PROPORTION OF ESBL AND CARBAPENEMASE PRODUCING ENTEROBACTERIACEAE CAUSING BLOODSTREAM INFECTIONS AND SHOWING MULTI DRUG RESISTANCE IN INFECTED PATIENTS IN TERTIARY CARE HOSPITAL AT AGARTALA, TRIPURA

Abstract

BACKGROUND: Enrerobacteriaceae species are the major leading cause of bloodstream infections in many developing countries. Moreover, ESBL and Carbapenemase-producing Enterobacteriaceae species are often associated with high resistance to a wide class of antibiotics. There are few studies regarding the bloodstream infections causing by Enterobacteriaceae with the production of Extended-spectrum β-lactamases and Carbapenemase enzymes in Tripura, North-East India. This study aimed to determine the “ proportion of ESBL and carbapenemase-producing Enterobacteriaceae causing bloodstream infection and showing Multi-drug resistance (MDR) in infected patients'' in Tertiary care Hospital at Agartala, Tripura. METHOD: Blood samples were collected from all indoor and outdoor patients suspected of Bloodstream infection. Then specimens were inoculated in various culture media after that with this culture isolates we performed gram staining and many biochemical tests (as per CLSI guidelines) to identies the Enterobacteriaceae species. And the production of β-lactamases and Carbapenemase was conrmed by the combined disk test and Modied Hodge method. RESULTS: In this study out of 760 samples processed in the laboratory 77 (10.13%) was tested positive for bacteremia from which 42 (54.54%) blood specimens were infected by Enterobacteriaceae. The members of the Enterobacteriaceae family isolated in patient samples are E.coli (22/42, 52.38%), K. pneumoniae (11/42, 52.38%) others are Enterobacter spp. (8/42, 52.38%) and S.typhi(1/42, 2.38%). In all 42 Enterobacteriaceae species, 17 (40.47%) isolates were found ESBL positive on antibiotic screening which is conrmed by Combined disc diffusion test, and out of 17 Beta-lactamase producers 8 (47.05%) were E. coli, 5 (29.41%) were K. pneumoniae and 4 (23.52%) were Enterobacter spp. And among 42 isolates of Enterobacteriaceae 16 (38.09%) isolates showed Carbapenemase producers, in that 8 (50%) were E.coli, 5 (31.25%) were K. pneumoniae, and 3 (18.75%) were Enterobacter spp. CONCLUSION: This study aims to provide an early, rapid, and effective phenotypic method for identifying Multi-drug resistant (MDR) Bloodstream infections (BSIs) causing by the species of the Enterobacteriaceae family