Shamim Mumtaz, Mumtaz Ahmad, Naeem Akhtar, Abdul Hameed.
Extended-spectrum lactamase (ESBL) mediated resistance to third generation cephalosporins among escherchia coli.
Ann Pak Inst Med Sci Jan ;4(1):18-22.

Background: ESBLs producing strains of Enterobacteriaceae have emerged as a major problem in hospitalized as well as community based patients. Infections due to ESBL-producers range from uncomplicated urinary tract infection to life threatening sepsis. Objective: The objective of this study was to find out the incidence of extended-spectrum ß- lactamase (ESBL)-producing Escherichia coli isolated from various samples and to found out its sensitivity pattern and compare it with the sensitivity pattern of ESBLs-non–producing Escherichia coli . Subjects and Methods: This descriptive study was conducted at the Microbiology department of Fauji Foundation Hospital Rawalpindi over a period of two years, (March 2004- April 2006). Multidrug resistance and ESBL- production was studied in a total of 193 isolates of Escherichia coli obtained from patients aged 0-70 years including both males and females from indoor and outdoor patients by the help of double disc diffusion technique. Results: Out of 263 isolates of Escherichia coli ESBL- production was detected in 125 strains (47.5%).Considerable resistance was demonstrated among the E.coli strains against all the commonly used antibiotics including ß-lactams. There was hardly any antibiotic showing 100% sensitivity that was tested against sufficient number of organisms, even carbapenems and beta-lactam/beta-lactamase inhibitors had developed resistance. The sensitivity pattern showed reduced sensitivity not only towards 3rd generation cephalosporins but also revealed cross-resistance towards most of the other antibiotics. Only some of the antibiotics exhibited high sensitivity against both ESBLs-producing and non-ESBLs-producing E.coli like carbapenems, beta-lactam/ beta-lactamase inhibitors and fosfomycin. Conclusions: It is very important to screen for ESBLs-production routinely by all the laboratories For the treatment of serious life threatening infections by ESBLs-producers, best antibiotics are carbapenems, b-lactam/b-lactamase inhibitor combinations and fosfomycin. On the other hand, regarding ESBLs non-producer, most of the conventional cheap antibiotics would be effective to combat the infection.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com