EXTENDED SPECTRUM β-LACTAMASES IN ENTERIC GRAM-NEGATIVE BACILLI: RELATED TO AGE AND GENDER

Authors

  • Shamim Mumtaz
  • Mumtaz Ahmad
  • Irum Aftab
  • Naeem Akhtar
  • Masood ul Hassan
  • Abdul Hamid

Abstract

Background: Extended Spectrum β-Lactamases (ESBLs)-producing strains of Enterobacteriaceaehave emerged as a major problem in hospitalized as well as community based patients. Infectionsdue to ESBLs-producers range from uncomplicated urinary tract infection to life threatening sepsis.The objective of this study was to find out the prevalence of ESBLs-producing Gram- negativebacilli among clinical isolates. Methods: This descriptive study was conducted at the Microbiologydepartment of Fauji Foundation Hospital, Rawalpindi over a period of two years (March 2004–April2006). Six hundred and nine isolates of Enteric Gram-negative rods from various samples weretested for ESBLs- production by double disc synergy test. In 176 ESBLs-producing isolates, sourceof samples in term of indoor/outdoor was analyzed. In 165 ESBLs-producing isolates, patients’gender and age was analysed from 3 months to 70 years. Results: The ESBLs-producing isolateswere more commonly isolated from indoor patients (88.1%) as compared to outdoor patients(11.9%). Escherichia coli was found to be most prevalent organism in indoor patients whileKlebsiella pneumoniae, was the most prevalent organism in outdoor patients. ESBLs were mostcommonly isolated from female patients (64.3%) suffering from urinary tract infections ((41.5%), ascompared to male patients (35.7%) in which the organisms were most commonly isolated from pussamples (54.2 %). ESBLs-producing Enteric Gram-Negative rods were most frequent at later part oflife where they were most common (27.9%) at 61–70 years, followed by 41–50 years of age group(20.0%). Another peak (13.3%) was also seen at younger age group (11–20 years). The leastprevalence (5.5%) was seen in two age groups (0–10 and 31–40 yrs). In case of female patients,ESBLs-producing EGNR were most frequently (29.2%) isolated from middle age group (41–50years) followed by later age groups (51–60 and 61–70 years, (15.1% and 25.5%). Conclusions:Considering the high prevalence of ESBLs in Enteric Gram-negative rods, it is suggested that allsuch isolates should be tested for the production of ESBLs in the routine microbiology laboratory.Key Words: Extended-Spectrum Beta-lactamases, Enterobacteriaceae, Enteric Gram-Negativerods, Escherichia coli, Klebsiella pneumoniae, Enterobacter spp

References

Livermore DM. –lactamases of Pseudomonas aeru ginosa.

Antibiot Chemother 1991;44:215–20.

Chambers HF. Beta lactam antibiotics and other inhibitors of

cell wall synthesis. In Basic & Clinical Pharmacology (Ed)

Katzaung BG. Boston: Mc Graw Hill; 2004. p 734–53.

Paterson DL and Bonomo RA. Extended-spectrum ß -

lactamases: a Clinical Update. Clinical Microbiology

Reviews 2005;18(4):657–86.

Jacoby GA & Medeiros AA. More extended -spectrum ß-

lactamases. Antimicrob Agents Chemother 1991;35:1697–704.

Naumovski L, Quinn JP, Miyashi ro D, Patel M, Bush K,

Singer SB, et al. Outbreak of ceftazidime resistance due to a

novel extended-spectrum beta -lactamase in i solates from

cancer patients. Antimicrob Ag ents Chemother

;36:1991–6.

Emery CL and Weymouth LA. Dete ction and clinical

significance of extended-spectrum beta-lactamases in a tertiary

care medical center. J Clin Microbiol 1997;35:2061–7.

Bhattacharya S. ESBL- From petri dish to the patient. Indian

J Med Microbiol. 2006;24:20–24.

Jarlier V, Nicolas MH, Fournier G & Philippon A. Extended

broad-spectrum β-lactamases conferring transfer able

resistance to newer ß -lactam agents in Enterobacteriaceae:

hospital prevalence and suscep tibility patterns. Rev Infect

Dis 1988;10:867–78.

