Coexistence of β-Lactamases in Community-Acquired Infections in a Tertiary Care Hospital in India

Abstract

Introduction The trends of β-lactamases producing Enterobacteriaceae is ever increasing, and limited studies have reported investigating coexistence of β lactamases in Enterobacteriaceae. A cross-sectional study after approval from the Institutional Ethical committee was conducted between June 2014 and May 2016 in community-acquired infections due to multidrug-resistant organisms in our tertiary care. Nonrepetitive clinical samples from the out-patient department (OPD) were processed for bacteriological culture and identification of Enterobacteriaceae. An antibiotic susceptibility test, screening, and phenotypic confirmation for ESBLs and carbapenemases and AmpC producers were performed to check for coexistence of these enzymes. Results Nonrepetitive clinical specimens processed for culture and identification in our hospital revealed 417 positive isolates in community acquired infections which were multidrug-resistant organisms, and on screening for β-lactamases, 293 isolates were positive for one of the three beta lactamases, ESBL, AmpC, or carbapnemases. Coproduction of ESBL and MBL was seen in 5 isolates, 35 isolates showed coproduction of ESBL and AmpC enzymes, and AmpC and MBL coproduction was exhibited in only in 5 isolates. Conclusions Coexistence of ESBLs, AmpC producers, and carbapenemases has been described. Continuous monitoring and surveillance and proper infection control and prevention practices will limit the further spread of these superbugs within the hospital and beyond.

Antimicrobial Resistance in Escherichia coli

“…To make matter worse, infectious disease specialists are starting to see an increase of cases of E. coli strains that co-express ESBL and AmpC genes, complicating antimicrobial treatment even further. Different reports in India [70,71] have shown that co-expression of blaESBL and blaAmpC genes by E. coli strains isolated from different human infections is not uncommon, thus continuous monitoring of these resistance patterns is a necessity that will help prevent the further spread of these multidrug-resistant microorganisms.…”

Metallo-β-lactamase and AmpC genes in Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolates from abattoir and poultry origin in Nigeria

“…Measuring the prevalence of MDR bacteria coupled with rational use of available antibiotics and proper susceptibility testing is critical to reducing the possible risks associated with infections due to multidrug resistance [ 5 , 6 ]. Both carbapenem-resistant Enterobacteriaceae and AmpC-producing Gram-negative bacteria (GNB) have emerged as important health issue that is of global health concern [ 7 , 8 ]. This trend can adversely affect the World Health Organization (WHO) ‘One Health’ policy because of the ease with which GNB harboring multidrug resistance genes can zoonotically move from animals to humans and vice versa [ 9 ].…”

Synergistic Antibacterial and Antibiofilm Activity of the MreB Inhibitor A22 Hydrochloride in Combination with Conventional Antibiotics against Pseudomonas aeruginosa and Escherichia coli Clinical Isolates

“…Globally, infections caused by multidrug resistant (MDR) Gram-negative bacteria are on the rise and responsible for high mortality and morbidity rates [ 2 ]. Among Gram-negative pathogens, carbapenem-resistant (CR) Pseudomonas aeruginosa and members of the Enterobacteriaceae family, especially extended-spectrum beta-lactamases (ESBLs)-producing and metallo-beta-lactamases (MBLs)-producing Escherichia coli , are associated with severe healthcare- and community-acquired infections, mainly in immunosuppressed and other vulnerable patients [ 3 – 6 ]. Today, a growing number of strains have been identified as resistant to essentially all commonly used antibiotics with a variety of resistance mechanisms including overexpression of efflux pumps, low membrane permeability, and target alterations [ 7 ].…”