Third generation cephalosporin-resistance in Klebsiella pneumoniae isolates: an emerging threat

Saroj Kothari, Vaibhav Mishra, Neelima Ranjan, Alok Singh

Abstract


Background: Newer generation cephalosporin-resistance among Klebsiella pneumoniae organisms has increased recently. Present study is undertaken to find incidence, antimicrobial susceptibility and prevalence of extended spectrum beta-lactamase (ESBL) in K. pneumoniae isolates in a tertiary care hospital.

Methods: Prospective study was carried out between June to December 2011. Samples of pus, blood, urine, cerebro-spinal fluid, stool, peritoneal, pleural and synovial fluid were collected from indoor and outdoor patients for isolation and antimicrobial susceptibility pattern of K. pneumoniae in the department of microbiology, G.R. Medical College Gwalior, M.P. Ceftazidime resistant K. pneumoniae were subjected to Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and Double Disc Synergy Test (DDST) for detection of ESBL.

Results: Out of 2480 samples collected a total of 530 K. pneumoniae were isolated and subjected to antimicrobial susceptibility. Antibiotic sensitivity to imipenem, cefoperazone, amikacin and ofloxacin were 82, 74, 73 and 72% respectively whereas sensitivity to ceftizoxime, ceftriaxone cefotaxime, ceftazidime ranged between 47-50%. K. pneumoniae were found to be resistant to ampicillin, co-trimoxazole, doxycycline and gentamicin, by 91, 82, 54 and 50% respectively. Among third generation cephalosporins K. pneumoniae were least sensitive (47%) to ceftazidime. About 33 and 32% of the ceftazidime resistant strains were found to be ESBL positive by PCDDT and DDST respectively.

Conclusions: This study has shown that prevalence of ESBL producing K. pneumoniae is the most important reason for increased resistance to third generation cephalosporins. There is need to carry out tests for detection of ESBL producing bacteria routinely.


Keywords


Antimicrobial-resistance, Clinical isolates, Klebsiella pneumoniae, Third generation- cephalosporins

Full Text:

PDF

References


Podschun R, Ullmann U. Klebsiella spp. as Nosocomial Pathogens: Epidemiology, Taxonomy, Typing Methods, and Pathogenicity Factors. Clin Microbiol Rev 1998;11:589-603.

Willemsen I, Elberts S, Verhulst C, Rwijnsburger M, Filus M, Savelkoul P, et al. Highly resistant gram negative microorganisms: incidence, density and occurrence of nosocomial transmission (TRIANGe Study). Infect Control Hosp Epidemiol 2011;32:331-41.

Roussel-Delvallez M, Wallet F, et al. Bactericidal activity of three beta lactams alone or in combination with a beta-lactamase inhibitor and two aminoglycosides against Klebsiella pneumoniae harbouring extended spectrum beta lactamases. Clin Microbiol Infect 1988;4:570-6.

Lee CH, Su LH, et al. Treatment of ESBL-producing Klebsiella pneumoniae bacteraemia with carbapenems or flomoxef: a retrospective study and laboratory analysis of the isolates. J Antimicrob Chemother 2006;58:1074-7.

Pound MW, Fulton KB. Successful treatment of Klebsiella rhinoscleromatis bacteremia with levofloxacin. Pharmacotherapy 2007;27:161-3.

Burwen DR, Banerjee SN, Gaynes RP. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. J Infect Dis 1994;170:1622-5.

Philippon A, Labia R. Extended spectrum betalactamases. Antimicrob Agents Chemother 1989;33:1131-6.

Collee JG, Miles RB, Watt B. Test for identification of bacteria. In Collee JG, Fraser AG, Marimion BP Simmons A, editors. Mackie and McCartney Practical Medical Microbiology: 14th ed. Newyork: Churchill Livingstone; 1996:131-49.

Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;36:493-96.

National Committee for Clinical Laboratory Standards. Methods for Antimicrobial disc diffusion tests. Approved standard M2-M9, 9th ed. Wayne, Pa. Clinical Laboratory Standards Institute; 2006.

Manchanda V, Singh NP, Goyal R, Kumar A, Thukral SS. Phenotypic characteristics of clinical isolates of Klebsiella pneumoniae and evaluation of available techniques for detection of extended spectrum beta-lactamases. Indian J Med Res 2005;122:330-7.

Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis1988;10:867-78.

Shukla I, Tiwari R, Agrawal M. Prevalence of extended spectrum β-lactamasee producing Klebsiella pneumoniae in a tertiary care hospital. Indian J Med Microbiol 2004;22:87-91.

Dalela G. Prevalence of Extended Spectrum Beta Lactamases (ESBL) Producer among Gram negative bacilli from various clinical isolates in a tertiary care hospital at Jhalawar, Rajasthan, India. J Clin Diagn Res 2012;6:182-7.

Subha A, Ananthan S. Extended spectrum beta lactamases (ESBLs) mediated resistance to third generation cephalosporins among Klebsiella pneumonia in Chennai. Indian J Med Microbiol 2002;20:92-5.

Hansotia JB, Agarwal V, Pathak AA, Saoji AM. Extended spectrum β-lactamase mediated resistance to third generation cephalosporins in Klebsiella pneumoniae in Nagpur, central India. Indian J Med Res 1997;105:158-61.

Babypadmini S, Appalaraju B. Extended spectrum -lactamases in urinary isolates of escherichia coli and klebsiella pneumoniae - Prevalence and susceptibility pattern in a tertiary care hospital. Indian J Med Microbiol 2004;22:172-4.

Du Bois SK, Marriott MS, Amyes SG. TEM-1 and SHV derived extended spectrum beta lactamases: relationship between selection, structure and function. J Antimicrob Chemother 1995;35:7-22.

Asensio A, Oliver A, Gonzalez-Diego P, Baquero F, Perez-Diaz JC, Ros P, et al. Outbreak of multiresistant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as risk factor for colonization and infection. Clin Infect Dis 2003;30:55-60.

Hardman JG, Limbird LE, Goodman LS, Gilman A. Goodman Gilman’s the Pharmacological Basis of Therapeutics. 12th ed. New York, N.Y.: The McGraw Hills Companies, Inc.

Philippon A, Arlet G, Jacoby GA. Plasmid-determined AmpC-type beta-lactamases. Antimicrob Agents Chemother 2002;46:1-11.

Sureda LC, Juan C, Sanchez AD, Alberti S. Role of Klebsiella pneumoniae LamB Porin in Antimicrobial Resistance. Antimicrob Agents Chemother 2011;55:1803-18.

Payne DJ, Woodford N, Amyes SG. Charactrization of the plasmid mediated beta lactamase BIL-1. J Antimicrob Chemother 1992;30:119-27.

Hibbertrogers LCF, Heritage J, Gascoynebinzi DM, Hawkey PM, Todd N, Lewis IJ, Bailey C. Molecular epidemiology of ceftazidime resistant Enterobacteriaceae from patients on a paediatric oncology ward. J Antimicrob Chemother 1995;36:65-82.

Nordmann P, Cuzon G, Nass T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9:228-36.

Montgomerie JZ. Epidemiology of Klebsiella and hospital-associated infections. Rev Infect Dis 1979;1:736-53.

Lucet JC, Chevret S, Decre D, Vanjak D, Macrez A, Bedos JP, et al. Outbreak of multiply resistant enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996;22:430-6.