RESUMO
Background: Antimicrobial resistance is a growing problem in H. pylori treatment. The study was intended to evaluate the prevalence of resistance amongst 80 H.pylori isolates cultured from biopsy taken during routine endoscopies in 2008-2011. Materials and Methods: 855 gastro duodenal biopsies were collected and cultured on H.pylori selective medium (containing Brucella agar and Columbia agar (Hi media), with Skirrow’s supplement (antibiotic supplement) and 7% human blood cells). H.pylori was isolated from 80 specimens. The antimicrobial susceptibility of H.pylori isolates was carried out by the Kirby Bauer technique against metronidazole (5 μg), clarithromycin (15 μg), ciprofloxacin (5 μg), amoxicillin (10 μg), tetracycline (30 μg), erythromycin (15 μg), levofloxacin (5 μg), and furazolidone (50 μg) (Sigma- Aldrich, MO). Results: 83.8% isolates were resistant to metronidazole, 58.8% were resistant to Clarithromycin 72.5% were resistant to Amoxicillin, 50% to Ciprofloxacin and 53.8% to tetracycline. furazolidone, erythromycin and Levofloxacin showed only 13.8% resistance to H.pylori. Multi drug resistance with metronidazole+ clarithromycin+ tetracycline was 85%. For all the drugs Antimicrobial resistance rate was found higher in males compare to females. Metronidazole and amoxicillin resistance was found noteworthy in patients with duodenal ulcer (p = 0.018), gastritis (P = 0.00), and in reflux esophagitis (P = 0.00). clarithromycin and tetracycline resistance was suggestively linked with duodenitis (P = 0.018), while furazolidone, erythromycin and levofloxacin showed excellent sensitivity in patients with duodenitis (P value- 0.018), gastritis (P= 0.00) and reflux esophagitis (P = 0.00). Resistance with metronidazole (P = 0.481), clarithromycin (P= 0.261), amoxicillin (P = 0.276), tetracycline (P = 0.356), ciprofloxacin (P = 0.164) was not correlated well with Age-group and Gender of the patients. Conclusion: A very high percentage of patients were infected with metronidazole and clarithromycin resistant strains. The use of antibiotics for other indications seems to be the major risk factor for the development of primary resistance. High incidence should alarm the gastroenterologist while prescribing the eradication regimen.
RESUMO
Objective: Infection by extended spectrum beta-lactamase (ESBL) producing strains of Escherichia coli and Klebsiella spp. is variably associated with presence of co-morbid conditions, predisposing factors and poor outcome. Objective of this study was to determine the prevalence of ESBL producing strains along with the outcome and risk factors in patients infected with such strains. Materials and Methods: This observational study was conducted on 6910 clinical samples. E coli & Klebsiella spp. were identified with detection of ESBL production according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Patients’ clinical and demographic details along with risk factors and co-morbid conditions, type of response to antimicrobial therapy, length of hospital stay and mortality were collected. Results: 69.62% out of 563 E.coli and 62.80% out of 342 Klebsiella spp. were isolated from 6910 samples were ESBL producers respectively. Male:Female ratio was 1.36:1 and 2.37:1 for E coli and Klebsiella spp. respectively. Blood Stream Infection (p=.006), soft tissue infections (p=0.08), genital tract infections (p=0.03) and admission in intensive care units were significantly associated with risk of infection by Klebsiella spp. Immunosuppressive therapy (p=0.02) and diabetes mellitus (p=0.04) were significant comorbid conditions in ESBL producing E coli infections. The mean duration of hospital stay for ESBL producing E coli and Klebsiella spp. was 13.65 ± 12.6 and 17.89 ± 14.76 days with mortality of 8.6% and 13.34% respectively. Conclusions: Several co-morbid conditions and invasive devices were significantly associated with infection by ESBL-producing, strains of E. coli and Klebsiella spp. with longer duration of hospital stay and increased mortality in comparison to ESBL non-producers.