywords: Escherichia coli, Minna, UTI, ESBL, Multidrug resistance

scholarly journals Prevalence and Antibiotic Susceptibility Pattern of Extended Spectrum Beta Lactamases Producing Escherichia Coli Isolated from Outpatients with Urinary Tract Infections in Babol, Northern of Iran

2018 ◽  
Vol 31 (2) ◽  
pp. 61-64
Author(s):  
Mana Baziboroun ◽  
Masomeh Bayani ◽  
Zahra Poormontaseri ◽  
Mehran Shokri ◽  
Tahmineh Biazar
Keyword(s):  
Empirical Therapy ◽  
Urine Samples ◽  
Diffusion Method ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Susceptibility Data ◽  
Extended Spectrum ◽  
North Of Iran ◽  
Set Up ◽  
Tract Infections

AbstractReceived 08 November 2017 Accepted 15 February 2018 The incidence of community-acquired UTIs due to extended-spectrum beta-lactamase (ESBL) producing E. coli isolates, has increased worldwide and is considered a great problem in the treatment of infections. The aim of this study was to determine the prevalence of ESBL producing E. coli isolates in urine samples of outpatients in Babol, North of Iran. A total of 3 699 urine samples from outpatients referred to Yahyanejad Hospital, Babol, Iran, were collected during 15 months, from March 2016 to June 2017. The samples were processed for bacterial culture using conventional methods, while antimicrobial susceptibility testing for E. coli isolates was performed by the disc diffusion method. The prevalence of ESBL producing E. coli isolates were assessed by Double-Disc tests. Of 3699 tested sample, 201 samples showed the growth of pathogens and among them, 106 isolates (52/7%) were E. coli. The rate of ESBL producing E. coli isolates was 25/4%.The majority (81/5%) of the isolates were from females. High percent resistance was found against ceftazidime, cefotaxime, ceftriaxone, cefixime and ciprofloxacin, ranging from 61-100%, while the highest percent susceptibility was seen to meropenem, piperacillin- tazobactam (100%), followed by nitrofurantoin and amikacin (91%). The high prevalence of ESBL producing E. coli isolates from outpatients calls for the need to aware of this increasing resistance between uropathogens and update bacterial susceptibility data and to set up our empirical therapy accordingly.

scholarly journals A high prevalence of multi-drug resistant Gram-negative bacilli in a Nepali tertiary care hospital and associated widespread distribution of Extended-Spectrum Beta-Lactamase (ESBL) and carbapenemase-encoding genes

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Sulochana Manandhar ◽  
Raphael M. Zellweger ◽  
Nhukesh Maharjan ◽  
Sabina Dongol ◽  
Krishna G. Prajapati ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Tertiary Care ◽  
Multi Drug Resistance ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Global Public Health ◽  
Gram Negative ◽  
E Coli ◽  
Extended Spectrum ◽  
High Prevalence

Abstract Background Multi-drug resistance (MDR) and extensive-drug resistance (XDR) associated with extended-spectrum beta-lactamases (ESBLs) and carbapenemases in Gram-negative bacteria are global public health concerns. Data on circulating antimicrobial resistance (AMR) genes in Gram-negative bacteria and their correlation with MDR and ESBL phenotypes from Nepal is scarce. Methods A retrospective study was performed investigating the distribution of ESBL and carbapenemase genes and their potential association with ESBL and MDR phenotypes in E. coli, Klebsiella spp., Enterobacter spp. and Acinetobacter spp. isolated in a major tertiary hospital in Kathmandu, Nepal, between 2012 and 2018. Results During this period, the hospital isolated 719 E. coli, 532 Klebsiella spp., 520 Enterobacter spp. and 382 Acinetobacter spp.; 1955/2153 (90.1%) of isolates were MDR and half (1080/2153) were ESBL producers. Upon PCR amplification, blaTEM (1281/1771; 72%), blaCTXM-1 (930/1771; 53%) and blaCTXM-8 (419/1771; 24%) were the most prevalent ESBL genes in the enteric bacilli. BlaOXA and blaOXA-51 were the most common blaOXA family genes in the enteric bacilli (918/1771; 25%) and Acinetobacter spp. (218/382; 57%) respectively. Sixteen percent (342/2153) of all isolates and 20% (357/1771) of enteric bacilli harboured blaNDM-1 and blaKPC carbapenemase genes respectively. Of enteric bacilli, Enterobacter spp. was the most frequently positive for blaKPC gene (201/337; 60%). The presence of each blaCTX-M and blaOXA were significantly associated with non-susceptibility to third generation cephalosporins (OR 14.7, p < 0.001 and OR 2.3, p < 0.05, respectively).The presence of each blaTEM, blaCTXM and blaOXA family genes were significantly associated with ESBL positivity (OR 2.96, p < 0.001; OR 14.2, p < 0.001 and OR 1.3, p < 0.05 respectively) and being MDR (OR 1.96, p < 0.001; OR 5.9, p < 0.001 and OR 2.3, p < 0.001 respectively). Conclusions This study documents an alarming level of AMR with high prevalence of MDR ESBL- and carbapenemase-positive ESKAPE microorganisms in our clinical setting. These data suggest a scenario where the clinical management of infected patients is increasingly difficult and requires the use of last-resort antimicrobials, which in turn is likely to intensify the magnitude of global AMR crisis.

