Resistance pattern of Klebsiella from urinary tract infections in a tertiary care hospital
Keywords:
Urinary Tract Infection, Klebsiella, Extended spectrum β-lactamase, Metallo β lactamase
Abstract
Urinary Tract Infection (UTI) is the most prevalent infection worldwide both in males and females. Klebsiella is one of the major pathogens causing UTI. Emerging antibiotic resistance due to extended spectrum β-lactamase (ESBL) and metallo-beta-lactamase (MBL) production has limited the use of β-lactam antibiotics for these bacteria. We isolated 66 Klebsiella pneumoniae and 11 Klebsiella oxytoca strains from urine of patients suffering from UTI. K. pneumoniae isolates were highly susceptible to Amikacin (80.3%) but were resistant to amoxicillin-clavulinic
acid (74.3%). Though, K. oxytoca was sensitive to aminoglycosides, it showed 91% resistance to amoxycillinclavulanic acid. Of the total isolated Klebsiella sp. 54.5% K. pneumoniae and 90.9% K. oxytoca were found to be ESBL producers; 33.3% K. pneumoniae and 36.3% K. oxytoca were MBL producers. Thus, prevalence of ESBL and MBL producing Klebsiella in our region is very high. Rising quantum of resistance to non-β-lactam antibiotics like quinolones in ESBL positive cases is a matter of grave concern considering the fact that these antibiotics are the first line drugs and also used for the empiric treatment of UTI.
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41.
2. Russo TA, Stapleton A, Wenderoth S, Hooton TM, Stamm WE. Chromosomal restriction fragment length polymorphism analysis of Escherichia coli strains causing recurrent urinary tract infections in young women. J Infect Dis. 1995;172: 440-5.
3. Bush K, Jacoby GA. An updated functional classification of β-lactamases. Antimicrob. Agents Chemother. 2010;54 (3):969-976.
4. Goussard S, Courvalin P. Updated sequence information for TEM beta-lactamase genes. Antimicrob Agents Chemother. 1999;43(2):367-370.
5. Chaudhary U and Aggarwal R . Extended spectrum -lactamases (ESBL) - An emerging threat to clinical therapeutics. Indian J Med Microbiol. 2004;22:75-80.
6. Kim YK, Pai H. Bloodstream Infections by Extended- Spectrum beta-Lactamase- Producing Escherichia coli and Klebsiella pneumoniae in Children: Epidemiology and Clinical Outcome. Antimicrob Agents Chemother. 2002;46 (5):1481-1491.
7. Infection of the urinary tract. In: Forbes BA, Sahm DF, Weissfeld AS (eds.) Bailey and Scott’s Diagnostic Microbiology, 12th edn.: Mosby publication. 2007:842-56.
8. Laboratory diagnosis of infective syndromes. In. Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A (eds.) Mackie and McCartney Practical Medical Microbiology, 14th edn.: Churchill-Livingstone Edinburgh. 1996:53–64.
9. Clinical and Laboratory Standards Institute (CLSI) (2009). Performance standards for antimicrobial susceptibility testing, 19th informational supplement M100–S19. CLSI, Wayne, PA.
10. Lee K, Lim YS, Yong D, Yum JH, Cheng Y. Evaluation of the Hodge test and imipenem EDTA double disc synergy test for differentiation of mettalo- lactamase producing clinical isolates of Pseudomonas spp and Acinetbacter spp. J. Clin. Microbiol. 2003;4:4623-9
11. Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon. 2003;49:71–82.
12. Akram M , Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India. Annals of Clinical Microbiology and Antimicrobials 2007;6:4
13. Tankhiwale SS, Jalgaonkar SV, Ahamad S, Hassani U. Evaluation of extended spectrum beta lactamase in urinary isolates. Indian J Med Res. 2004;120:553-6.
14. Vromen M, van der Van AJ, Knols AM, Stobberingh EE. Antimicrobial resistance patterns in urinary tract isolates from nursing homes residents. Fifteen years of data reviewed. J Antimicrobial chemotherapy 1999;44:113-116
15. Kahlmeter G. Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis Europe. The ECOSENS study. Int J Antimicrob Agents. 2003;22:49-52
16. Honderlick P, Cahen P, Gravisse J, Vignon D. Uncomplicated urinary tract infections what about Fosfomycin and nitrofurantoin in 2006? Pathol Biol 2006; 54: 462-6
17. Mehrgan H, Rahbar M. Prevalence of extended-spectrum betalactamase-producing Escherichia coli in a tertiary care hospital in Tehran, Iran. Int. J. Antimicrob Agents 2008; 31:1471-1451.
18. Philippon A, Labia R, Jacoby G. Extended spectrum beta lactamases. Antimicrob Agents Chemother. 1989;33:1131-6.
19. Mekki AH, Hassan AN, Elsayad DEM. Extended-spectrum beta- lactamases among multidrug resistant Escherichia coli and Klebsiella species causing urinary tract infections in Khartoum. J Bacteriol Res. 2010;2(3):18-21
20. Aminzadeh Z, Sadat KM, Shabani M. Bacteriuria by extended spectrum Beta-lactamase-producing E.coli and Klebsiella pneumoniae: isolates in a governmental hospital in South of Tehran, Iran. Iran J Kidney Dis. 2008;2(4):197-200
21. Babypadmini S, Appalaraju B. Extended spectrum lactamase in urinary isolates of E. coli and Klebsiella pneumoniae- prevalence and susceptibility pattern in a Tertiary care hospital. Indian J Med Microbiol. 2004;22:172-174.
22. Ejaz H, Haq I, Zafar A, Mahmood S, Javed MM . Urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumonia. African Journal of Biotechnology. 2011;10(73):16661-6
23. Mathur P, Kapil A. Prevalence of extended spectrum beta lactamase producing gram negative bacteria in a tertiary care hospital. Indian J Med Res. 2002;115:153-7.
24. Miller GH, Sabatelli FJ. The most frequent aminoglycoside resistance mechanisms-changes with time and geographic area: a reflection of aminoglycoside usage patterns? Aminoglycoside Resistance Study Groups. Clin Infect Dis. 1997; Suppl (24)1: S46-62.
25. Zahrani AJ, Akhtar N. Susceptibility Patterns of Extended Spectrum ß- Lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae isolated in a teaching hospital. Pak J Med Res. 2005;44(2): 64-67
26. Walsh TR, Toleman MA, Poirel L, Nordmann P. Metallo- β- lactamase, the quiet before the storm? Clin Microbiol Rev. 2005;18:306-25.
Published
2019-08-31
How to Cite
Dr. Bichitrananda Swain, Otta S, Rout S. (2019). Resistance pattern of Klebsiella from urinary tract infections in a tertiary care hospital. The Indian Practitioner, 68(2), 18-22. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/672
Section
Original Article
