Rabia Anjum, Javaid Usman, Maria Mushtaq Gill, Nazish Babar.
Fecal Carriage and Antibiogram of Extended Spectrum Beta-lactamase Producing Enterobacteriaceae in Patients at a Tertiary Care Hospital in Rawalpindi.
Infect Dis J Jan ;22(2):549-52.

Objective: The presence of extended spectrum beta-lactamase (ESBL) producing Escherichia coli in the gut not only contributes to extra-intestinal infections, but can also result in the transfer of antimicrobial-resistance genes to other susceptible strains carried as commensals in the gut flora, resulting in increased treatment failures, increased mortality and a higher cost of care. We aim to determine the fecal carriage and antimicrobial susceptibility pattern of extended spectrum beta lactamase producing enterobacteriaceae in patients at a tertiary care hospital in Rawalpindi. Methods: We conducted a descriptive study at the Department of Microbiology, Army Medical College/National University of Sciences and Technology, from January 2012 to June 2012 on fecal samples from patients of Military Hospital, Rawalpindi, Pakistan. Two hundred and twelve fecal samples were tested for extended spectrum beta lactamase (ESBL)enzyme by double disc method; Co-Amoxiclav (AMC) (20µg/10 µg) disc placed in the centre with Aztreonam (AZT) (30µg) and ceftriaxone (CRO) (30µg) discs. Antimicrobial sensitivity was then carried out for each by the modified Kirby-Bauer disc diffusion method. Results: From the 212 fecal samples, fifty eight isolates were extended spectrum beta-lactamase producers with majority of the (38.76%) samples from admitted patients. Escherichia coli was the most frequently isolated (69%) ESBLproducing organism. The antimicrobial susceptibilities were higher for Carbapenem (100%), Tigecycline (98.3%), Amikacin (94.8%), Piperacillin/ Tazobactam (75.8%)and Cefoperazone/Sulbactam (63.8%) as compared to Ciprofloxacin (48.3%), Gentamicin (51.7%) and Co-Amoxiclav (32.75%). Conclusion: This study shows an alarmingly high fecal carriage rate of extended spectrum beta lactamase producing Enterobacteriaceae in our setting.

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