Prevalence of extended spectrum beta lactamase producers in an Egyptian critical care center

ABSTRACT

To determine the existence of extended spectrum beta lactamase [ESBL] producing Gram negative bacilli [GNB], in an Egyptian critical care center [CCC], we conducted a study over a period of 14 months at Kasr El Aini hospital, Cairo University. We collected 340 samples from health care workers [HCWs], and from 50 patients who acquired infections during hospitalization. Susceptibility of all isolated GNB was done to cephalosporin's [e.g. ceftazidime, cefotaxime], aztreonam, aminoglycosides [e.g. amikacin, gentamycin, and tobramycin], ciprofloxacin, imipenem, piperacillin and other beta lactamase inhibitors. Out of 176 isolated GNB, 106 isolates [60.2%] were confirmed as ESBL producers, mostly Escherichia coli [E. coli, 34%] followed by Klebsiella species [spp.] [30.2%] and Pseudomonas spp. [24.5%]. The predominant hospital acquired infection was respiratory tract infection [RTI] [60.2%] followed by urinary tract infection [UTI] [15.9%]. ESBL producing E. coli were responsible for 23.6% of hospital acquired RTI followed by ESBL producing Pseudomonas spp. [21.7%] and ESBL producing Klebsiella spp. [15.1%]. On the other hand, ESBL producing E. coli and Klebsiella spp. were equally responsible for hospital acquired UTI. 80-90% of these ESBL producing GNB were sensitive to imipenem and 70-90% was sensitive to piperacillin/tazobactam. ESBL producing GNB were isolated from hands of HCWs. Plasmid profile analysis demonstrated that hands of HCWs play an important role in spread of ESBL producing GNB among patients. In conclusion, ESBL producing GNB exist in this Egyptian CCC [106/340, 31.2%]; and rational antibiotic guidelines are mandatory to minimize the problem along with infection control practices. Incorporating microbial genetic typing in infection control program is recommended