PREVALENCE AND ANTIMICROBIAL RESISTANCE PROFILE OF ESBL-PRODUCING ENTEROBACTERIACEAE ISOLATED FROM INTENSIVE CARE UNIT PATIENTS IN A TERTIARY CARE HOSPITAL
Main Article Content
Keywords
ESBL, Enterobacteriaceae, ICU, Antibiotic resistance, Carbapenem, E. coli, Klebsiella spp.
Abstract
Background: Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae are an escalating threat to global healthcare, particularly in Intensive Care Units (ICUs), due to their capacity for multidrug resistance and nosocomial spread.
Objective: To determine the prevalence and antimicrobial resistance profile of ESBL-producing Enterobacteriaceae among ICU patients in a tertiary care hospital.
Methods: 100 clinical samples from ICU patients were processed using standard bacteriological methods. ESBL production was confirmed by phenotypic techniques including Combined Disk Test (CDT), Double Disk Synergy Test (DDST), and Three-Dimensional Test (TDT). Antimicrobial susceptibility was determined by the Kirby–Bauer method per CLSI 2024 guidelines.
Results: Of 100 samples, 58 isolates belonged to Enterobacteriaceae, among which 42 (72.4%) were ESBL producers. E. coli (52.3%) and Klebsiella spp. (38%) were predominant. Resistance was highest to β-lactams and third-generation cephalosporins, while carbapenems remained effective.
Conclusion: The high prevalence of ESBL-producing Enterobacteriaceae in ICU settings highlights an urgent need for robust antibiotic stewardship and infection control policies.
References
2. CDC. Antibiotic resistance threats in the United States. Atlanta: CDC; 2022.
3. Bush K, Bradford PA. Epidemiology of β-lactamase-producing pathogens. Clin Microbiol Rev. 2020;33(2):e00102-19.
4. Paterson DL, Bonomo RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev. 2005;18(4):657–86.
5. Rawat D, Nair D. Extended-spectrum β-lactamases in Gram-negative bacteria. J Glob Infect Dis. 2010;2(3):263–74.
6. Jacoby GA. AmpC β-lactamases. Clin Microbiol Rev. 2009;22(1):161–82.
7. Schwaber MJ, Carmeli Y. Mortality and hospital stay associated with ESBL production. J Antimicrob Chemother. 2007;60(5):913–20.
8. Kumarasamy KK et al. Emergence of multidrug-resistant bacteria in India. Lancet Infect Dis. 2010;10(9):597–602.
9. Shakil S et al. Antibiotic resistance among Gram-negative pathogens. Indian J Med Microbiol. 2011;29(3):230–5.
10. Kaur J et al. Prevalence of ESBL-producing Enterobacteriaceae in ICU. J Clin Diagn Res. 2016;10(9):DC19–DC23.
11. Shahid M et al. ESBL prevalence and characterization in North India. J Med Microbiol. 2012;61(3):309–14.
12. Bhattacharya S. ESBLs in India: a growing concern. J Assoc Physicians India. 2013;61(10):703–11.
13. Datta P et al. Phenotypic detection of ESBL producers. Indian J Pathol Microbiol. 2012;55(3):344–7.
14. Behera B et al. Prevalence of ESBL-producing E. coli and Klebsiella. J Lab Physicians. 2015;7(1):11–5.
15. Singh A et al. Antimicrobial resistance trends in Enterobacteriaceae. Indian J Med Res. 2021;153(6):726–33.
16. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. CLSI; 2024.
17. Tamma PD et al. Treatment of infections caused by ESBL-producing organisms. Clin Infect Dis. 2021;72(7):1109–16.
18. Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev. 1995;8(4):557–84.
19. Iqbal J et al. ESBL prevalence among ICU isolates. Pak J Med Sci. 2017;33(5):1103–8.
20. Paterson DL. Resistance due to ESBL-producing Enterobacteriaceae. Clin Infect Dis. 2000;31(Suppl 2):S135–43.
21. Rawat D, Nair D. J Glob Infect Dis. 2010;2(3):263–74.
22. Sharma R et al. Prevalence of ESBL-producing Enterobacteriaceae. Int J Med Microbiol Res. 2019;9(2):45–9.
23. Aggarwal R et al. Antimicrobial profile of ESBL-producing Klebsiella. Indian J Med Microbiol. 2018;36(3):389–93.
24. Nordmann P et al. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2011;17(10):1791–8.
25. Doi Y et al. Carbapenem-resistant Enterobacteriaceae. Clin Infect Dis. 2017;64(5):628–34.
26. Thomson KS, Sanders CC. Detection of ESBLs in Enterobacteriaceae. J Clin Microbiol. 1992;30(2):376–81.
27. CLSI M100-S33. CLSI; 2024.
28. Gandra S et al. Trends in antibiotic resistance in India. Clin Infect Dis. 2016;63(12):1569–75.
29. Goel N et al. ICU infections and antimicrobial resistance in India. J Infect Dev Ctries. 2019;13(8):695–702.
30. Guh AY et al. Prevention strategies for multidrug-resistant organisms in healthcare. Clin Infect Dis. 2021;72(7):S3–S10.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Sonika Bhagat
Senior Resident, Department of Microbiology, Guru Gobind Singh Medical College, Faridkot, Punjab, India.
Lt. Col. Taranjit Singh
Medical Officer, AMC, India.
Dr. Seetu Priya
PG, Department of Pathology, GMC Jammu, India.
Dr. Shashi Sudhan Sharma
Professor and Head, Department of Microbiology, GMC Jammu, India.