Prevalence of extended spectrum beta lactamases and Metallo beta lactamases among Escherichia coli isolates in a tertiary care hospital, Thiruvananthapuram

Thuhina P.; Biju Rani V. R.; Syed Ali A.; Ashalekshmi P. A.

doi:10.18203/2320-6012.ijrms20260953

Authors

Thuhina P. Department of Medical Laboratory Technology, Government Medical College Thiruvananthapuram, Kerala, India
Biju Rani V. R. Department of Medical Laboratory Technology, Government Medical College Thiruvananthapuram, Kerala, India
Syed Ali A. Department of Microbiology, Government Medical College Thiruvananthapuram, Kerala, India
Ashalekshmi P. A. Department of Medical Laboratory Technology, KVM College of Allied Health Sciences, Alappuzha, Kerala, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260953

Keywords:

Amp C, Antimicrobial resistance, Beta-lactamase, ESBL, Escherichia coli, MBL

Abstract

Background: Antimicrobial resistance in Escherichia coli, particularly due to extended-spectrum β-lactamases (ESBL), Amp C β-lactamases, and Metallo-β-lactamases (MBL), poses a major therapeutic challenge. This study aimed to determine the prevalence of these resistance mechanisms among clinical E. coli isolates and to assess their antibiotic susceptibility patterns.

Methods: A hospital-based cross-sectional study was conducted on 130 non-duplicate E. coli isolates obtained from urine, blood, sterile body fluids, and aspirates over six months in a tertiary care hospital in south India. Identification was performed using standard microbiological techniques. Antimicrobial susceptibility testing was carried out by Kirby-Bauer disc diffusion following CLSI guidelines. ESBL, Amp C, and MBL production was detected using phenotypic screening and confirmatory disc synergy tests.

Results: ESBL production was detected in 67 (51.5%) isolates, MBL in 9 (7%), and AmpC in 6 (4.6%). Co-production of ESBL and MBL was observed in 2 (1.5%) isolates, while no isolate produced all three enzymes. The highest resistance was observed to ampicillin (96.1%), ceftriaxone (91.5%), and ciprofloxacin (77.6%). Colistin (100%) and tigecycline (98.4%) showed the highest susceptibility. ESBL-producing isolates were most susceptible to colistin (100%), tigecycline (97%), and carbapenems (68-73%), whereas MBL producers retained susceptibility mainly to colistin and tigecycline.

Conclusions: The high prevalence of ESBL-producing E. coli and the emergence of MBL producers underscore the urgent need for continuous surveillance, rational antibiotic use, and strengthened antimicrobial stewardship programs to limit the spread of multidrug-resistant organisms.

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References

World Health Organization. Global action plan on antimicrobial resistance. Geneva: WHO; 2015.

Paterson DL, Bonomo RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev. 2005;18(4):657-86. DOI: https://doi.org/10.1128/CMR.18.4.657-686.2005

Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-84. DOI: https://doi.org/10.1038/nrmicro3432

Rawat D, Nair D. Extended-spectrum β-lactamases in Gram negative bacteria. J Glob Infect Dis. 2010;2(3):263-74. DOI: https://doi.org/10.4103/0974-777X.68531

Jacoby GA. AmpC β-lactamases. Clin Microbiol Rev. 2009;22(1):161-82. DOI: https://doi.org/10.1128/CMR.00036-08

Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2011;17(10):1791-8. DOI: https://doi.org/10.3201/eid1710.110655

Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev. 2007;20(3):440-58. DOI: https://doi.org/10.1128/CMR.00001-07

Walsh TR, Toleman MA, Poirel L, Nordmann P. Metallo-β-lactamases: the quiet before the storm? Clin Microbiol Rev. 2005;18(2):306-25. DOI: https://doi.org/10.1128/CMR.18.2.306-325.2005

Logan LK, Weinstein RA. The epidemiology of carbapenem-resistant Enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis. 2017;215(suppl_1):S28-36. DOI: https://doi.org/10.1093/infdis/jiw282

Bush K, Bradford PA. β-lactams and β-lactamase inhibitors: an overview. Cold Spring Harb Perspect Med. 2016;6(8):a025247. DOI: https://doi.org/10.1101/cshperspect.a025247

Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance- the need for global solutions. Lancet Infect Dis. 2013;13(12):1057-98. DOI: https://doi.org/10.1016/S1473-3099(13)70318-9

World Health Organization. Global antimicrobial resistance surveillance system (GLASS) report 2022. Geneva: WHO; 2022.

Tamma PD, Holmes A, Ashley ED. Antimicrobial stewardship: another focus for patient safety? Curr Opin Infect Dis. 2014;27(4):348-55. DOI: https://doi.org/10.1097/QCO.0000000000000077

Shahandeh Z, Sadighian F, Mahdavi M. Prevalence of metallo-β-lactamase-producing Escherichia coli isolates in clinical samples. Iran J Microbiol. 2015;7(2):102-8.

