1) The document analyzes β-lactamase production among multi-drug resistant Klebsiella pneumoniae isolates from patients with cystitis in Hilla City, Iraq.
2) Testing found high rates of resistance to β-lactam antibiotics like ampicillin, ceftazidime, and cefotaxime. Extended spectrum β-lactamase production was detected in 43.5-52.2% of isolates by two different tests.
3) Klebsiella pneumoniae carbapenemase was found in 13-17.4% of isolates based on two tests, indicating the emergence of resistance to carbapenem antibiotics.
The occurrence of AmpC β-lactamase and ESBL producing Gram-negative bacteria ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Staphylococcus lugdunensis is a coagulase-negative staphylococci. The organism is found as a skin commensal in healthy individuals. S. lugdunensis has been implicated in invasive diseases. The mecA gene has been reported in several data, the first in a neonate with MRSL that produces an alternative penicillin binding protein (PBP2A).
Trends in Antibiotic Resistance of Vibrio Cholerae Isolates in Kenya (2006 - ...paperpublications3
Abstract: The evolution of antibiotic resistance was studied among revived Vibrio cholerae strains which were previously archived at -800c between 2006 and 2015. Antibiotic susceptibility testing (AST) on 12 antimicrobials; ampicillin (10µg), cefpodoxime (10 µg), ceftazidime (30 µg), cefotaxime (30 µg), amoxicillin- clavulanic acid (10/ 100 µg ratio) nalidixic acid (30 µg), tetracycline (30 µg), ciprofloxacin (10 µg), SXT (sulphamethoxazole -30 µg trimethoprim -5.2 µg), streptomycin (25 µg), gentamycin (10 µg) and chloramphenicol (30 µg) was carried out using Kirby-Bauer disc diffusion method. AST results revealed susceptibility to tetracycline, which is the drug of choice in Kenya administered as doxycycline during cholera outbreaks, among all isolates. Resistance to βeta-lactams and ciprofloxacin emerged in latter years while a decline in resistance to SXT, Chloramphenicol and Streptomycin was noted. This study gave a clear indication that there were changes in the resistance patterns whereby resistance to some antimicrobials declined and others emerged over the ten year period. In order to slow down the emergence and spread of resistance strains, care should be taken by health professionals when prescribing antimicrobials to patients suffering from cholera disease and should be restricted to only severe cases. It is also recommended that antimicrobial susceptibility testing should be done before giving antimicrobials in management of cholera cases.
Keywords: Antimicrobial resistance, Evolution, Kenya, Vibrio cholera.
Title: Trends in Antibiotic Resistance of Vibrio Cholerae Isolates in Kenya (2006 - 2015)
Author: Penina Muthoni Kung’u, Samuel Njoroge, John Kiiru, Paul Okemo, Samuel Kariuki
ISSN 2349-7823
International Journal of Recent Research in Life Sciences (IJRRLS)
Paper Publications
The occurrence of AmpC β-lactamase and ESBL producing Gram-negative bacteria ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Staphylococcus lugdunensis is a coagulase-negative staphylococci. The organism is found as a skin commensal in healthy individuals. S. lugdunensis has been implicated in invasive diseases. The mecA gene has been reported in several data, the first in a neonate with MRSL that produces an alternative penicillin binding protein (PBP2A).
Trends in Antibiotic Resistance of Vibrio Cholerae Isolates in Kenya (2006 - ...paperpublications3
Abstract: The evolution of antibiotic resistance was studied among revived Vibrio cholerae strains which were previously archived at -800c between 2006 and 2015. Antibiotic susceptibility testing (AST) on 12 antimicrobials; ampicillin (10µg), cefpodoxime (10 µg), ceftazidime (30 µg), cefotaxime (30 µg), amoxicillin- clavulanic acid (10/ 100 µg ratio) nalidixic acid (30 µg), tetracycline (30 µg), ciprofloxacin (10 µg), SXT (sulphamethoxazole -30 µg trimethoprim -5.2 µg), streptomycin (25 µg), gentamycin (10 µg) and chloramphenicol (30 µg) was carried out using Kirby-Bauer disc diffusion method. AST results revealed susceptibility to tetracycline, which is the drug of choice in Kenya administered as doxycycline during cholera outbreaks, among all isolates. Resistance to βeta-lactams and ciprofloxacin emerged in latter years while a decline in resistance to SXT, Chloramphenicol and Streptomycin was noted. This study gave a clear indication that there were changes in the resistance patterns whereby resistance to some antimicrobials declined and others emerged over the ten year period. In order to slow down the emergence and spread of resistance strains, care should be taken by health professionals when prescribing antimicrobials to patients suffering from cholera disease and should be restricted to only severe cases. It is also recommended that antimicrobial susceptibility testing should be done before giving antimicrobials in management of cholera cases.
