MULTIDRUG RESISTANCE AND EXTENDED SPECTRUM β-LACTAMASE PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE ISOLATES FROM URINE SAMPLES OF PATIENTS ATTENDING A HOSPITAL OF SUNSARI, NEPAL

Abstract

Multi drug resistant Escherichia coli and Klebsiella pneumoniae expressing extended spectrum β-lactamase enzymes (ESBLs) has become a serious challenges to clinicians for the therapeutic management of clinical cases in urinary tract infection. The main objective of the study was focused to determine the dominance of MDR E.coli and Klebsiella pneumoniae and the evaluation of status of β-lactamase enzyme produced by them. The study was carried out in Apex Hospital, Itahari between June and November, 2019. A total of 350 midstream urine samples were processed among suspected cases of urinary tract infection. The bacteria were isolated by semi quantative culture technique and identified by conventional biochemical tests. The antimicrobial susceptibility testing was performed by modified Kirby Bauer disc diffusion method following Clinical and Laboratory Standards Institute guidelines and were tested for ESBL by combination disc method. The p value <0.05 was considered as statistically significant. A total of 85 samples showed significant bacteriuria with 62 E. coli and 23 Klebsiella pneumoniae. Among the isolates, 62.35% were found MDR strains. By combined disk test, 86.67% E. coli and 13.33% Klebsiella spp. were found ESBL producers. There is significant association between MDR and ESBL production as well as between age group of patients and ESBL producing organisms (P=0.01). Higher prevalence of ESBL producing E. coli and Klebsiella spp. was observed warranting prompt need of surveillance for effective management of such MDR strains. Imipenem, Meropenem and Nitrofurantoin seemed to be drug of choice for UTI. Amoxycillin should no longer considered as drugs for empirical treatment of clinically evident UTI, because of high resistance rates. There is an increasing need for periodic monitoring of drug susceptibility pattern to prevent the spread and development of antimicrobial resistant strains and ESBL producers.