Characterization of plasmid mediated AmpC producing Escherichia coli clinical isolates from a tertiary care hospital in South India.
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Date
2014-04
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Abstract
Context: Plasmid mediated AmpC (pAmpC) β-lactamase producing Escherichia
coli are an emerging problem worldwide as they are now exhibiting resistance
to multiple classes of antibiotics and are a major cause of therapeutic failure.
Aims: The aim of this study was to characterize pAmpC β-lactamase producing
extraintestinal E. coli, their phylogenetic distribution, resistance pattern,
treatment options, and impact on patient’s clinical outcome. Settings and
Design: This descriptive study was carried out in a multi-specialty tertiary care
hospital. Materials and Methods: A total of 300 clinically signifi cant, non-repeat
isolates were studied. AmpC disk test was used for phenotypic AmpC-β-
lactamase detection. Molecular types of pAmpC were determined by a multiplex
polymerase chain reaction (PCR). Phylogenetic analysis was performed by
triplex PCR methods. Metallo-beta-lactamase (MBL) detection was done by E
test. Antibiogram, treatment, and clinical outcome were collected in a structured
proforma. Results: Although 95 isolates (32%) were phenotypically positive for
AmpC, PCR detected CIT type of AmpC gene in only 37 isolates. Majority of
strains were from phylogroup A (85%) and B1 (58%) which are considered as
commensal groups. Co-production of ESBL’s was observed in 33 strains and 5
strains were found to be MBL producers. Most widely prescribed antibiotics were
3rd generation cephalosporins (30%), carbapenems (19%) and aminoglycosides
(16%). Conclusions: Plasmid mediated AmpC producing isolates were found to
exhibit a high degree of drug resistance, and they mainly belonged to commensal
strains possibly due to misuse of antibiotics. Proper antibiotic policy is required
to limit the spread of pAmpC producers or else it will lead to a therapeutic dead
end in the near future.
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Keywords
Clinical outcome, multidrug-resistance, multiplex polymerase chain reaction, phylogenetic group, plasmid mediated AmpC β-lactamases
Citation
Chakraborty Arindam, Adhikari Prabha, Shenoy Shalini, Saralaya Vishwas. Characterization of plasmid mediated AmpC producing Escherichia coli clinical isolates from a tertiary care hospital in South India. Indian Journal of Pathology & Microbiology. 2014 Apr-Jun 57 (2): 255-258.