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 Identification and Antibiotic Susceptibility Testing of ESBL producing Klebsiella strains by Phenotypic methods

2018 ◽  
Vol 9 (1) ◽  
pp. 8-13
Author(s):  
Malik Taqdees ◽  
Asma Naim ◽  
Asma Saeed
Keyword(s):  
Diffusion Method ◽  
Multi Drug Resistance ◽  
Beta Lactamase ◽  
Disk Diffusion Method ◽  
Klebsiella Species ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Klebsiella Spp ◽  
Esbl Producers

Multi drug resistance has now become a worldwide therapeutic challenge due to the widespread use of broad spectrum antibiotics. Klebsiella species have significant importance in clinical field as they cause various infections in human and are considered as potential pathogens that express antibiotic resistance through their strong enzymatic activity. Extended spectrum beta lactamases (ESBLs) are plasmid mediated enzymes produced mostly because of mutation and few other factors.  These enzymes confer resistance against various β-lactam drugs including cephalosporins and monobactams. Among the genus Klebsiella, ESBLs are highly prevalent in K. pneumoniae followed by K. oxytoca. This study was conducted in Pakistan to assess the distribution of ESBL producers among Klebsiella spp., an important member of the family Enterobacteriaceae. From January 2010 to January 2012, a total of 236 gram-negative isolates were collected from different renowned microbiological laboratories. Out of the 236 gram-negative isolates, 125 were found as Klebsiella spp. by using standard microbiological techniques. Antimicrobial susceptibility profiling of these strains was performed by using Kirby Bauer disk diffusion method. Phenotypic detection of the production of extended spectrum beta lactamase enzyme was performed using double disc synergy method and combination disc method. It has been identified that Klebsiella strains are highly resistant against Amoxicillin, Tetracycline, Nalidixic Acid, Cephradine, Gentamicin, co-amoxyclav with the percentage of 100%, 86%, 86%, 82%, 82% and 80% respectively. The most effective antibiotics for Klebsiella spp. were found to be Amikacin, Meropenem and Piperacillin-tazobactam, with highest sensitivities of 96%, 94% and 91%. Phenotypic detection of Extended spectrum beta lactamase production by double disc synergy test was able to identify 28% ESBL producers among Klebsiella isolates whereas 64% were detected by combination disc test.

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 Prevalence and Characterization of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Isolated in Canadian Hospitals: Results from CANWARD 2007

2009 ◽  
Vol 20 (suppl a) ◽  
pp. 43A-48A ◽  
Author(s):  
Patricia J Baudry ◽  
Melissa McCracken ◽  
Philippe Lagacé-Wiens ◽  
Michael R Mulvey ◽  
George G Zhanel ◽  
...  
Keyword(s):  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
Diffusion Method ◽  
Beta Lactamase ◽  
Single Strain ◽  
Pulsed Field ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Esbl Producers

OBJECTIVE: The purpose of the present study was to determine the prevalence and molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae identified from Canadian hospitals in 2007. METHODS: Clinically significant isolates were collected as part of the Canadian Ward Surveillance Study (CANWARD 2007) from January to December 2007, inclusive, from 12 sentinel hospital centres across Canada. Minimum inhibitory concentrations were determined by broth microdilution, and putative ESBL isolates were confirmed by the Clinical and Laboratory Standards Institute disk diffusion method. Polymerase chain reaction and DNA sequencing were used to detectblaSHV,blaTEM,blaCTX-MandblaOXA-likegenes. Strains were typed using pulsed-field gel electrophoresis. RESULTS: A total of 3.4% and 1.6% ofEscherichia coliandKlebsiella pneumoniae, respectively, were identified as ESBL producers. Resistance to fluoroquinolones, doxycycline, trimethoprim/sulfamethoxazole and gentamicin occurred in 92.5% and 71.4%, 75.5% and 71.4%, 67.9% and 57.1%, and 58.5% and 57.1% of ESBL-producingE coliandK pneumoniae, respectively. A total of 90.6% and 71.4% of ESBL-producingE coliandK pneumoniaewere identified as multidrug resistant. The CTX-M type was the predominant ESBL, with CTX-M-15 as the predominant genotype. A total of 81.7% ESBL-producers carried several beta-lactamase genes. Pulsed-field gel electrophoresis revealed that the majority of ESBL producers were not genetically related (less than 80% homology). Similar patient demographics were observed among both ESBL-producingE coliand K pneumoniae. CONCLUSION: CTX-M has become the most common enzyme among both ESBL-producingE coliandK pneumoniae. The spread of ESBLproducing bacteria across Canada is polyclonal and is not due to the clonal spread of a single strain.

