Prevalence of extended spectrum beta lactamases and AmpC producing gram negative bacilli among surgical site infections at a Tertiary Care Hospital

Paper Details

Research Paper 10/04/2022
Views (303) Download (59)
current_issue_feature_image
publication_file

Prevalence of extended spectrum beta lactamases and AmpC producing gram negative bacilli among surgical site infections at a Tertiary Care Hospital

A. Divya, Pramod N. Sambrani, Uma Chikkaraddi
Int. J. Micro. Myco.14( 4), 1-9, April 2022.
Certificate: IJMM 2022 [Generate Certificate]

Abstract

Infection control professionals, Clinicians, Microbiologists are concerned about Gram negative bacteria producing Extended spectrum Beta lactamases (ESBL) and AmpC because they pose a challenge of effective antimicrobial therapy resulting in adverse patient outcomes. The objective of the present study is to know the prevalence of ESBL and AmpC thereby making appropriate changes in the choice of antimicrobial therapy and minimizing treatment failures. To know the prevalence of Extended Spectrum Beta Lactamases and AmpC producers among Gram Negative isolates from pus samples suspected of Surgical-Site Infections (SSI). This study is a prospective cross-sectional study. A total of 100 samples from wounds in General Surgery, Obstetrics Obstetrics-Gynaecology, Orthopaedic, ENT and Ophthalmology departments, which were suspected of surgical site infection submitted to the Microbiology Laboratory of Karnataka Institute of Medical Sciences, were included in the study. Out of the total 100 cases, 17 (21.3%) were ESBL producers and Escherichia coli was the most common ESBL producing bacteria. 31 (38.8%) were AmpC producers and Klebsiella species were the most common AmpC producing bacteria. 27 (33.8%) were both ESBL and AmpC producers/ Co-producers. In the present study, we found an increasing number (21.3%) of ESBL and (38.8%) AmpC producing Gram negative isolates. ESBL and AmpC producing strains were found to show higher rates of resistance to various class of antibiotics when compared to non ESBL and non AmpC producers. The indiscriminate use of cephalosporins should be limited, which helps to minimize the emergence of resistance.

VIEWS 88

Agrawal AC, Jain S, Jain RK, Raza HT. 2008. Pathogenic bacteria in an orthopaedic hospital in India. The Journal of Infection in Developing Countries 2(02), 120-123.

Agrawal P, Ghosh AN, Kumar S, Basu B, Kapila K. 2008. Prevalence of extended-spectrum β-lactamases among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital. Indian Journal of Pathology and Microbiology 51(1), 139.

Ananthakrishnan AN, Kanungo R, Kumar A, Badrinath S. 2000. Detection of extended spectrum beta-lactamase producers among surgical would infections and burns patients in JIPMER. Indian Journal of Medical Microbiology 18(4), 160-165.

Anguzu JR, Olila D. 2007. Drug sensitivity patterns of bacterial isolates from septic post-operative wounds in a regional referral hospital in Uganda. African health sciences 7(3).

Baral P, Neupanea S, Shresthac B, Ghimirea KR, Marasinia BP, Lekhaka B. 2013. Clinical and microbiological observational study on AmpC β-lactamase-producing Enterobacteriaceae in a hospital of Nepal. Brazilian Journal of Infectious Diseases 17(2), 256-259.

Beauchamp RD. 2017. MD Evers, B. Mark, MD, et al. Sabiston Textbook of Surgery.

Bradford PA. 2001. Extended-spectrum β-lactamases in the 21st century: Characterization, epidemiology, and detection of this important resistance threat. Clinical microbiology reviews 14(4), 933-951.

Chaudhary U, Aggarwal R. 2004. Extended spectrum β-lactamases (ESBL)–An emerging threat to clinical therapeutics. Indian journal of medical microbiology 22(2), 75-80.

Coudron PE, Moland ES, Thomson KS. 2000. Occurrence and detection of AmpC beta-lactamases among Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis isolates at a veterans medical center. Journal of Clinical Microbiology 38(5), 1791-1796.

Dutta H, Nath R, Saikia L. 2014. Multi-drug resistance in clinical isolates of Gram-negative bacilli in a tertiary care hospital of Assam. The Indian Journal of Medical Research 139(4), 643.

Eliopoulos GM, Bush K. 2001. New β-lactamases in gram-negative bacteria: diversity and impact on the selection of antimicrobial therapy. Clinical Infectious Diseases 32(7), 1085-1089.

Fadnis MP, Desai S, Kagal A, Bharadwaj R. 2014. Surgical site infections in tertiary care hospital. Int J Healthcare Biomed Res 2(3), 152-61.

Forbes BA, Sahm DF, Bailey WR, Weissfeld AS, Scott EG. 2007. Bailey & Scott’s diagnostic microbiology. Mosby.

Giri BR, Pant HP, Shankar PR, Sreeramareddy CT, Sen PK. 2008. Surgical site infection and antibiotics use pattern in a tertiary care hospital in Nepal. JPMA. The Journal of the Pakistan Medical Association 58(3), 148-151.

