Identification of ESBL producing Escherichia coli from Urine Samples at Tertiary Care Hospital in Jhalawar

Abstract

Introduction: Antibiotic resistance (ABR) is a serious worldwide threat to public health due to the emergence of multidrug resistant bacteria and is considered as a great problem in the treatment of bacterial infections both in hospital as well as community settings. Extended Spectrum Beta-Lactamase (ESBL) producing strains have emerged as a significant challenge to counter with present antibiotics. Aims: Our study was aimed to know the prevalence of ESBL producing E. coli in our hospital setting for effective therapeutic outcome and patient care. Materials and Method: A total of 459 urine samples of urinary tract infection (UTI) suspects were processed in the Microbiology Department at Jhalawar in Rajasthan, India. All samples were cultured on Mac Conkey Agar and Blood Agar and incubated at 37 °C for 24–48 h. The isolates were identified and confirmed using standard microbiological methods and biochemical reaction. Antibiotic sensitivity testing of all E. coli isolates was performed on Muller Hinton agar plates by Kirby-Bauer disk diffusion technique with guidelines established by the Clinical Laboratory Standards Institute (CLSI). Initial screening of ESBL producing E. coli was performed using the Cefotaxime and Ceftriaxone antimicrobial disc. Double-Disc Synergy Test (DDST) and CLSI confirmatory test i.e., Phenotypic Confirmatory Double-Disc Test (PCDDT) were performed for confirmation of ESBL-producing E. coli. Results: Of the 459 samples processed, 212 isolates were found to be culture positive. Out of 212 positive isolates, 184 (86.79%) were identified as gram negative bacilli (GNB). Of the 184 GNB, 115 (62.50%) were detected as Escherichia coli followed by Klebsiella 30 (16.30%), Pseudomonas 21 (11.41%), Proteus 15 (8.15%), Citrobacter 8 (4.32%), and Acinetobacter 5 (2.71%). Out of 115 E. coli isolates, 86 (74.78%) were found to be ESBLpositive by screening method and 81 (70.43%%) were found to be ESBL producers by PCDDT and 68 (59.13%) were found to be ESBL producers by DDST. Imipenem and Piperacillin–tazobactum were the most active and reliable agents for the treatment of infections which were caused by the ESBL-producing organisms. The ESBL-producing strains were more resistant than non-ESBL producing strains. Among ESBL producers the resistance pattern was highest for Ceftriaxone followed by Cefotaxime and Ceftazidime. Conclusion: As results showed that there was a high prevalence of ESBL production in our setup so, it is essential to report the ESBL production along with the routine sensitivity reports, which will help the clinician in selection of proper antibiotics.

Keywords: antibiotic resistance, Extended Spectrum Beta-Lactamase (ESBL), multidrug resistant, Escherichia coli

Cite this Article Pawan K, Tiwari YK, Saraf G et al. Identification of ESBL producing Escherichia coli from Urine Samples at Tertiary Care Hospital in Jhalawar. Research & Reviews: A Journal of Microbiology and Virology. 2017; 7(3): 38–45p.