South-Asia is known as a hub for multidrug-resistant (MDR) bacteria. Unfortunately, proper surveillance and documentation of MDR pathogens is lacking in Pakistan. The alarming increase in the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is a serious problem. From this perspective, we analysed published data regarding ESBL-producing Enterobacteriaceae in different regions of Pakistan. A meta-analysis was performed to determine the prevalence of ESBL-producing Enterobacteriaceae in Pakistan. A Web-based search was conducted in electronic databases, including PubMed, Scopus and PakMedi Net (for non-indexed Pakistani journals). Articles published (in either indexed or non-indexed journals) between January 2002 and July 2016 were included in the study. Relevant data were extracted, and statistical analysis was performed using the Metaprop command of STATA version 14.1. A total of 68 studies were identified from the electronic data base search, and 55 of these studies met our inclusion criteria. Pakistan’s overall pooled proportion of ESBL-producers was 0.40 (95% CI: 0.34–0.47). The overall heterogeneity was significant (I2 = 99.75%, p < 0.001), and significant ES = 0 (Z = 18.41, p < 0.001) was found. OXA, SHV, TEM and CTX-M were the most commonly found gene variants for ESBLs in these studies. The prevalence of ESBL-producing Enterobacteriaceae is high in Pakistan. Little is known about the annual frequency of ESBLs and their prevalence in different provinces of Pakistan. No data are available regarding ESBL frequency in Baluchistan. This underscores an urgent demand for regular surveillance to address this antimicrobial resistance problem. Surveillance to better understand the annual ESBL burden is crucial to improve national and regional guidelines.

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Prevalence of extended-spectrum-β-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan.

Purpose: Virulent and resistant Klebsiella pneumoniae strains are considered as one of the most significant causes of hospital-acquired infections. The present investigation was done to study the distribution of virulence factors, capsule serotypes and phenotypic and genotypic evaluation of antibiotic resistance of the K. pneumoniae strains isolated from hospital-acquired infections. Patients Materials and methods: Two hundred and sixty different types of hospital-acquired infections were collected and cultured. Antibiotic resistance pattern of K. pneumoniae isolates and their molecular characterization were studied using disk diffusion and PCR, respectively. Results: One hundred and fifty out of 260 (44.22%) hospital-acquired infections harbored K. pneumoniae. Urine samples (63.75%) had the highest prevalence of K. pneumoniae, while wound (33.33%) had the lowest. K. pneumoniae strains harbored the highest prevalence of resistance against ampicillin (100%), cefuroxime (100%), amoxicillin/clavulanic acid (95.65%) and ceftazidime (95.52%). FimH-1 (93.04%), traT (92.17%), mrkD (84.34%), and entB (80.86%) were the most commonly detected virulence genes. AcrAB (96.52%) and tolC (85.21%) were the most commonly detected antibiotic resistance genes. Prevalence of ompK35 and ompK36 virulence genes were 75.65% and 79.13%, respectively. Prevalence of K1 and K2-positive serotypes were 27.82% and 6.96%, respectively. Conclusions: High prevalence of resistance against several types of antibiotics and simultaneous presence of some virulence factors and multi-drug resistance genes pose an important public health issue.

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Molecular characterization, serotypes and phenotypic and genotypic evaluation of antibiotic resistance of the Klebsiella pneumoniae strains isolated from different types of hospital-acquired infections.

The extended- spectrum β-lactamase producing bacteria are widely spread worldwide. The productions of these enzymes cause bacterial resistance to a wide range of antibiotics. The aim of this study was to investigated the frequency of K. pneumonia encoding genes for CTX-M, TEM-1 and SHV-1 extended-spectrum beta lactamases enzymes isolated from urinary tract infection. This study is cross-sectional study. All K. pneumonia isolates from urine samples, which had grown on media culture more than 105 were delivered to the medical microbiology laboratory. K. pneumonia susceptibility of 198 samples were confirmed by disk diffusion. The gene frequency of genes was determined using PCR, and analyzed using SPSS version 21 software. Most of the K. pneumonia isolated from urine producing β-lactamase were resistant to cotrimoxazole (53.2%) followed by cefotaxime (50%), ceftazidime, ceftriaxone (40.3%), nalidixic acid (17.8%), amikacin and imipenem (1.6%) and meropenem (0%) respectively. Out of the 198 confirmed isolates of K. pneumonia, 62 cases (31.3%) have the gene phenotype of broad spectrum β-lactamase enzymes and highest frequency of gene phenotype was related to the SHV-1 gene (85.5%). Then in the terms of abundance from highest to lowest CTXM-3 (56.5%), CTXM-1 (27.4%), TEM-1 (16.1%) and CTXM-2 (8.1%), were respectively. This study showed that K. pneumonia isolated from urine producing β-lactamase were resistance to a wide range of antibiotics. Due to the increasing resistance of most antibiotics, control and supervision in the use of antibiotics and identification of broad spectrum β-lactamase enzymes by phenotypic methods appears to be essential.