Keywords: Antimicrobial resistance, Evolution, Kenya, Vibrio cholera.
Title: Trends in Antibiotic Resistance of Vibrio Cholerae Isolates in Kenya (2006 - 2015)
Author: Penina Muthoni Kung’u, Samuel Njoroge, John Kiiru, Paul Okemo, Samuel Kariuki
ISSN 2349-7823
International Journal of Recent Research in Life Sciences (IJRRLS)
Paper Publications
I reviewed several manuscripts, books, grants and project proposals. This is one of the paper I reviewed recently published in Plant Biotechnology Journal
International Journal of Pharmaceutical Science Invention (IJPSI) inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
An Overview of Array Signal Processing and Beam Forming TechniquesAn Overview...Editor IJCATR
For use as hydrophones, projectors and underwater microphones, there is always a need for calibrated sensors. Overview of
multi path and effect of reflection on acoustic sound signals due to various objects is required prior to finding applications for different
materials as sonar domes, etc. There is also a need to overview multi sensor array processing for many applications like finding
direction of arrival and beam forming. Real time data acquisition is also a must for such applications.
I reviewed several manuscripts, books, grants and project proposals. This is one of the paper I reviewed recently published in Plant Biotechnology Journal
International Journal of Pharmaceutical Science Invention (IJPSI) inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
An Overview of Array Signal Processing and Beam Forming TechniquesAn Overview...Editor IJCATR
For use as hydrophones, projectors and underwater microphones, there is always a need for calibrated sensors. Overview of
multi path and effect of reflection on acoustic sound signals due to various objects is required prior to finding applications for different
materials as sonar domes, etc. There is also a need to overview multi sensor array processing for many applications like finding
direction of arrival and beam forming. Real time data acquisition is also a must for such applications.
TJC is a place where the pursuit of academic excellence is encouraged, but also where the holistic development and growth of the students is paramount.
Hier werden einige open-source-Tools vorgestellt und es gibt eine Mind-Map zu verschiedenen Tools. tricider ist ein Brainstorming-Tool, das vom Entwickler mit vorgestellt wird.
Grazie alla nostra esperienza di più di 30 anni nel mondo della distribuzione, abbiamo elaborato un’offerta formativa specialistica per il personale di vendita.
Background &Objective: Klebsiella pneumonia causes different serious nosocomial infections for human and several strains became multiple drug resistance .This study was conducted to describe the epidemiology and molecular typing of Klebsiella pneumonia with the extended spectrum of B lactamase enzyme in Gaza strip .Methods :A cross-sectional survey was conducted during the period of December 2008 to November2009. One hundred and fifty clinical specimens were collected from patients admitted in different wards . Results : Sixty six percentage of the isolates were K.pneumonia .These were isolated from different infected sites : urine 24% , sputum 14%, wound 11% , stool11% , blood14% , cerebrospinal fluid 11% , skin16% . The ESBLs was detected in 67% of the strains ,53% strains were resistant for more than eight antibiotics , PCR demonstrated different patterns for the presence of SHV(80%) , TEM(60%) enzyme and CTX-M(20%), PFGE Showed 10 clusters of genetically unrelated strains with high prevalence of polyclonal strains of Klebsiella pneumonia. Antibiotic resistance was found against Cephalothin(95.0%),Cefotaxime(82.0%),Ceftazidime(59.0%),Ceftriaxone(86.0%),Gentamicin(56.0%),Trimethoprim/sulphamethoxazole(47.0%)..Chloramphenicol(42%),Amikacin(33%),Aztreonam (32%) and Imipenem(0%). Interpretation, Conclusion : our findings showed that genetically-related isolates of K. pneumoniae producing SHV and TEM and CTX-M were present in Gaza Strip. Larger studies need to be done to better define the molecular epidemiology of ESBL producing K. pneumoniae and its clinical implications
Presented by Dr. Jenkins at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
