Susceptibility Pattern Of Extended Spectrum Beta Lactamase Producing Klebsiella Pneumoniae From Clinical Isolates
I Iroha, E Amadi, A Agabus, A Oji
drug resistance, enzyme, organism, specimen
I Iroha, E Amadi, A Agabus, A Oji. Susceptibility Pattern Of Extended Spectrum Beta Lactamase Producing Klebsiella Pneumoniae From Clinical Isolates. The Internet Journal of Microbiology. 2007 Volume 5 Number 2.
The antibiotic sensitivity pattern of extended spectrum beta lactamase (ESBL) producing
Extended spectrum β- lactamase (ESBL) producing organisms, are now being recognized as one of the major threats to effective management of patients in medical institutions, especially in the less developed nations 1 .
Detection of ESBL enzymes using routine laboratory susceptibility tests is often difficult and consequently, ESBL producing
Material And Methods
Isolation of organisms
A total of one hundred and five (105) clinical isolates of
The sensitivity studies was conducted using the Kirby and Bauer method of Sensitivity determination. Sterile Petri – dishes of Mueller Hinton agar were prepared according to manufactures specification. 0.1ml of
Detection of ESBL production
All isolates that was resistant to any of the 2 nd and 3 rd generation cephalosporins (ceftazidime, ceftriaxone cefotaxime) were tested for ESBL production using the double disc synergy test (DDST). Several plates of Mueller- Hinton agar were prepared and 30µg discs of ceftazidime and cefotaxime were placed 15 mm center to center from an amoxicillin – clavulanic acid disc (20:10µg ) (Oxoid UK). Inoculated media were incubated for 18 – 24 hours at 37 0 C. Enhanced zone of inhibition between any of the beta- lactam discs and the center disc (amoxicllin/clavulanic acid) was recorded.
The result of the present study showed that out of the 105
The susceptibility studies revealed a clear difference in susceptibility patterns of organisms obtained from different specimens including urine, blood and stool. ESBL producing organisms isolated from urine were susceptible to nitrofurantoin, nalidixic, ceporex, augmentin, ciprofloxacin and amikacin while isolates from blood were susceptible to nitrofurantoin, gentamicin, augmentin, ciprofloxacin, septrin and amkacin. Further, organisms isolated from stool specimen were susceptible to nalidixic acid, augmentin, ceporex, ciprofloxacin, and amikacin. It was observed that ESBL organisms from all the specimens were generally resistant to ceftazidime, cefotaxime and ceftriaxone (Table 2).
The result of this investigation shows that organisms harboring ESBL enzymes are multi-drug resistant and thus, could pose serious treatment challenges. The presence of ESBL on plasmids makes it possible for them to be easily transferred from one organism to another. Some studies have shown that floroquinolones and aminoglycosides have antimicrobial activity against ESBL organisms than other non β- lactams drugs 9,10 . The overall result of the present study shows that while the prevalence of ESBL producing isolates in Abakaliki is currently not very high, it may escalate and cause a very serious public health problem, if not checked in good time. The constant use of third generation cephalosporins in the treatment of infections in Nigeria, is probably the reason for the current spread of ESBL organisms in our environment 11 .
Information as regards ESBL are very uncommon in our environment and as a result, most clinicians probably don't know when to test for ESBL or any preventive measures to adopt that will help to control its spread. This level of ignorance could culminate to devastating consequences. While some studies have shown that the use of β?lactam β lactamase inhibitors such as amoxicillin-clavulanic acid and piperacillin – tazobactam in the treatment of ESBL infection is possible, others states that
It is interesting to note however, that the results of susceptibility studies also revealed that ESBL producing organisms were sensitive to the floroquinolones and the aminoglycosides than other non-beta lactam drugs. This probably indicates that they could be a drug of choice in treating infections caused by ESBL producing organisms, particularly
In conclusion, the results of our work shows that ESBL producing
The authors appreciate the vital contributions of Prof. C.O. Esimone, Prof. M.U. Adikwu and Dr. I. Aibinu, which lead to the successful completion of this work. Also appreciated are the staff of the Medical Microbiology unit, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria.