FREQUENCY OF ESBL PRODUCTION AND CARBAPENEM RESISTANCE IN URINARY ISOLATES FROM A TERTIARY CARE HOSPITAL

Abstract

Objective: To determine the frequency of ESBL production, Carbapenem resistance and antimicrobial susceptibility in Escherichia coli and Klebsiella pneumoniae urinary isolates from a tertiary care hospital.

Materials and Methods: This cross-sectional study was performed from July to December, 2017 in the Department of Microbiology, Armed Forces Institute of Pathology in collaboration with CMH Rawalpindi, AFBMTC and AFIU Intensive Care Units. All urine specimens collected from indoor and outdoor patients yielding growth of E.coli and K. pneumoniae were processed as per standard protocols. ESBL production was detected by phenotypic confirmatory disc diffusion test as per CLSI guide lines. The antimicrobial susceptibility testing was performed by modified Kirby Baur disc diffusion method and the results were interpreted as per CLSI guidelines. Carbapenem resistance was reconfirmed by breakpoint MICs on VITEK 2 systems-version 08.01.

Results: Among 622 samples, 499 yielded E.coli (80.22%)  and 123(19.77%)  K.pneumoniae. Out of 499 E.coli, 320 (64%) were ESBL producers and 30(6%) were Carbapenem resistant. Out of 123 K.pneumoniae isolates, 73 (59%) were ESBL producers and 28 (23%) were carbapenem resistant. Fosfomycin and Nitrofurantoin were found sensitive in most of isolates with only 3% and 9% resistance respectively.

Conclusion:  This study has highlighted the high frequency of ESBL production in uropathogens and significant Carbapenem resistance in K.pneumoniae in our setup. Detailed analysis of  antibiogram will not only be useful in formulating the antibiotic policy but also strong antimicrobial stewardship program.

Key Words: Carbapenem resistance, ESBLs, Escherichia coli, Klebsella pneumoniae