Evaluation of Antibiotic Resistance and β- lactamase Production in Clinical Isolates from a Tertiary Care Hospital in Central India

Abstract

Introduction: Antimicrobial resistance in bacterial pathogens is associated with high morbidity and mortality. We aimed to evaluate antibiotic resistance and β-lactamase production in clinical isolates of a tertiary care hospital in Central India. Materials and Methods: Clinical isolates (n=6472 isolates) from patients with infection were identified using standard microbiological techniques. Antibiotic susceptibility testing was performed according to the CLSI guidelines using the Kirby-Bauer disc diffusion technique. AmpC production in Enterobacteriaceae isolates was tested in screening test. Cloxacillin combined disc diffusion test was performed using cefoxitin disc with and without cloxacillin. Metallo-β-lactamase production in Enterobacteriaceae isolates was tested in screening test. Non-fermenting Gram-negative isolates were tested by combined disc test using imipenem and imipenem-EDTA discs. Results: Most bacteremia cases were caused by Staphylococcus aureus (43.13%), non-fermenting spp. (27.44%) and coagulase-negative staphylococci (11.76%). Escherichia coli (55.85%) was the main cause of urinary tract infection followed by Acinetobacter spp. (11.71%) and Klebsiella pneumoniae (10.36%). No resistance to linezolid was seen in Gram-positive isolates. Frequency of vancomycin-resistance was about 9% in Enterococcus spp. Methicillin resistance was seen in 19% of S. aureus isolates. Enterobacteriaceae and Citrobacter freundii isolates were completely resistant to aminopenicillin, first-and second-generation cephalosporins and cefamycin. Moreover, Klebsiella isolates were resistant to aminopenicillin. Enterobacteriaceae isolates showed resistance to aminopenicillin (89.87%), cephalosporins (54-90%) and cephamycin (37-45%). E. coli isolates were sensitive to piperacillintazobactam (87-96%) and imipenem (99.68-100%). Extended spectrum β-lactamase production was seen in 166 Enterobacteriaceae isolates (30.24%). AmpC production was seen in 15 (2.73%) Enterobacteriaceae isolates. Total β-lactamase production was found in 19.23% of the isolates. The frequency of β-lactamase production was highest in K. pneumoniae (51.67%). Conclusions: It is necessary to monitor drug resistance and β-lactamase production. Moreover, it is recommended to perform routine β-lactamase testing in microbiology laboratories for determining prevalence of antibiotic resistance and controlling their spread.

Comprehensive study of antimicrobial susceptibility pattern and extended spectrum beta-lactamase (ESBL) prevalence in bacteria isolated from urine samples

“…In this survey, ESBL production was found in 28.26% (398/1408). In line with this result, some researchers reported the rate of ESBL production as 29% and 30.23% 31 , 32 . In contrast, an earlier study revealed that 11.75% of uropathogens were ESBL positive 33 which is lower than our result.…”

“…Elsewhere, the researcher reported 55.4% for ESBL production rate which is larger than ours 34 . These differences may be due to geographical area, time, and the diagnostic technique used 32 .…”

Determination of ESBL Production & Antibiotic Resistance Profile of Escherichia Coli Isolated from Patients with Urinary Tract Infections: A Study from Tertiary Care Hospital

“…A signicant change in proportion and number of isolation of multi drug resistant (MDR) pathogens has increased over last decade. Global organizations such as World Health Organization (WHO), Centre for Disease Control and Prevention (CDC), and European Centre for Disease Prevention and Control (ECDPC), consider MDR (4) isolates as a global threat to public health worldwide.…”

“…The MDR isolates are associated with increased morbidity and mortality, such agents usually fails to respond to conventional treatment so become more (5) tedious. So although rational use of antibiotics is necessary, development of new antimicrobial agent is in (4) pipeline.…”