Evaluation Of Charlson’s Co-Morbidity Index And Risk Factors Among Patients With And Without Extended Spectrum Β-Lactamase Producing Enterobacteriaceae Spp. Urinary Isolates In A Super-Specialty Hospital
Evaluation Of Charlson’s Co-Morbidity Index And Risk Factors
DOI:
https://doi.org/10.70284/njirm.v7i5.1138Keywords:
ESBL, Enterobacteriaceae spp., MAR index, Charlson’s indexAbstract
Background & Objectives: Extended-Spectrum Beta-Lactamase (ESBL) producing members of the family Enterobacteriaceae are emerging worldwide The aim of this study was to evaluate risk factors, co-morbidity status and short term mortality rates among hospitalized patients with and without ESBL producing Enterobacteriaceae spp. urinary isolates. Methods: An analytical cross-sectional study conducted in a super-specialty hospital from December 2014 to July 2015. Urine samples from 100 patients which repeatedly yielded significant colony counts of Enterobacteriaceae spp. isolates were identified using standard biochemical tests. Antibiotic susceptibility testing of these isolates was carried out by modified Kirby Bauer disk diffusion method as per CLSI guidelines 2014. Isolates which were resistant to cefotaxime and/or ceftazidime were tested for the production of ESBL by phenotypic confirmatory disc diffusion test. Relevant clinico-epidemiological details of these patients were subsequently obtained from Medical records as per the proforma formulated. The original version of the Charlson Index (CI) was used to assess co-morbidity and short term mortality rates. Results & Interpretation: Escherichia coli followed by Klebsiella pneumonia were the predominant isolates. 40 isolates were confirmed as ESBL producers. All isolates had Multiple Antibiotic Resistance (MAR) index of >0.2. The p-value of difference in proportion of all the risk factors distributed among patients with and without ESBL producing urinary Enterobacteriaceae spp. isolates respectively was found to be >0.05. The p-value of difference in mean Charlson index scores between these two groups of patients was 0.45. Conclusions: The results obtained in our study are largely inconclusive. It is imperative that more number of multicentre studies should be conducted in order to generate conclusive evidence on this subject. [Mohit B NJIRM 2016; 7(5):40-45]
References
2. Briongos-Figuero LS, Gómez-Traveso T, Bachiller-Luque P, DomÃnguez-Gil González M, Gómez-Nieto A, Palacios-MartÃn T, et al. Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract. 2012;66:891–6
3. Lu PL, Liu YC, Toh HS, Lee YL, Liu YM, Ho CM, et al. Epidemiology and antimicrobial susceptibility profiles of Gram-negative bacteria causing urinary tract infections in the Asia-Pacific region: 2009-2010 results from the Study for Monitoring Antimicrobial Resistance Trends (SMART) Int J Antimicrob Agents.2012;40:S37–43
4.Calbo E, Romani V, Xercavins M, Gomez L, Vidal CG, Quintana S, et al. Risk factors for community-onset urinary tract infections due toEscherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother 2006;57:780-3
5. Infections of the urinary tract. In: Betty AF, Daniel FS, Alice SW, editors. Bailey & Scott's Diagnostic Microbiology. 12th ed. St.Louis, Missouri: Pub : Mosby Elsevier; 2007. p.842-55
6. Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Fraser AG, Marimon BP, Simmons A, editors. Mackie & Mc Cartney Practical Medical Microbiology.14th ed. New Delhi: Pub : Elsevier; 1996. p.131-49
7. Krumperman, P.H., 1983. Multiple antibiotic resistance indexing of Escherichia coli to indentify high-risk sources of fecal contamination of foods. Applied Environ. Microbiol, 1983; 46: 165-170
8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic cormorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373-83
9. Brumfitt W, Hamilton-Miller MT. Efficacy and safety profile of long term nitrofurantoin in urinary infections: 18 years’ experience. J Antimicrob Chemother. 1998;42:363-371
10. Grayson ML, Whitby M. Nitrofurans: nitrofurazone, furazolidone, and nitrofurantoin. In: Grayson ML, Crowe SM, McCarthy JS, editors. Kucers’ The Use of Antibiotics. 6th ed. London, England: Hodder Arnold; 2010. p.1195-1204
11. Bradford PA. Extended-Spectrum ß-Lactamases in the 21st Century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 2001; 14:933–51
12. Mukherjee M, Basu S, Mukherjee SK, Majumder M. Multidrug-resistance and extended spectrum beta-lactamase production in uropathogenic E. coli which were isolated from hospitalized patients in Kolkata, India. J Clin Diagn Res. 2013;7:449–53
13. Cross-sectional studies. In: Ilona C, Natasha H, Lucianne B, Katerina V, Julia L, Daniel C, editors. Introduction to epidemiology. 2nd ed. Berkshire, England: Open University Press; 2011. P. 93-99