Background: The widespread use of antibiotics has resulted in emergence of community-acquired antibiotic resistance among uropathogens in outpatient’s population. This constitutes an impediment in the management of urinary tract infection (UTI) in both community and hospital settings. Objective: The aim of this study was to determine the current antibiotic resistance trends, extended spectrum beta-lactamase (ESBL) production and plasmid profile of uropathogens from outpatients. Methods: A total of 370 mid-stream urine samples were collected and cultured by standard methods. Isolated uropathogens were identified using appropriate biochemical methods. The modified Kirby Bauer disk method was used for antibiotic susceptibility test. The ESBL-producing uropathogens were identified and their plasmid DNA extraction and curing were carried out by standard methods. Results: About 35.7% and 32.7% of uropathogens were multi-drug resistant and ESBL-producing respectively. There was higher prevalence of ESBL-production among isolates from female patients (62.5%) when compared to that from male patients (37.5%). The isolated uropathogens were most resistant to Cefotaxime, and most sensitive to Imipenem. Resistance to antibiotics by ESBL-producing uropathogens was found to be plasmid-mediated. Conclusion: Community acquired Uropathogens from outpatients were multidrug resistant due to ESBL production localized on plasmids, a probable cause of treatment failures experienced in Uyo.
DOI: 10.21276/ijlssr.2016.2.3.5
ABSTRACT- Purpose: Multidrug resistant organisms are on rise. Various enzymes present in the organisms are
responsible for this resistance. Detection of these enzymes become challenging if organisms harbor multiple enzymes.
This study was done to find the prevalence of various enzymes at our tertiary care hospital.
Materials and methods: Extended spectrum beta lactamases (ESBL) detection was done by screening method followed
by two phenotypic confirmatory methods (double disc synergy and disc potentiation method). Carbapenems (imipenem,
meropenem) resistant strain were analyzed for metallo beta lactamases (MBL) and carbapenemases (KPC) using
combined disc test and modified Hodge test. Amp C detection was done by using cefoxitin disc on heavy lawn of E. coli
ATCC 25922. Distortion of the zone size on the streaked line of test was taken as positive for Amp C.
Results: 87.15% were screened positive for ESBL and confirmed cases were 36.80%. Carbapenem resistant was 31.86%,
MBL was 7.52%, KPC was 0.82 %, Amp C in 0.23%.
Conclusions: There is high prevalence of ESBL. Detection of these enzymes is important in routine diagnostics for
treatment. Co-expression of multiple enzymes was detected in this study. Judicious and rational use of antibiotics is
required which might lead to decrease in emergence of resistance. Also knowledge of the prevalence of these enzymes
helps in empirical antibiotic therapy and in infection control purpose.
Key-words- Multidrug resistant, ESBL, MBL, KPC, Amp C
Emergence of ESBL worldwide has become a threat to successful treatment of noocomial infections. This deals with detection and treatment of ESBL infetions.
Comparative Study of the Prevalence and Antibiogram of Bacterial Isolates fro...iosrjce
The study compared the prevalence and antibiogram of bacterial isolates from the urinary and
genital tracts of pregnant women attending ante-natal clinics in Imo State. Urine and High vaginal swab (HVS)
samples were collected from across the three geopolitical zones of Imo State (Owerri, Orlu and Okigwe).
Federal Medical Centre (FMC) Owerri, Imo State University Teaching Hospital (IMSUTH) Orlu and General
Hospital Okigwe (GHO) were used as focal points. A total of 1197 samples were obtained from women and
used. Infection was significantly more with the urine samples than the HVS samples (P < 0.05) while
polymicrobial growth was more observed with the HVS samples. Escherichia coli was the predominantly
isolated organism (38.3%) from the urine samples while Staphylococcus aureus (29.1%) was the predominant
bacterial isolates in HVS. Other commonly isolated bacterial species include; Enterococcus faecalis and
Staphylococcus epidermidis, Klebsiella pneumoniae, Proteus mirabilis and Bacteriodes were solely isolated
from urine while Lactobacillus was solely isolated from HVS. Overall antibiogram showed ciprofloxacin to be
the most effective antibiotic followed by nalidixic acid and pefloxac in for both specimens. Generally, multidrug
resistance was more in urine isolates (55.7%) than vaginal isolates (53.6%) with many showing the same
resistance patterns. The rate of multi/drug resistance in both samples is high (>50%) and worrisome. These call
for routine HVS as well as urine culture to be carried out on all antenatal women to ensure holistic antenatal care/ management.
