Browsing by Subject "Enterobacteriaceae"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
Item Multidrug Resistant Bacterial Isolates at Nobel Medical College Teaching Hospital(Department of Microbiology, 2012) Thakur, PrashantAntimicrobial resistance is one of the big issues especially among members of family enterobacteriaceae. This study was conducted for a period of 6 months from January to June 2011 at Nobel Medical College Teaching Hospital and Research Centre with the objective to know the multi-drug resistant bacterial isolates of family enterobacteriaceae from different clinical samples. A total of 2454 non-repeated clinical samples were processed during the study by using standard microbiological techniques and the antibiotic susceptibility pattern in vitro was evaluated by modified Kirby-Bauer disc diffusion method. The total growth was 25.35% (n=622). Among them gram positive and gram negative bacteria accounted for 48.0% (n=298) and 52.0% (n=324) respectively. Of total gram negative isolates, 92.60% (n=300) belonged to family enterobacteriaceae and 7.40% (n=24) were gram negative other than enterobacteriaceae (Pseudomonas aeruginosa; Acinetobacter species). The bacterial isolates were of 6 different species isolated from 7 different clinical specimens. Among them, E. coli 237/300 (79.0%) were the most predominant followed by Citrobacter species 36/300 (12.0%), Klebsiella pneumoniae 16/300 (5.33%) and Enterobacter species, Proteus mirabilis and Morganella morganii with 0.33% each. Among the antibiotics used, imipenem (98.11%) followed by amikacin (89.55%), meropenem (89.47%) and choramphenicol (78.37%) were found to be most effective. About half of the isolates were susceptible to cefotaxime (52.90%), ceftazidime (42.34%) and ciprofloxacin (53.50%). Overall 59.00% (n=178) of the isolates were multiple-drug resistant with higher among in-patients than out-patients (p<0.05). Of total multiple-drug resistant, E. coli accounted for highest 81.35% (n=144) followed by Citrobacter species 14.40% (n=25). Of total E. coli isolated 52.74% (144/273) were multiple-drug resistant while 69.44% (25/36) and 40.00% (6/15) Citrobacter species and K. pneumoniae respectively were multiple-drug resistant. The study found the higher magnitude of the problems of multiple-drug resistance among enterobacteriaceae that necessitates a reevaluation of first and second line therapies for the treatment of infections due to these organisms and regular monitoring of the usage in order to make reliable information available for optimal empirical therapy.Item Status of Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae among Bacterial Uropathogens(Department of Microbiology, 2013) Paudel, SantoshThe prevalence of Extended Spectrum Beta Lactamases (ESBL), the main cause of resistance to broad spectrum β-lactams, among uropathogenic bacteria have increased over time raising a global concern in the therapeutic management of infections caused by these organisms. This resistance poses difficulties with the choice of therapeutic options for the treatment of severe infections. The study was carried out in the Alka Hospital, Lalitpur between May to October 2012 with an objective to determine the status of ESBL producing Enterobacteriaceae isolated from the urine sample, collected from patients suspected of urinary tract infection. During the study, the Enterobacteriaceae isolated were tested for the presence of ESBL by double disc synergy test (DDST) and combination disk method and antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. Among the total 1054 mid-stream urine samples, 267 Enterobacteriaceae were isolated. By screening test using third generation cephalosporins, 81 of the isolates were suspected of ESBL producers. Among 81 isolates, 72 isolates were positive for ESBL test by combination disk method and only 28 isolates were positive by DDST method. Among the 72 (27%) isolates 67 (30.2%) Escherichia coli, 3 (15.8%) of Klebsiella pneumoniae, 1 (25%) of Citrobacter spp. and 1 (14.3%) of Morganella morganii were found to be ESBL producers. Majority of ESBL producer showed resistance to amoxicillin (100%), cotrimoxazole (79.2%) followed by ciprofloxacin (76.4%). Imipenem (100%), tigecycline (98.6%), amikacin (97.2%), piperacillin- tazobactam (98.6%) and nitrofurantoin (91.7%) seemed to be the agent of choice for urinary tract infections when ESBL producers are susceptible to it. Combination disk method was found to be more sensitive than DDST method for the detection of ESBL producing Enterobacteriaceae. The high level of ESBL production found in these Enterobacteriaceae with the resultant microbial resistance to the available cephalosporins and other agents may pose difficulties with the choice of therapeutic options for the treatment of severe infections. Efforts to prevent and/or control outbreaks of infections with ESBL producing strains must emphasize on the judicious use of all antibiotics.