scholarly journals Peningkatan Mutu Penggunaan Antibiotik Bijak Melalui Kesesuaian Temuan Hasil Kultur Dengan Kajian Risiko Pasien Menurut Model Regulasi Antimikroba Sistem Prospektif (Raspro)

2021 ◽  
Vol 3 (2) ◽  
pp. 114-118
Author(s):  
Ronald Irwanto Natadidjaja ◽  
Hadianti Adlani ◽  
Hadi Sumarsono
Keyword(s):  
Drug Resistance ◽  
Multi Drug Resistance ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Diabetes Melitus

Masalah Mutu: Standar 4 Kajian SNARS 2018 menyatakan bahwa rumah sakit wajib memiliki surveilens kepekaan kuman terhadap antibiotik. Hal ini harus menjadi dasar pertimbangan pembuatan Panduan Penggunaan Antibiotik (PPAB). Di sisi lain, timbulnya kuman Multi Drug Resistance (MDR) juga dipengaruhi oleh berbagai faktor. Pemberian antibiotik empirik, selain berdasar pada pola kuman, juga sebaiknya mempertimbangkan berbagai faktor risiko timbulnya kuman MDR. Pilihan Solusi: Regulasi Antimikroba Sistem Prospektif (RASPRO) adalah sebuah model tataguna antimikroba yang disintesis dari berbagai kepustakaan dengan mempertimbangkan berbagai faktor yang dapat menyebabkan timbulnya kuman-kuman MDR pada surveilans kepekaan kuman, sehingga dapat mengarahkan klinisi pada peresepan antibiotik bijak. Implementasi: Kajian risiko yang dibuat dalam RASPRO menentukan bahwa immunocompromised dan/ atau dengan komorbid Diabetes Melitus yang tidak terkontrol atau dengan riwayat konsumsi antibiotik kurang dari 90 hari, dan/ atau riwayat perawatan di rumah sakit lebih dari 48 jam dalam waktu kurang dari 90 hari, dan/ atau riwayat penggunaan instrumen medis kurang dari 90 hari masuk dalam risiko MDR. Pasien-pasien yang tidak termasuk dalam kategori di atas akan masuk ke dalam prediksi infeksi oleh kuman multisensitif. Evaluasi dan Pembelajaran: Pada surveilans kepekaan kuman dengan data sekunder diambil dari sebuah rumah sakit swasta tipe B di Jakarta antara tahun 2016-2018, dengan rumus sampel tunggal, didapatkan 106 sampel kultur dari 86 pasien. Terdapat kesesuaian pada 54 dari 57 hasil kultur yang diambil dari pasien dengan kajian risiko infeksi kuman multisensitif (94,74%). Kesesuaian antara temuan hasil kultur MDR dengan kajian risiko model RASPRO terdapat pada 44 dari 49 kultur (89,80%), dengan 9 kultur menunjukkan Extended Spectrum Beta-Lactamase (ESBL). Total kesesuaian hasil kultur dengan kajian risiko empirik model RASPRO mencapai 92,45%. Tingginya persentase kesesuaian temuan kultur kuman penyebab infeksi dengan kajian faktor risiko model RASPRO sepertinya dapat menjadi pertimbangan dalam mengarahkan klinisi dalam pemberian antibiotik empirik spektrum sempit dan luas pada praktek klinis sehari-hari di rumah sakit. Dengan praktik seperti ini kualitas penggunaan antibiotik diharapkan dapat meningkat.

scholarly journals Extended-spectrum beta-lactamase production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Dejenie Shiferaw Teklu ◽  
Abebe Aseffa Negeri ◽  
Melese Hailu Legese ◽  
Tesfaye Legesse Bedada ◽  
Hiwot Ketema Woldemariam ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Addis Ababa ◽  
Multi Drug Resistance ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum

scholarly journals Phenotypic and Genotypic Study of Klebsiella species with Reference to Extended Spectrum Beta-Lactamase

2021 ◽  
Author(s):  
Rakesh Prasad Sah ◽  
Rakesh Kumar Mukhia ◽  
AD Urhekar ◽  
Kshitija Rane
Keyword(s):  
Drug Resistance ◽  
Multi Drug Resistance ◽  
Pcr Analysis ◽  
Beta Lactamase ◽  
Klebsiella Species ◽  
Single Strain ◽  
Antimicrobial Drug Resistance ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Esbl Producers

