Extra-intestinal β-lactamase producing escherichia coli infection-an emerging infection in a South Indian tertiary care hospital

Arindam Chakraborty, Prabha Adhikari, Shalini Shenoy, Shrikala Baliga, Satish Rao, B. Dhanashree

Research output: Contribution to journalArticle

Abstract

Introduction: In the recent years, extra-intestinal Escherichia coli infection has been a very important cause of mortality and morbidity. However, only a limited number of literatures are available on the clinical presentation and the outcome of the extra-intestinal pathogenic E.coli (ExPEC) infections. We investigated the prevalence, risk factors, anti-biogram and the outcome of the antibiotic treatment of the extra-intestinal infections caused by E.coli among hospitalized patients. This descriptive study was carried out in a multispeciality, tertiary care hospital. Methods and Material: Two hundred ExPEC infected patients were included in the study. The demographic data, risk factors, details of the organ failure, anti-biogram, treatment and the outcome were collected in a structured pro forma. The severity was assessed by the APACHE II Score. The E.coli isolates were microbiologically characterized as Extended Spectrum β lactamase (ESBL) producers if they were found to be resistant to penicillin and the cephalosporins. Statistical analysis: The proportions were expressed as percentages. The categorical data between the infection with the ESBL producers and the non-ESBL producers were compared by using the Chi-square test. The statistical analysis was performed by using SPSS, version 17.0 Results: Out of the 200 E.coli isolates, 132(66%) were extended spectrum beta lactamase producers. Diabetes mellitus (DM) was the most important risk factor for the ExPEC infection. In the anti-biogram, a high degree of resistance was seen against ampicillin (84%), the fluoroquinolones (71%), the 3rd generation cephalosporins (66%), the sulfonamides (58.5%), and the aminoglycosides (41%). Carbapenam resistance was seen in 8% of the isolates. For the treatment, the most widely prescribed antibiotics were the β-lactam+β-lactamase inhibitor combinations (39%) and the 3rd generation cephalosporins (18.5%). 65.15% patients improved with proper treatment, 15.9% patients expired (p=0.02) and 16.5% patients relapsed. There was no correlation between the risk factors, ages of the patients, the APACHE II score, organ failure and the ESBL producers. However, an increased mortality was seen in patients with blood stream infections and lung infections which were caused by E. coli. Conclusions: The ExPEC Infection is associated with a high level of drug resistance, mortality, morbidity and relapse. The early use of the appropriate empirical antibiotics will probably reduce the mortality and the morbidity in these patients. The 8% carbapenam resistance implies that the organisms which produce carbapenemase (superbug) also infect our patients and this may emerge as a major cause of morbidity and mortality among the patients with ExPEC in the future.

Original languageEnglish
Pages (from-to)1210-1214
Number of pages5
JournalJournal of Clinical and Diagnostic Research
Volume6
Issue number7 SUPPL.
Publication statusPublished - 30-09-2012

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Escherichia coli Infections
Tertiary Healthcare
Tertiary Care Centers
Escherichia coli
Infection
Cephalosporins
Mortality
Morbidity
APACHE
Anti-Bacterial Agents
Statistical methods
Patient treatment
Organ Dysfunction Scores
Lactams
Fluoroquinolones
Sulfonamides
Aminoglycosides
Chi-Square Distribution
Ampicillin
beta-Lactamases

