MULTIDRUG RESISTANT ENTEROBACTERIACEAE FROM BLOOD STREAM INFECTIONS AT A TERTIARY CARE HOSPITAL OF EASTERN NEPAL

Abstract

Background Blood stream infection (BSI) is one of the major causes of morbidity and mortality worldwide. It has poses significant challenge to the clinicians and clinical microbiologists alike. Therefore its accurate diagnosis, isolation and identification of causative agents with appropriate antibiotics is required. This study is aimed to find out resistance pattern, e.g. extended-spectrum-beta-lactamase (ESBL), AmpC, K1, carbapenemase and metallo-β-lactamase (MBL) among isolates obtained from BSI. Methods A cross-sectional study was conducted in the Department of Microbiology, BPKIHS from 1st September 2014 to 31st August 2015. Isolates were screened for ESBL, AmpC, K1, and carbapenemase production by ten disk method. Confirmation for ESBL was done phenotypically by using combined disk method recommended by CLSI, AmpC sterile disk method for AmpC and K1 by combined disk method. Metallo-beta-lactamase (MBL) production was detected by imipenem-ethylene-diamine-tetra acetic acid double disk synergy test. Results A total of 11,264 blood samples were collected from the patients suspected of Blood Stream Infection. Of these isolates, 192 (1.70%) were Enterobacteriaceae. Among them, 94 (49%) were ESBL, 51 (26.5%) were carbapenemase and 10 (5%) were AmpC producers. Of 51 carbapenemase producers, 22 (11.5%) were MBL producers. None of the isolates were found to produce K1 β-lactamase. A total of 64 (33.4%) isolates were MDR. Conclusion MDR Enterobacteriaceae is found to be prevalent in our set up as important cause of BSI.