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CORRESPONDENCE
Year : 2008  |  Volume : 26  |  Issue : 3  |  Page : 281-282
 

Extended spectrum beta lactamase (ESBL) producing Escherichia coli and klebsiella pneumoniae in diabetic foot infection


Department of Microbiology, S.L. Raheja Hospital, Mahim West, Mumbai - 400 016, India

Date of Submission19-Dec-2007
Date of Acceptance12-Jan-2008

Correspondence Address:
A Varaiya
Department of Microbiology, S.L. Raheja Hospital, Mahim West, Mumbai - 400 016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.42056

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How to cite this article:
Varaiya A, Dogra J, Kulkarni M, Bhalekar P. Extended spectrum beta lactamase (ESBL) producing Escherichia coli and klebsiella pneumoniae in diabetic foot infection. Indian J Med Microbiol 2008;26:281-2

How to cite this URL:
Varaiya A, Dogra J, Kulkarni M, Bhalekar P. Extended spectrum beta lactamase (ESBL) producing Escherichia coli and klebsiella pneumoniae in diabetic foot infection. Indian J Med Microbiol [serial online] 2008 [cited 2019 Sep 23];26:281-2. Available from: http://www.ijmm.org/text.asp?2008/26/3/281/42056


Dear editor,

Trauma, leading to infection is a common sequel of diabetic foot ulceration, which, once established, progressively worsens and becomes more difficult to treat. Extended spectrum β lactamases (ESBLs) are the derivatives of common β-lactamases (TEM and SHV β-lactamases) that have undergone one or more amino acid substitutions near the active site of the enzyme, thus increasing their affinity and the hydrolytic activity against third generation cephalosporins and monobactams. [1] Production of ESBL enzymes is either chromosomally mediated or plasmid mediated. [2] The majority of ESBL producing strains are Klebsiella pneumoniae,  Escherichia More Details coli and Klebsiella oxytoca . [1] This study was carried out to find out ESBL producing E.coli and K.pneumoniae in diabetic foot infection with type 2 diabetes mellitus and the clinical outcome of these patients.

Over a one year period from January-December 2006, 191 samples (tissue 116, wound swab 75) were collected from indoor patients admitted at S.L. Raheja Hospital, tertiary care hospital for diabetic patients. Patients with non - healing diabetic foot ulcers for two weeks with empirical antibiotic treatment were included in the study. The samples were processed, identified and tested for antibiotic sensitivity test based on standard laboratory technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines [3] with commercially available discs (Hi Media) on Muller Hinton agar plates.

ESBL producer was identified if there was ≥5 mm increase in zone diameter of ceftazidime/clavulanate disc than that of ceftazidime disc alone. Escherichia. coli ATCC 25922 was used as negative control.

From 43 E.coli isolated, ESBL production was observed in 46.51% whereas from 27 K.pneumoniae isolated, ESBL production was found in 44.44%. Maximum ESBL producers were isolated from tissue samples. A combination of carbapenem, amikacin and piperacillin/tazobactam was given to the patients. The mean hospital stay for the indoor patients was 20 days. There was no mortality associated with this infection.

There is paucity of Indian data on the ESBL producing pathogens in diabetic foot infection. In a study conducted in 2001, the prevalence was only 6% amongst E.coli isolates. [4] Kapil et al, have reported 54.5 % E.coli isolates to be ESBL producers. [5] We report overall 46.51% E.coli and 44.44% K.pneumoniae isolates to be ESBL producers.

Thus, the prevalence of ESBLs among members of Enterobacteriaceae constitutes a serious threat to current beta-lactam therapy leading to treatment failure in diabetic foot infection.

 
 ~ References Top

1.Nathisuwan S, Burgess DS, Lewis JS 2 nd . ESBLs: Epidemiology, detection and treatment. Pharmacotherapy 2001;21:920-8.  Back to cited text no. 1    
2.Subha A, Ananthan S. Extended Spectrum beta lactamase (ESBL) mediated resistance to third generation cephalosporins among Klebsiella Pneumoniae in Chennai. Indian J Med Microbiol 2002;20:92-5.  Back to cited text no. 2    
3.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk tests; Approved Standards, 9 th ed. CLSI Document M2- A9, Vol. 26 No 1. Wayne PA: 2006.  Back to cited text no. 3    
4.Motta RN, Oliveira MM, Magalhaes PS, Dias AM, Aragao LP, Forti AC, et al . Plasmid mediated extended spectrum beta-lactamase producing strains of Enterobacteriaceae isolated from diabetic foot infections in Brazilian diabetic centre. Braz J Infect Dis 2003;7:129-34.  Back to cited text no. 4    
5.Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care 2006;29:1727- 32.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]



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