Comparison of Methods for Detection of Extended Spectrum Beta Lactamases Production by Escherichia coli and Klebsiella Isolates from Neonatal Sepsis Cases.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 1
Abstract
Background: ESBL production in critical conditions especially in neonatal sepsis is a burgeoning problem and their detection poses hindrance in establishing the prompt diagnosis. Aim: This study was carried out to unearth the effective and easy standard method to identify ESBL production in Escherichia coli and Klebsiella species isolated from neonatal sepsis cases. Methodology: 382 neonatal sepsis cases were subjected to blood culture and the isolates were identified and screened as per CLSI guidelines 2016 while the confirmation were done by combined disc diffusion test, Minimum inhibitory concentration test, Double Disc approximation test and E-test to check their efficacy. Results: Blood culture positivity was found to be 32.46% (EONS- 47.38% &LONS- 52.42%) out of which 58.87% were Gram negative isolates, 37.9%were Gram positive isolates and 3.22% were Candida spp. E.coli and Group B Streptococci were more common in EONS while Klebsiella spp, CoNS and Pseudomonas aeruginosa were more common in LONS cases. Out of 54.72% presumptive ESBL producers, phenotypic confirmation by CDDT and MIC reduction test were done in 45.28% isolates (E. coli; 81.25%&Klebsiella species; 84.6%) while 68.75% & 69.23% for E.coli and Klebsiella species respectively were confirmed by E strip test. The DDAT were positive for 62.5% & 61.5% number of cases respectively. The sensitivity, specificity, PPV and NPV were found to be 100% each for MIC, for DDAT (70.83%, 100%, 100% and 42%) and for E test to be (83.33%, 100%, 100% and 55.56%). Conclusion: Low specificity of screening test reflects detection of many false positive strains and low sensitivity of tests signals many missed identification. This study suggested the use of E test is better method to confirm screening positive ESBL isolates along with CDDT and MIC reduction test at microbiology laboratory.
Authors and Affiliations
Dakshina Bisht
Keywords
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