β-LACTAMASE PRODUCING ENTEROBACTERIACEAE: A GROWING CONCERN IN COMMUNITY ACQUIRED INFECTIONS

S.B. MIRZA¹, R.N. MISRA², N.R. GANDHAM³, K.M. ANGADI⁴, N.K. DASS⁵, SAVITA JADHAV⁶*
¹Department of Microbiology, Dr D.Y. Patil Medical College Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India
²Department of Microbiology, Dr D.Y. Patil Medical College Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India
³Department of Microbiology, Dr D.Y. Patil Medical College Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India
⁴Department of Microbiology, Dr D.Y. Patil Medical College Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India
⁵Department of Microbiology, Dr D.Y. Patil Medical College Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India
⁶Department of Microbiology, Dr D.Y. Patil Medical College Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India
* Corresponding Author : patilsc78@gmail.com

Received : 02-08-2018     Accepted : 27-11-2018     Published : 30-11-2018
Volume : 10     Issue : 11       Pages : 1418 - 1421
Int J Microbiol Res 10.11 (2018):1418-1421

Keywords : Enterobacteriaceae, MDR GNB, β-lactamases, ESBL`s, MBL`s, AmpC
Conflict of Interest : None declared
Acknowledgements/Funding : Authors are thankful to Dr D.Y. Patil Medical College Hospital and Research Centre, Dr D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India
Author Contribution : All authors equally contributed

Background: The rising rate of antimicrobial drug resistance in Enterobacteriaceae reduces the number of reliably effective drugs that can be used to treat infections. Gram negative bacteria producing β-lactamases that are resistant to many other antibiotics and very few antimicrobial agents remain effective as treatment option. Presence of these enzymes can result in treatment failure when cephalosporins or Carbapenems are used. Due to extensive use of β-lactam and carbapenems over the last several decades in the clinical practice, various β-lactamases have emerged. β-lactamase producing bacteria have been increasingly reported as causal agents of not only nosocomial infection but also community acquired infection. The widespread use of ceftriaxone and/or cefotaximine has been proposed as a reason for the emergence of CTX-M enzymes. The increased frequency of isolation & reporting of CTX-M ESBLs is alarming and is likely to represent only the tip of iceberg for the underdeveloped continents where molecular technology for the analysis of ESBL enzymes is scares. The loss of oxyaminocephalosporins for the treatment of infections represents a serious problem that seems to reach unprecedented level globally. We investigated the clinical isolates positive for β-Lactamase producing bacteria in our institution, a tertiary care hospital in Pune (India), during a 2-year period (2014–2016). Aim: To isolate and identify the Extended spectrum β lactamase producer (ESBL), Metallo-β-lactamase (MBLs), AmpC β-lactamases in Enterobacteriaceae among community acquired infections in a tertiary care hospital and to find out antibiotic sensitivity pattern of these organisms. Methodology: Screening for all β-lactamase producers (ESBL`s, MBL`s, AmpC) done by Kirby-Bauer sensitivity testing as per CLSI guidelines and followed by confirmatory tests like combined disk diffusion, double disk diffusion, Modified Hodge test and E–strip testing. Results: Total 581 isolates from Enterobacteriaceae were isolated, 417 were MDR strains which were screened for these enzymes, where 293 isolates came out to be positive for either one of the three enzymes. Screening tests for ESBLs resulted in 283(67.86%) isolates out of the 417 MDR resistant to Ceftazidime. 269 (95.05%) of these were ESBL producers which were confirmed by Double Disk Diffusion Method (DDDT). E.coli 154(54.41%) and K. pneumoniae 83(29.32%)were the two most common isolate producing this enzyme. 15 (3.59%) isolates out of the 417 MDR were resistant to Imipenem when screened for carbapenemases. Out of which all 15 were carbapenemase producers confirmed by MHT, while 12 were MBL producers confirmed by CDT and E-strip test. 53 out of 114 screen (cefoxitin) positive were AmpC producers, which was confirmed by CC-DDS AmpC disc test and E-strip test. 269 ESBL producers, 53 AmpC producers and 12 MBL producers were isolated. Conclusion: The study emphasizes the high prevalence of multidrug-resistant Enterobacteriaceae organisms producing β-lactamase enzymes of diverse mechanisms in community acquired infections.

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