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.
Description:
A Dissertation
Submitted to the Department of Microbiology
Central Campus of Technology, Dharan
(Constituent Campus of Tribhuvan University)
In the Partial Fulfillment of the Requirements for the Award of the
Degree of Master of Science in Microbiology (Medical)
