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Aim:
the goal of this study is to understand the phenotype characteristic of beta-lactamase enzymes producing Enterobacteriaceae, such as ESBL, AmpC, and carbapenemase.
Methods:
three different methods are performed to confirm those phenotypic characteristics, namely double disk diffusion method to confirm ESBL, AmpC disk test (cefoxitin-based)...
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Introduction . Infections due to extended spectrum β -lactamase producing Enterobacteriaceae are on the rise. They pose serious public health problems due to their resistance to large number of antibiotics. However, little is known about the genotypes of ESBL from Nepal. Therefore, the study presents results of phenotypic and molecular characteriza...
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Citations
... In our investigation, the prevalence of Carbapenemase-resistance Gram-negative bacteria was 13.7%, which is comparable with the research conducted in Taiwan 15.4%, 65 Indonesia 13.7%, 58 Nepal 11.2% 37 and Romania 66 although our findings were lower than study done at Addis Ababa 36% 67 in Nigeria 34.5%, 30 India 34.5% 47 and 44.1%. 68 It was higher than the study conducted in Bahir Dar, Ethiopia (5.2%), 31 Addis Ababa Ethiopia (2%) 32 and CDC reports from 1.2% (2001) to 4.2%.2011. ...
Tilahun M. Infect Drug Resist. 2022;15:3949–3965. The author has advised due to a clerical error, the headings for Tables 1 and 2 on pages 3954 and 3955, respectively, are incorrect. The text “Debre Birhan” should read “Dessie and Borumeda”.
... In our investigation, the prevalence of Carbapenemase-resistance Gram-negative bacteria was 13.7%, which is comparable with the research conducted in Taiwan 15.4%, 65 Indonesia 13.7%, 58 Nepal 11.2% 37 and Romania 66 although our findings were lower than study done at Addis Ababa 36% 67 in Nigeria 34.5%, 30 India 34.5% 47 and 44.1%. 68 It was higher than the study conducted in Bahir Dar, Ethiopia (5.2%), 31 Addis Ababa Ethiopia (2%) 32 and CDC reports from 1.2% (2001) to 4.2%.2011. ...
Background:
Antibiotic resistance is becoming a global issue, with estimated 2.8 million people in the United States developing antibiotic-resistant diseases each year. The carriage of ESBL and Carbapenemase-producing Enterobacteriaceae among hospitalized patients is a threat to the future of antibiotic treatment.
Objective:
Multi-drug resistance profile, prevalence of extended-spectrum beta-lactamase and Carbapenemase-producing Gram-negative bacilli among admitted patients after surgery with suspected surgical site nosocomial infection north east Ethiopia.
Material and methods:
A hospital-based cross-sectional study was conducted from April 2021 to February 2022. Socio-demographic and clinical data were assessed using a structured questionnaire. A total of 384 relevant clinical samples (pus, pus aspirates, and wound swabs) were collected aseptically and processed within 30 min by placing the swabs into the sterile test tubes having 0.5 mL of sterile normal saline. The samples were cultured on MacConkey agar, chocolate agar and blood agar, and species identification was done using standard biochemical tests. Disk diffusion antimicrobial sensitivity test was done on Mueller-Hinton agar. All the cefoxitin resistant Enterobacteriaceae isolates were checked for the presence of AmpC beta-lactamase using four cartridges of disk diffusion tablets. ESBL output validation was conducted by the combination disk test. The production of Carbapenemase was checked using modified carbapenem inactivation method.
Results:
The prevalence of significant bacterial nosocomial infection among surgical site infection 343 (89.32%). S. aureus 125 (36.4%) was predominant followed by E. coli 80 (23.3%) P. aeruginosa 31 (9.03%). The overall MDR rate of isolated bacteria was 251 (73.3%). About 150 (73.9%) bacteria were suspected for ESBL production and 67 (33%) AmpC beta-lactamase and 27 (13.3%) Carbapenemase-producing Gram-negative bacterial, respectively.
Conclusions and recommendations:
The severity of ESBL-PE was critical, and the CPE was alarming. Meropenem and imipenem were the most effective antibiotics against ESBL-producing Enterobacteriaceae. Therefore, strict infection prevention and control measures are needed.
... The magnitude of CR among Acinetobacter species and/or Pseudomonas aeruginosa bacterial isolates in the present study was 25.3%. This is relatively higher compared with the previous report in Addis Ababa, Ethiopia (12.1% and 2%) 29,32 Bahir Dar, Ethiopia 5.2%, 13 Taiwan, 33 Indonesia, 34 Nepal, 35 and Romania 36 reported 15.4%, 13.7%, 11.2% and 21.6% of Carbapenemase production, respectively, which are much lower than the present finding, whereas reports in Nigeria, 37 India, 38 which accounted 34.5% each also much higher than the present study. However, systematic review also indicated that 0.96% to 35% CR was reported in other countries of East Africa. ...
