Prevalence & antimicrobial resistance pattern of extended spectrum beta-lactamase producing Klebsiella spp isolated from cases of neonatal septicaemia

Abstract

Background & objective: Extended spectrum beta-lactamase (ESBL) producing Klebsiella spp led to serious concern about septicaemic neonates in neonatal intensive care units (NICU) due to high resistance against commonly used antimicrobial agents. Knowledge of disease burden and information on resistance to antimicrobials are required for proper management of such cases in NICUs. Here we report the prevalence and resistance pattern of ESBL producing Klebsiella spp isolated from cases of neonatal septicaemia at a tertiary care hospital from north India.

Methods: A total of 100 clinical isolates of Klebsiella spp isolated from 2995 blood samples of suspected cases of neonatal septicaemia were studied. Antimicrobial susceptibility was determined by Kirby- Bauer's disc diffusion method. All isolates were screened for ESBL production on the basis of inhibition zone against cephotaxime (<27 mm) and ceftazidime (<22 mm) and a breakpoint of minimum inhibitory concentration (MIC) (<2 microg/ml for cephotaxime and <8 microg/ml for cefpodoxime) by agar dilution method. Resistance pattern of ESBL producers and non-ESBL producers was compared.

Results: Of the 100 Klebsiella isolates, 58 were positive for ESBL production, which was much lower than 86.6 per cent reported in 2003. Almost all the isolates were sensitive to imipenam and meropenam. Drug resistance was found to be significantly more common in ESBL producing isolates than in non-ESBL producers.

Interpretation & conclusion: We found that 56 per cent of Klebsiella spp isolates were ESBL producers. There is a need to carefully formulate therapeutic strategies to control infections in NICUs. The high percentage of drug resistance in ESBL producing Klebsiella spp suggests that routine detection of ESBL is required by reliable laboratory methods.