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Indian Pediatr 2009;46: 1106-1107 |
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Prevalence of Extended- spectrum
b-lactamase
Producing Escherichia coli and Klebsiella spp in a
Neonatal Intensive Care Unit |
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Shalini Anandan, Niranjan Thomas*, Balaji Veeraraghavan and Atanu K Jana*
From the Departments of Microbiology and *Neonatology,
Christian Medical College, Vellore, India.
Email:
[email protected]
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This study reports the prevalence of extended-spectrum
b-lactamase producing Escherichia
coli and Klebsiella spp among septicemic neonates. Over a
five year period, there were 94 isolates of Klebsiella spp and
E .coli. Of these, 68 (72.3%) were ESBL producers. Forty (80%) of
the Klebsiella spp isolates produced ESBL as compared to 28
(63.6%) of E.coli.
Key Words: ESBL, Neonates, Septicemia.
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Prevalence of extended-spectrum
b-lactamase
(ESBL) producing bacteria ranges from 23-86% in earlier reports from
India(1-5). This study was carried out from January 2003 to December 2007.
Newborns with clinical signs of sepsis or those who were born to mothers
with risk factors for infection were screened for sepsis with a blood
culture. Standard methods were used for identification of microorganisms
and antimicrobial susceptibility. Screening for ESBL production was done
as per the Clinical Laboratory Standards Institute (CLSI) guidelines(6).
Of the 8330 blood cultures during the 5-year study period, bacterial
isolates were obtained in 262 (3.1%). Of these 152 (58%) were Gram
negative organisms. These included Klebsiella spp (n=50,
32.9%), E.coli (n=44, 28.9%), non-fermenting Gram negative
bacilli (n=23, 15.1%), Pseudomonas spp (n=14, 9.2%),
Enterobacter spp (n=12, 7.9%), Acinetobacter spp
(n=4, 2.6%), Citrobacter spp (n=3, 2%),
Achromobacter spp (n=1, 0.66%) and Serratia spp (n=1,
0.66%). Of the 94 isolates of Klebsiella spp and E. coli
tested for ESBL production, 68 (72.3%) were ESBL producers. Forty (80%) of
the Klebsiella spp isolates produced ESBL as compared to 28 (63.6%)
of E.coli.
There was no significant difference in the number of
ESBL producing organism between inborn and outborn babies (79.2% vs
70%, P=0.44) or late onset sepsis and early onset sepsis (57.4%
vs 42.6%, P=0.362). The incidence of ESBL producing organisms
remained constant over the five years. The overall mortality was 27.6% and
was comparable between the ESBL and the non ESBL group. The antibiotic
resistance pattern is shown in Table I.
TABLE I
Resistance Pattern of Antibiotics
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Antibiotic |
Overall |
Non ESBL( n = 26) |
ESBL(n = 68) |
P value |
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Ampicillin |
51/62 (82.2%) |
5/16 (31.2%) |
46/46 (100%) |
<0.001 |
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Cefotaxime |
68/94 (72.3%) |
0/26 (0%) |
68/68 (100%) |
<0.001 |
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Ceftazidime |
67/93 (72%) |
0/26 (0%) |
(67/67)100% |
<0.001 |
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Ciprofloxacin |
60/92 (65.2%) |
7/25 (28%) |
53/67 (79.1%) |
<0.001 |
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Gentamicin |
63/90 (70%) |
2/25 (8%) |
61/65 (93.8% |
<0.001 |
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Amikacin |
32/65 (49.2%) |
1/16 (6.2%) |
31/49 (63.2%) |
<0.001 |
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Pipiracillin- Tazobactam |
24/38 (63.1%) |
0/8 (0%) |
24/30 (80%) |
<0.001 |
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Ticarcillin -Clavulanic acid |
24/45 (53.3%) |
0/11 (0%) |
24/34 (70.6%) |
<0.001 |
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Imipenem |
0/85 (0%) |
0/17 (0%) |
0/68 (0%) |
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Meropenem |
0/85 (0%) |
0/17 (0%) |
0/68 (0%) |
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ESBL: is extended
spectrum ß-lactamase producers |
Most laboratories in India do not routinely check for
ESBL production. As can be seen from our data, there is a high prevalence
of ESBL producing organisms causing neonatal sepsis. What is alarming is
that a major proportion of early onset sepsis, which is perinatally
acquired and hence reflects community acquired infection, is caused by
drug resistant organisms. This is probably because of the widespread use
of antibiotics in the community. Thus, it is imperative that this
irrational use of antibiotics be discouraged not only in the neonatal unit
but also in the community. Further, the routine screening for ESBL
production should be encouraged.
References
1. Jain A, Roy I, Gupta MK, Kumar M, Agarwal SK.
Prevalence of extended-spectrum beta-lactamase-producing gram-negative
bacteria in septicaemic neonates in a tertiary care hospital. J Med
Microbiol 2003; 52: 421-425.
2. Vinodkumar CS, Neelagund YF. Emergence of extended
spectrum beta lactamase mediated resistance in neonatal septicemia. Indian
J Pathol Microbiol 2006; 49: 616-619.
3. Sehgal R, Gaind R, Chellani H, Agarwal P.
Extended-spectrum beta lactamase-producing gram-negative bacteria:
clinical profile and outcome in a neonatal intensive care unit. Ann Trop
Paediatr 2007; 27: 45-54.
4. Jain, A, Mondal R. Prevalence and antimicrobial
resistance pattern of extended spectrum beta-lactamase producing
Klebsiella spp isolated from cases of neonatal septicaemia. Indian J
Med Res 2007; 125: 89-94.
5. Bhattacharjee A, Sen MR, Prakash P, Gaur A, Anupurba
S. Increased prevalence of extended spectrum beta lactamase producers in
neonatal septicaemic cases at a tertiary referral hospital. Indian J Med
Microbiol 2008; 26: 356-360.
6. Clinical and Laboratory Standards Institute. Performance Standards
for Antimicrobial Susceptibility Testing; Approved Standards M2- A7,
Eighteenth Informational Supplement. Wayne, PA: CLSI document M100 –S 18;
2008.
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