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Clinical Biochemistry

Cite this

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title = "Extra-intestinal β-lactamase producing escherichia coli infection-an emerging infection in a South Indian tertiary care hospital",
abstract = "Introduction: In the recent years, extra-intestinal Escherichia coli infection has been a very important cause of mortality and morbidity. However, only a limited number of literatures are available on the clinical presentation and the outcome of the extra-intestinal pathogenic E.coli (ExPEC) infections. We investigated the prevalence, risk factors, anti-biogram and the outcome of the antibiotic treatment of the extra-intestinal infections caused by E.coli among hospitalized patients. This descriptive study was carried out in a multispeciality, tertiary care hospital. Methods and Material: Two hundred ExPEC infected patients were included in the study. The demographic data, risk factors, details of the organ failure, anti-biogram, treatment and the outcome were collected in a structured pro forma. The severity was assessed by the APACHE II Score. The E.coli isolates were microbiologically characterized as Extended Spectrum β lactamase (ESBL) producers if they were found to be resistant to penicillin and the cephalosporins. Statistical analysis: The proportions were expressed as percentages. The categorical data between the infection with the ESBL producers and the non-ESBL producers were compared by using the Chi-square test. The statistical analysis was performed by using SPSS, version 17.0 Results: Out of the 200 E.coli isolates, 132(66{\%}) were extended spectrum beta lactamase producers. Diabetes mellitus (DM) was the most important risk factor for the ExPEC infection. In the anti-biogram, a high degree of resistance was seen against ampicillin (84{\%}), the fluoroquinolones (71{\%}), the 3rd generation cephalosporins (66{\%}), the sulfonamides (58.5{\%}), and the aminoglycosides (41{\%}). Carbapenam resistance was seen in 8{\%} of the isolates. For the treatment, the most widely prescribed antibiotics were the β-lactam+β-lactamase inhibitor combinations (39{\%}) and the 3rd generation cephalosporins (18.5{\%}). 65.15{\%} patients improved with proper treatment, 15.9{\%} patients expired (p=0.02) and 16.5{\%} patients relapsed. There was no correlation between the risk factors, ages of the patients, the APACHE II score, organ failure and the ESBL producers. However, an increased mortality was seen in patients with blood stream infections and lung infections which were caused by E. coli. Conclusions: The ExPEC Infection is associated with a high level of drug resistance, mortality, morbidity and relapse. The early use of the appropriate empirical antibiotics will probably reduce the mortality and the morbidity in these patients. The 8{\%} carbapenam resistance implies that the organisms which produce carbapenemase (superbug) also infect our patients and this may emerge as a major cause of morbidity and mortality among the patients with ExPEC in the future.",
author = "Arindam Chakraborty and Prabha Adhikari and Shalini Shenoy and Shrikala Baliga and Satish Rao and B. Dhanashree",
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Extra-intestinal β-lactamase producing escherichia coli infection-an emerging infection in a South Indian tertiary care hospital. / Chakraborty, Arindam; Adhikari, Prabha; Shenoy, Shalini; Baliga, Shrikala; Rao, Satish; Dhanashree, B.

In: Journal of Clinical and Diagnostic Research, Vol. 6, No. 7 SUPPL., 30.09.2012, p. 1210-1214.

Research output: Contribution to journalArticle

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T1 - Extra-intestinal β-lactamase producing escherichia coli infection-an emerging infection in a South Indian tertiary care hospital

AU - Chakraborty, Arindam

AU - Adhikari, Prabha

AU - Shenoy, Shalini

AU - Baliga, Shrikala

AU - Rao, Satish

AU - Dhanashree, B.

