Expression of ESBL, MBL and AmpC β lactamases by extra intestinal Escherichia coli isolates: correlation with treatment and clinical outcome

Chakraborty, Arindam and Adhikari, Prabha and Shenoy, Shalini and Baliga, Shrikala and Rao, Satish and Biranthabail, Dhanashree and Saralaya, Vishwas (2013) Expression of ESBL, MBL and AmpC β lactamases by extra intestinal Escherichia coli isolates: correlation with treatment and clinical outcome. Journal of Microbiologyand Infectious Diseases, 3 (4). pp. 150-156.

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Abstract

Objective: We investigated the expression of Extended Spectrum β-Lactamases (ESBLs), AmpC β lactamases and Carbapenemases in extraintestinal pathogenic Escherichia coli (ExPEC) isolates and correlated with treatment and outcome of the patients. Methods: Three hundred ExPEC infected patients were included in the study. Demographic data, antibiogram, treatment and outcome were collected. Production of ESBLs was detected by combination disk method; AmpC was detected by AmpC disk test. Carbapenemase production was detected by disk diffusion and confirmed by modified Hodge test. Identification of metallo- β-lactamase (MBL) activity was performed by the carbapenem-EDTA combined disk method and MBL E-test. Results: Out of 300 E. coli isolates, 212 (71%) were ESBL producers. AmpC β lactamase production was seen in 95 (32%) isolates; 16 (17%) isolates were pure AmpC producers whereas 79 (83%) were ESBL co-producers. Twenty nine (9.5%) isolates were carbapenemase producers of which 15 (5%) were MBL producers. For treatment, most widely prescribed antibiotics were β-lactam+β-lactamase inhibitor combinations (39%). Sixty seven percent patients improved; relapse/re-infection was seen in 18% of patients and 11% patients expired. Increased mortality was seen in patients with blood stream infection and more number of relapses was seen in urinary tract infection. Conclusion: ExPEC producing ESBL or AmpC along with carbapenemases are particularly challenging for clinicians and are a major threat worldwide. Early use of appropriate antibiotics like β-lactam+β-lactamase inhibitor combinations will probably reduce complications in these patients.

Item Type: Article
Uncontrolled Keywords: AmpC, ExPEC, ESBL, MBL
Subjects: Medicine > KMC Mangalore > Microbiology
Medicine > KMC Mangalore > Medicine
Depositing User: KMCMLR User
Date Deposited: 17 Jan 2014 11:21
Last Modified: 17 Jan 2014 11:21
URI: http://eprints.manipal.edu/id/eprint/138428

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