Study on Sensitivity Pattern of Micro-Organisms in Respiratory Tract Infectio...iosrjce
Wide reports in literatures from different parts of the world revealed that antibiotics are
used both widely and indiscriminately. RTIs comprise the most common indication for consulting a general
practitioner, and obtaining an antibiotic prescription.
1. ISSN: 0975-8585
July– August 2015 RJPBCS 6(4) Page No. 903
Research Journal of Pharmaceutical, Biological and Chemical
Sciences
Analysis of β-lactamases Among Multi Drug Resistant Klebsiella pneumoniae
in Hilla city-Iraq.
Noor Salman Kadhim Al-Khafaji1
, Hasanain Khaleel Shareef2
*, and
Hussein Oleiwi Muttaleb Al-Dahmoshi3
.
1,3
Babylon University-Science faculty-Biology Dept., Iraq.
2
Babylon University- College of Science for Women, Biology Dept., Iraq.
ABSTRACT
Among urinary tract infection (UTI) pathogen, Klebsiella pneumoniae rank second, after Escherichia
coli and this may be due to seldom structural and physiological defences mechanisms like antiphagositic,
anticomplement and serum resistance capabilities. Moreover the ability to form biofilm and their production
to β-lactamases (such as ESBL) and carbapenemases (such as KPC) augment their resistance to the most
common antibiotics used to get red UTI. During a period of 3 months, 135 mid-stream urine samplescollected
from patients clinically diagnosed with cystitis who visit urology consultant clinic in Al-Hilla teaching hospital.
All urine samples firstly checked for Pyuria with general urine examination and uriscan strip. Only samples with
pyuria processed for bacteriological culture on MacConkey agar and eosin methylene blue (EMB) agar and
then finally confirmed with VITECK 2 compact system using GN card. All Klebsiella pneumoniae isolates were
tested for antibiotic susceptibility, ESBL production using both double disc synergy test and chromatic ESBL
medium and tested for KPC production using MIC test and chromatic CRE medium test.The results revealed
high percentage of Klebsiella pneumoniae isolation 23(31.9%) among cystitis patients and high sensitivity for
amikacin 2(8.7%) norfloxacin 7(30.4%) and tobramycin 9(39.1%) while high percentage of resistance displayed
to ampicillin 23(100%), ceftazidim 20(91.3%), cefotaxime 19(82.6%) and cefepime 17(73.9%) and ertapenem
10(43.5%). Investigation of ESBL and KPC were performed using DDST and chromatic ESBL medium for ESB,
MIC test strip and chromatic CRE medium for KPC. Among Klebsiella pneumoniae 10 (43.5%) and 12(52.2%)
positive DDS test and Chromatic ESBL medium respectively while 3(13%) and 4(17.4%) positive for KPC using
MIC test and Chromatic CRE medium respectively. The current study conclude occurrence of ESBL and KPC
among Klebsiella pneumoniae recovered from patients with cystitis.
Keywords: K. pneumoniae, ESBL, KPC, Cystitis, Chromatic.
*Corresponding author
2. ISSN: 0975-8585
July– August 2015 RJPBCS 6(4) Page No. 904
INTRODUCTION
Klebsiella pneumoniae, accounts for a significant proportion of urinary tract infections and the
principal pathogenic reservoirs for transmission of Klebsiella are the gastrointestinal tract and the
contaminated hands. The most important virulence of uropathogen is antibiotics resistance especially due to
hydrolyzing enzymes rendering them hard to or untreatable. Until yet β-Lactam antibiotics represent the most
common agents for treatment of most bacterial infections and at the same time regard the leading cause of
resistance to β-lactam antibiotics among Gram-negative bacteria globally. The frequent exposure of bacterial
isolates to a multitude of β-lactams induces vigorous, continuous production and mutation of β- lactamases in
these bacteria, increasing their activity even against the newly developed β-lactam antibiotics. These enzymes
are known as β-lactamases and the most important of them are Extended-spectrum β-lactamases (ESBLs) and
Klebsiella pneumoniae carbapenemase (KPC) [1, 2].
