بحث منشور الى المدرس عطور طالب Extended Spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae

International Journal of Current Microbiology and Applied Sciences

ISSN: 2319-7706 Volume 5 Number 9 (2016) pp. 400-404

Journal homepage: http://www.ijcmas.com

Original Research Article http://dx.doi.org/10.20546/ijcmas.2016.509.043 Extended Spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolated from Burn Wound Infections Khulood Abdulkareen Hussein*, Zainab Alag Hasan, Utoor Talib Jassim, and Abdulameer Abdullah Al-Mussawi College of Nursing, University of Basra, Basra, Iraq *Corresponding author

A B S T R A C T

To detect the extended spectrum beta lactamase (ESBL) producing Klebsiella pneumoniae isolated from burn infections using phenotypic methods, and then testing their resistance against antibiotic. Forty two bacterial isolates were collected from infected burn wounds at burn center in Al-Fayhaa General Hospital in Basra city/Iraq, then cultured on MacConkey agar to detect Klebsiella, and then cultured on CHROM agar orientation to identify K. pneumoniae. Ninteen of K. Pneumonia isolates were screened for antibiotic resistance, including: Amoxicillin (AX), Doxycycline (DO), Gentamicin (CN), Amikacin (AK),and screening it for ESBL producing. 19 (45.23%) isolates identified as K. pneumoniae, 15 (78.9%) of them were ESBL producer and 4 (21%) were ESBL nonproducer. All the nineteen isolates were resistant to Amoxicillin, 11 isolates to Doxycycline, 16 isolates to Gentamicin, and 18 isolates to Amikacin, while 15 isolates were ESBL resistant. Increasing prevalence of ESBL producing K. pneumoniae in nosocomial infections, especially in infected burn wounded this adds difficulty in curing post burn infections and may increase the rate of post burn mortality and morbidity. High number of isolates were antibiotics resistant, and this reflect the importance of implementation of susceptibility tests for successful treatment. Using CHROM agar media gives better results and faster in identifying ESBL.

Ke ywo rds

Extended-spectrum β-lactamases (ESBL),

Klebsiella pneumoniae,

β-lactamases,

burn infections, CHROMagar.

Accepted:

15 August 2016

Available Online:

10 September 2016

Article Info

Introduction

Klebsiella pneumoniae is a Gram-negative, nonmotile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. It is found in the normal flora of the mouth, skin, and intestines (Ryan et al., 2004), it can cause many infections like destructive changes to human and animal lungs if aspirated, specifically to the alveoli resulting in bloody sputum. Infection is the most common cause of morbidity and mortality in

burned patients (Gomez et al., 2009). The type and quantity of microorganisms that colonize the burn wound may influence the risk of invasive wound infection. The pathogens that infect the wound are primarily gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative bacteria such as Acinetobacter baumannii-calcoaceticus complex, Pseudomonas aeruginosa, and Int.J.Curr.Microbiol.App.Sci (2016) 5(9): 400-404 401

Klebsiella species. These latter pathogens are notable for their increasing resistance to multiple antimicrobial agents (Keen et al., 2010; Albrecht et al., 2006).

Length of hospital stay and performance of invasive procedures are risk factors for acquisition of resistance strains.Current evidence implicates plasmids as the primary source of the resistance genes in Klebsiella species (Hudson et al., 2014). With the ability to produce extended-spectrum beta-lactamases (ESBL), Klebsiella is resistant to many classes of antibiotics. The most frequent are resistance to aminoglyco-sides, fluoroquinolones, tetracyclines, chloramphenicol and trimethoprim/ sulfa-methoxazole (Nathisuwan et al., 2001).

Increasing the incidence of infections with extended-spectrum β-lactamase (ESBL)-producing organisms has resulted in a therapeutic dilemma, as the choice of antibiotics is limited because of ESBL production (Paterson, 2000). The interactive effects of β-lactams are mediated through the inhibition of the bacterial cell wall and protein synthesis, respectively. Combination therapy with β-lactams and aminoglycosides is well accepted for the treatment of bacteremia caused by ESBL-producing K. pneumoniae isolates (Paterson et al., 2004) as well as other systemic infections (Korvick et al., 1992).

Prevent spreading Klebsiella infections between patients is a very important application, healthcare personnel must follow specific infection-control precautions (Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007), including strict adherence to hand hygiene and wearing gowns and gloves when they dealing with patients with Klebsiella–related illnesses. Healthcare facilities also must follow strict cleaning procedures to prevent the spread of Klebsiella.

Methodology

Forty two bacterial isolates were collected from burn center in Al-Fayhaa General Hospital in Basra city Basra/ Iraq during the period from 01 March to 30 May 2015. Nineteen isolates were identified as Klebsiella by culturing on MacConkey agar, then identified as K. pneumoniae by culturing on CHROMagar Orientation (CHROM agar™, Paris, France) with supplement, then incubated aerobically at 37°C for 18 to 24 h. Appearance of coloured colonies on the chromogenic medium was considered a positive test result.

Susceptibility against Amoxicillin (AX), Doxycycline (DO), Gentamicin (CN), Amikacin (AK) and Extended spectrum β-lactamase antibiotics by using ISBL CHROM agar (Paris, France).

Results and Discussion

A total of 19/42(45.23%) K. pneumoniae isolates were obtained from infected burn wounds. K. pneumoniae colonies identified by morphological and biochemical characterization. Also CHROM agar Orientation was used for selective and differential colonies of K. pneumoniae.

Among 19 isolates of K. pneumoniae, 15(78.9%) isolates exhibited extended spectrum β-lactamase activity and showed metallic blue colonies on CHROMagar Orientation. The activities of 4antibioticsagainst isolates as shown in table (1), Figure (1).

In addition to pneumonia, Klebsiella can also cause infections in the urinary tract, lower biliary tract, and surgical wound sites. The range of clinical diseases includes pneumonia, thrombophlebitis, urinary tract infection, cholecystitis, diarrhea, Int.J.Curr.Microbiol.App.Sci (2016) 5(9): 400-404 402

upper respiratory tract infection, wound infection, osteomyelitis, meningitis, and bacteremia and septicemia.