Prevalence and antibiotic susceptibility pattern of esbl producing klebsiellae isolated from clinical specimens in a nigerian tertiary hospital

Background: Infection by Extended Spectrum Beta Lactamases (ESBLs) producing bacteria is a threat to man as a consequence of treatment challenges. This study evaluated the prevalence and antimicrobial susceptibility pattern of ESBL producing Klebsiellae (EPK) in clinical specimens at the University of Ilorin Teaching hospital, Ilorin (UITH), Nigeria. Methods: ESBL production was assayed using Double Discs Synergy Test (DDST). Antimicrobial susceptibility was performed by Modified Kirby-Baeur method with the organism tested against ceftazidime (30µg), cefotaxime (30µg), amoxicillin clavulinic acid (20/10µg), cefepime (30µg), ciprofloxacin (5µg), gentamicin (10µg), trimethoprim-sulphamethoxazole (23.75/1.25µg), imipenem (10µg) and doripenem (10µg) (Oxoid, UK). Results: Fifty (26.7%) of the 187 Klebsiellae studied were EPK comprising of 37(26.8%) Klebsiella pneumoniae and 13(26.5%) Klebsiella oxytoca. EPK were mostly from wound specimens (24.0%) although Klebsiellae were mostly occurring in sputum (26.2%). The EPK were resistant to ceftazidime (100%), cefotaxime (94.0%), trimethoprim-sulphamethoxazole (92.0%), gentamicin (70.0%) and ciprofloxacin (70.0%) but 100% susceptible to both doripenem and imipenem. Conclusion: The prevalence of EPK in this study is high and they are multi-drug resistant. Carbapenems are the best antibiotic treatment option for infections arising from these organisms although a coordinated rational usage is desired along with functional antibiotic prescription policy to avoid treatment failures. Continuous surveillance for ESBL producing Klebsiellae and resistance monitoring are necessary routine to strengthen infection control policies

Prevalence of Extended Spectrum beta-Lactamase-Producing Klebsiella Species at the University of Ilorin Teaching Hospital

Background: Persistent blind antibiotic treatment of patients; in resource poor nations like Nigeria; makes the prevalence of antibiotic resistance to increase sporadically. Extended spectrum beta-lactamase (ESBL) production is one of the ways by which bacteria become resistant to antibiotics. For this reason; isolation; identification; sensitivity and screening for possible resistance genes is very important before prescription; if the affected patients must receive qualitative care particularly when their condition is chronic. Materials and Methods: Four hundred suspected isolates of Klebsiella belonging to various species obtained from routine specimens such as swabs; urine; blood; and sputum from May to October 2009 were studied. The identity of all isolates obtained was biochemically analyzed. The isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer method and ESBL production was phenotypically determined using double disc synergy test for laboratory detection and reporting of bacteria by CLSI method. Results: Ninety-eight (24.5%) isolates expressed ESBL. Majority of the ESBL producing isolates were from swab specimens 59 (14.75%) followed by blood culture 16 (4.0%); urine 13 (3.25%); and sputum 10 (2.5%). Sensitivity patterns of ESBL producing Klebsiella spp. revealed that all ware resistant to augmentin (AUG); ceftazidime (CAZ); cefotaxime (CTX); cefuroxime (CRO); cefpodoxime (CPD); and none resistant to imipenem (IMP).Conclusion: ESBL producing Klebsiella spp.; were present in University of Ilorin Teaching Hospital. They are resistant to augmentin (AUG); CAZ; CTX; and CPD. Presence of ESBL in any Klebsiella spp. has made cephalosporins which are first line antibiotics usually given non-effective; thereby reducing the treatment options. We; therefore; suggest screening and confirmation for ESBL; in other to prevent treatment failure