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