engleski

Antibiotic susceptibility of extended-spectrum beta-lactamases producing isolates in the outpatient setting from Bosnia and Herzegovina

Background We have recently reported that SHV-ESBLs were dominant among K. pneumoniae, and TEM-ESBLs in E. coli isolates in outpatient setting in Zenica-Doboj Canton, Bosnia and Herzegovina. The aim of this study was to describe its epidemiology and antimicrobial resistance. Methods Fifteen K. pneumoniae and 5 E. coli ESBL-producing strains were isolated from 2157 (0.9%) urine samples obtained from outpatients with confirmed urinary tract infections. The antibiotic susceptibilities were determined by disk-diffusion and broth microdilution method according to NCCLS. ESBLs were detected by double-disk synergy test and by 8 fold reduction in ceftazidime MIC in the presence of clavulanate. Plasmids encoding ESBLs were extracted by alkalyne lysis procedure and analysed after electrophoresis in agarose gel. Molecular relatedness between the strains was investigated by PFGE. Results Nine out of 20 ESBLs (45%) isolated in children below 1 year of age. All K. pneumoniae and E. coli strains were resistant to amoxycillin, ceftazidime, and aztreonam. Resistance rates to gentamicin and ciprofloxacin were 86% and 100%, 64% and 50% in K. pneumoniae and E. coli, respectively. No resistance to carbapenems and combination of ceftazidime and clavulanate was detected. All K. pneumoniae and E. coli strains showed CAZ phenotype of resistance which means higher level of resistance to ceftazidime and aztreonam in comparison to cefotaxime and ceftriaxone. Conclusion This is the first description of ESBLs from Bosnia and Herzegovina. Significant prevalence of ESBLs in children below one year of age, and high prevalence of resistance to aminoglycosides and fluoroquinolones in both, K. pneumoniae and E. coli, warrants further monitoring. Carbapenems should be recommended as antibiotics of choice for the treatment of infections caused by ESBL producing K. pneumoniae and E. coli in this region..

extended-spectrum beta-lactamases; Klebsiella pneumoniae; Escherichia coli; antibiotic resistance

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