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• W2885393104 abstract "INTRODUCTION :The advent of plasmid mediated ESBL production by Klebsiella and E.coli in the early 1980s signaled an emerging and evolving global problem with antibioticresistance among Enterobacteriaceae. These organisms were susceptible to β-lactamantibiotics, but, with widespread use, have developed resistance through production of β-lactamases, which are the major defense mechanism of gram-negative bacteria against β-lactam antibiotics, and were first reported in the early 1980s.1The presence of ESBLs carries tremendous clinical significance. Plasmidsresponsible for ESBL production frequently carry genes encoding resistance to other drugclasses (for example, aminoglycosides), thus limiting the antibiotic options available fortreatment of resistant strains .2 Thus, it becomes imperative to quantify the problem, andreinforce guidelines promoting appropriate antibiotic use.Since -lactam antibiotics came into clinical use, -lactamases havecoevolved with them. As and when agents like cephamycins, cephalosporins with anoxyimino side chain, carbapenems, and aztreonam, that could break through theantimicrobial resistance were introduced, bacteria responded with a plethora of -lactamases —including extended-spectrum -lactamases (ESBLs), plasmid-mediatedAmpC enzymes, and carbapenem-hydrolyzing -lactamases (carbapenemases) — that,with variable success, can confer resistance to the latest -lactam antibiotics.3 Presumablythe selective pressure by the use and overuse of these new introductions periodically forthe treatment of patients, has allowed the proliferation and survival of new variants ofβ-lactamase. Thus, ESBLs represent an impressive example of the ability of gramnegativebacteria to develop new antibiotic resistance mechanisms in the face of theintroduction of new antimicrobial agents.Antimicrobial resistance development is a function of bacterial geneticvariability, such as the replication or generation rate in response to environmental stress(physical, nutrient availability etc), and selection pressure due to the use of similarantibiotics (class). The spreading antimicrobial resistance may be due to dispersion ofresistant clones, or the genomes rapidly expanding its reservoirs or massive consumptionof antimicrobials due to worldwide usage.OBJECTIVES :To determine1. The prevalence of ESBL producing isolates of E.coli and Klebsiella amongbacteremic adult hospitalized patients,2. The rates of ESBL production among community acquired and nosocomialinfections,3. The risk factors for bacteremia due to ESBL producing E. coli and Klebsiellaspecies.4. The outcome of antibiotic treatment in bacteremia caused by E. coli andKlebsiella species in hospitalized adults.MATERIALS AND METHODS :Study Setting:The study was conducted in Christian Medical College Hospital, Vellore, a2500 bedded academic medical center in South India with an average of 1815 inpatientsand approximately 3500 out- patient visits every day.Study design:This was a prospective cohort study.Subjects:The study recruited all sequentially encountered patients older than 16years with Klebsiella or E. coli bacteremia who were admitted in various wards andIntensive care units of this hospital during the study period. We recruited a total of 131patients over a 4 month period.INCLUSION CRITERIA:1. Isolation of E. coli or Klebsiella from blood culture samples and2. Willingness to participate in the study.EXCLUSION CRITERIA:1. Patients aged less than 16 years,2. Outpatients ,3. Bacteremias of polymicrobial etiology,4. Patients unwilling for inclusion in the study.METHODOLOGY :A written informed consent was taken from either the patient, or from thelegal guardian in those with altered mental status, prior to enrollment. All patients with Ecoli and Klebsiella bacteremia were evaluated within 48 hours of detection of a positiveblood culture. Bacteremias of polymicrobial etiology were not included.Blood culture was taken at the onset of fever by venupuncture from aperipheral vein after adequate preparation of the skin with povidone iodine (Betadine). Aminimum of 5 ml of blood was inoculated into a blood culture bottle (BacT/ALERT)which is used with the BacT/ALERT microbial detection system in qualitativeprocedures for enhanced recovery and detection of aerobic and facultative anaerobicmicro organisms. The blood culture bottles were then transported to the department ofMicrobiology where culture and sensitivity tests were done. In all patients only the firstepisode of bacteremia was included for further analysis.A study form was completed which included the patients demographicdetails, co-morbidities and the possible source of infection (community acquired ornosocomial). The history of prior antibiotic use and the details of antibiotics used for thecurrent episode of bacteremia were noted. The antibiotics were prescribed by the treatingphysician and the choice was not influenced by the study.RESULTS :One hundred and thirty one episodes of bacteremia were included inthe study during the period of 4 months from Feb 2007 to May 2007, the baselinecharacteristics are shown in table 5. Seventy eight (59.54%) of the subjects were males.CONCLUSIONSOne hundred and thirty one sequentially encountered adult patients with E coli orKlebsiella bacteremia were studied and followed up prospectively over a period of 2weeks to assess clinical outcome.1. ESBL production was observed in 73.28% of the isolates with 53.06 % of thecommunity acquired infection and 85.36% of nosocomial infections caused by ESBLproducing strains.2. Prior use of antibiotics, especially 3rd and 4th generation cephalosporins wereassociated with an increased risk of infection by ESBL producing isolates of E coliand Klebsiella3. A very high rate (50.4% -81.7%) of resistance to other major classes of antibiotics(e.g. fluoroquinolones, aminoglycosides, β-lactams and β-lactamase inhibitors) wasobserved, with carbapenems being the only class of drug with a good activity againstESBL producing Enterobacteriaceae. That, resistance to carbapenems was also notedamong the isolates, is a cause of concern for the future.4. Initial antibiotics were inappropriate in 53% (based on antibiotic susceptibilityprofile).5. The mortality following the episode of bacteremia was not influenced by the initial choice of the antibiotic. However, carbapenems should be the choice of initial empiric therapy for serious life threatening infections caused by ESBL producing Enterobacteriaceae (with de-escalation when culture and sensitivity reports are available)." @default.
• W2885393104 created "2018-08-22" @default.
• W2885393104 creator A5053991594 @default.
• W2885393104 date "2008-03-01" @default.
• W2885393104 modified "2023-09-27" @default.
• W2885393104 title "Epidemiology of ‘Extended Spectrum Beta Lactamae’producing isolates of Escherichia coli and Klebsiella sppamong bacteremic adults admitted to a tertiary care teaching hospita" @default.
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