Introduction: Klebsiella species is an important nosocomial pathogen with the emergence of Multi Drug Resistance (MDR). MDR in Klebsiella species is increasing worldwide with the production Extended Spectrum Beta-Lactamase (ESBL). The emergence of ESBL is a critical concern in Klebsiella species due to resistance to ceftazidime and other cephalosporins which compromise the efficacy of life saving antibiotics against these infections. Aim: To know the factors responsible for antimicrobial drug resistance in Klebsiella species with respect to ESBL and their responsible genes. Materials and Methods: A prospective and experimental study was carried out over a period of three years (August 2013 to July 2016). Total 200 isolates of Klebsiella species were screened for cefotaxime and ceftazidime. The resistant strains (cefotaxime/ ceftazidime) were subjected to ESBL agar, Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and Modified Three Dimensional Test (M3DT). Genetic analysis by Polymerase Chain Reaction (PCR) was done for the detection of beta-lactamase (bla) genes i.e., blaTEM, blaSHV & blaCTX-M in 58 isolates of Klebsiella species. The data was presented using frequency and percentage. The proportion was compared using Z-test for the proportions. Results: Out of 200 isolates, 135 (67.5%) were found resistant to cefotaxime and 125 (62.5%) were resistant to ceftazidime. Among which 110 (55%), 75 (37.5%) and 95 (47.5%) Klebsiella species were found positive for production of ESBL by ESBL agar, PCDDT and M3DT respectively. PCR analysis in 48 isolates were positive by PCDDT/M3DT or both were also positive for beta- lactamase genes i.e., 43 (89.58%) blaTEM; 44 (91.67%) blaSHV and 48 (100%) blaCTX-M. Ten negative isolates either by PCDDT/M3DT or both were also negative by PCR. Co-existence of (blaTEM+blaSHV +blaCTX-M), (blaTEM+blaSHV), (blaTEM+blaCTX-M) and (blaSHV+blaCTX-M) were found 81.25%, 0%, 8.33% and 10.42%, respectively. Conclusion: The M3DT is the best phenotypic method for the confirmation of ESBL producer in Klebsiella species which is not included by CLSI while inclusion with PCDDT enhances the detection of ESBL producers. Co-existence of all three genes (blaTEM, blaSHV and blaCTX-M) in a single strain is a serious concern for us. So it is important to include M3DT and PCDDT in routine basis for the detection and management of ESBL producers which will help clinician to prescribe proper antibiotics.

scholarly journals High Prevalence of Multi-Drug Resistance and Extended Spectrum Beta Lactamase Production in Non-Fermenting Gram-Negative Bacilli in Ethiopia

2019 ◽  
Vol 12 ◽  
pp. 117863371988495 ◽  
Author(s):  
Adane Bitew
Keyword(s):  
Drug Resistance ◽  
Bacterial Species ◽  
Multi Drug Resistance ◽  
Clinical Samples ◽  
Beta Lactamase ◽  
Drug Resistant ◽  
Acinetobacter Species ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum

Background: Emergence of resistance to multiple antimicrobial agents in Non-Fermenting Gram-Negative Bacilli is a major problem to public health, as it limits drug treatment options against infections. The aim of this study was to determine the prevalence of multi-drug resistance and extended spectrum beta lactamase production in Non-Fermenting Gram-Negative Bacilli. Materials and methods: Different clinical samples were collected and processed following standard procedures. Each sample was then inoculated onto culture media. Identification, drug susceptibility testing, and extended spectrum beta lactamase production of the isolates were carried out by using the VITEK 2 compact system. Results: Among 996 clinical samples, 135 samples yielded Non-Fermenting Gram-Negative Bacilli of which Pseudomonas and Acinetobacter species were the commonest isolates. The overall drug resistance rates of Non-Fermenting Gram-Negative Bacilli were above 80% against ampicillin (89.6%), cefuroxime axetil (88.9%), nitrofurantoin (85.9%), cefalotin (84.4%), cefoxitin (83.7%), cefazolin (83.0%), and cefuroxime (83.0%). Tobramycin with a resistance rate of 19.3% was the most active antimicrobial agent. Out of 135 isolates, 81.5% were multi-drug resistant of which 13.3% were extensively drug resistant and 10.4% were pandrug resistant. Extended spectrum beta lactamase production was detected in 48.9% of the isolates. Conclusions: The spectrum of bacterial species isolated was diverse. The isolates demonstrated high level of drug resistance in different classes of antibiotics. The magnitude of multi-drug resistance and the level of extended spectrum beta lactamase production were high. Hence, further studies on multi-drug resistant and extended spectrum beta lactamase producing Non-Fermenting Gram-Negative Bacilli both in the community and in hospital setting are essential.

scholarly journals Evaluation of extended spectrum beta lactamase enzymes prevalence in clinical isolates of Escherichia coli

