Shamim Mumtaz, Mumtaz Ahmad, Naeem Akhtar, Abdul Hameed.
Extended spectrum ß-lactamases in urinary gram-negative bacilli and their susceptibility pattern.
Pak J Med Res Jan ;47(4):75-8.

Background: Beta-lactamases of Gram-negative bacteria are the most important mechanism of resistance against ß–lactams. Two types of ß-lactamases can confer resistance against third generation cephalosporins; inducible chromosomal ß-lactamases, and extended-spectrum ß-lactamases. The extended-spectrum ß-lactamases producing strains of Enterobacteriaceae have emerged as a major problem in hospitalized as well as community based infections resulting in range of infections from uncomplicated urinary tract infection to life threatening sepsis. Objectives: To find out the prevalence of extended-spectrum ß-lactamases producing Gram- negative bacilli among urinary isolates and their sensitivity pattern. Materials and Methods: The study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years (April 2004-March 2006). Multidrug resistance and extended-spectrum ß-lactamases production was studied in 111 enteric Gram-negative bacilli isolated from urine of symptomatic patients (1-70 years) including males and females from indoor and outdoor patients by using double disc diffusion technique. Results: Prevalence of extended-spectrum ß-lactamases production was seen in 71 (61.2%) enteric gram-negative organisms, the most prevalent gram-negative organism was Klebsiella pneumoniae 40 (71.4%) followed by Escherichia coli 27 (62.8%) and Pseudomonas aeruginosa 3 (25%). The extended-spectrum ß-lactamases producers were more prevalent in indoor patients 63 (88.7%) compared to outdoor patients 8 (11.3%), more in females 43 (60.6%) than males, 28 (39.4%). The extended-spectrum ß-lactamases producing gram-negative rods had more antibiotic-resistant profile than non-producers. Conclusions: All enteric gram negative rods should be tested for the production of extended-spectrum ß-lactamases in routine microbiology laboratory.

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