Background:
The emergence of extended spectrum beta lactamase and carbapenemase production of Acinetobacter and Pseudomonas aeruginosa is a great concern and major cause of nosocomial infections due to its ability to production of extended spectrum beta lactamase and carbapenemase enzymes.
Objective:
To assess Emergence of high prevalence of extended-spectrum beta-lactamase and Carbapenemase producing Acinetobacter species and Pseudomonas aeruginosa among hospitalized patients at Dessie Comprehensive Specialized Hospital, North-East Ethiopia.
Materials and methods:
A hospital-based cross-sectional study was conducted from February-August 2021 at Dessie Referral Hospital in the North eastern Ethiopia. A total of 423 clinical samples taken from admitted patients. Clinical specimens were collected aseptically and inoculated on blood agar and MacConkey agar media. Antimicrobial susceptibility test, ESBL and carbapenemase production were performed as CLSI guideline. The data were entered into the Epi-data and imported to Statistical Package for Social Science version 25. P value of <0.05 with odds ratio and 95% confidence interval was considered as statistically significant.
Results:
Out of 423 clinical specimens 17.7% (75/423) were culture positive nosocomial infection. The proportions of nosocomial infection were higher in blood stream followed by wound infection which accounted 24.6%, 20.8%, respectively. Overall, 32/75 (42.7%) and 19/75 (25.3%) patients had infection with ESBL and CP producing bacterial infection. P. aeruginosa was the most predominant isolated bacteria 46/75 (52.9%). The overall multidrug resistance rate of the isolated bacteria was 88% (66/75). The majority of highest resistance rate was Piperacillin tazobactam 50 (66.7%) and Aztreonam 26 (56.5%), respectively, while least resistance rate was Amikacin 27 (36%).
Conclusion:
The incidence rates of ESBL, carbapenemase production and antimicrobial resistant Acinetobacter species and P. aeruginosa infections are high. Therefore, treatment should be based on culture and antimicrobial test result and minimize the use of antibiotics empirically.
... 38 E. cloacae and P. aeruginosa isolates were the leading ESBL producers with K. pneumoniae and E. coli. This is consistent with findings reported in Indonesia, 39 Algeria 40 and India 37 where E. cloacae was the predominant ESBL producing isolate. In reports from Uganda, 6 Nepal, 30 Brazil 41 and Mexico, 28 E. coli and K. pneumoniae were also the most common ESBL producing isolates. ...
... It is a fact that non-ICU patients have a lower risk and lower chance of acquiring CP producing bacteria than patients in the ICU. Previous studies in Nigeria, 33 India, 37 Taiwan, 43 Indonesia, 39 Nepal 30 and Romania 44 reported 34.5%, 34.5%, 15.4%, 13.7%, 11.2% and 21.6% of CP production, respectively which are much higher than the present finding. This could be due to heterogeneity in region, ICU The predominant carbapenemase producing bacteria were isolated from LRTI (14.7%) and BSI (5.5%) in the present study. ...
Background
Owing to the specific risk profile of its residents, intensive care units (ICUs) are the best place for selection pressure and the epicenter for resistance development and dissemination. Infections with β-lactamase releasing Gram-negative bacilli (GNB) at ICUs are an emerging global threat. This study dogged the magnitude of extended-spectrum β-lactamase (ESBL) and carbapenemase releasing Gram-negative bacilli infections and associated factors among patients in the ICUs of Felegehiwot Referral Hospital, Ethiopia.
Methods
A cross-sectional study was done through February to June 2020. Wound swabs, urine, blood and sputum samples were collected from patients in the ICUs symptomatic for infections while excluding those under coma and shock. Bacterial species were verified using standard microbiological methods. Carbapenemase and ESBL production were identified using modified carbapenem inactivation and combined disk diffusion methods, respectively. Multivariable analysis was calculated for factors associated with ESBL production. P-value < 0.05 was taken as cut-off for statistical significance.
