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Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 456-457
β-lactamase producing Acinetobacter species in hospitalized patients

Department of Microbiology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, U.P. 250 002, India

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Date of Web Publication12-Aug-2009

How to cite this article:
Kansal R, Pandey A, Asthana AK. β-lactamase producing Acinetobacter species in hospitalized patients. Indian J Pathol Microbiol 2009;52:456-7

How to cite this URL:
Kansal R, Pandey A, Asthana AK. β-lactamase producing Acinetobacter species in hospitalized patients. Indian J Pathol Microbiol [serial online] 2009 [cited 2021 Oct 20];52:456-7. Available from: https://www.ijpmonline.org/text.asp?2009/52/3/456/55035


Extended-spectrum β -lactamases (ESBLs) continue to be a major problem in clinical setups the world over and knowledge about their prevalence is essential to guide towards appropriate antibiotic treatment. ESBL production in Gram-negative bacteria, particularly in E. coli, K. pneumoniae, Enterobacter spp, Proteus spp and P. aeruginosa have been studied by various workers in the past. [1],[2] However, there is limited data on β -lactamase producing Acinetobacter spp. from India. [3],[4] Therefore in view of the above fact this study was undertaken to find the prevalence of ESBL producing Acinetobacter spp.from our institute. Our aim was also to study the susceptibility of these ESBL producers to various other antimicrobial agents and to delinate the magnitude of the problem and to define appropriate therapeutic options.

A total of 48 clinical isolates of Acinetobacter spp. obtained from different clinical specimens such as pus, sputum, urine, chest tubes, ventilator tubes, intravenous cannula and blood samples of hospitalized patients from various wards and ICUs were tested for ESBL production by double disc approximation test on Mueller-Hinton agar plates prepared and inoculated (swabbed) with standard inoculums (corresponding to 0.5 McFarland tube). ESBL production was detected by placing a susceptibility disc containing ceftazadime and ceftazadime/ clavulanic acid, cefotaxime and cefotaxime/ sulbactum, cefoperazone and cefoperazone/ sulbactam at a distance of 15 mm (center to center). [2],[5] The plates were incubated aerobically at 37 C and enhancement of the zone of inhibition of disc of ceftazidime, cefotaxime and cefoperazone, towards the disc containing ceftazidime/ clavulanic acid, cefotaxime/ sulbactum and cefoperazone/ sulbactam showing a figure of eight impression was considered as an evidence of ESBL production [Figure 1]. Antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standard Institute (CLSI) recommendations. [6]

In the present study, the prevalence of ESBL producing Acinetobacter spp. was found to be 75% (36 out of 48). The overall prevalence of ESBL-producing Acinetobacter spp. varies greatly in different geographical areas and from institute to institute. Previous studies from India have reported ESBL production varying from 68%-72%. [3],[4] However, selection of clinical samples from hospitalized patients and high risk areas such as admission in ICU's, invasive devices in situ , increased length of stay in the hospital, as well as indiscriminate and inappropriate use of antibiotics may be contributory to high level of ESBL production in our study. The present study also highlights that the ESBL production coexisted with resistance to third generation cephalosporins including multidrug resistance (MDR) to other antibiotics like ciprofloxacin, levofloxacin, gatifloxacin, gentamicin and amikacin, thus leaving only limited options for treatment. Carbapenems such as meropenem, imipenem and etrapenem are often the alternatives in infection due to MDR strains since they are stable to a extended spectrum beta lactamases.

Prevalence of ESBL among clinical isolates is world-wide challenge. The emergence and possible transmission of these highly resistant isolates should be focus of intensive infection control. ESBL producing Acinetobacter spp. was also the cause of severe clinical disease that was associated with high mortality rates in our setup. Clinicians should consider ESBL production as a possibility in case of treatment failure with β -lactam antimicrobials.

In conclusion, this study highlights that it is not only the members of Enterobacteriaceae such as E. coli, Klebsiella pneumoniae , Citrobacter spp., Enterobacter spp., Proteus spp., and other Gram negative bacteria like Pseudomonas aeruginosa , but a significantly high level of Acinetobacter spp. also produce ESBL and these ESBL producers are multidrug resistant. Routine antimicrobial susceptibility tests may fail to detect such ESBL producers. But a simple, rapid and relatively inexpensive method like double disc approximation test may help to screen all the clinical Gram negative isolates for ESBL production. Moreover, as this method is inexpensive and less cumbersome, it can also be performed as part of the routine antibiotic sensitivity testing, which may help to screen all the clinical Gram negative isolates for ESBL production even in smaller laboratories and peripheral centers like ours where there is limitation of funds. In addition, it also helps in formulating appropriate antibiotic policy for the hospitals and prevents further development and spread of resistant strains.

   References Top

1.Agrawal P, Ghosh AN, Kumar S, Basu B, Kapila K. Prevalence of extended- spectrum β lactamases among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital. Indian J Pathol Microbiol 2008;51:139-42.  Back to cited text no. 1  [PUBMED]  Medknow Journal
2.Pandey A, Malenie R, Asthana A. β -lactamase producing Pseudomonas aeruginosa in hospitalized patients. Indian J Pathol Microbiol 2005;48:530-3.  Back to cited text no. 2    
3.Mittal N, Nair D, Gupta N, Rawat D, Kabra S, Kumar S, et al . Outbreak of Acinetobacter spp. Septicemia in a neonatal ICU. Southeast Asian J Trop Med Public Health 2003;34:365-6.  Back to cited text no. 3    
4.Kapil A, Gulati S, Goel V, Kumar L, Krishnan R, Kochupillai V. Outbreak of nosocomial Acinetobacter baumanii bacteremia in a high risk ward. Med Oncol 1998;15:270-4.  Back to cited text no. 4    
5.Bradford PA. Extended spectrum β -lactamases in the 21 st century: Characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933-51.  Back to cited text no. 5    
6.Clinical and Laboratory Standards Institute; Performance standards for antimicrobial susceptibility testing; 17 th Informational Supplement: 2007.  Back to cited text no. 6    

Correspondence Address:
Anita Pandey
Department of Microbiology, Subharti Medical College, Meerut, U.P. 250 002
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.55035

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  [Figure 1]

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