ESBLs are plasmid borne and capable of conferring bacterial resistance to the penicillins, first, second-
and third-generation cephalosporins, and aztreonam (but not the cephamycins or carbapenems). They still the
major challenge in clinical setups world over, conferring resistance to the expanded-spectrum cephalosporins
by hydrolysis of these antibiotics. ESBLs producers are clinically resistant to many β-lactams, while non- ESBLs
producers still keep a good sensitivity to most β-lactams [3, 4].As an uropathogen, Klebsiella pneumoniae have
the capability to produce extended-spectrum ß-lactamases (ESBL) in large quantities and confer multiple drug
resistance making urinary tract infection difficult to treat [5].
The presence of an ESBL is a good marker of the MDR phenotype. The drugs of choice for the
treatment of infections caused by ESBLs were carbapenem and this may leads to emerging of carbapenem
resistance isolates in certain areas [6]. At the first time the resistances to carbapenems are attributed to
overproduction of AmpC until statement of the emergence of carbapenemases as another mechanism for
carbapenem resistance. The most common carbapenemase in the United States is Klebsiella pneumoniae
carbapenemase (KPC), an Ambler molecular class A enzyme that utilizes serine at the active site to facilitate
hydrolysis of a broad variety of β-lactams. Both of them, ESBL and KPC, belong to the same class Ambler
molecular class A (subgroup 2be for ESBL and subgroup 2f for KPC) and inhibited by clavulanic acid and boronic
acid respectively [7]. The current study aims to investigate ESBL and KPC among Klebsiella pneumoniae
isolated from patients with cystitis.
MATERIALS AND METHODS
Patients and Samples
Mid-stream urine samples were collected from 135 patients with ages (10-60 years) clinically
diagnosed with cystitis. All patients visit urology consultant clinic in Al-Hilla teaching hospital during a period
December - February 2014. The patientsAll urine samples firstly checked for Pyuria with general urine
examination and uriscan strip. Only samples with pyuria processed for bacteriological culture on MacConkey
agar and eosin methylene blue (EMB) agar.
Bacterial Diagnosis
The mucoid pink to faint pink colonies on MacConkey agar were transferred to EMB agar plates. On
the EMB agar plates the mucoid (with deep purple to black center) were primary suspected as Klebsiella
pneumoniae which are further confirmed using VITECK 2 Compact system (Biomerieux/France) using GN card.
Antibiotics Susceptibility Test (AST) and Double Disc Synergy Test
This test were done according to CLSI-2013[8], including selection of antibiotics with defined potency,
test conditions and result interpretation. Double Disc Synergy Test (DDST) used to detect ESBL among K.
pneumoniae isolates were performed also according to CLSI-2013[8]. This test consist of two step, the first one
called initial screening step using third generation cephalosporin antibiotics such as cefpodoxime (10µg) or
ceftazidim (30µg) or cefotaxime (30µg) or ceftriaxone (30µg) or monobactam antibiotics like aztreonam(30µg).
When the K. pneumoniae isolates resist to one or more of the previously antibiotics will suspected as ESBL and
must confirmed by second step called phenotypic confirmatory step which use combined antibiotic disc
3. ISSN: 0975-8585
July– August 2015 RJPBCS 6(4) Page No. 905
consisted from (antibiotics+clavulanic acid). When the inhibition zone of the combined disc increased by ≥
5mm than those disc tested alone the results were positive for ESBL. The current study uses Cefotaxime (30μg)
and Ceftazidime (30μg) in the screening test and use Cefotaxime-clavulanic acid (30/10μg) and Ceftazidime-
clavulanic acid (30/10μg) in the confirmatory test.
