Extended-spectrum ß-Lactamase-producing Enterobacteriaceae as a Common Cause of Urinary Tract Infections in Sri Lanka

BACKGROUND: Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasingly reported as pathogens in urinary tract infections (UTIs). However, in Sri Lanka, the clinical and molecular epidemiology of ESBL-PE implicated in UTIs has not been well described. MATERIALS AND METHODS: We conducted prospective, laboratory-based surveillance from October to December 2013 at a tertiary care hospital in southern Sri Lanka and enrolled patients ≥1 year of age with clinically relevant UTIs due to ESBL-PE. Isolate identity, antimicrobial drug susceptibility, and ESBL production were determined. Presence of ß-lactamase genes, bla(SHV), bla(TEM), and bla(CTX-M), was identified by polymerase chain reaction. RESULTS: During the study period, Enterobacteriaceae were detected in 184 urine samples, with 74 (40.2%) being ESBL producers. Among 47 patients with ESBL-PE who had medical records available, 38 (80.9%) had clinically significant UTIs. Most UTIs (63.2%) were community acquired and 34.2% were in patients with diabetes. Among 36 cultured ESBL-PE isolates, significant susceptibility (>80%) was only retained to amikacin and the carbapenems. The group 1 bla(CTX-M) gene was present in 90.0% of Escherichia coli isolates and all Klebsiella pneumoniae and Enterobacter cloacae isolates. The bla(SHV) and bla(TEM) genes were more common in K. pneumoniae (75% and 50%) and E. cloacae (50% and 50%) isolates than in E. coli (10% and 20%) isolates, respectively. CONCLUSION: The majority of UTIs caused by ESBL-PE were acquired in the community and due to organisms carrying the group 1 CTX-M ß-lactamase. Further epidemiologic studies of infections due to ESBL-PE are urgently needed to better prevent and treat these infections in South Asia.

audit on ventilator associated pneumonia in the intensive care unit at teaching hospital Karapitiya, Galle, Sri Lanka

Critical care is one of the most expensive services provided by a hospital. The aim of this audit was to ascertain the incidence of ventilator associated pneumonia in the intensive care unit. A descriptive study. Teaching Hospital Karapitiya, Galle [Sri Lanka]. 1[st] June 2010 to 30[th] August 2010. All patients, who were admitted to ICU and who stayed there for more than 48hrs during a period of three months were studied. Infections were identified on clinical parameters such as fever and on laboratory investigations such as full count, CRP and cultures. Out of 82 patients, 48[58.5%] were subsequently discharged to the ward and 30[36.6%] succumbed to their illness. 68[82.9%] were ventilated and 26 of them had an underlying pathology related to an infection. A total of 20[29.4%] patients of this ventilated group subsequently developed a lower respiratory tract infection. The main nosocomial infection was ventilator associated pneumonia and had an incidence of 21.9%. The most prevalent organisms were mixed gram negative bacilli and Acinetobacter spp. Nosocomial infections are a cause of increased mortality and morbidity in the intensive care unit. Awareness of the risk factors together with simple preventive measures and surveillance will help to reduce its occurrence