Early Detection of Drug Resistant Enterobacteriaceae in Urinary Tract Infections using Chromogenic Agar Medium in a Tertiary Care Hospital, Kakinada, Andhra Pradesh, India
Introduction: The irrational and inappropriate use of beta lactam antimicrobial drugs has led to the advent of Extended Spectrum Beta-Lactamase (ESBL) resistant strains. ESBL producing Enterobacteriaceae strains are frequent causative agents both in community and in acquired nosocomial infection...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Pvt. Ltd.
2022-07-01
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| Series: | National Journal of Laboratory Medicine |
| Subjects: | |
| Online Access: | https://www.njlm.net/articles/PDF/2678/59117_CE(AD)_F(SHU)_PF1(AG_SHU)_PFA(SHU)_PB(AG_SHU)_PN(SHU).pdf |
| Summary: | Introduction: The irrational and inappropriate use of beta lactam
antimicrobial drugs has led to the advent of Extended Spectrum
Beta-Lactamase (ESBL) resistant strains. ESBL producing
Enterobacteriaceae strains are frequent causative agents both
in community and in acquired nosocomial infections and Urinary
Tract Infections (UTI). The phenotypic confirmatory tests rarely
identify all ESBLs. Chrom ID (Chromogenic identification Media)
ESBL – Bx (bioMerieux) is a completely new and innovative
chromogenic medium designed specifically for the screening of
ESBL producing Enterobacteria directly from urine samples. It
is a ready to use selective media which is sensitive and specific
for rapid and presumptive identification of ESBL producing
Enterobacteriaceae.
Aim: Early detection of ESBL producing Enterobacteriaceae
directly from urine samples on chromogenic medium (Chrom IDESBL- Bx) and confirmation of ESBL producing Enterobacteria
using Disc Potentiation Test (DPT).
Materials and Methods: The present cross-sectional study was
conducted in the Department of Microbiology, Rangaraya Medical
College, Kakinada, Andhra Pradesh, India from November 2019
to March 2020 (five months duration). The study was done
on 70 urine samples from patients with UTI. All samples were
subjected to wet mount, inoculated directly for culture on Chrom
ID ESBL- Bx agar and MacConkey agar. Antibiotic Susceptibility
testing of ceftazidime and cefotaxime was done by Kirby-Bauer
disc diffusion method and conformation of ESBL production by
DPT using Clinical and Laboratory Standards Institute (CLSI)
method. The Statistical Package for the Social Sciences (SPSS)
Statistical package version (18.0) was used.
Results: A total of 56 (80%) isolates were obtained from 70
urine samples, out of them 28 (50%) were Escherichia coli,
21 (37.5%) were Klebsiella spp., 7 (12.5%) were Proteus
spp., 23 (82.14%) isolates of Escherichia coli, 15 (71.43%)
of Klebsiella spp., 6 (85.71%) of Proteus spp., isolated were
screened positive using Chrom ID ESBL-Bx agar. About 44
(78.57%) of total Enterobacteria (56) were screened for ESBL
production. 20 (86.96%) of Escherichia coli, 11 (73.33%) of
Klebsiella spp., and 5 (83.33%) of Proteus spp., that were
screened positive using Chrom ID ESBL agar were confirmed
(by DPT) as ESBL producers and 2 (16.6%) of total (12)
isolates that were screened negative by Chrom ID ESBL
agar were confirmed as ESBL producers when screened and
confirmed by DPT. So sensitivity and specificity CHRO Magar
was 94.73% and 55.5%.
Conclusion: ESBL continues to become a serious public
health threat. Results from present study showed that
CHROMagar ESBL has a high sensitivity and a convenient
method for making provisional diagnosis of drug resistant
Enterobacterial infections in 24 hours. Chrom ID ESBL- Bx
agar medium allows easy differentiation of different bacteria
based on colony colouration |
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| ISSN: | 2277-8551 2455-6882 |