Prevalence of Extended Spectrum β-Lactamase Producers (ESBLs) with antibiotic resistance pattern of Gram negative pathogenic bacteria isolated from door handles in hospitals of Pokhara, Western Nepal.

IF 3.6 Q2 BIOTECHNOLOGY & APPLIED MICROBIOLOGY Journal, genetic engineering & biotechnology Pub Date : 2023-11-24 DOI:10.1186/s43141-023-00616-4
Binita Koirala Sharma, Birendra Prasad Sharma, Anjeela Kunwar, Nirmala Basnet, Padam Darlami Magar, Sajana Adhikari
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Abstract

Background: The presence of drug-resistant Gram-negative pathogenic bacteria and Extended Spectrum β-Lactamase Producers (ESBLs) in hospital associated fomites like door handles can serve as vehicles in transmission and may be the key factor in epidemiology of ESBL producing bacterial infection not only in a hospital setting but also in the community. The aim of this study was to determine the prevalence of ESBLs and antibiotic resistance of Gram-Negative pathogenic Bacteria isolated from door-handles in two selected hospitals in Pokhara Metropolitan City, Nepal. The study was conducted in selected hospitals in Pokhara Metropolitan City, Western Nepal. A cross-sectional study design was used. The hospitals were selected randomly. A total of 100 swab samples were taken from door-handles. Isolation and identification of bacteria were done using standard microbiological procedures. An antibiotic susceptibility test, screening and confirmation of ESBLs were performed using the Clinical Laboratory Standard Institute's guidelines.

Results: Out of the 100 swab samples cultured, 96 (96%) showed bacterial growth. A total of one hundred and forty isolates were isolated in this study which were further identified based on cultural, morphological and biochemical characteristics. The study also found that door handles/knobs had higher level of contamination in Outpatient Departments (OPDs), Emergency, Laboratory, General wards and Toilets, in that order as compared to Radiology Room, Staff rooms, Intensive Care Unit and Operation Theatre which were lower. The level of contamination varies depending on the traffic exposure and the environment. The most prevalent Gram-negative bacteria identified was Escherichia coli 28.85%, followed by Klebsiella spp 21.15%, Pseudomonas aeruginosa 15.38%, Proteus spp 11.54%, Enterobacter spp 9.62%, Acenetobacter spp 7.69%, Citrobacter spp 5.77%. The most effective drug of choice was Amikacin, Nitrofurantoin, Norfloxacin, Ciprofloxacin, Tetracycline and Imipenem for many Gram-negative isolates. The overall prevalence of ESBLs in this study was 27.14%. Out of total 15 Escherichia coli isolated, 11(73.3%), Klebsiella spp 9/11 (81.8%); Pseudomonas spp 7/8 (87.5%), Proteus spp 4/6 (66.6%); Enterobacter spp 3/5 (60%), Acenetobacter spp 3/4 (75%) and Citrobacter spp 1/3 (33.3%) were found to be Extended β-Lactamase Producers (ESBLs).

Conclusion: The isolation of of pathogenic Gram-negative bacteria and ESBLs in hospital environments and subsequent detection of high drug resistance patterns indicates a potentially serious public health challenge that strengthens the need for the effective and routine cleaning of door-handles in hospitals.

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尼泊尔西部博卡拉医院门把手上分离的革兰氏阴性致病菌的广谱β-内酰胺酶产生菌(ESBLs)抗生素耐药模式的流行情况
背景:耐药革兰氏阴性致病菌和广谱β-内酰胺酶产生菌(ESBLs)存在于医院相关物如门把手中,可作为传播媒介,可能是医院和社区中产生ESBL细菌感染流行病学的关键因素。本研究的目的是确定尼泊尔博卡拉市两家选定的医院中从门把手上分离的革兰氏阴性致病菌的ESBLs患病率和抗生素耐药性。这项研究是在尼泊尔西部博卡拉大都会选定的医院进行的。采用横断面研究设计。这些医院是随机选择的。从门把手上采集了100个拭子样本。采用标准微生物学程序进行细菌的分离和鉴定。根据临床实验室标准协会的指南进行抗生素敏感性试验、筛选和确认ESBLs。结果:培养的100份拭子样品中,96份(96%)有细菌生长。本研究共分离到140株菌株,并对其进行了进一步的培养、形态和生化鉴定。研究还发现,门诊部、急诊科、化验室、普通病房和厕所的门把手/把手污染程度较高,而放射科、工作人员室、重症监护病房和手术室的污染程度较低。污染程度取决于交通暴露和环境。革兰氏阴性菌检出率最高的是大肠杆菌28.85%,其次是克雷伯氏菌21.15%、铜绿假单胞菌15.38%、变形杆菌11.54%、肠杆菌9.62%、乳酸菌7.69%、柠檬酸杆菌5.77%。许多革兰氏阴性分离株最有效的药物是阿米卡星、呋喃妥因、诺氟沙星、环丙沙星、四环素和亚胺培南。本研究中ESBLs的总体患病率为27.14%。15株大肠埃希菌中11株(73.3%),9/11克雷伯氏菌(81.8%);假单胞菌spp 7/8(87.5%),变形杆菌spp 4/6 (66.6%);肠杆菌3/5(60%)、乳酸菌3/4(75%)和柠檬酸杆菌1/3(33.3%)为扩展β-内酰胺酶产生菌(Extended β-Lactamase producer, ESBLs)。结论:医院环境中致病性革兰氏阴性菌和ESBLs的分离以及随后的高耐药模式的检测表明,这是一个潜在的严重公共卫生挑战,加强了对医院门把手进行有效和常规清洁的需求。
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