Isolation of Extended Spectrum Beta Lactamase producing Klebsiella from various clinical samples in a Tertiary Care Hospital.

Raja, J (2008) Isolation of Extended Spectrum Beta Lactamase producing Klebsiella from various clinical samples in a Tertiary Care Hospital. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Klebsiella is well known to most clinicians as a cause of Community-acquired bacterial pneumonia, occurring particularly in Chronic alcoholics, which has a high fatality rate if untreated. The Vast majority of Klebsiella infections, however, are associated with Hospitalization. As opportunistic pathogens, Klebsiella species Primarily attack immunocompromised individuals who are Hospitalized and suffer from severe underlying diseases such as Diabetes mellitus or chronic pulmonary obstruction. It is estimated That Klebsiella species cause 8% of all nosocomial bacterial Infections in the United States and in Europe. No great Geographical variations frequency has been noted. In the United States, Klebsiella accounts for 3 to 7% of all nosocomial bacterial Infections, placing them among the eight most important infectious Pathogens in hospitals, and data collected from the United Kingdom, Italy and from Germany are remarkably similar to those Reported by the Centers for Disease Control and Prevention. The urinary tract is the most common site of infection. Klebsiella accounts for 6 to 17% of all nosocomial urinary tract Infections (UTI). As a cause of nosocomial gram-negative Bacteremia, Klebsiella is second only to Escherichia coli. Klebsiella Species are often the pathogens involved in neonatal sepsis. AIMS AND OBJECTIVES : 1. To isolate and speciate Klebsiella obtained from various clinical specimen in the department of Microbiology of Government Stanley Hospital. 2. To find out the incidence of ESBL producers amongst Klebsiella species. 3. To assess the antibiotic sensitivity pattern of ESBL producing bacteria in comparison with non-ESBL producers. 4. To formulate a treatment plan in ESBL harboring patients resistant to routine antibiotics, for effective recovery and for avoiding further emergence and spread of Extended Spectrum β- Lactamases. CONCLUSION : Our study gives 59.3 %, which is intermediate to the varied studies in India, but high compared to western countries like in US 4.2-44.0 per cent, in Canada 15-17 %, and in China 51 %48. In India, high prevalence of ESBL producing Klebsiella strains has been reported by various groups. Reported frequency of ESBL producing Klebsiella spp. from India ranged between 6 and 87 per cent. The high percentage of ESBL producing Klebsiella spp may be due to the selective pressure imposed by extensive use of antimicrobials. The infection control implications of ESBL producing Klebsiella spp. are under-recognized. Our results showed a high incidence of ESBL producing Klebsiella species in both In-patient and Outpatient. Routine detection of ESBL producing microorganisms is required by reliable laboratory methods and since most of these are multidrug resistant, the therapeutic strategies to control infections in the hospital setup have to be carefully formulated. Phenotypic confirmatory method is less worktime and less skill demanding while being economical, and will be the ideal method for confirmation of ESBL producers. A fall in the incidence of ESBL producers, have been noted in France in a study after implementing an effective strategy against ESBLs were brought in. Such a workup is imminent for our country in the present scenario. While ESBL producing organisms were 100% sensitive to Imipenem, they were also sensitive to cheaper drugs like, Gentamicin (7.44 %), Amikacin (54.54 %) and Ciprofloxacin (16.53 %). Hence if we screen carefully we can minimize the cost of treatment for the patients with infections due to ESBL producing organisms.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Isolation ; Spectrum Beta Lactamase ; Klebsiella ; various clinical samples ; Tertiary Care Hospital.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 26 Jul 2017 05:48
Last Modified: 26 Jul 2017 05:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/1717

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