Incidence of infections with extended spectrum beta Lactamase (ESBL)-producing gram-negative bacteria among patients admitted in medical intensive care unit of tertiary care hospital
Abstract
Introduction: Extended spectrum beta-lactamases (ESBLs) are beta-lactamases capable of conferring bacterial resistance to the Penicillins, first, second and third generation cephalosporins, and Aztreonam (but not the Cephamycins or Carbapenems). Clinicians, Microbiologists and hospital epidemiologists are concerned about ESBL-producing Gram negative bacteria because of increased incidence of such infections, limitations of effective antimicrobial therapy and adverse patient outcomes.
Aims and Objectives: To find the incidence of infections caused by ESBL producing Gram negative bacteria among patients admitted in Medical ICU of tertiary care hospital. To compare the antimicrobial susceptibility patterns of the ESBL producing Gram negative isolates with ESBL non-producing isolates.
Materials and Methods: Clinical samples were collected from patients admitted in Medical ICU & processed as per standard protocol. Antibiotic susceptibility was performed by Kirby-Bauer disc diffusion method. Screening for ESBL production was done as per CLSI guidelines. Presence of ESBL was detected by Phenotypic confirmatory disc diffusion method using discs containing 30µg of Ceftazidime with and without 10µg of Clavulanic acid on Mueller-Hinton Agar.
Results: A total of 50 samples were collected. Of these, majority (38%) of samples were urine followed by sputum (36%). Of the 50 samples, majority of the isolates were Klebsiella spp and E.coli, 14(28%) each. Among 50 samples, 42(84%) isolates were ESBL producers. Of the 42 ESBL producing organisms, majority(13(30.9%)) of them were Klebsiella spp.
Conclusion: In the present study, we found an alarming number(84%) of ESBL producing Gram negative isolates in Medical ICU patients. Strict antibiotic policies and measures to limit indiscriminate use of Cephalosporins should be undertaken to minimize the emergence of such resistance.
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References
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