Livermore DM and Yuan M. Antib iotic resistance and

production of extended -spectrum β-lactamases amongst

Klebsiella spp from intensive care units in Europe J

Antimicrob Chemother 1996;38(3):409–24.

Jacoby GA. Extended -spectrum ß -lactamases and other

enzymes providingresistance to oxyimino-lactams. Infect Dis

Clin North Am 1997;11(4):875–87.

Brun-Buisson C, Legrand P, Philippo n A, Montravers F,

Ansquer M, Duval J et al. Transferable enzymatic resistance

to third -generation cephalosporins duri ng a nosocomial

outbreak of multi resistant Kl ebsiella pneumoniae. Lancet

;8(2):302–6.

Blomberg B, Roland Jureen, Karim P, Manji, Bushir S.

Tamim, Davis SM et al. High rate of fatal cases of pediatric

septicemia caused by Gram-negative bacteria with extendedspectrum β-lactamases in Dares Salaam, Ta nzania. J Clin

Microbiol. 2005;43(2):745–9.

Hobson RP, MacKenzie FM, Gould IM. An outbreak of

multiple-resistant Klebsiella pneumonia e in the Grampion

region of Scotland. J Hosp Infect 1996;33:249–62.

Coulter C, Faoagali JC, Doige S, Bodman J, and George N.

Hand Culture surveillance to i nvestigate transmission of

epidemic extended -spectrum beta -lactamase producing

Klebsiella pneumoniae in a maj or intensive care unit. Aust

NZ J Med 1995;25:572.

Thomson KS, Prevan AM and Sanders CC. Beta lactamases in

Enterobacteriaceae: Emerging problem for new Beta –lactam

antibiotics. Curr Clin Trop Infect Dis 1996;16:151–63.

Spencer RC, Wheet PF, WinstanleyTG, Cox DM, Plested SJ.

Novel -lactamase in a clinical isolat e of Klebsiella

pneumoniae conferring unusual resistanc e to -lactam

antibiotics. J Antimicrob chemother 1987;20:919–21.

Luzzaro F, Mezzatesta M, Mugnaioli C, Perilli M, Stefani S,

Amicosante G, et al. Trends in p roduction of extended -

spectrum beta-lactamases among Enterobacteria of Medical

Interest: Report of the Second Italian Nationwide Survey. J

Clin Microbiol 2006;4(5):1659–64.

Calbo E, Romani V, Xercavins M, Gomez L, Vidal CG,

Quintana S, et al. Risk factors for community-onset urinary

tract infections due to Escherichia coli harbouring extendedspectrum beta -lactamases. J Antimicrob Chemother

;7(4):780-3.

Pena C, Gudiol C, Tubau F, Saballs M, Pujol M, Dominguez

MA, et al. Risk factors for acquisition of extended-spectrum

beta-lactamase producing Escherichia coli among hospitalised

patients. Clin Microbiol Infect 2006;12(3):279–84.

Sorlozano A, Gutierrez J, de Dios Luna J, Oteo J, Liebana J,

Soto MJ, et al. High presence of extended -spectrum betalactamases and resistance to quinolones in clinical isolates of

Escherichia coli. Microbiol Res Mar 23, 2006 (Ahead of print).

Lin TL, Tang SI, Fang CT, Hsueh PR, Chang SC, Wang JT.

Extended-spectrum beta -lactamase genes of Klebsie lla

pneumoniae strains in Taiwan: recharacterization of shv-27,

shv-41, and tem-116. Microb Drug Resist 2006;12(1):12–5.

Chanal C, Sirot D, Romaszko JP, Bret L and Sirot J. Survey of

prevalence of extended -spectrum ß -lactamases among

Enterobacteriaceae. J Antimicrob Chemother 1996;38:127–32.

Shah AA, Hasan F, Ahmed S, Ham eed A. Extended -

spectrum beta-lactamases in Enterobacteriaceae: related to

age and gender. New Microbiol 2002;25(3):363–6.

Gold HS and Moellering RC Jr. Antimicrobial Drug

Resistance. N Eng J Med 1996;335(19):1445–53.

Downloads

Most read articles by the same author(s)