Qadeer S, Javed I, Mushtaq S, Anwar M S.
Frequency Of Extended Spectrum B-Lactamases (ESBLS) And AMP C B-Lactamase Producing Escherichia Coli And Klebsiella Pneumoniae Isolated From Neonatal Sepsis In A Tertiary Care Hospital, Lahore.
Biomedica Jan ;33(2):89-95.

Background and Objectives: ESBLs and Amp C producers are resistant to variety of antimicrobials which has made treatment strategies complicated. The main objective of study is to determine the frequency of ESBLs and Amp C beta lactamase producing Escherichia coli and Klebsiella pneumonia isolated from neonatal sepsis in a tertiary care hospital Lahore. Methods: It is a descriptive study carried out on blood samples from clinically suspected septicemic neonates. 95 positive blood cultures with clinical signs and symptoms of sepsis were included in this study in PGMI, Lahore. The blood cultures were taken before the start of antimicrobial therapy. Blood culture reports were assessed for identification by standard methods. Escherichia coli and Klebsiella pneumoniae were identified by using API 20E kit. Antimicrobial susceptibility testing was carried out by Modified Kirby Bauer disk diffusion method on Mueller Hinton agar using CLSI protocols. ESBLs screening and confirmation was done according to CLSI recommendations. Boronic acid disk test was used for detection of Amp C producers. Results: Out of the 450 blood samples, 95 (21.1%) were culture positive. Among 95 positive blood cultures, Gram negative organisms were recovered from 56 (58.9%). Among Gram negative organisms 13 (23.2%) Esherichia coli and 10 (17.8%) Klebsiella pneumoniae were isolated. 46.1% and 60% isolates of Esherichia coli and Klebsiella pneumoniae were ESBLs producers. Pure Amp C production was seen in 30.7% and 20% of E.coli and K.pneumoniae respectively. However, co-production was observed in 23% E.coli and 20% K.pneumonia isolates. ESBLs producing E.coli and K.pneumoniae showed 100% resistance to amoxicillin-clavulanic acid, ceftazidime, ceftriaxone, cefotaxime and aztreonam. Similarly pure Amp C producers showed 100% resistance to cefoxitin, ceftazidime, ceftriaxone, cefotaxime and aztreonam respectively. Conclusion: It is very important to differentiate between ESBLs and Amp C producers. Boronic acid compound is a practical and most efficient method to detect Amp C beta lactamase enzymes.

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