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CORRESPONDENCE
Year : 2013  |  Volume : 31  |  Issue : 4  |  Page : 420-421
 

Prevalence of extended-spectrum-beta-lactamase and metallo-beta-lactamase producing multi drug resistance gram- negative bacteria from urinary isolates


1 Department of Microbiology, Institute of Medical Sciences and SUM Hospital, S'O'A University, Kalinga Nagar, Bhubaneswar, Odisha, India
2 Applied Microbiology Lab, Center of Biotechnology, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India

Date of Submission19-Apr-2013
Date of Acceptance26-Aug-2013
Date of Web Publication25-Sep-2013

Correspondence Address:
N K Debata
Department of Microbiology, Institute of Medical Sciences and SUM Hospital, S'O'A University, Kalinga Nagar, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.118890

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How to cite this article:
Jena J, Debata N K, Subudhi E. Prevalence of extended-spectrum-beta-lactamase and metallo-beta-lactamase producing multi drug resistance gram- negative bacteria from urinary isolates. Indian J Med Microbiol 2013;31:420-1

How to cite this URL:
Jena J, Debata N K, Subudhi E. Prevalence of extended-spectrum-beta-lactamase and metallo-beta-lactamase producing multi drug resistance gram- negative bacteria from urinary isolates. Indian J Med Microbiol [serial online] 2013 [cited 2019 Jun 16];31:420-1. Available from: http://www.ijmm.org/text.asp?2013/31/4/420/118890


Dear Editor,

Urinary tract infection (UTI) is an important cause of morbidity and mortality ranking next to upper respiratory tract infection. Bacteria are the major causative organisms and account for more than 95% of UTIs. [1] Organisms causing UTIs are frequently resistant to many of the antimicrobial agents, leading to recurrent UTIs, increased length of hospitalisation and cost of healthcare. [2] With the increase in occurrence of multi drug resistance (MDR) in UTI isolates and types of multiple β-lactamase enzymes, early detection is crucial, which helps in implementation of proper antibiotics therapy and infection control policy. Hence, the present study is conducted to determine the prevalence of extended-spectrum-beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) producing MDR uropathogens and their susceptibility to the antibiotics generally used for the treatment of UTI.

Over a period of 7 months (May 2012-November 2012), of total 1,890 urine samples processed in the Department of Microbiology, Institute of Medical Sciences (IMS) and Sum Hospital, Bhubaneswar, only 290 (15.34%) samples yielded many bacteria, of which n = 112 (38.62%) were found to be MDR. For all studies, National Collection of Type Cultures (NCTC)-10418, a β-lactamase negative strain was used as reference. Screening of ESBL was performed by Double disc approximation test, National Committee for Clinical Laboratory Standards (NCCLS) confirmatory test and screening of MBL was done byDouble disc synergy test.

Antibiogram revealed that 112 (100%) and 109 (97.32%) isolates were resistant to ceftazidime and norfloxacin, respectively, indicating maximum resistance. Imipenem, Nitrofurantoin, netilimicin, amikacin, ceftazidime/clavulanic acid and ceftriaxone/sulbactum constitute the reasonable option for treatment of UTI. Imipenem shows higher susceptibility, but increase use of carbapenems leading to emergence of MBL-mediated resistant. Of the 112 MDR uropathogens, 58 (51.78%) and 20 (17.85%) were found to be ESBL and MBL producers, respectively. The highest positivity of ESBL and MBL was found to be in K. Oxytoca 3/4 (75%) and Citrobacter spp. 3/4 (75%), respectively [Table 1]. Our study showed that ESBL and MBL production was high among uropathogens and the situation is worsened due to increased rate of MDR. Our study shows high prevalence of ESBL (51.78%) as compared to the report of Taneja et al., (36.5%). [3] Of six isolates exhibiting intermediate resistance to imipenem, five were found to be MBL producer, which corroborates with other report where K. pneumoniae and E. coli were found to be carbapenem sensitive but positive for MBL gene. [4]
Table 1: Identification of ESBL positive and MBL positive isolates (n=112)

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Therefore, it can be concluded that the knowledge of institutional resistance patterns can help physicians' select adequate empirical antibiotic regimens, avoiding highly resistanceantibiotics. Treatment can be tailored in each patient, considering individual risk factors and ESBL and MBL targeting if necessary, thus reducing morbidity and mortality and better control over hospital infections.

 
 ~ References Top

1.Ramesh N, sumathi CS, Balsubramanian V, Palaniappan KR, Kannan VR. Urinary tract infection and antimicrobial susceptibility pattern of extended Spectrum of beta Lactamase Producing Clinical Isolates. Adv Biol Res 2008;2:78-82.  Back to cited text no. 1
    
2.Haque SF. Extended spectrum beta-lactamases mediated resistance in urinary tract infections "Changing profile at a teaching hospital of north India. Int J Cur Bio Med Sci 2011;1:103-7.  Back to cited text no. 2
    
3.Taneja N, Rao P, Arora J, Ashok DA. Occurrence of ESBL and Amp-C β-lactamases and susceptibility to newer antimicrobial agents in complicated UTI. Indian J Med Res 2008;127:85-8.  Back to cited text no. 3
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4.Arakawa Y, Shibata N, Shibayama K, Kurokawa H, Yagi T, Fujiwara H, et al. Convenient test for screening of metallo-beta lactamase producing gram negative bacteria by using thiol compounds. J Clin Microbiol 2000;38:40-3.  Back to cited text no. 4
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