Prevalence of Extended Spectrum Beta Lactamase (ESBL) Producers among Gram Negative Bacilli from Various Clinical Isolates in a Tertiary Care Hospital at Jhalawar, Rajasthan, India
Background and Objectives: The resistance to broad spectrum β-lactams which is mediated by the extended spectrum beta lactamase (ESBL) enzyme is an increasing problem now-a-days. This resistance mechanism has been responsible for nosocomial outbreaks, serious therapeutic failure if it is not det...
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2012-04-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/1926/9-%203537.A..pdf |
| Summary: | Background and Objectives: The resistance to broad spectrum
β-lactams which is mediated by the extended spectrum beta
lactamase (ESBL) enzyme is an increasing problem now-a-days.
This resistance mechanism has been responsible for nosocomial
outbreaks, serious therapeutic failure if it is not detected on time
and the outbreak of multidrug resistant, gram negative pathogens
that need expensive control measures. As no data was available
on the prevalence of ESBL in this region, the current study was
undertaken to determine the prevalence of the ESBL producing
strains in our hospital based population of Jhalawar.
Aim: To know the prevalence of ESBL producing organisms at
our tertiary care hospital at Jhalawar.
Material and Methods: A total of 219 consecutive, nonrepetitive, gram negative isolates, which were resistant to one of
the third generation cephalosporins (cefotaxime, ceftriaxone or
ceftazidime) were selected as “Suspicious for ESBL production”
as recommended by the Clinical and Laboratory Standards
Institute (CLSI). These isolates were confirmed for ESBL
production by the double disc synergy test (DDST) and the
phenotypic confirmatory disc diffusion test (PCDDT) and they
were further confirmed by the E-test ESBL strip randomly.
Result: Out of the 219 isolates which were tested, 135 (61.6%)
were found to be ESBL producers by PCDDT and 126 (57.5%)
were found to be ESBL producers by DDST. Twenty-eight
randomly selected isolates were further confirmed by the E-test
ESBL strip, which showed a highly significant correlation with
PCDDT (p value <0.001). The isolates of Escherichia coli (73.5%)
were the most common ESBL producers, followed by Proteus
vulgaris (60%), K. pneumoniae (58.1%) and others. The maximum
ESBL production was seen in urine (66.4%), followed by pus
(57.3%) and others (54.2%). Imipenem (98.5%), piperacillin/
tazobactum (72.6%) and amikacin (64.5%), in the decreasing
order, were the most active and reliable agents for the treatment
of the infections which were caused by the ESBL producing
organisms.
Conclusion: There is a high prevalence of ESBL production in
our hospital and so, it is essential to report the ESBL production
along with the routine sensitivity reports, which will help the
clinician in prescribing proper antibiotics. Also, control measures
which include the judicious use of antibiotics, antibiotic cycling,
the implementation of appropriate infection control measures
and the formulation of an antibiotic policy must be done, to
prevent the spread of these strains. |
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| ISSN: | 2249-782X 0973-709X |