A STUDY ON PREVALENCE OF URINARY TRACT INFECTIONS DUE TO EXTENDED SPECTRUM BETA LACTAMASE PRODUCING KLEBSIELLA SPECIES & ESCHERICHIA COLI BY PHENOTYPIC METHODS FROM CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL

Background:Urinary tract infections(UTIs) are the most commonly encountered bacterial infection, particularly in women.Escherichia coli and Klebsiella spp are the most common organisms causing urinary tract infection(UTI) and is responsible for Extended spectrum beta lactamases(ESBL) production.Emergence of extended spectrum beta lactamases producing strains of gram negative bacteria leads to serious infection that complicates the treatment and clinical outcome.ESBL enzymes shows increased hydrolysis of oxyimino-β lactams that have been reported increasingly in recent years and are significantly detected from various Escherichia coli & klebsiella strains. This study is conducted to know the prevalence of ESBL producing Escherichia coli & Klebsiella spp causing urinary tract infection in our health care facility. Materials And Methods:This is a prospective study done in the Department of Microbiology,P.K Das Institute of Medical sciences, Vaniamkulam from a period of November 2022- September2023.Urine specimens received from both In-patients and Out-patients of P.K Das Institute of Medical sciences&hospitalsduring the study period were subjected to culture in the bacteriology laboratory ,Department of Microbiology ,according to CLSI guidelines.Antibiotic susceptibility testing was done by modified Kirby-Bauer disc diffusion method on Muller-Hinton agar.ESBL producing organisms were identified using Ceftazidime disks (30µg) with or without Clavulanate(10µg) was used for phenotypic conformation of the presence of ESBL as recommended by CLSI guidelines 2022. Results: Out of the 2065 samples processed during theperiod of November 2022 – September 2023, 576 samples were culture positive for Escherichia coli and Klebsiella . Out of the 576 culture positive samples 372 (64.6%)were Escherichia coli isolates & 204 were Klebsiella spp(35.4%). Out of the total 576 culture positives , 339 (59%)were females & 237(41%) were males.Out of the total 576 culture positive Escherichia coli and klebsiella spp, 198 (34.3%) were ESBL producers,of which 122 out of 372 ESBL producers were of Escherichia coli isolates and 76 out of 204 ESBL producers were of Klebsiella spp.Among 576 culture positive isolates , 294 were obtained from Inpatients samples and 282 isolates were outpatient samples in the study whereas 102 out of 198 and 96 out of 198 were inpatients and outpatients respectively among the ESBL producers. In the study , 99% Escherichia coli and 97.8% Klebsiella spp which were ESBL producers were susceptible to carbapenams.The susceptibility to Piperacillin /tazobactam, cefoperazone/sulbactam, fluroquinolones , Nitrofurantoin ,Amoxicillin/clavulanic acid, ceftazidime/clavulanate , aminoglycosides were in between 50 % up to 95% for isolates of both the organisms which were ESBL producers. Conclusion: The ESBL producing Escherichia coli & Klebsiella spp are a cause of concerns to the microbiologist as well as to the clinicians, particularly the multidrug resistant strains. Screening for these resistant pathogen might eventually become necessary as ESBLs become more of an issue in hospitals and community settings especially in high risk units where infections caused by resistant organisms are more. Conflict Of Interest: No conflict of interest.