Results
Out of 270 patients in the ICU, 67 (24.8%) and 14 (5.2%) had infections with ESBL and carbapenemase releasing GNB, respectively. The most frequent ESBL producing isolates were P. aeruginosa (100%), E. cloacae (100%), K. pneumoniae (82.8%) and E. coli (64%). The predominant carbapenemase producer isolates were K. pneumoniae (27.6%) and E. cloacae (33.3%). Overall, 77 (81.1%) of species were multi-drug resistant. All GNB species were 100% resistant to tetracycline and ampicillin. They are also resistant to cefuroxime, ceftazidime, sulfamethoxazole-trimethoprim and cefotaxime. Prior hospitalization (AOR = 5.5, CI = 2.63–11.46), support with medical care devices (AOR = 23.7, CI = 4.6–12) and arterial intravenous catheterization (AOR = 2.7, CI = 1.3–5.3) had significant association with β-lactamase producing GNB infection.
Conclusion
Infection with ESBL and carbapenemase producing Gram-negative bacilli linked with an alarming degree of multi-drug resistant isolates is a major healthcare threat among patients in ICUs. Hence, strict adherence to infection prevention practices and wise use of antibiotics are recommended to slow the spread of antimicrobial resistance.
... Selain ESBL, resistensi terhadap sefalosporin generasi ketiga juga dapat disebabkan oleh produksi enzim Ampc Cephamycinase (AmpC) terutama oleh Enterobacter spp dan Citrobacter spp yang dikode oleh gen AmpC di kromosom. [12][13] Bakteri terbanyak penyebab sepsis pada pasien stroke yang dirawat di ruang rawat inap terpadu adalah Acinetobacter 39,1% yang merupakan patogen oportunistik penting yang berkembang pesat menuju resistensi multiobat dan terlibat dalam berbagai infeksi nosokomial. Bakteri ini termasuk gram negatif genus Acinetobacter yang terdiri dari banyak spesies yang ditemukan selama 3 dekade terakhir. ...
... Bakteri ini mampu memproduksi enzim extended spectrum beta lactamase (ESBL) yang dapat menyebabkan resistensi multiobat, sering di ruang perawatan intensif. 13 Selain itu, pasien-pasien yang dirawat di ruang intensif umumnya mempunyai imunitas yang rendah, pemantauan keadaan secara invasif, terpapar dengan berbagai jenis antibiotik, dan terjadi kolonisasi oleh bakteri resisten, sehingga memiliki potensi yang lebih besar mengalami infeksi. 15 Adapun ruang rawat inap terpadu ditujukan untuk perawatan pasien stroke di luar fase akut, bergabung dengan pasien lain, baik pasien stroke maupun bukan stroke. ...
... Hal ini kemungkinan mencerminkan periode risiko tertinggi dalam hal prevalensi disfagia, imobilisasi, gangguan kesadaran, dan adanya penekanan pada respons imun pada pasien stroke. 13 Hal ini sesuai dengan penelitian di beberapa RS di Indonesia mengenai pola kuman di ruang perawatan intensif, bahwa infeksi terbanyak adalah pneumonia. 8 Pneumonia dapat disebabkan adanya aspirasi organisme orofaring ke bronkus distal, terjadi pembentukan biofilm oleh bakteri diikuti dengan proliferasi dan invasi bakteri pada parenkim paru. ...
BACTERIAL PATTERN AND ANTIBIOTICS SENSITIVITY OF SEPSIS STROKE PATIENTS IN NEUROLOGY INPATIENT ROOMS OF HAJI ADAM MALIK GENERAL HOSPITAL MEDANABSTRACTIntroduction: Stroke patients are at high risk of sepsis because of the immune-suppressive effect of cerebral damage and the immobilization due to neurological deficit. The choice of empiric antibiotics for sepsis depends on epidemiology data of the bacterial pattern and antibiotics sensitivity.Aims: To know the incidence rate, bacterial pattern and antibiotics sensitivity of sepsis stroke patients in Haji Adam Malik General Hospital.Methods: A descriptive study of sepsis stroke patients in intensive stroke corner care and neurology ward of Adam Malik General Hospital, Medan, during February 2018-June 2018. The diagnosis of sepsis was based on the Criteria of American College of Chest Physicians (ACCP) and Society of Critical Care Medicine (SCCM).Results: From total of 153 stroke patients admitted between February and June 2018, 28.2% stroke patients were identified with sepsis; 20 patients in stroke corner and 23 patients in neurology ward. The average of time to develop sepsis was 4.74±1.9 days based on the increasing of procalcitonin level in blood. Aerobic and gram negative organisms were dominating the microbiologic spectrum (97.7% and 86%, respectively). The