Sarasu, V P (2011) A study on Prevalence of extended spectrum Beta lactamase and Amp C Beta lactamase production among escherichia coli and Klebsiella isolated in Urinary Tract Infection. Masters thesis, Thanjavur Medical College, Thanjavur.
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Abstract
INTRODUCTION : Urinary Tract Infections (UTIs) are one of the most common bacterial infections in humans, both in the community and the hospital settings affecting approximately 150 million people worldwide annually which results in more than 6 billion US dollars loss to the global economy. Incidence of UTI in India is 50,000/ million persons per year and accounts for 1-2 % of patients in primary care. About 50% of all women experiences atleast 1 episode of UTI during their life time.Recurrent infection occurring in 20 – 30 % of the females results in high morbidity and mortality. The incidence of UTI is greatly influenced by age, sex, anatomical and functional abnormalities of the urinary tract. Infected urine in pregnant women stimulates an immunological and inflammatory response in the unborn leading to many complications such as premature babies and IUGR as well as Hypertension and renal failure ending fatally from cradle to grave. More than 90% of acute UTI in community is acquired infection caused by Escherichia coli and 10 – 20 % by CONS especially Staphylococcus saphrophyticus which is the second most common cause in young sexually active women and 5% or less by other Enterobacteriaceae and Enterococci. In complicated cases of UTI resulting from anatomical obstruction and catheterization, the most common causative agents are E. coli followed by Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Enterococcus spp. In general, the urinary tract infections are treated mostly with broad spectrum Cephalosporins, Flouroquinolones and Aminoglycosides. The Cephalosporins which includes, Cephelexin, Cefotaxime, Ceftazidime etc., are cell wall inhibitors and are used commonly for treating infections caused by Gram negative organism. The Fluroquinolones consisting of Norfloxacin, Ciprofloxacin, Oflaxicin, Sparfloxicin, Levofloxicin etc., are antibiotics which act by inhibiting the activity of DNA gyrase and Topoisomerase the enzymes that are essential for bacterial DNA replication. The aminoglycosides antibiotics include Gentamicin, Kanamicin and Amikacin etc., and they act by inhibiting bacterial protein synthesis. OBJECTIVES : 1. To find out the bacteriological profile of Urinary Tract Infections. 2. To identify the prevalence of Escherichia coli and Klebsiella among the isolated organisms. 3. To see the sensitivity pattern for the pathogens those are isolated. 4. To screen ESBL production among the isolated E. coli and Klebsiella. 5. To detect Amp C β- lactamase production among the isolated E. coli and Klebsiella. 6. To compare the sensitivity pattern among the isolated ESBL producing and non ESBL producing E. coli and Klebsiella. 7. To provide guidelines to the clinician regarding the treatment of UTI caused by ESBL and Amp C β- lactamase producing E. coli and Klebsiella. MATERIALS AND METHODS : Place of study : Thanjavur Medical College Hospital, Thanjavur. Study period : One year between August 2009 and July 2010. Design of study : Observational study. Inclusion criteria : 1. Fresh case of UTI, 2. No H/O antibiotic intake, 3. No H/O instrumentation, 4. No H/O immune compromised state, 5. Non pregnant women, 6. No H/O recent delivery, 7. No H/O liver or renal dysfunction. The patients of all age groups belonging to both the sex with fever, dysurea, frequency, urgency, lower abdominal pain / flank pain and supra pubic tenderness that are suggestive of upper and lower Urinary tract infections were considered and included in the study. Exclusion criteria: Those with Diabetes mellitus and associated co-morbid conditions, promiscuous individual, immuno compromised status, repeated catheterization, instrumentation and on antimicrobial therapy were excluded. RESULTS : The data on the age and gender wise distribution of patients included in the study are presented in Table 4. Among the samples collected from 500 patients both Inpatient and Outpatients, 49% were male, 51% were female, mean age was 39 years with the range from new born to 78 years. The observations showed 53.8% (27.2% of male and female 26.6%) of the patients were less than 14 years of age. 29 % ( 11.6% + 17.4%) of patients were in reproductive age group, 12.8% (7.4% + 5.4%) of patients from middle age group, 4.4% ( 2.8% + 1.6% ) of patients were in older age groups more than 60 years. In the present study, among the in-patients, ESBL producing E. coli was found to be the most prevalent organism with 49% prevalence followed by Klebsiella spp (40%). Whereas, in outpatients Klebsiella (20%) was the most prevalent ESBL producing organism followed by E. coli (6%). Among the inpatients, the prevalence of Amp C β- lactamase producing E. coli and Klebsiella 12% and 23% respectively while, in case of outpatient, the Amp C β- lactamase production was nil. CONCLUSION : There is a high prevalence rate of ESBL and Amp C β- Lactamase production seen among uropathogenic E. coli and Klebsiella spp. Based on the prevalence rate of the ESBL and Amp C β- Lactamase production in a health care facility, institutional antibiotic policy can be tailored to achieve superior therapeutic outcome and bring about a reduction in healthcare costs. It also eliminates misuse of conventional cephalosporin in a significant proportion of patients. Drug resistance pattern varied from place to place which may be related to the nature of the pathogen and preferred antimicrobial agents.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | spectrum beta lactamase ; Amp C beta lactamase ; escherichia coli ; Klebsiella isolated ; urinary tract infection. |
| Subjects: | MEDICAL > Microbiology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Aug 2017 07:29 |
| Last Modified: | 14 Aug 2017 07:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1455 |
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