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Indian Journal of Medical Microbiology, Vol. 26, No. 3, July-September, 2008, pp. 281-282 Correspondence Extended spectrum beta lactamase (ESBL) producing Escherichia coli and klebsiella pneumoniae in diabetic foot infection Varaiya A, Dogra J, Kulkarni M, Bhalekar P Department of Microbiology, S.L. Raheja Hospital, Mahim West, Mumbai - 400 016 Date of Submission: 19-Dec-2007 Code Number: mb08089 Dear editor, Trauma, leading to infection is a common sequel of diabetic foot ulceration, which, once established, progressively worsens and becomes more difficult to treat. Extended spectrum β lactamases (ESBLs) are the derivatives of common β-lactamases (TEM and SHV β-lactamases) that have undergone one or more amino acid substitutions near the active site of the enzyme, thus increasing their affinity and the hydrolytic activity against third generation cephalosporins and monobactams. [1] Production of ESBL enzymes is either chromosomally mediated or plasmid mediated. [2] The majority of ESBL producing strains are Klebsiella pneumoniae, Escherichia coli and Klebsiella oxytoca . [1] This study was carried out to find out ESBL producing E.coli and K.pneumoniae in diabetic foot infection with type 2 diabetes mellitus and the clinical outcome of these patients. Over a one year period from January-December 2006, 191 samples (tissue 116, wound swab 75) were collected from indoor patients admitted at S.L. Raheja Hospital, tertiary care hospital for diabetic patients. Patients with non - healing diabetic foot ulcers for two weeks with empirical antibiotic treatment were included in the study. The samples were processed, identified and tested for antibiotic sensitivity test based on standard laboratory technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines [3] with commercially available discs (Hi Media) on Muller Hinton agar plates. ESBL producer was identified if there was ≥5 mm increase in zone diameter of ceftazidime/clavulanate disc than that of ceftazidime disc alone. Escherichia. coli ATCC 25922 was used as negative control. From 43 E.coli isolated, ESBL production was observed in 46.51% whereas from 27 K.pneumoniae isolated, ESBL production was found in 44.44%. Maximum ESBL producers were isolated from tissue samples. A combination of carbapenem, amikacin and piperacillin/tazobactam was given to the patients. The mean hospital stay for the indoor patients was 20 days. There was no mortality associated with this infection. There is paucity of Indian data on the ESBL producing pathogens in diabetic foot infection. In a study conducted in 2001, the prevalence was only 6% amongst E.coli isolates. [4] Kapil et al, have reported 54.5 % E.coli isolates to be ESBL producers. [5] We report overall 46.51% E.coli and 44.44% K.pneumoniae isolates to be ESBL producers. Thus, the prevalence of ESBLs among members of Enterobacteriaceae constitutes a serious threat to current beta-lactam therapy leading to treatment failure in diabetic foot infection. References
Copyright 2008 - Indian Journal of Medical Microbiology |
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