Prevalence of extended-spectrum beta-lactamase producing klebsiella pneumoniae by phenotypic and genotypic methods in Assiut University Hospital

ABSTRACT

This study investigated the urinary tract infection in Assiut university hospitals to evaluate the rate of infection, and the prevalence of extended spectrum ?-lactamase producing Klebsiella pneumoniae to define the magnitude of the problem and may help to implement appropriate infection control measures. This study was conducted from January 2014 to June 2014. Urine samples were collected from urinary tract infected patients to detect the causative organisms. After antimicrobial susceptibility testing, resistant strains to ?-lactam antibiotics were selected for detection of ESBLs. In addition PCR was done to determine the most common group of beta-lactamase genes responsible for resistance. The study included 340 patients presented to urology department at Assiut University Hospitals. The rate of community and hospital acquired UTI were 41% [140/340] and 59% [200/340] respectively. For community patients the commonest isolate was E. coli [54.28%] followed by Klebsiella pneumonia [29.28%] then Staphylococcus aureus [7.14%], Pseudomonas aeruginosa [1.42%], Coagulase-negative Staphylococcus [3.57%], and Candida species [4.28%].While the pattern of nosocomial isolates was Klebsiella pneumoniae [51%] followed by E. coli [30%] whereas, Staphylococcus aureus [4%], Pseudomonas aeruginosa [11%], Coagulase-negative Staphylococcus [3%], Candida species [1%] Antibiotics sensitivity of K. pneumoniae isolates showed that these organisms were mostly sensitive to meropenem [100%]. Phenotypic confirmatory tests [combined disc method, double disc method and ESBL-E-Test] were done to test K. pneumoniae isolates for ESBL production. It was concluded that 60.97% [25/41] of community isolates and 81.37% [83/102] of nosocomial isolates were ESBLs producers. PCR was done to determine the responsible ESBL gene; it revealed that the common ESBL gene was CTX-M followed by TEM then SHV. Further analysis of CTX-M positive isolates showed that CTX-M-group-1 was the predominant type. ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, rapid and clinically relevant antibiotic testing service is always required to provide services. Besides, the controlled use of 3[rd] generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates