Evaluation of methods for detection of extended spectrum beta lactamases in patients with urinary tract infection
EJMM-Egyptian Journal of Medical Microbiology [The]. 2011; 20 (4): 93-106
in En
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| ID: emr-195476
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Antimicrobial resistance is a major public health concern in human medicine both in the community and in medical institutions. Knowledge on local antimicrobial resistance among urinary isolates is important in guiding the recommendations in empirical antibiotic treatment of UTI. Production of Extended Spectrum Beta-Lactamases [ESBL] is the most common amongst the mechanisms of antimicrobial resistance. ESBLs have been found in a wide range of Gram-negative rods. However, the vast majority of strains expressing these enzymes belong to the family Enterobacteriaceae. In this study we evaluate the methods for detection of extended spectrum beta lactamases to determine the magnitude and pattern of antimicrobial resistance among gram -ve bacilli [E. coli and Klebsiella Pneumoniae] isolated from urine specimens as well as providing a better delineation of the clinical patterns associated with the carriage of ESBL-producing urine isolates that may allow the identification of at risk patients more rapidly
Methods: eighty four patients with UTI collected over a 11-month period were obtained. Microbiological cultures were carried out by standard laboratory methods ESBL production was detected by the double disk synergy testand phenotypic confirmatory double disc diffusion test and genes encoding ESBLs [blaTEM, blaCTX-M, blaSHV] were detected by polymerase chain reaction [PCR]
Results: 84% of the total isolated bacteria were Enterobacteriaceae. Among Enterobacteriaceae, E.coli was [57.8%] and Klebsiella Pneumoniae were [26.3 %]. However, 33.3% of E. coli was ESBL producer and 53.3% of Klebsiella Pneumoniae was ESBL producer by PCDDT. ESBL producer bacteria were higher among isolates from female [46.2%], from patients in ICU [80%], from outpatient clinic [33.3%], from catheterized patients [71.4%] and those with co morbidities. There was highly significant occurrence of ESBL in those with increased weight and BMI. ESBL- producing E. coli strains showed/00% resistance to Amoxicillin-clavulanic acid, Ciprofloxacin, Norfloxacin, Piperacillin-tazobactam. E.coli showed less rate of resistance to Gentamicin [54.5%], Cefoxitin [36.3%], Amikacin [27.2%], and Nitrofurantoin [18.1%] and no resistance for imipenem. However ESBL- producing K. pneumoniae strains showed high resistance to Ciprofloxacin [75%], Gentamicin and Norfloxacin [62.5%], Nitrofurantoin [50%]. K. pneumoniae isolates were showed less rate of resistance to Cefoxitin [25%], and no resistance was found to Amikacin and imipenem
Conclusion: routine detection of ESBL-producing microorganisms is required to be done by each laboratory by the standard detection methods so as to control the spread of these infections and also to institute proper therapeutic strategies. PCPDT was found to be better than DDST in the detection of ESBLs. Amikacin and imipenem were the most effective and drugs of choices in the treatment of UTI caused by ESBL producing E. coli and Klebsiella pneumoniae. High BMI appears as a new risk factor for acquisition of ESBL-producing E coli and k pneumonia. The genotypic methods provided an efficient and rapid differentiation of ESBLs
Methods: eighty four patients with UTI collected over a 11-month period were obtained. Microbiological cultures were carried out by standard laboratory methods ESBL production was detected by the double disk synergy testand phenotypic confirmatory double disc diffusion test and genes encoding ESBLs [blaTEM, blaCTX-M, blaSHV] were detected by polymerase chain reaction [PCR]
Results: 84% of the total isolated bacteria were Enterobacteriaceae. Among Enterobacteriaceae, E.coli was [57.8%] and Klebsiella Pneumoniae were [26.3 %]. However, 33.3% of E. coli was ESBL producer and 53.3% of Klebsiella Pneumoniae was ESBL producer by PCDDT. ESBL producer bacteria were higher among isolates from female [46.2%], from patients in ICU [80%], from outpatient clinic [33.3%], from catheterized patients [71.4%] and those with co morbidities. There was highly significant occurrence of ESBL in those with increased weight and BMI. ESBL- producing E. coli strains showed/00% resistance to Amoxicillin-clavulanic acid, Ciprofloxacin, Norfloxacin, Piperacillin-tazobactam. E.coli showed less rate of resistance to Gentamicin [54.5%], Cefoxitin [36.3%], Amikacin [27.2%], and Nitrofurantoin [18.1%] and no resistance for imipenem. However ESBL- producing K. pneumoniae strains showed high resistance to Ciprofloxacin [75%], Gentamicin and Norfloxacin [62.5%], Nitrofurantoin [50%]. K. pneumoniae isolates were showed less rate of resistance to Cefoxitin [25%], and no resistance was found to Amikacin and imipenem
Conclusion: routine detection of ESBL-producing microorganisms is required to be done by each laboratory by the standard detection methods so as to control the spread of these infections and also to institute proper therapeutic strategies. PCPDT was found to be better than DDST in the detection of ESBLs. Amikacin and imipenem were the most effective and drugs of choices in the treatment of UTI caused by ESBL producing E. coli and Klebsiella pneumoniae. High BMI appears as a new risk factor for acquisition of ESBL-producing E coli and k pneumonia. The genotypic methods provided an efficient and rapid differentiation of ESBLs
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Type of study:
Diagnostic_studies
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Guideline
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Prognostic_studies
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Language:
En
Journal:
Egypt. J. Med. Microbiol.
Year:
2011