most common etiology of sepsis in were Klebsiella Pneumonia and Acinetobacter Baumanii. The most sensitive antibiotics were Amikacin and Meropenem.Discussion: There were 28.3% subjects diagnosed with sepsis due to Klebsiella Pneumonia (40%) and Acinetobacter Baumanii (39.1%) infection which are aerobic gram negative bacteria. Amikacin and meropenem were the most sensitive antibiotics against the bacteria which cause the sepsis.Keywords: Antibiotic sensitivity, bacterial pattern, sepsis, strokeABSTRAKPendahuluan: Adanya kerusakan serebral (cerebral injury) berefek penekanan terhadap sistem imun serta imobilisasi akibat defisit neurologis menyebabkan pasien stroke berisiko tinggi untuk mengalami sepsis. Pemilihan antibiotik empiris pada sepsis tergantung pada data epidemiologi dari pola bakteri dan sensitivitas antibiotik.Tujuan: Untuk mengetahui persentase kejadian sepsis dan gambaran bakteri dan sensitivitas antibiotik pada pasien stroke dengan sepsis di ruang rawat inap Neurologi RSUP Haji Adam Malik.Metode: Studi deskriptif pada pasien stroke dengan sepsis di ruang intensif stroke corner dan ruang rawat inap terpadu (Rindu) RSUP Haji Adam Malik, Medan selama Februari-Juni 2018. Diagnosis sepsis didasarkan pada Kriteria American College of Chest Physicians (ACCP) dan Society of Critical Care Medicine (SCCM).Hasil: Dari total 152 pasien stroke yang dirawat pada bulan Februari hingga Juni 2018 dijumpai sebanyak 28,2% yang mengalami sepsis; yang terdiri dari 20 orang di stroke corner dan 23 orang di bangsal neurologi. Rerata waktu terjadinya sepsis adalah 4,74±1,9 hari dengan peningkatan rerata kadar prokalsitonin. Bakteri yang paling banyak dijumpai adalah tipe aerob (97,7%) dan gram negatif (86%). Jenis bakteri penyebab sepsis tersering adalah Klebsiella Pneumonia, Acinetobacter Baumanii. Antibiotik yang paling sensitif adalah amikasin dan meropenem.Diskusi: Didapatkan 28,2% subjek yang mengalami sepsis dengan bakteri penyebab terbanyak adalah Klebsiella Pneumonia (40,0%) dan Acinetobacter Baumanii (39,1%) yang merupakan bakteri aerob gram negatif. Amikasin dan meropenem merupakan antibiotik yang memiliki sensitivitas yang tinggi terhadap bakteri penyebab sepsis tersebut.Kata Kunci: Gambaran bakteri, sensitivitas antibiotik, sepsis, stroke
... Our study showed the antibiotic-resistant bacteria problems in hospital setting which are also reported by some studies [38,39]. This situation is alarming when considering the quality and quantity of antibiotics prescriptions in most hospitals. ...
Background:
Klebsiella pneumoniae (K. pneumoniae) is a common cause of health-care associated infections (HAIs) and has high levels of antibiotic resistance. These bacteria are well-known for their ability to produce biofilm. The purpose of this study was to identify the antibiotic resistance pattern and biofilm-producing capacity of K. pneumoniae isolated from clinical samples in a tertiary care hospital in Klaten, Indonesia.
Methods:
K. pneumoniae was isolated from inpatients in Soeradji Tirtonegoro Hospital Klaten from June 2017 to May 2018. Identification of K. pneumoniae isolate was done by analyzing colony morphology, microscopic examination, and by performing biochemical testing. Testing of antibiotics susceptibility and biofilm-producing capacity used the Kirby-Bauer disk diffusion method and adherence quantitative assays, respectively.
Results:
A total of 167 (17.36%) K. pneumoniae isolates were isolated from 962 total clinical bacterial isolates during the study. Most of them were collected from patients aged more than 60 years old and were mainly obtained from respiratory specimens (51.50%). Most of K. pneumoniae isolates were extensively resistant to antibiotics. A more favorable profile was found only towards meropenem, amikacin, and piperacillin-tazobactam, showing 1.20%; 4.79% and 10.53% of resistance, respectively. The overall proportion of multidrug-resistant K. pneumoniae isolates was 54.49%. In addition, 148 (85.63%) isolates were biofilm producers, with 45 (26.95%) isolates as strong, 48 (28.74%) isolates as moderate, and 50 (29.94%) isolates as weak biofilm producers.
Conclusion:
Most of the K. pneumoniae isolates demonstrated resistance to a wide range of antibiotics and are biofilm producers.
