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Prevalence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in an urban hospital in Dhaka, Bangladesh

https://doi.org/10.1016/j.ijantimicag.2004.05.007Get rights and content

Abstract

The prevalence of extended-spectrum β-lactamases (ESBL)-producing organisms in an urban hospital in Dhaka City was assessed over a 10-month period. A double disk test was performed to detect ESBL-producing Escherichia coli and Klebsiella pneumoniae. 43.2% and 39.5% of E. coli and K. pneumoniae had ESBL phenotypes, respectively. The combination of augmentin with ceftazidime detected the most ESBL-producing E. coli (39.5%) while augmentin with ceftriaxone was the best combination for the detection of ESBL (31.6%) in K. pneumoniae.

Introduction

Bacterial antibiotic resistance has become a major clinical concern worldwide including Bangladesh [1], [2], [3]. Recently, the use of second and third generation cephalosporins has led to the selection of Gram-negative organisms resistant to β-lactamase stable cephalosporins. This resistance is attributed to the production of extended-spectrum β-lactamases (ESBL) [4], [5], [6], [7], [8]. ESBL-producing organisms have been reported from many parts of the world [5], [6], [7] but so far no study has determined the prevalence of ESBL-producing bacteria in Bangladesh.

This study was designed to detect the prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae in clinical specimens from an urban hospital in Dhaka city.

Section snippets

Study population and types of specimen

All the samples were collected from hospitalized patients of a 550-bed referral hospital of Dhaka City, Bangladesh. Each infected anatomical site was considered to be a separate infection regardless of whether the pathogen was the same or different and each patient was sampled once. Samples were collected over a 10-month period from both sexes and different age groups. The specimen types included in this study were urine, pus, sputum, blood, vaginal swab and throat swab. ESBL were only looked

Results

During the 10-month study period, a total of 393 E. coli and K. pneumoniae were isolated from various specimens; antibiograms and production of ESBLs were recorded.

The majority of the specimens were urine (48.09%), sputum (22.39%) and pus (18.07%). The detail antibiotic sensitivity pattern of the E. coli and K. pneumoniae isolates is given in Table 1. About 45–66% isolated E. coli and K. pneumoniae were sensitive to third generation cephalosporin such as ceftriaxone, ceftazidime and cefotaxime.

Discussion

It was observed that 43.2% and 39.5% of isolated E. coli and K. pneumoniae had ESBL phenotypes. ESBL-positive E. coli and K. pneumoniae were isolated from all types of specimen studied. This rate is higher than that of countries of the western Pacific region [4], North America or Europe and some South American nations [5], [7]. Since no previous data is available about the prevalence of ESBL-positive E. coli and K. pneumoniae in Bangladesh, it is assumed that this high rate of ESBL-positive

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