PY - 2012/9/30

Y1 - 2012/9/30

N2 - Introduction: In the recent years, extra-intestinal Escherichia coli infection has been a very important cause of mortality and morbidity. However, only a limited number of literatures are available on the clinical presentation and the outcome of the extra-intestinal pathogenic E.coli (ExPEC) infections. We investigated the prevalence, risk factors, anti-biogram and the outcome of the antibiotic treatment of the extra-intestinal infections caused by E.coli among hospitalized patients. This descriptive study was carried out in a multispeciality, tertiary care hospital. Methods and Material: Two hundred ExPEC infected patients were included in the study. The demographic data, risk factors, details of the organ failure, anti-biogram, treatment and the outcome were collected in a structured pro forma. The severity was assessed by the APACHE II Score. The E.coli isolates were microbiologically characterized as Extended Spectrum β lactamase (ESBL) producers if they were found to be resistant to penicillin and the cephalosporins. Statistical analysis: The proportions were expressed as percentages. The categorical data between the infection with the ESBL producers and the non-ESBL producers were compared by using the Chi-square test. The statistical analysis was performed by using SPSS, version 17.0 Results: Out of the 200 E.coli isolates, 132(66%) were extended spectrum beta lactamase producers. Diabetes mellitus (DM) was the most important risk factor for the ExPEC infection. In the anti-biogram, a high degree of resistance was seen against ampicillin (84%), the fluoroquinolones (71%), the 3rd generation cephalosporins (66%), the sulfonamides (58.5%), and the aminoglycosides (41%). Carbapenam resistance was seen in 8% of the isolates. For the treatment, the most widely prescribed antibiotics were the β-lactam+β-lactamase inhibitor combinations (39%) and the 3rd generation cephalosporins (18.5%). 65.15% patients improved with proper treatment, 15.9% patients expired (p=0.02) and 16.5% patients relapsed. There was no correlation between the risk factors, ages of the patients, the APACHE II score, organ failure and the ESBL producers. However, an increased mortality was seen in patients with blood stream infections and lung infections which were caused by E. coli. Conclusions: The ExPEC Infection is associated with a high level of drug resistance, mortality, morbidity and relapse. The early use of the appropriate empirical antibiotics will probably reduce the mortality and the morbidity in these patients. The 8% carbapenam resistance implies that the organisms which produce carbapenemase (superbug) also infect our patients and this may emerge as a major cause of morbidity and mortality among the patients with ExPEC in the future.

AB - Introduction: In the recent years, extra-intestinal Escherichia coli infection has been a very important cause of mortality and morbidity. However, only a limited number of literatures are available on the clinical presentation and the outcome of the extra-intestinal pathogenic E.coli (ExPEC) infections. We investigated the prevalence, risk factors, anti-biogram and the outcome of the antibiotic treatment of the extra-intestinal infections caused by E.coli among hospitalized patients. This descriptive study was carried out in a multispeciality, tertiary care hospital. Methods and Material: Two hundred ExPEC infected patients were included in the study. The demographic data, risk factors, details of the organ failure, anti-biogram, treatment and the outcome were collected in a structured pro forma. The severity was assessed by the APACHE II Score. The E.coli isolates were microbiologically characterized as Extended Spectrum β lactamase (ESBL) producers if they were found to be resistant to penicillin and the cephalosporins. Statistical analysis: The proportions were expressed as percentages. The categorical data between the infection with the ESBL producers and the non-ESBL producers were compared by using the Chi-square test. The statistical analysis was performed by using SPSS, version 17.0 Results: Out of the 200 E.coli isolates, 132(66%) were extended spectrum beta lactamase producers. Diabetes mellitus (DM) was the most important risk factor for the ExPEC infection. In the anti-biogram, a high degree of resistance was seen against ampicillin (84%), the fluoroquinolones (71%), the 3rd generation cephalosporins (66%), the sulfonamides (58.5%), and the aminoglycosides (41%). Carbapenam resistance was seen in 8% of the isolates. For the treatment, the most widely prescribed antibiotics were the β-lactam+β-lactamase inhibitor combinations (39%) and the 3rd generation cephalosporins (18.5%). 65.15% patients improved with proper treatment, 15.9% patients expired (p=0.02) and 16.5% patients relapsed. There was no correlation between the risk factors, ages of the patients, the APACHE II score, organ failure and the ESBL producers. However, an increased mortality was seen in patients with blood stream infections and lung infections which were caused by E. coli. Conclusions: The ExPEC Infection is associated with a high level of drug resistance, mortality, morbidity and relapse. The early use of the appropriate empirical antibiotics will probably reduce the mortality and the morbidity in these patients. The 8% carbapenam resistance implies that the organisms which produce carbapenemase (superbug) also infect our patients and this may emerge as a major cause of morbidity and mortality among the patients with ExPEC in the future.

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