Goossens H, MYSTIC Study Group. 2001. MYSTIC program: Summary of European data from 1997 to 2000. Diagnostic microbiology and infectious disease 41(4), 183-189.

Hanifah YA. 1990. Post-operative surgical wound infection. Med J Malaysia 45(4), 293-297.

Hemalatha V, Padma M, Sekar U, Vinodh TM, Arunkumar AS. 2007. Detection of Amp C beta lactamases production in Escherichia coli & Klebsiella by an inhibitor based method. Indian Journal of Medical Research 126(3), 220.

Iftikhar A, Abdus S. 2002. Extended spectrum beta-lactamases and bacterial resistance.

Jacoby GA. 2009. AmpC β-lactamases. Clinical Microbiology Reviews 22(1), 161-182.

Jitendranath A, Vishwamohanan I, Bhai G. 2019. Occurrence and detection of ESBL among enterobacteriaceae in a tertiary care center in trivandrum. Journal of Evolution of Medical and Dental Sciences 8(12), 839-843.

Khan MKR, Thukral SS, Gaind R. 2008. Evaluation of a modified double-disc synergy test for detection of extended spectrum β-lactamases in AMPC β-lactamase-producing Proteus mirabilis. Indian Journal of Medical Microbiology 26(1), 58-61.

Lilani SP, Jangale N, Chowdhary A, Daver GB. 2005. Surgical site infection in clean and clean-contaminated cases. Indian journal of medical microbiology 23(4), 249-252.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. 1999. Guideline for prevention of surgical site infection, 1999. Infection Control & Hospital Epidemiology 20(4), 247-280.

Menon T, Bindu D, Kumar CPG, Nalini S, Thirunarayan MA. 2006. Comparison of double disc and three dimensional methods to screen for ESBL producers in a tertiary care hospital. Indian Journal of Medical Microbiology 24(2), 117-120.

Mohanty S, Gaind R, Ranjan R, Deb M. 2010. Use of the cefepime-clavulanate ESBL Etest for detection of extended-spectrum beta-lactamases in AmpC co-producing bacteria. The Journal of Infection in Developing Countries 4(01), 024-029.

Paterson DL, Bonomo RA. 2005. Extended-spectrum β-lactamases: a clinical update. Clinical Microbiology Reviews 18(4), 657-686.

Pena C, Gudiol C, Tubau F, Saballs M, Pujol M, Dominguez MA, Calatayud L, Ariza J, Gudiol F. 2006. Risk-factors for acquisition of extended-spectrum β-lactamase-producing Escherichia coli among hospitalised patients. Clinical Microbiology and Infection 12(3), 279-284.

Purva M, Arti K, Bimal D, Benu D. 2002. Prevalence of extended spectrum βlactamase producing Gram negative bacteria in a tertiary care Hospital. Indian J Med Res 115, 153-157.

Rao R, Sumathi S, Anuradha K, Venkatesh D, Krishna S. 2013. Bacteriology of postoperative wound infections. Int J Pharm Biomed Res 4(2), 72-76.

Rao SP, Rama PS, Gurushanthappa V, Manipura R, Srinivasan K. 2014. Extended-spectrum beta-lactamases producing Escherichia coli and Klebsiella pneumoniaei: A multi-centric study across Karnataka. Journal of Laboratory Physicians 6(01), 007-013.

Rupp ME, Fey PD. 2003. Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Drugs 63(4), 353-365.

Sahu S, Shergill J, Sachan P, Gupta P. 2011. Superficial incisional surgical site infection in elective abdominal surgeries-A prospective study. Internet J Surg 26(1), 514-24.

Sattar F, Sattar Z, Zaman M, Akbar S. 2019. Frequency of post-operative surgical site infections in a Tertiary care hospital in Abbottabad, Pakistan. Cureus 11(3).

Siguan SS, Ang BS, Pala IM, Baclig RM. 1990. Aerobic surgical infection: A surveillance on microbiological etiology and antimicrobial sensitivity pattern of commonly used antibiotics. Phil J Microbiol Infect Dis 19(1), 27-33.

Singhal S, Mathur T, Khan S, Upadhyay DJ, Chugh S, Gaind R, Rattan A. 2005. Evaluation of methods for AmpC β-lactamase in gram negative clinical isolates from tertiary care hospitals. indian Journal of Medical Microbiology 23(2), 120-124.

Sirot D. 1995. Extended-spectrum plasmid-mediated β-lactamases. Journal of Antimicrobial Chemotherapy 36(suppl_A), 19-34.

Taneja N, Rao P, Arora J, Dogra A. 2008. Occurrence of ESBL & Amp-C [beta]-lactamases & susceptibility to newer antimicrobial agents in complicated UTI. Indian Journal of Medical Research 127(1), 85-89.

Wayne PA. 2021. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing.