Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal
Background. Extended-spectrum β-lactamase (ESBL)- and AmpC-β-lactamase-producing Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, there...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Canadian Journal of Infectious Diseases and Medical Microbiology |
| Online Access: | http://dx.doi.org/10.1155/2020/5154217 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832547151553495040 |
|---|---|
| author | Dipendra Kumar Mandal Shiv Kumar Sah Shyam Kumar Mishra Sangita Sharma Hari Prasad Kattel Sanjeet Pandit Pranav Kumar Yadav Ujjwal Laghu Rajani Lama Niranjan Prasad Sah Jeevan Bahadur Sherchand Keshav Parajuli Anup Bastola Sher Bahadur Pun Basista Prasad Rijal Bharat Mani Pokharel |
| author_facet | Dipendra Kumar Mandal Shiv Kumar Sah Shyam Kumar Mishra Sangita Sharma Hari Prasad Kattel Sanjeet Pandit Pranav Kumar Yadav Ujjwal Laghu Rajani Lama Niranjan Prasad Sah Jeevan Bahadur Sherchand Keshav Parajuli Anup Bastola Sher Bahadur Pun Basista Prasad Rijal Bharat Mani Pokharel |
| author_sort | Dipendra Kumar Mandal |
| collection | DOAJ |
| description | Background. Extended-spectrum β-lactamase (ESBL)- and AmpC-β-lactamase-producing Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC-β-lactamase-producing Enterobacteriaceae and also to determine their drug resistance pattern. Methods. During a 6-month period (November 2014–April 2015), a total of 190 stool specimens from 190 participants were obtained from different population. Of the total 260 fecal isolates, 152 from outpatient department (OPD) and 108 from healthy volunteer were collected. Stool specimens were cultured and enterobacterial isolates were subjected to antimicrobial susceptibility tests according to the standard microbiologic guidelines. ESBL was screened using ceftazidime (CAZ, 30 μg) and cefotaxime (CTX, 30 μg) disks and confirmed by double-disk synergy test. AmpC-β-lactamase enzyme production was detected by the aminophenylboronic acid inhibitor-based detection method. Antibiotic susceptibility test was performed for ESBL-positive isolates as per the Kirby-Bauer disk diffusion method, and interpretation was done according to CLSI (Clinical and Laboratory Standard Institute). Results. The prevalence of ESBL, AmpC-β-lactamases, and coproducer (ESBL + AmpC-β-lactamase) producing Enterobacteriaceae in OPD participants were 30.92%, 18.4%, and 13.81%, respectively, while 25%, 6.4%, and 1.8% in healthy population. ESBL-producing E. coli was 70.2% followed by K. pneumoniae (12.7%), and among AmpC-β-lactamase producer, E. coli were detected in half of the isolates (14/28, 50.0%) among OPD patients. Similarly, E. coli remained the most frequent ESBL producers 21/27 (77.8%) followed by K. pneumoniae 4/27 (14.21%) in healthy participants, and K. pneumoniae 5/7 (71.42%) and C. freundii 2/7 (28.57%) were detected highest among AmpC-β-lactamase-producing isolates. All isolates were highly sensitive (100%) to imipenem in both OPD and healthy participants. Conclusion. Our study revealed a high prevalence of ESBL- and AmpC-β-lactamase-producing enteric pathogen in Nepalese OPD and healthy population. The significant increase of these isolates and increased rate of drug resistance indicates a serious threat that stress the need to implement the surveillance system and a proper control measure so as to limit the spread of ESBL-producing Enterobacteriaceae (ESBL-PE) in both OPD as well as in community. Therefore, healthcare providers need to be aware that ESBL- and AmpC-β-lactamase-producing strains are not only circulating in hospital environments but also in the community and should be dealt with accordingly. |
| format | Article |
| id | doaj-art-6b04ad3fca164739986c7670edd7625d |
| institution | Kabale University |
| issn | 1712-9532 1918-1493 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Infectious Diseases and Medical Microbiology |
| spelling | doaj-art-6b04ad3fca164739986c7670edd7625d2025-02-03T06:45:54ZengWileyCanadian Journal of Infectious Diseases and Medical Microbiology1712-95321918-14932020-01-01202010.1155/2020/51542175154217Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in NepalDipendra Kumar Mandal0Shiv Kumar Sah1Shyam Kumar Mishra2Sangita Sharma3Hari Prasad Kattel4Sanjeet Pandit5Pranav Kumar Yadav6Ujjwal Laghu7Rajani Lama8Niranjan Prasad Sah9Jeevan Bahadur Sherchand10Keshav Parajuli11Anup Bastola12Sher Bahadur Pun13Basista Prasad Rijal14Bharat Mani Pokharel15Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, NepalFaculty of Pharmaceutical Science, Purbanchal University, Little Buddha College of Health Science, Minbhawan, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalNational Public Health Laboratory, HIV Reference Unit, Kathmandu, NepalDepartment of Laboratory Medicine, Udaypur District Hospital, Udaypur, NepalDepartment of Microbiology, Grande International Hospital, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalSukraraj Tropical and Infectious Diseases Hospital, Teku, Kathmandu, NepalSukraraj Tropical and Infectious Diseases Hospital, Teku, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalDepartment of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, NepalBackground. Extended-spectrum β-lactamase (ESBL)- and AmpC-β-lactamase-producing Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC-β-lactamase-producing Enterobacteriaceae and also to determine their drug resistance pattern. Methods. During a 6-month period (November 2014–April 2015), a total of 190 stool specimens from 190 participants were obtained from different population. Of the total 260 fecal isolates, 152 from outpatient department (OPD) and 108 from healthy volunteer were collected. Stool specimens were cultured and enterobacterial isolates were subjected to antimicrobial susceptibility tests according to the standard microbiologic guidelines. ESBL was screened using ceftazidime (CAZ, 30 μg) and cefotaxime (CTX, 30 μg) disks and confirmed by double-disk synergy test. AmpC-β-lactamase enzyme production was detected by the aminophenylboronic acid inhibitor-based detection method. Antibiotic susceptibility test was performed for ESBL-positive isolates as per the Kirby-Bauer disk diffusion method, and interpretation was done according to CLSI (Clinical and Laboratory Standard Institute). Results. The prevalence of ESBL, AmpC-β-lactamases, and coproducer (ESBL + AmpC-β-lactamase) producing Enterobacteriaceae in OPD participants were 30.92%, 18.4%, and 13.81%, respectively, while 25%, 6.4%, and 1.8% in healthy population. ESBL-producing E. coli was 70.2% followed by K. pneumoniae (12.7%), and among AmpC-β-lactamase producer, E. coli were detected in half of the isolates (14/28, 50.0%) among OPD patients. Similarly, E. coli remained the most frequent ESBL producers 21/27 (77.8%) followed by K. pneumoniae 4/27 (14.21%) in healthy participants, and K. pneumoniae 5/7 (71.42%) and C. freundii 2/7 (28.57%) were detected highest among AmpC-β-lactamase-producing isolates. All isolates were highly sensitive (100%) to imipenem in both OPD and healthy participants. Conclusion. Our study revealed a high prevalence of ESBL- and AmpC-β-lactamase-producing enteric pathogen in Nepalese OPD and healthy population. The significant increase of these isolates and increased rate of drug resistance indicates a serious threat that stress the need to implement the surveillance system and a proper control measure so as to limit the spread of ESBL-producing Enterobacteriaceae (ESBL-PE) in both OPD as well as in community. Therefore, healthcare providers need to be aware that ESBL- and AmpC-β-lactamase-producing strains are not only circulating in hospital environments but also in the community and should be dealt with accordingly.http://dx.doi.org/10.1155/2020/5154217 |
| spellingShingle | Dipendra Kumar Mandal Shiv Kumar Sah Shyam Kumar Mishra Sangita Sharma Hari Prasad Kattel Sanjeet Pandit Pranav Kumar Yadav Ujjwal Laghu Rajani Lama Niranjan Prasad Sah Jeevan Bahadur Sherchand Keshav Parajuli Anup Bastola Sher Bahadur Pun Basista Prasad Rijal Bharat Mani Pokharel Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal Canadian Journal of Infectious Diseases and Medical Microbiology |
| title | Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal |
| title_full | Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal |
| title_fullStr | Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal |
| title_full_unstemmed | Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal |
| title_short | Carriage of Extended-Spectrum-β-Lactamase- and AmpC-β-Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal |
| title_sort | carriage of extended spectrum β lactamase and ampc β lactamase producing enterobacteriaceae esbl pe in healthy community and outpatient department opd patients in nepal |
| url | http://dx.doi.org/10.1155/2020/5154217 |
| work_keys_str_mv | AT dipendrakumarmandal carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT shivkumarsah carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT shyamkumarmishra carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT sangitasharma carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT hariprasadkattel carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT sanjeetpandit carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT pranavkumaryadav carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT ujjwallaghu carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT rajanilama carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT niranjanprasadsah carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT jeevanbahadursherchand carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT keshavparajuli carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT anupbastola carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT sherbahadurpun carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT basistaprasadrijal carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal AT bharatmanipokharel carriageofextendedspectrumblactamaseandampcblactamaseproducingenterobacteriaceaeesblpeinhealthycommunityandoutpatientdepartmentopdpatientsinnepal |