Transforming susceptibility profile of Extended spectrum beta lactamase (ESBL) producing Klebsiella pneumoniae in a Tertiary care hospital

Abstract

Objective: To determine the transforming susceptibility of ESBL producing Klebsiella pneumoniae yielded from the clinical isolates in a tertiary care hospital.

Methodology: After getting the ethical approval, received samples from different wards, ICU and NICU were inoculated on the appropriate culture media, followed by bacterial identification through colony morphology, Gram staining and biochemical testing. As per Clinical and Laboratory Standards Institute guidelines, antibiotic susceptibility was performed using Kirby Bauer disc diffusion method and Double disc synergy Test (DDST) was performed for phenotypic detection of ESBL production.

Results: Based on the antibiotic susceptibility out of the 95 ESBL producing Klebsiella pneumoniae isolates collected during the time of study,   62.10% were XDR and 37.89% were MDR.  100% co-resistance was observed against Cefotaxime, Ceftriaxone and Amoxicillin clavulanic acid, followed by 95.78% resistance against Ciprofloxacin. 60% of the isolates were resistant to Meropenem and Imipenem. For urinary isolates, Nitrofurantoin showed better efficacy, with a sensitivity of 52.64% as compared to Fosfomycin where the sensitivity was substantially reduced i.e. 36.84%.

Conclusion: Very low sensitivity was recorded amongst the ESBL producing Klebsiella pneumoniae isolates against maximum groups of antibiotics. Efficacy was substantially reduced against the Carbapenems and Amikacin as well. Nitrofurantoin showed comparatively better efficacy to Fosfomycin when tested in the urinary isolates. Based on these results empirical treatment needs to be followed in conjunction with continuous surveillance of MDROs.