2011 ◽  
Vol 2 (1) ◽  
pp. 8
Author(s):  
Ronak Bakhtiari ◽  
Jalil Fallah Mehrabadi ◽  
Hedroosha Molla Agamirzaei ◽  
Ailar Sabbaghi ◽  
Mohammad Mehdi Soltan Dallal
Keyword(s):  
Escherichia Coli ◽  
Disk Diffusion ◽  
Confirmatory Test ◽  
Diffusion Method ◽  
Multi Drug Resistance ◽  
Beta Lactamase ◽  
Disk Diffusion Method ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum

Resistance to b-lactam antibiotics by gramnegative bacteria, especially <em>Escherichia coli (E. coli)</em>, is a major public health issue worldwide. The predominant resistance mechanism in gram negative bacteria particularly <em>E. coli </em>is via the production of extended spectrum beta lactamase (ESBLs) enzymes. In recent years, the prevalence of b-lactamase producing organisms is increased and identification of these isolates by using disk diffusion method and no-one else is not satisfactory. So, this investigation focused on evaluating the prevalence of ESBL enzymes by disk diffusion method and confirmatory test (Combined Disk). Five hundred clinical samples were collected and 200 <em>E. coli </em>isolates were detected by standard biochemical tests. To performing initial screening of ESBLs was used from Disk diffusion method on <em>E. coli </em>isolates. A confirmation test (Combined Disk method) was performed on isolates of resistant to cephalosporin's indicators. Up to 70% isolates exhibited the Multi Drug Resistance phenotype. In Disk diffusion method, 128(64%) <em>E. coli </em>isolates which resistant to ceftazidime and cefotaxime while in Combined Disk, among 128 screened isolates, 115 (89.8%) isolates were detected as ESBLs producers. This survey indicate beta lactamase enzymes are playing a significant role in antibiotic resistance and correct detection of them in phenotypic test by using disk diffusion and combined Disk is essential for accurate recognition of ESBLs.

scholarly journals Extended-Spectrum Beta-Lactamase Gene Sequences in Gram-Negative Saprophytes on Retail Organic and Nonorganic Spinach

2011 ◽  
Vol 77 (5) ◽  
pp. 1601-1607 ◽  
Author(s):  
Eva Raphael ◽  
Lisa K. Wong ◽  
Lee W. Riley
Keyword(s):  
Drug Resistance ◽  
Resistance Genes ◽  
16S Rrna Gene Sequencing ◽  
Drug Susceptibility Testing ◽  
Rrna Gene ◽  
Beta Lactamase ◽  
Human Pathogens ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum

ABSTRACTA substantial proportion of infections caused by drug-resistant Gram-negative bacteria (GNB) in community and health care settings are recognized to be caused by evolutionarily related GNB strains. Their global spread has been suggested to occur due to human activities, such as food trade and travel. These multidrug-resistant GNB pathogens often harbor mobile drug resistance genes that are highly conserved in their sequences. Because they appear across different GNB species, these genes may have origins other than human pathogens. We hypothesized that saprophytes in common human food products may serve as a reservoir for such genes. Between July 2007 and April 2008, we examined 25 batches of prepackaged retail spinach for cultivatable GNB population structure by 16S rRNA gene sequencing and for antimicrobial drug susceptibility testing and the presence of extended-spectrum beta-lactamase (ESBL) genes. We found 20 recognized GNB species among 165 (71%) of 231 randomly selected colonies cultured from spinach. Twelve strains suspected to express ESBLs based on resistance to cefotaxime and ceftazidime were further examined forblaCTX-MandblaTEMgenes. We found a 712-bp sequence inPseudomonas teessideathat was 100% identical to positions 10 to 722 of an 876-bpblaCTX-M-15gene of anE. colistrain. Additionally, we identified newly recognized ESBLblaRAHN-2sequences fromRahnella aquatilis. These observations demonstrate that saprophytes in common fresh produce can harbor drug resistance genes that are also found in internationally circulating strains of GNB pathogens; such a source may thus serve as a reservoir for drug resistance genes that ultimately enter pathogens to affect human health.

scholarly journals Quantifying antibiotic impact on within-host dynamics of extended-spectrum beta-lactamase resistance in hospitalized patients

2019 ◽  
Author(s):  
Rene Niehus ◽  
Esther van Kleef ◽  
Mo Yin ◽  
Agata Turlej-Rogacka ◽  
Christine Lammens ◽  
...  
Keyword(s):  
Drug Resistance ◽  
16S Rrna ◽  
Gene Family ◽  
Antibiotic Use ◽  
Beta Lactamase ◽  
Prospective Longitudinal Study ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Variable Nature ◽  
Prospective Longitudinal

