Prevalence of multidrug-resistant and extended-spectrum beta-lactamase producing Gram-negative isolates from clinical samples in a tertiary care hospital of Nepal

Abstract

Background The existence of multidrug-resistant organisms, including extended-spectrum beta-lactamases (ESBLs), is on rise across the globe and is becoming a severe problem. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to study the prevalence of Gram-negative isolates exhibiting ESBL at a tertiary care hospital and study their antibiogram profile. Methods A cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal, from June 2018 to November 2018. A total of 770 clinical samples were collected and identified using the conventional biochemical tests following the Clinical and Laboratory Standard Institute (CLSI) guidelines. Antimicrobial susceptibility testing (AST) was performed using the standardized Kirby-Bauer disk diffusion method. The screening test for ESBL producers was performed as recommended by the CLSI and the confirmatory test was performed phenotypically using the E-test. Results Out of the 92 isolates, 84 (91.3%) were multidrug-resistant, and 47 (51.1%) were found to be potential ESBL producers. Of these, 16 isolates were confirmed ESBL producers by the E-test. Escherichia coli and Klebsiella pneumoniae were the predominant isolates and were also the major ESBL producers. Besides polymyxin B (100% sensitive), meropenem and imipenem showed high efficacy against the ESBL producers. Conclusion Multidrug resistance was very high; however, ESBL production was low. Polymyxin B and carbapenems are the choice of drugs against ESBL producers but should be used only as the last line drugs.

Prevalence of carbapenemase-producing Klebsiella pneumoniae at a tertiary care hospital in Kathmandu, Nepal

“…In this study, 38.8% of the samples were growth positive, with more than half were Gram-negative bacteria of which K. pneumoniae (31.4%) was the predominant isolate. This was in agreement with previous studies from Nepal [ 4 ]. Vibas et al [ 29 ] reported a much higher, while Aryal et al [ 30 ] reported a lower prevalence of K. pneumoniae .…”

“…Thus, colistin and tigecycline could be the drug of choice for carbapenem-resistant K. pneumoniae isolates. Many researchers have also reported high sensitivity against colistin [ 2 , 4 , 30 ]. Ciprofloxacin showing maximum ineffectiveness was in agreement with previous finding in Nepal [ 19 ].…”

“…MDR is a global issue and a relatively high burden seen in developing countries [ 27 ]. Various prevalence of MDR K. pneumoniae have been frequently reported in Nepal [ 4 , 17 , 33 ]. In our study, more than half of isolates were MDR.…”

“…It is one of the most frequently isolated organisms after Escherichia coli from clinical specimens in Nepal [ 2 ] and has a greater clinical significance. Irrational and widespread use of antimicrobial agents has led to the increase in antimicrobial resistance in these isolates [ 3 ] and the multidrug-resistant (MDR) K. pneumoniae isolates have been reported by many workers in Nepal [ 2 , 4 , 5 ]. Such multidrug-resistant K. pneumoniae isolates show a high resistance to a broad spectrum of drugs including beta-lactam antibiotics, fluoroquinolones, and aminoglycosides [ 6 ].…”

Bacteriological Profile and Antimicrobial Sensitivity Pattern of the Uropathogens in a Rural Hospital

“…ESBL detection has gained high attention among uropathogens from the suspected cases of UTI as urine specimen may be considered as a tool for consideration of epidemiological markers in the assessment of community spread of pathogenic drug resistant organisms. 11 In recent storyline, antibiotic resistance is increasing alarmingly with emergence of new multidrug resistant bacteria which in turn results into enhanced mortality and morbidity rate.…”