High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

Abstract

BackgroundRecent reports of the rapid evolution of bacterial resistance in India require urgent antibiotic stewardship programs. This study aimed to define the magnitude and pattern of resistance of bacterial pathogens to guide empirical therapy.MethodsWe prospectively collected consecutive, clinically significant, and nonduplicate bacterial isolates from each patient from two hospitals in Ujjain, India. The antibiotic susceptibility of the bacteria was tested using a disc diffusion method as recommended by the Clinical and Laboratory Standards Institute.ResultsA total of 716 pathogens were isolated from 2568 patients (median age, 25 years; range, 0 days to 92 years). Gram-negative infections were predominant (62%). The isolated pathogens included Staphylococcus aureus (n = 221; 31%), Escherichia coli (n = 149; 21%), Pseudomonas aeruginosa (n = 127; 18%), and Klebsiella pneumoniae (n = 107; 15%). Common diagnoses included abscesses (56%), urinary tract infections (14%), blood stream infections (10%), pneumonia (10%), and vaginal infections (10%). In E. coli isolates, 69% (95% confidence interval [CI] 61.6–76.6) were extended-spectrum β-lactamase (ESBL) producers and 41% (95% CI 31.6–50.5) of K. pneumoniae isolates were ESBL producers. These isolates had a high resistance to fluoroquinolones and β-lactams, except for imipenem and piperacillin-tazobactam. Salmonella typhi remained sensitive to third-generation cephalosporins. Methicillin-resistant S. aureus (MRSA) constituted 30% of all S. aureus isolates and showed resistance to ciprofloxacin (81%), cotrimoxazole (76%), and levofloxacin (60%).ConclusionOur results showed a high prevalence of ESBL among Gram-negative bacterial isolates and a high prevalence of MRSA among S. aureus isolates. Carbapenems provided the broadest coverage for Gram-negative bacteria, while glycopeptides were the most effective against MRSA; however, both classes of drugs need to be used judiciously. This study will help in planning future antibiotic stewardship programs.

Frequency and factors associated with carriage of multi-drug resistant commensal Escherichia coliamong women attending antenatal clinics in Central India

“…The difference in the resistance rates could be due to variation in the geographical area of the study [7,8,26] and also is dependent on the pattern of antibiotic prescribing in the local community [27,28]. The ESBL rate (15%) in the present study is lower than that reported among pathogenic E. coli (69%) isolated from patients with clinical infections in the same geographical area [29]. …”

Multi-drug Resistance and Extended-Spectrum β-Lactamase Production in Uropathogens from Hospitalized Patients in Gurugram, India

“…The resistance rates of ESBL positive E. coli and K. pneumoniae to nitrofurantoin were 3.0% and 50.0%, respectively. Resistance rate (12%) by E. coli isolates was shown in a report from Indore, India 46 .…”

“…In comparison, E. coli shown a much low resistance rate: Gentamicin 55.0 %; Amikacin: 8.0%. In contrast, K. pneumoniae showed resistance to Gentamicin (69%) and Amikacin (38%) while 59% and 33% resistance rates were confirmed by E. coli isolates in a study done in Indore, India 46 . A resistance rate of 46.7% to gentamicin was demonstrated by K. pneumoniae isolates in a report from Karachi, Pakistan 47 , which is similar to results in this study.…”

Prevalence and Characterization of Extended Spectrum Beta-Lactamase Production in Clinical Isolates of Klebsiella pneumonia

“…In some center's like Ujjain, Bijapur, Kanchipuram (some of the cities in India) the incidence of ESBLs is still very low [14][15][16]. But in metropolitan cities (of India) like New Delhi there is gradual increase in ESBL producers, from 80% in 2002, 91% in 2005, 97% in 2007 and 100% in 2010 [17][18][19].This probably relates to rampant and inadvertent use of third generation cephalosporin's).…”