... [11] In the present study, ESBL was found to be the most common β lactamase produced by Enterobacteriaceae with 38.11% isolates testing positive for it followed by MBL (3.20%) and AmpC β lactamase (0.56%) [ Table 2]. In Yulia et al.'s (2013) study [23] , the prevalence of ESBL, MBL and AmpC β producing Entrobacteriaceae isolated from intensive care unit (ICU) patients were 58.42%, 27.59% and 1.98% respectively. 35.16% ...
Beta- lactamases resistance among Enterobacteriaceae
... Similar resistance patterns were reported by several investigators 22,28,29 . The present study indicated a high incidence of MBL-producing E. coli (22%) in patients with nosocomial UTI, which is higher than the reported rate from Nepal (18.98%) 30 and lower than that from earlier studies in Iran (31%) 29 , India (27.59%) 31 , and Iraq (45.2%) 32 . Numerous studies from other parts of Asia also demonstrated increasing incidence of MBL production in Enterobacteriaceae isolates 33,34 Overall, these findings exhibited a high frequency of resistance among E. coli isolates to the common antibiotics used routinely in the treatment of UTIs, especially in Iran. ...
Aloe vera, as a traditional folk medicine plant, is used for its curative and therapeutic properties. In the current study, attempts were made to evaluate in vitro antimicrobial activity of A. vera gel against Escherichia coli strains isolated from patients with urinary tract infection. A total of 150 E. Coli isolates were recovered from urine samples between July 2015 and September 2015. Extended-spectrum ²-lactamase (ESBL) screening in Escherichia coli isolates was on the basis of double disc synergy tests and combined disk diffusion test. Epsilometer test was performed to determine susceptibilities of E. Coli isolates to 13 antimicrobial agents. Metallo-beta-lactamase (MBL) production was detected by performing combined disc test. Also, the micro broth dilution method was used to determine the antimicrobial activity of A. vera gel against E. Coli isolates.In the present study, out of 150 E. Coli isolates, 110 (73.3%) were confirmed as ESBL. MBL screening, using phenotypic methods, indicated that 33 (22%) isolates were positive. The antibiogram revealed that 148 isolates (98.7%) were multi drug resistance E. Coli strains. The coexistences of ESBL and MBL were found in 15 isolates (10%). All of ESBL and MBL E. Coli strains were inhibited by ethanol extract of A. vera gel at minimum inhibitory concentration £200 μg/ml. More than half of the tested isolates (53.3%) were inhibited by concentrations that did not exceed 50 μg/ml for ethanol extract from A. vera gel.The results of the present study highlighted that A. vera gel, at various concentrations, could be used as an antibacterial agent for treatment and prevention of UTIs.
... 7 Therefore, there is a need to conduct an examination using PCR (Polymerase Chain Reaction) as the gold standard method to 1 INTRODUCTION Inadequate regulation of antibiotic therapy for many infectious diseases in most Asian countries, including Indonesia, may increase resistance spectrum of gram-negative bacteria to beta-lactam antibiotics. 1 With the increasing use of betalactam antibiotics and various inhibitor combinations, such as amoxicillin-clavulanic acid or sulbactam, production of AmpC beta-lactamase enzyme by gram-negative bacteria have emerged. 2 This enzyme can hydrolyze and inactivate the third generation of beta-lactam antibiotics, including oxyimino-cephalosporins (cefotaxime, ceftazidime, and ceftriaxone), monobactam (aztreonam), and cephamycins (cefoxitin and cefotetan). ...
... K. pneumoniae, in particular ESBL-producing strains, is an important cause of nosocomial infections in humans worldwide (Podschun and Ullmann, 1998; Marra et al., 2006; EFSA, 2011; Sumer et al., 2014). For Indonesia, an increase of ESBLs within clinical isolates of K. pneumoniae has been reported in recent years (Herwana et al., 2008, Kuntaman et al., 2011; Parwati et al., 2012; Saharman and Lestari, 2013). In dairy farming, K. pneumoniae is one of the most ...
Bulk tank milk from 80 dairy farms located in the West Java Region of Indonesia was analyzed for the presence of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae. Isolates from seven dairy farms were ESBL positive, and all were identified as Klebsiella pneumoniae. The isolates showed ESBL-characteristic antibiotic resistance patterns. Further analysis revealed that all K. pneumoniae isolates harbored the blaSHV gene, and two isolates were additionally positive for the blaTEM-1 and blaCTX-M-15 genes. Isolates from different farms were clonally diverse according to macrorestriction analysis. The results indicate that the relatively high frequency of ESBL-producing K. pneumoniae in bulk tank milk implies the risk that milk is both a source of local exposure and a vector contributing to the supraregional spread of antibiotic-resistant bacteria by trade.