Virulence factors analysis and antibiotic resistance of uropathogenic Escherichia coli isolated from patients in northeast of Iran

2020 ◽  
Author(s):  
Mahdis Ghavidel ◽  
Tahere Gholamhosseini-Moghadam ◽  
Kimiya Nourian ◽  
Kiarash Ghazvini
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Virulence Genes ◽  
High Rate ◽  
Resistance Pattern ◽  
Antibiotics Resistance ◽  
Disk Diffusion Test ◽  
E Coli ◽  
Genes Encoding ◽  
Tract Infections

Background and Objectives: Escherichia coli is known to be the pathogen commonly isolated from those infected with uri- nary tract infections (UTIs). The aim of this study was to investigate the presence of E. coli virulence genes and antibiotics’ resistance pattern among clinical isolates in the Northeast of Iran. Relationships between virulence genes and antimicrobial resistances were studied as well. Materials and Methods: Three hundred isolates of E. coli were isolated from patients with UTIs that referred to Ghaem and Imam Reza hospitals (Mashhad, Iran) during August 2016 to February 2017. A multiplex PCR was employed to amplify the genes encoding pyelonephritis associated pili (pap), S-family adhesions (sfa), type1fimbriae (fimH) and aerobactin (aer). Disk diffusion test was performed to test the susceptibility of isolates to β-lactams, aminoglycosides, cephalosporins, quino- lone, fluoroquinolones, carbapenems and trimethoprim-sulfamethoxazole. Results: The PCR results identified the fimH in 78.4%, aer in 70.5%, sfa in 13.6% and the pap in 8.2% of isolates. The rates of antibiotic resistance of the isolates were as follows: 64.7% resistant to cephalosporins, 34% to trimethoprim-sul- famethoxazole, 31% to fluoroquinolones, 15.3% to aminoglycosides, 13.3% to β-lactams, 7.8% to quinolones and 4.4% to carbapenems. Significant relationships existed between pap and aer, pap and sfa, aer and fluoroquinolones also pap and cephalosporins. Conclusion: fimH and aer were found in > 50% of isolates suggesting the importance of both genes in UPEC. The majority of isolates had fimH as adhesion factor for colonization. Determining antibiotic resistance patterns in specific geographical areas is necessary for appropriate treatment of urinary tract infection. The high rate of resistance to cephalosporins is most likely due to incorrect drug administration

scholarly journals Multidrug-resistant urinary tract isolates of escherichia coli: Frequency and patient demographics in a Tertiary Care Hospital.

2020 ◽  
Vol 27 (02) ◽  
pp. 335-340
Author(s):  
Salman Azhar ◽  
Muhmmad Wasif Baig ◽  
Shahid Rasool ◽  
Rizwan Rasool Khan ◽  
Talha Munir ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
E Coli ◽  
Patient Demographics ◽  
Tract Infections

Urinary tract infections (UTIs) are a major burden to the health care as it is estimated that around 150 million UTIs occur yearly worldwide. Enterobacteriaceae are the most common agent causing serious urinary tract infections; and MDR cases are increasing day by day. Objectives: To determine the frequency and patient demographics of multidrug resistant urinary tract isolates of Escherichia Coli in a Tertiary Care Hospital. Study Design: Retrospective cross sectional study. Setting: Medicine Department of Madinah Teaching Hospital / The University of Faisalabad, Faisalabad. Period: From May 2016 to Sep 2018. Material & Methods: 187 patients of age 15 to 90 years with positive E. coli on urine culture and sensitivity were included in this Retrospective cross sectional study. All those patients with history of dysuria (pain during urination) or frequent urination (more than 7 times per day) were advised urine complete analysis and those with >5 WBCs or pus cells /HPF or having positive for leukocyte esterase and/or nitrite, were advised urine culture and sensitivity. Main outcome variable was the frequency of MDRE cases among the culture positive E. coli UTI patients. Results: Among all the cases of E. coli UTI, frequency of MDRE UTI was 66.8% (n=125) and rest 33.2% (n= 62) cases were not MDR UTI. 97.3% patients were resistant to lactam antibiotics, 95.7% were resistant to quinolones and 68.4% were resistant to aminoglycosides.

PREVALENCE OF VARIOUS BETA LACTAMASES AMONG GRAM NEGATIVE BACILLI IN URINARY ISOLATES FROM PATIENTS IN A TERTIARY CARE HOSPITAL OF NORTHERN INDIA

2017 ◽  
Vol 10 (4) ◽  
pp. 129
Author(s):  
Rameshwari Thakur ◽  
Kumar Atul ◽  
Chaudhary Varsha ◽  
Singh Paramjit ◽  
Sharma Vk ◽  
...  
Keyword(s):  
Rapid Development ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Care Hospital ◽  
Strict Adherence ◽  
Gram Negative ◽  
Northern India ◽  
Extended Spectrum ◽  
Tract Infections ◽  
Urinary Isolates

Objective: Urinary tract infections are considered among the most common infections, occurring either in the community or health-care setting. We are left with very few options for the treatment due to rapid development of antibiotic resistance among the organisms. To find out the prevalence of various types of β-lactamases among urinary isolates.Methods: Seven antibiotic discs (HiMedia) were placed in combinations and approximation in a particular sequence on a 90 mm diameter MuellerHintonagar plate.Results: Out of a total 165 urinary isolates, 66 (40%) isolates were positive for extended spectrum β-lactamase (ESBL) production, AmpC β-lactamases(AmpC) activity was present in 31 (18.78%) isolates, co-production of both ESBL and AmpC was seen in 16 (9.69%) isolates, 3 (1.81%) isolatesproduced metallo β-lactamase (MBL), 2 (1.21%) isolates produced both MBL, and ESBL and 1 (0.60%) isolates were positive for inducible third generation cephalosporin resistance.Conclusion: With the presence of such high prevalence of various β-lactamases in clinical isolates of gram-negative bacilli and also other types ofantibiotic resistance, antibiotic policy should be made, and strict adherence should be followed.Keywords: Extended spectrum β-lactamase, AmpC β-lactamase, Metallo β-lactamase.

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