AbstractAntibiotic exposure can perturb the human gut microbiome and cause changes in the within-host abundance of the genetic determinants of drug-resistance in bacteria. Such within-host dynamics are expected to play an important role in mediating the relationship between antibiotic use and persistence of drug-resistance within a host and its prevalence within a population. Developing a quantitative representation of these within-host dynamics is an important step towards a detailed mechanistic understanding of the population-level processes by which antibiotics select for resistance. Here we study extended-spectrum beta-lactamase (ESBL) producing organisms of the Enterobacteriaceae bacterial family. These have been identified as a global public health priority and are resistant to most first-line antibiotics for treatment of Enterobacteriaceae infections.We analyse data from 833 rectal swabs from a prospective longitudinal study in three European countries including 133 ESBL-positive hospitalised patients. Quantitative polymerase chain reaction was used to quantify the abundance of the CTX-M gene family – the most wide-spread ESBL gene family – and the 16S rRNA gene as a proxy for bacterial load. We find strong dynamic heterogeneity in CTX-M abundance that is largely explained by the variable nature of the swab sampling. Using information on time-varying antibiotic treatments, we develop a dynamic Bayesian model to decompose the serial data into observational variation and ecological signal and to quantify the potentially causal antibiotic effects.We find an association of treatment with cefuroxime or ceftriaxone with increased CTX-M abundance (approximately 21% and 10% daily increase, respectively), while treatment with meropenem or piperacillin-tazobactam is associated with decreased CTX-M (approximately 8% daily decrease for both). Despite a potential risk for indirect selection, oral ciprofloxacin is also associated with decreasing CTX-M (approximately 8% decrease per day). Using our dynamic model to make forward stochastic simulations of CTX-M dynamics, we generate testable predictions about antibiotic impacts on duration of carriage. We find that a typical course of cefuroxime or ceftriaxone is expected to more than double a patient’s carriage duration of CTX-M. A typical course of piperacillin-tazobactam or of meropenem – both options to treat hospital acquired infections (HAI) like pneumonia – would reduce CTX-M carriage time relative to ceftriaxone plus amikacin (also an option to treat HAIs) by about 70%. While most antibiotics showed little association with changes in total bacterial abundance, meropenem and piperacillin-tazobactam were associated with decrease in 16S rRNA abundance (3% and 4% daily decrease, respectively).Our study quantifies antibiotic impacts on within-host resistance abundance and resistance carriage, and informs our understanding of how changes in patterns of antibiotic use will affect the prevalence of resistance. This work also provides an analytical framework that can be used more generally to quantify the antibiotic treatment effects on within-host dynamics of determinants of antibiotic resistance using clinical data.

scholarly journals Comparative Study of Anti Microbial Activity of Dose Dependent Silver Nanoparticle Preparation, Iodophor and Chlorhexidine against Extended Spectrum Beta Lactamase Strains

2020 ◽  
pp. 32-36
Author(s):  
Rajasri Pradeep ◽  
N. P. Muralidharan
Keyword(s):  
Silver Nanoparticle ◽  
Antimicrobial Properties ◽  
Antibacterial Activities ◽  
Multidrug Resistant ◽  
Multi Drug Resistance ◽  
Beta Lactamase ◽  
Human Beings ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Nanoparticle Preparation

Iodophor, chlorhexidine and silver nanoparticle preparation were tested against Extended spectrum beta lactamase strains (ESBL strains) in this study. This was done in order to compare the antibacterial activities of 5% iodophor, 4% chlorhexidine and silver nanoparticle preparation. A major problem for chemotherapy of bacterial agents in today’s world is the development of multi drug resistance. ESBL is one of the most common problematic multidrug resistant pathogens. Beta lactamase are enzymes which are produced by certain kinds of bacteria. They have the ability to breakdown the active ingredient in certain common antibiotics and thus making them ineffective. Iodophor and chlorhexidine are chemical disinfectants which show antimicrobial activity.  Iodine is said to be one of the most lethal agents that enters the cell and inhibits synthesis of proteins. Iodophors are less toxic and they do not irritate the skin when used for disinfection. Chlorhexidine is also a commonly used antiseptic and they are very commonly used as a disinfectant before surgical procedures and for sterilisation procedures. Silver nanoparticle, another component tested against ESBL strain in this study is a biological preparation. Many studies have described the antimicrobial properties of silver and it is proven to be a powerful bactericidal agent as it can effectively cross biological membranes. Although considered to be toxic at high concentrations in human beings, less than 1% concentration of silver nanoparticle preparation is used for controlling bacteria in dental therapies, wounds, burns and catheters.

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