Extended spectrum β-lactamase in clinical isolates of Escherichia coli in a tertiary care centre

Background: The Extended Spectrum β-Lactamase (ESBL) producing organisms are increasing rapidly and becoming a major problem in the area of infectious disease. The present study was conducted to know the prevalence of ESBL producing Escherichia coli (E. coli ) isolated from different clinical specimens received in the Department of Microbiology at the Sheri-Kashmir institute of medical sciences, (SKIMS) and to observe the drugresistance pattern of these ESBL producing E. coli.

Methods: Various isolates of E. coli were obtained from patients admitted or attending Out Pateint Department (OPD) over a period of 2 years from 1st August 2005 to 31st July 2007. In this study, 221 E. coli were subjected to screening by using cefotaxime, ceftazidime and ceftriaxone 30mg discs.Among them, 211 were positive for potential ESBL production which were further subjected to confirmatory tests by the following Phenotypic methods;doubledisc synergy test (DDST), phenotypic confirmatory disc diffusion test (PCDDT) and E-test.

Findings: 55.9 % (118/211) of E.coli isolates were positive for ESBL production from different clinical specimen, highest number being from urine (72.9 %). The highest number of ESBL production were from inpatients (71.2 %) followed by outpatient (28.8 %).The resistance pattern of ESBL positive isolates showed higher resistance to 3rd and 4th generation cephalosporins (97.5 % to 99.2 %), quinolones (93.1 % to100 %) and aminoglycosides (65.2 %). They showed high degree of sensitivity to imipenem (98.3 %), nitrofurantoin (91.5 %), gatifloxacin (64.1 %) and amikacin (78.2 %).

Conclusions: The high prevalence of ESBL production among E. coli was observed which should alert the physician as it is associated with indiscriminate use of 3rd and 4th generation cephalosporins. The presence of ESBL in outpatient is of main concern as it can be responsible for communityacquired ESBL and can spread fast in our community. The multidrug resistance pattern of ESBL isolates was observed.

Author(s): Kaiser Ahmed, Manzoor Thakur, Bashir Fomda Fomda, Gulnaz Bashir, Peer Maroof, SM Kadri

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