Prevalence of Extended Spectrum Beta-Lactamases among Escherichia coli and Klebsiella spp isolates in Manipal Teaching Hospital, Pokhara, Nepal

Abstract

Objective: To isolate, identify and phenotypically characterize extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp in Manipal Teaching Hospital.Methods: Cross sectional study was conducted among E. coli and Klebsiella spp recovered from patients' various samples to establish the prevalence of organisms producing ESBL in Manipal Teaching Hospital, Pokhara, Nepal between October 2011 and April 2012.ESBL production was detected by Clinical laboratory Standards Institute (CLSI) recommendations.Results: E. coli (n=285) and Klebsiella spp (n=55) were isolated from various clinical samples.The specimens were urine 255 (75%), blood 18 (5.3%),pus 48 (14.1%), sputum 17 (5.1%),and body fluid 2 (0.6%).Seventy six (22.4%) were ESBL producing organisms by phenotypic confirmatory test with double disk diffusion method.ESBL group of organisms showed 100% resistance to ampicillin and cefotaxime.All the organisms in this study were 100% sensitive to imipenem and 95.6% sensitive to cefoperazone+sulbactam combination.ESBL producing isolates showed high rate of resistance to ciprofloxacin (90.7%), ceftriaxone (89.4%), ceftazidime (89.4%), cotrimoxazole (90.4%) and norfloxacin (88.1%) as compared to non-ESBL group.Conclusion: ESBL producing E. coli and Klebsiella spp showed high prevalence in Nepal.Routine laboratory testing for ESBL in Nepalese hospitals is needed in order to optimize antibiotic management and reduce the risk of spread of infections caused by ESBL producers.