Rath Shakti, Padhy Rabindra N
Department of Botany, B.J.B. Autonomous College, Bhubaneswar 751014, Odisha, India; Central Research Laboratory, IMS and Sum Hospital, Siksha 'O' Anusandhan University, Bhubaneswar 751003, Odisha, India.
Department of Botany, B.J.B. Autonomous College, Bhubaneswar 751014, Odisha, India; Central Research Laboratory, IMS and Sum Hospital, Siksha 'O' Anusandhan University, Bhubaneswar 751003, Odisha, India.
J Infect Public Health. 2014 Nov-Dec;7(6):496-507. doi: 10.1016/j.jiph.2014.05.002. Epub 2014 Jul 2.
The Gram-negative pathogenic bacteria Klebsiella oxytoca and Klebsiella pneumoniae produce the extended spectrum β-lactamase (ESBL) and cephalosporinase enzymes and are the major causes of hospital acquired (HA) infections and epidemics in non-hygienic communities in the majority of developing countries.
The prevalence of multidrug resistance among 445 strains of K. oxytoca and K. pneumoniae isolated from clinical samples of patients with gastrointestinal infections over a period of 42 months in the hospital was recorded, along with the sensitivity patterns to 23 antibiotics, including third-generation cephalosporin and fluoroquinolone antibiotics, using the disk-diffusion method.
Of 175 K. oxytoca isolates, 143 were ESBL positive and 117 were fluoroquinolone resistant. Of 270 K. pneumoniae isolates, 200 were ESBL positive and 195 were independently fluoroquinolone resistant. The HA samples yielded more isolates than the community acquired (CA) samples for each species. The K. oxytoca strains were resistant to cefepime, gatifloxacin, ciprofloxacin, ceftazidime, levofloxacin and imipenem, whereas the K. pneumoniae strains were highly resistant to ampicillin, norfloxacin, ciprofloxacin, gatifloxacin, ofloxacin, amoxyclav, ceftazidime, cefepime, cefixime, piperacillin and imipenem. The ESBL-producing and fluoroquinolone-resistant K. pneumoniae strains were more prevalent than the K. oxytoca strains in the HA/CA samples. The minimum inhibitory concentration values of the third-generation cephalosporins: cefotaxime and ceftazidime and the fluoroquinolones: ciprofloxacin and levofloxacin against both species of Klebsiella confirmed the resistance in the current/coveted treatment options.
Patients with other bacterial infections had a relatively higher probability of infection with ESBL-producing and fluoroquinolone-resistant Klebsiella strains. The data presented here highlight the alarming state of Klebsiella infection dynamics in the hospital and adjoining communities.
革兰氏阴性病原菌产酸克雷伯菌和肺炎克雷伯菌可产生超广谱β-内酰胺酶（ESBL）和头孢菌素酶，是大多数发展中国家医院获得性（HA）感染以及非卫生社区中传染病的主要病因。
记录了在42个月期间从该医院胃肠道感染患者临床样本中分离出的445株产酸克雷伯菌和肺炎克雷伯菌的多重耐药率，以及使用纸片扩散法对包括第三代头孢菌素和氟喹诺酮类抗生素在内的23种抗生素的敏感性模式。
在175株产酸克雷伯菌分离株中，143株ESBL呈阳性，117株对氟喹诺酮耐药。在270株肺炎克雷伯菌分离株中，200株ESBL呈阳性，195株独立对氟喹诺酮耐药。对于每个菌种，HA样本分离出的菌株比社区获得性（CA）样本更多。产酸克雷伯菌菌株对头孢吡肟、加替沙星、环丙沙星、头孢他啶、左氧氟沙星和亚胺培南耐药，而肺炎克雷伯菌菌株对氨苄西林、诺氟沙星、环丙沙星、加替沙星、氧氟沙星、阿莫西林克拉维酸、头孢他啶、头孢吡肟、头孢克肟、哌拉西林和亚胺培南高度耐药。在HA/CA样本中，产ESBL和耐氟喹诺酮的肺炎克雷伯菌菌株比产酸克雷伯菌菌株更普遍。第三代头孢菌素头孢噻肟和头孢他啶以及氟喹诺酮类环丙沙星和左氧氟沙星对两种克雷伯菌的最低抑菌浓度值证实了当前/理想治疗方案中的耐药性。
患有其他细菌感染的患者感染产ESBL和耐氟喹诺酮克雷伯菌菌株的可能性相对较高。此处呈现的数据突出了该医院及周边社区克雷伯菌感染动态的警示状态。
