Isolation and Identification of Extented Spectrum Beta Lactamase Producing Multi Drug Resistance Bacteria from Sputum Samples of Suspected LRTI Patients Visiting Nepal Public Health Laboratory, Nepal

Abstract

An eight month study was undertaken with an objective to study the isolation and identification of ESBL producing MDR bacteria from sputum samples of suspected LRTI patients visiting NPHL, Nepal.The laboratory work was conducted in National Public Health Laboratory Teku, Kathmandu. Out of 250 sputum samples collected, 211 samples meeting the ASM criteria were accepted and further processed, of those 211 processed sample, only82 (38.86%)were culture positive.Of 144 male suspected cases of LRTI, 49 (34.02%)were found to be culture positive and among67 female suspected cases, 33 (49.2%) of them were found culture positive.Among different age groups LRTI was found most prevalent in 51-60 (11, 13.41%). Of 82 culture positive LRTI cases, 62.19% were Gramnegative bacteria and 37.81%were Gram Positive Bacteria.Among the total isolates,Klebsiella pneumoniae (25.6%) was the commonest isolate followed by Staphylococcus aureus(24.39%),Haemophilus influenzae(15.85%), Streptococcus pyogenes(7.31%) and Streptococcus pneumoniae(6.09%). Other were Pseudomonas aeruginosa (6.09%), Escherichia coli (4.87%), Citrobacter freundii (2.43%),Klebsiella oxytoca(2.43%),Proteus mirabilis(2.43%),Acinetobacter calcoaceticus(1.21%) and Moraxella catarrhalis(1.21%). Of the total sputum samples screened forAFB, 18 different samples showed the positive cases. Male patients (11, 61.66%)were more affected than the female(7, 38.88%). Gram negative bacteria showed high sensitivity towards Nitrofurantoin (57%),followed by Cotrimoxazole (55%), Ciprofloxacin (53%), Cefriaxone (51%) and Amoxicillin (33%). Among the Gram positive bacteria, Azithromycin showed the highest sensitivity (62%) and least towards Cotrimoxazole (48%).The prevalence ofMDR was 47.61% in S aureus and 20% in S pneumoniea. Among the GNB, allisolates of P aeruginosa (5), Klebsiella oxytoca (2), M catarrhalis (1) and Acinetobacter calcoaceticus(1) showed MDR in in-vitro experiment. Three isolates of Klebsiella pneumoniae(14.28%) and one isolate of Escherichiacoli(25%) were detected as Extended Spectrum of Beta Lactamase (ESBL) strain.