title: Prevalence of ESBL inEscherichia coliIsolates Among ICU Patients in a Tertiary Care Hospital.
abstract: BACKGROUND
  Resistance to common antibiotics is a matter of grave concern in treating infections in hospital settings especially in Intensive Care Units (ICUs). One of the most commonly used and effective group of antibiotics, cephalosporins, exhibit resistance due to production of Extended Spectrum Beta- Lactamases (ESBLs). The prevalence of ESBL producingEscherichia coli(E.coli) has increased throughout the world and is a major cause of treatment failure in ICUs. As per our knowledge studies were not available on the prevalence of ESBL producingE.coliin ICUs of this region.
  
  
  OBJECTIVE
  To determine the prevalence of ESBLs amongEscherichia coliisolates in ICUs of a tertiary care hospital.
  
  
  METHODS
  A cross sectional study was conducted over a period of 4 years (Sept 2011 to Sept 2015) in the Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar. Consecutive non-duplicate isolates ofE.colirecovered from 6800 clinical samples of patients admitted to different Intensive Care Units (ICUs) were subjected to ESBL screening test and then to CLSI recommended Phenotypic Confirmatory Disc Diffusion Tests (PCDDT) for ESBL production determination.
  
  
  RESULTS
  Out of 6800 samples, 1038 wereE.coliisolates and 452(44%) were resistant to third generation cephalosporins. ESBL producingEscherichia coliamong them were 276 (61.1%). Paediatric ICU showed the highest prevalence of ESBLE.coliat 80.9%. The highest prevalence of ESBLE.coliwas in urine samples (82.6%) followed by pus (9.8%). The most effective antibiotic for ESBL producers was imipenem (96.7% sensitive), followed by amikacin (88.4%) and piperacillin- tazobactum (87%).
  
  
  CONCLUSIONS
  This study has highlighted the high prevalence of ESBL producingE.coliin the ICUs of our hospital. An in depth analysis of their antibiogram will be helpful in formulating the antibiotic policy and prevent spread of ESBL strains. It is recommended that ESBL testing should be done routinely to curtail antibiotic resistance and to effectively implement infection control measures.
authors: Assistant Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India .
authors: Nipa
authors: N
authors: Singh
authors: Professor and HOD, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India .
authors: Dipti
authors: D
authors: Pattnaik
authors: Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India .
authors: Dhruba Kumar
authors: DK
authors: Neogi
authors: Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India .
authors: Jagadananda
authors: J
authors: Jena
authors: Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India .
authors: Bandana
authors: B
authors: Mallick
keywords: Antibiogram; Imipenem; Phenotypic confirmatory disc diffusion test