Klebsiella pneumoniae Carbapenemase (KPC) Detection
All K. pneumonia isolates resist to meropenem and ertapenem tested for KPC using MIC Test Strip for
KPC detection using (ERTAPENEM / ERTAPENEM + BORONIC ACID) (ETP/EBO) (0.125-8 / 0.032-2 μg/mL). The
results were interpreted as positive when the ration of ETP/EBO≥8 according to the instruction of
manufacturer (Liofilchem/Italy).
Chromatic Medium Test for ESBL and KPC
Chromatic test used to check production of ESBL and KPC by K. pneumoniae isolates. This test
includes inoculation of Chromatic ESBL and chromatic CRE medium with suspected colonies and incubated
over night at 37˚C and the results were read as positive when blue-green or blue-purple colonies grown.
RESULTS AND DISCUSSION
Isolation results record positive bacterial culture for 72(52.6%) of urine samples. Klebsiella
pneumoniae isolates compile 23(31.9%) of total bacterial cultures and the others 49(68.1%) were diagnosed as
gram negative bacilli figure (1). As urinary tract pathogen K. pneumoniae is second only to Escherichia coliand
compile (6-35%) of all UTI. The high percentage of UTI caused by K. pneumoniae may be due to the unique
virulence factor like uronic acid capsule (that inhibit complement activation, protect them from phagocytosis
and empower biofilm formation). In addition to type I and type III fimbriae that play vital role in adhesion and
biofilm formation, K. pneumoniae have siderophore and serum resistance. Moreover the ability to produce
ESBL and KPC may augment their prevalence among uropathogens [9].
Figure 1: Percentage of K. pneumoniae Isolation
Antibiotics susceptibility results revealed high level resistance among K. pneumoniae isolates for
ampicillin 23(100%), ceftazidim 20(91.3%), cefotaxime 19(82.6%), cefepime 17(73.9%) and ertapenem
10(43.5%) while low level of resistance displayed for norfloxacin 7(30.4%), tobramycin 9(39.1%) and amikacin
2(8.7%) figure (2). According to in vitro results, the amikacin and norfloxacin still active against Uropathogenic
K. pneumoniae.
4. ISSN: 0975-8585
July– August 2015 RJPBCS 6(4) Page No. 906
Figure 2: Antibiotic Resistance among K. pneumoniae Isolates.
The resistance to the β-lactams antibiotics mainly due to the production of β-lactamases which
hydrolyze β-lactam ring rendering them inactive. The common β-lactamases among K. pneumoniae either ESBL
(called group 2 or molecular class A) or AmpC (called group 1 or molecular class C) which can be differentiated
according to their inhibition by clavulanic acid (ESBL inhibited while AmpC not inhibited). ESBL can hydrolyze
oxyimino-β-lactam agents such as third-generation cephalosporins and aztreonam and the isolates may carry
genes that confer resistance to other antibiotics including aminoglycosides, chloramphenicol, sulfonamides,
trimethoprim, and tetracycline [10].
The results of ESBL and KPC detection using different tests displayed that, 10 (43.5%) and 12(52.2%)
positive for ESBL using DDS test and Chromatic ESBL medium respectively while 3(13%) and 4(17.4%) positive
for KPC using MIC test and Chromatic CRE medium respectively.
Figure 3: Positive Results for ESBL and KPC among K. pneumoniae.
The most common ESBL enzymes in clinical isolates of K. pneumoniae were SHV- and TEM-type ESBL
enzymes while CTX-M type ESBL was infrequently reported [11, 12]. The CTX-M-14, which belongs to the CTX-
M-9 group, is most common variant that is greatly prevalent in some Asian and European countries [13]. The
carbapenemase enzyme produced by Klebsiella pneumoniae may cause an increase in spread of carbapenem-
resistant Enterobacteriaceae (CRE) worldwide. Patel et al state that, there is risk for KPC acquisition or
infection and found invasive infections with carbapenem-resistant K. pneumoniae were independently linked
with organ transplantation, exposure to antimicrobials and receipt of automated ventilation, in comparsion
with patients of carbapenem susceptible K. pneumoniae [14].The current study conclude occurrence of ESBL
and KPC among Klebsiella pneumoniae recovered from patients with cystitis.
5. ISSN: 0975-8585
July– August 2015 RJPBCS 6(4) Page No. 907
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