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Monitoring and detection of Escherichia coli and Klebsiella pneumoniae strains with Extended Spectrum Beta-Lactamase (ESBL) production in Hospital Prachatice, a. s. in 2014-2018.
TVRDKOVÁ, Pavla
The ever increasing resistance of bacteria is a grave issue world-wide. Some bacteria are resistant naturally but for other resistance is acquired. As a result, we can encounter bacterium that would formerly be quite easily killed by administering antibiotics but, in the course of time, as a result of, for example, communication between various bacteria species and strains in the form of various mutations and, frequently, after the administration of incorrect antibiotic and the effects of selective antibiotic pressure, the same bacterium becomes resistant to antibiotics. One of the types of such acquired resistance is the production of broad-spectrum beta-lactamases ESBL. The objective of this thesis is to establish the representation and development of ESBL production in Escherichia coli strains and Klebsiella pneumoniae strains as these make the most frequent producers of these broad-spectrum beta-lactamases, in certain hospital departments and in various types of clinical materials over the period of 5 years. In addition, the thesis focuses on the development of antibiotic resistance, accordingly, over the 5 year period. Data gathering and utilization of methods took place at the Medical Microbiology Department of the Prachatice Hospital (Nemocnice Prachatice, a.s.). To identify microbes to a more precise level, the commercial set ENTEROtest 24 N and INDOL test were used. The disk diffusion method and method for determining the minimum inhibitory concentration were used to determine sensitivity to antimicrobial agents. The commercial set MASTDISC AmpC and ESBL (D68C) were used to detect ESBL. The outcomes indicated that the number of Escherichia coli strains producing ESBL and Klebsiella pneumoniae strains producing ESBL grew almost each year (with the exception of 2016). The outcomes also indicated that the greatest number of ESBL producers were found with Klebsiella pneumoniae strains. Furthermore, the ESBL producers were grouped depending on hospital departments in which most frequent occurrences were found; the most frequent ESBL occurrence of both producers was found in the department of internal medicine. Additionally, the ESBL producers were grouped based on capture in various types of clinical materials; the greatest quantities of both microbes were found in urine. Based on these findings, the development of antibiotic resistance for both microbes over the period of 5 years was analyzed on samples of urine. When monitoring antibiotic resistance development, no considerable growths in bacterial strains resistant to individual anti-microbial agents was found over the 5 year period. Only for 3rd generation cephalosporins, there was a certain growth in resistance detected almost every year for both microbes. Namely, Escherichia coli isolates showed a growth from 6 % to 9 % and Klebsiella pneumoniae isolates showed a growth from 29 % to 33 % in the percentual quantity of strains resistant to these antibiotics.
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