PHENOTYPIC DETECTION OF EXTENDED SPECTRUM BETA LACTAMASE AND THEIR ANTIBIOTIC SENSITIVITY PATTERN IN VARIOUS CLINICAL ISOLATES OF ENTEROBACTERIACEAE

2021 ◽  
pp. 54-58
Author(s):  
Deepali Gupta ◽  
Vipin Kumar Varshney ◽  
Shachi Shachi
Keyword(s):  
Tertiary Care ◽  
Antibiotic Sensitivity ◽  
Research Centre ◽  
Care Hospital ◽  
Beta Lactamase ◽  
Klebsiella Species ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Sensitivity Pattern ◽  
Esbl Producers

Extended-spectrum β-lactamases (ESBLs) are a group of plasmid-mediated, diverse, complex and rapidly evolving enzymes that are posing a major therapeutic challenge today in the treatment of hospitalized and community-based patients. Enterobacteriaceae group is the main cause of bacterial infection and in this family Escherichia coli and Klebsiella species are the most common causes of nosocomial infections. ESBLs represents a major threat among multidrug-resistant (MDR) bacteria isolates. These ESBL producing pathogens are now recognized globally as major causes of nosocomial and community-acquired infections. ESBL detection is important from a therapeutic point of view and for infection control purposes. Carbapenems are often used to treat infections caused by ESBL producing E. coli and Klebsiella. This study was conducted in indoor patient department of Teerthanker Mahaveer Medical College & Research Centre, Moradabad, U.P., which is a tertiary care hospital. This study was conducted during the period from April 2015 to December 2017.A total no. of 350 gram negative Enterobacteriaceae were isolated in 800 no. of samples. They were screened for the beta-lactamase production. Among the 350 isolates 210 strains were ESBL producers. The major ESBL producers were E.coli (32%) followed by Klebsiella, Enterobacter, Citrobacter, Proteus. Multidrug resistance to Fluoroquinolones and Aminoglycosides were observed in the ESBL producing organism. The most common ESBL producing organism were from ICU.

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.

Extended Spectrum Beta-Lactamase (ESBL) producing Escherichia coli and Klebsiella species in pediatric patients visiting International Friendship Children's Hospital, Kathmandu, Nepal

2019 ◽  
Author(s):  
Karuna Kayastha ◽  
Binod Dhungel ◽  
Shovana Karki ◽  
Bipin Adhikari ◽  
Megha Raj Banjara ◽  
...  
Keyword(s):  
Clinical Samples ◽  
Beta Lactamase ◽  
Esbl Production ◽  
Klebsiella Species ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Children's Hospital ◽  
Extended Spectrum ◽  
Children’S Hospital ◽  
Esbl Producers

Abstract Background Emergence of antibiotic resistance among pathogenic strains has spread due to production of β-lactamases, which can lead to failure of empirical therapy in clinical settings. Inappropriate use of antibiotics, particularly third generation cephalosporins has contributed to the development of antimicrobial resistance (AMR). This study aims to determine the prevalence of Extended Spectrum β-Lactamase (ESBL) production in E. coli and Klebsiella species isolated from various clinical samples. Methods This cross-sectional study was conducted at International Friendship Children's Hospital, Kathmandu, Nepal from August 2017 to January 2018. Various clinical samples that included urine, pus, Cerebro-Spinal Fluid (CSF), body fluids, wound swab, endotracheal tip, catheter tip and blood were processed for culture. Following sufficient incubation, isolates were identified by colony morphology, gram staining and necessary biochemical tests. Identified bacterial isolates were then tested for antibiotic susceptibility test by modified Kirby Bauer disc diffusion method, and were subjected to Extended Spectrum Beta Lactamase (ESBL) screening by using 30µg cefotaxime and ceftazidime. ESBL production was confirmed by combination disc method. Results From a total of 103 non-duplicated clinical isolates, E. coli (n=79), Klebsiella pneumoniae (n=18) and K. oxytoca (n=6) were isolated from different clinical specimens. Majority (62.1%; 64/103) exhibited Multi-Drug Resistance (MDR) and 28.2% (29/103) were ESBL producers. All of ESBL producing isolates were resistant towards ampicillin, cefotaxime, ceftriaxone, ceftazidime. Most ESBL producers were found to be susceptible towards imipenem (89.7%; 26/29), nitrofurantoin (82.8%; 24/29), piperacillin/tazobactam (79.3%; 23/29), and Amikacin (72.4%; 21/29). Conclusions High prevalence of multi-drug resistant ESBL organisms found in this study warrants restricting empirical treatment of the bacterial infection. Identification of ESBL producers in routine treatment of infectious diseases can reduce unnecessary and inappropriate antimicrobial use and can reduce the preventable morbidity and mortality.

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