Collee JG, Fraser AG, Marmion BP, Simmons A. Mackie and McCartney Practical Medical Microbiology. 14th ed. Edinburgh: Churchill Livingstone; 1996.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI supplement M100. Wayne (PA): CLSI; 2023.

Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum β-lactamases conferring transferable resistance to newer β-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis. 1988;10(4):867-78. DOI: https://doi.org/10.1093/clinids/10.4.867

Black JA, Moland ES, Thomson KS. AmpC disk test for detection of plasmid-mediated AmpC β-lactamases in Enterobacteriaceae lacking chromosomal AmpC β-lactamases. J Clin Microbiol. 2005;43(7):3110-3. DOI: https://doi.org/10.1128/JCM.43.7.3110-3113.2005

Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA disk method for differentiation of metallo-β-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2002;40(10):3798-801. DOI: https://doi.org/10.1128/JCM.40.10.3798-3801.2002

Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113(Suppl 1A):5S-13S. DOI: https://doi.org/10.1016/S0002-9343(02)01054-9

O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. CABI Digital Library. 2016.

Tewari R, Mitra SD, Ganaie F. Prevalence of extended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae in tertiary care hospital. J Clin Diagn Res. 2012;6(4):608-11.

Balaji V, Jeremiah SS, Baliga PR. Polymyxins: antimicrobial susceptibility concerns and therapeutic alternatives. Indian J Med Microbiol. 2011;29(3):230-42. DOI: https://doi.org/10.4103/0255-0857.83905

Tasina E, Haidich AB, Kokkali S, Arvanitidou M. Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis. Lancet Infect Dis. 2011;11(11):834-44. DOI: https://doi.org/10.1016/S1473-3099(11)70177-3

Shrestha A, Shrestha R, Ghimire A. Extended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae in urinary tract infections. J Nepal Health Res Counc. 2015;13(29):20-5.

Oberoi L, Singh N, Sharma P, Aggarwal A. ESBL, MBL and AmpC β-lactamases producing superbugs-havoc in the intensive care units of Punjab India. J Clin Diagn Res. 2013;7(1):70-3. DOI: https://doi.org/10.7860/JCDR/2012/5016.2673

Das A, Ray P, Garg R. Extended spectrum β-lactamase producing Gram negative bacteria in neonatal sepsis. Indian J Med Res. 2006;124(5):545-8.

Thakar YS, Jain A, Kapila K. Extended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae from clinical isolates. Indian J Pathol Microbiol. 2007;50(3):538-42.

Chaudhary U, Aggarwal R. Extended spectrum β-lactamases (ESBL)- an emerging threat to clinical therapeutics. Indian J Med Microbiol. 2004;22(2):75-80. DOI: https://doi.org/10.1016/S0255-0857(21)02884-X

Rawat D, Singhai M, Kumar A, Jha PK. Detection of different β-lactamases and their co-existence by using various methods in clinical isolates of Enterobacteriaceae and Pseudomonas aeruginosa in a tertiary care hospital. J Lab Phys. 2013;5(1):21-6. DOI: https://doi.org/10.4103/0974-2727.115918

Chatterjee S, Datta S, Roy S, Ramanan L, Saha A, Viswanathan R, et al. Carbapenem resistance in Acinetobacter baumannii and other Acinetobacter spp. causing neonatal sepsis: focus on NDM-1 and its linkage to IS Aba125. Front Microbiol. 2016;7:1126. DOI: https://doi.org/10.3389/fmicb.2016.01126

Wadekar MD, Anuradha K, Venkatesha D. Prevalence of metallo-β-lactamase producing Pseudomonas aeruginosa in a tertiary care hospital. Indian J Med Microbiol. 2013;31(1):78-80.

Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20(9):821-30. DOI: https://doi.org/10.1111/1469-0691.12719

Falagas ME, Rafailidis PI. Tigecycline for the treatment of multidrug-resistant organisms. Lancet Infect Dis. 2008;8(12):823-31.

Ibadin EE, Omoregie R, Igbarumah IO, Anogie NA, Idemudia OG. Extended-spectrum β-lactamase, AmpC and metallo-β-lactamase producing Gram negative bacteria in a tertiary hospital in Nigeria. Int J Trop Med. 2011;6(4):73-8.

Kolhapure S, Jadhav S, Gandham N. Prevalence of β-lactamases among Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital. J Clin Diagn Res. 2014;8(10):DC20-3.

Thomson KS. Controversies about extended-spectrum and AmpC β-lactamases. Emerg Infect Dis. 2001;7(2):333-6. DOI: https://doi.org/10.3201/eid0702.010238

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. Pharm Ther. 2015;40(4):277-83.