https://link.springer.com/content/pdf/10.1186/s12941-018-0256-y.pdf

The frequency of Klebsiella pneumonia encoding genes for CTX-M, TEM-1 and SHV-1 extended-spectrum beta lactamases enzymes isolated from urinary tract infection.

Introduction: Urinary tract infections (UTIs) caused by extended – spectrum beta lactamase (ESBL) – producing bacteria have become a growing problem due to emerging antibiotic resistance. This observational study was carried out from January 2012 to August 2012 to see the frequency and antibiotic susceptibility of ESBL producers E.coli and KI.pneumoniae in urinary tract infection. Materials and Methods: A total of 672 urine sample received at Microbiology laboratory of Shalamar Medical College, Lahore and processed for culture / sensitivity. Results: On culture 256 isolates were obtained, of which 163 isolates were identified by AP 120 E as E.coli 125 (76.3%) and K.pneumoniae 38 (23.3%). The ESBL producing E.coli 90 (72%) and Klebsiella pneumoniae 25 (65.8%) were detected by double disc synergy test (DDST). Sensitivity testing showed a multidrug resistance in ESBL producing E.coli and K.pneumoniae. Maximum resistance recorded in E.coli (ESBL) was as cafatoxime (98.9%), Ceftazidime (96.7%) and Cefuroxime (93.4%) while minimum resistance was seen with Imipenum (0.8%) fosfomycine (1.2%) and Nitrofurantoin as well piperacillin / tazobactam (2.2%) each. The ESBL producing Klebsiella showed maximum resistance tocetoceftazidime (100%) cefotaxime (89%) Cefuroxime (84%) while minimum resistance seen with imipenam (4%) Nitrofurantoin and Piperacillin / Tazobactam (8%). Conclusion: ESBL producing bacteria, area matter of concern in high frequency of antimicrobial resistance to non beta lactam and aminoglycocides antibiotics. Monitoring of ESBL production and antimicrobial susceptibility testing are necessary to avoid treatment failure in patients with UTI.

Evaluation of extended spectrum beta - lactamase mediated resistance in escherichia coli and klebsiella in urinary tract infection at a tertiary care hospital

https://www.tandfonline.com/doi/pdf/10.1080/16878507.2020.1730579

Assessment of multidrug resistance in bacterial isolates from urinary tract-infected patients

Emerging antibiotic resistance due to extended spectrum β-lactamase (ESBL) production limited the use of β-lactam antibiotics against Escherichia coli and Klebsiella pneumoniae. This observational study was conducted at the Microbiology department of the Children’s Hospital, Lahore Pakistan, from June, 2009 to November, 2010 to determine the frequency and antimicrobial resistance of ESBL producing E. coli and K. pneumoniae. A total of 13638 urine samples were processed for culture and antimicrobial sensitivity testing. E. coli and K. pneumoniae were identified using API 20E. A double disk synergy test (DDST) was performed to determine ESBL production. ESBL production was detected in 312 (57.4%) E. col i and 386 (71.7%) K. pneumoniae . A multidrug resistance pattern was seen in ESBL producing E. coli and Klebsiella pneumoniae . ESBL producing E. coli showed maximum resistance to cefotaxime (100%), ceftazidime (99.4%) and cefuroxime (93.3%) while minimum resistance was seen with meropenem (1.3%), piperacillin/tazobactam (10.3%) and nitrofurantoin (27.6%). ESBL producing K. pneumoniae showed maximum resistance to ceftazidime (100%), cefotaxime (98.7%) and cefuroxime (98.1%) while minimum resistance was seen with meropenem (3.6%), piperacillin/tazobactam (17.6%), and nitrofurantoin (28.5%). In ESBL producing bacteria, high prevalence of antibacterial resistance of non-β-lactam antibiotics is a serious matter of concern. Monitoring of ESBL production and antimicrobial susceptibility testing are necessary to avoid treatment failure in patients with urinary tract infection (UTI). Key words : Extended spectrum, beta-lactamases, urinary tract infections, Escherichia coli, Klebsiella pneumoniae.

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K ul-Haq

Papers

Urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae