Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1552 - 1554

ESBL and MBL Mediated Resistance in Pseudomonas aeruginosa: An Emerging Threat to Clinical Therapeutics

Prashant Durwas Peshattiwar, Basavaraj Virupaksappa Peerapur

1. MD (Microbiology), Asst. Prof, Konaseema institute of medical sciences and research foundation, Amalpuram, East Godavari, AP. 2. MD (Microbiology) Prof and head Department of Microbiology, BLDEU’s Shri B M Patil Medical college Bijapur, Karnataka. PLACE OF STUDY: BLDEU’s Shri B M Patil Medical college Bijapur, Karnataka.

Correspondence Address :
Basavaraj Virupakshappa Peerapur
MD (Microbiology) Prof and head Department of Microbiology,
BLDEU’s Shri B M Patil Medical college Bijapur,
Karnataka, India.
Phone: 09448139438
E-mail: peerapur_2003@yahoo.co.in

Abstract

Purpose: The present study was undertaken to detect the extended spectrum β lactamases (ESBL) and metallo β lactamases (MBL) in isolates of Pseudomonas aeruginosa which were isolated from wound infections and to evaluate their susceptibility patterns.

Materials and Methods: One hundred and twenty six isolates of P.aeruginosa were analyzed to study their sensitivity patterns. The presence of the ESBL enzyme was detected by the Phenotypic confirmatory test and the MBL enzyme was detected by the Imipenem – EDTA Double Disk Synergy test.

Result: Out of 126 isolates of P.aeruginosa, 28 (22.22%) were ESBL producers and 10 (7.8%) were MBL producers. None of the isolates showed the coexistence of ESBL and MBL in the same isolate. All the ESBL producing isolates were sensitive to Imipenem, while the MBL producing isolates showed widespread resistance to aminoglycosides, ciprofloxacin and the piperacillin with tazobactum combination.

Conclusion: The present study underlines the unique problem that the presence of ESBL has led to the widespread use of Imipenem, but that the emergence of MBLs and their broad spectrums and unrivalled drug resistance is creating a therapeutic challenge for clinicians and microbiologists. Hence, we suggest that the detection of ESBL and MBL in Pseudomonas aeruginosa should be a routine practice. We recommend a routine surveillance on antibiotic resistance in the hospital.

Keywords

P.aeruginosa , Third generation cephalosporins, Imipenem

How to cite this article :

Prashant Durwas Peshattiwar, Basavaraj Virupaksappa Peerapur. ESBL AND MBL MEDIATED RESISTANCE IN PSEUDOMONAS AERUGINOSA: AN EMERGING THREAT TO CLINICAL THERAPEUTICS. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Feb 22 ]; 5:1552-1554. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1552-1554&id=1805

Introduction
Pseudomonas aeruginosa is reported to be amongst the leading causes of nosocomial infections. It is known to exhibit intrinsic resistance to several antimicrobial agents (1). In addition to the intrinsic resistance of P. aeruginosa , it also produces the enzymes, namely ß-lactamases, which are responsible for the wide-spread ß-lactam resistance. These ß -lactamases hydrolyse the amide bond of the four-membered characteristic ß - lactam ring, thus rendering the antimicrobial ineffective (2). The ESBL enzymes encoded by the genes, SHV2a and the genes, SHV2a and TEM have been found in P. aeruginosa and the Enterobacteriaceae family, which suggests that these organisms are widespread reservoir of the ESBL enzymes (3).

MBLs are class B enzymes which hydrolyze carbapenems and are encoded by genes like IMP, VIM, etc (4). They have been described as the enzymes which require divalent cations, usually zinc, as metal co-factors for their enzymatic activity. In recent years, the MBL genes have spread from P. aeruginosa to Enterobacteriaceae. Given the fact that we are several years away from the implementation of a therapeutic inhibitor of MBLs, their continued spread is going to be a major therapeutic challenge (5).

Hence, the present study was conducted with an objective to know the antibiogram of P. aeruginosa. We also aimed to detect the presence of ESBL and MBL producing P. aeruginosa, so as to help in formulating an effective antibiotic strategy and to plan a proper hospital infection control strategy to prevent the spread of these strains.

Material and Methods

This prospective study was conducted in the Department of Microbiology of BLDEU’s Shri BM Patil Medical College, Bijapur,over a period from Nov 2008 to Sept 2010. 126 isolates of P. aeruginosa were obtained from the pus samples of wound infection cases. The cases which yielded a growth of P. aeruginosa from cultured wound swabs on blood agar and MacConkey’s agar were included in the study and they were further identified as per the standard microbiological procedures (6).The isolates were further tested by employing the Kirby Bauer disc diffusion method to study their antimicrobial susceptibility pattern for cephotaxime (30μg), ceftazidime (30μg), ciprofloxacin (5μg), gentamicin (10μg), amikacin (30μg), tobramycin (10μg), piperacillin (100 μg), piperacillin/tazobactum (100 μg/ 10 μg) , meropenem (10μg) and imipenem (10μg). The results were recorded and interpreted as per the CLSI guidelines (7).

Extended spectrum β – lactamase (ESBL) detection
All the isolates of P.aeruginosa which showed resistance to ceftazidime were evaluated for ESBL production by using the phenotypic confirmatory test (7). Briefly, a 0.5 MacFarland’s suspension of each isolate was spread on a Muller – Hinton agar (MHA) plate and ceftazidime (30 μg) and ceftazidime / clavulanic acid (30 μg/ 10 μg) discs were placed aseptically on the agar plate. A distance of about 15mm was kept between the two discs (edge to edge) and the cultures were incubated at 370C overnight. The observation of a ≥ 5mm increase in the zone diameter for the antimicrobial agent which was tested in combination with clavulanic acid, versus its zone diameter when tested alone, confirmed the presence of ESBL production by the organism. The increase in the zone diameter was due to the inhibition of the β lactamse by clavulanic acid.

THE METALLO - b- LACTAMASE (MBL) DETECTION METHOD
The Imipenem resistant isolates were tested by the Imipenem-EDTA double disk synergy test (DDST) as described by Lee et al. (8). The test organism was inoculated onto MHA plates as recommended by CLSI. An Imipenem 10 μg disk was placed 10mm edge to edge from a blank disc which contained 10 μl of EDTA (750 μg), with overnight incubation at 37°C. An enhancement in the zone of inhibition in the area between the Imipenem and the EDTA discs in comparison with the zone of inhibition on the far side of the drug was interpreted as a positive result.

The ESBL Phenotypic Confirmatory test and the Metallo β lactamase production by the Imipenem - EDTA Double Disk Synergy test are shown in (Table/Fig 1) and (Table/Fig 2) respectively.

Results

The Department of Microbiology, Shri B.M. Patil Medical College, Bijapur, received a total of 1628 pus samples between November 2008 and September 2010. Out of 1628 pus samples which were cultured, 126[12.92 %] yielded the growth of Pseudomonas aeruginosa. 103 samples yielded a pure growth of Pseudomonas aeruginosa, while 23 isolates were mixed cultures with E. Coli, S. aureus, Proteus species, K. pneumoniae, Acinetobacter species and Citrobacter species. Out of the 126 subjects who showed the growth of Pseudomonas aeruginosa, 81[64.28 %] were male patients and 45 [35.71%] were female patients. The male to female ratio in the present study was 1.8: 1. Out of the 126 isolates, 19 [15.07%] isolates were from the Outpatients Department and 107 [84.92%] were from inpatients. Among the isolates from the InPatients Departments, 76 [71.02%] isolates were from the surgery ward, followed by 24 [22.42%] from the orthopaedics ward and 7 [6.54 %] patients from the ENT ward. In the present study, a majority of the P. aeruginosa isolates were obtained from cases of cellulitis [19.04 %], followed by traumatic wound infections [16.66%], cases of diabetic foot [15.07%], CSOM [11.90%] and burns cases [9.5 2%]. The resistance pattern of P.aeruginosa was noted as follows, ceftazidime -67 [53%], cephotaxime -64 [50.79%], tobramycin -40[31.74%], netilmicin -57[45.23%], gentamicin – 48[38.09%], amikacin- 46 [ 36.50%] , ciprofloxacin- 59 [46.82%], imipenem and meropenem- 16 each [12.69 %], The piperacillin + tazobactum combination -26[20.63 %] and piperacillin -52 [ 41.26 %]. Among the 126 Pseudomonas aeruginosa isolates, 28 [22.22%] were ESBL producers. A total of sixty seven strains showed resistance to ceftazidime, of which 28 [41.79%] were found to be ESBL producers . Among the 126 isolates of Pseudomonas aeruginosa, 10 [7.8 %] isolates were metallo β lactamase producers and these were isolated from 16 imipenem resistant isolates. Hence, the percentage of MBLs in the imipenem resistant isolates was 62.5 %. Also, those 10 MBL producing strains were also resistant to netilmicin, gentamicin and ciprofloxacin (9) each and tobramycin and amikacin (8) each. None of the isolates showed the coexistence of ESBL and MBL.

Discussion

The emergence of antibiotic resistant bacteria is threatening the effectiveness of many antimicrobial agents. It has increased the hospital stay of the patients, thus leading to an increased economic burden on them.

In the present study, the rate of isolation of P. aeruginosa was higher in indoor patients [84.92%] as compared to that in the outdoor patients [15.07 %]. A similar observation was made by Shampa Anupurba et al, who reported the isolation of Pseudomonas aeruginosa to be more common in indoor patients [73.42%] as compared to that in the OPD cases [26.57%]. They expressed their view that the duration of the hospital stay was directly proportional to a higher prevalence of the infection, since the rate of isolation of the organisms was higher in indoor patients than in outdoor patients (9).

In the present study, the antibiogram of the 126 isolates of P. aeruginosa showed more resistance against ceftazidime [53.17%], which was similar to the observations which were by Diwivedi et al, who reported the ceftazidime resistance to be around 63%, and Arya M et al who reported a ceftazidime resistance of 55.4% in isolates obtained from post operative wound infections (10),(11). Our findings differed from those of Ibukun et al, who reported a higher susceptibility for ceftazidime of 79.4% (1). In the present study, we observed an increased resistance of this organism to various antibiotics like cephotaxime- 50.79%, netilmicin- 45.23%, gentamicin - 38.09%, amikacin -36.50%, ciprofloxacin- 46.82% and piperacillin- 41.26 %. A decreased susceptibility of P.aeruginosa to the commonly used antibiotics has already been noted by previous researchers (3),(4),(11),(12) Our study showed that among the 126 Pseudomonas aeruginosa isolates, 28 [22.22%] were ESBL producers, which was similar to 20.27 % ESBL producing isolates of P. aeruginosa which was reported by Aggarwal et al. (3). The ESBL mediated resistance of P. aeruginosa to the third generation cephalosporins as reported by Uma et al [77.3%], was much higher than that reported in the present study (14). We observed that only 12.69 % strains were resistant to carbapenem in our study. In the present study, imipenem and meropenem showed good antipsuedomonal activity. A similar observation was made by Jaykumar S. (4), while a higher degree of carbapenem resistance was noted by Varaiya et al [25%] (15). This difference could be attributable to the study environment under which the study was performed. A study by Varaiya et al from Mumbai involved patients from the ICU, where the use of broad spectrum antibiotics was common (15). In our study, out of the 126 isolates of Pseudomonas aeruginosa, 10 [7.8 %] isolates were metallo β lactamases producers. The prevalence of MBLs in the present study was consistent with the findings of Ibukun et al, Navaneeth et al and others (1),(16),(17). The percentage of MBLs in the imipenem resistant isolates was 62.5%. This suggested that the carbapenem resistance in P. aeruginosa was mediated predominantly via MBL production. A similar finding was observed by the SARI study group and by Behara et al. (17),(13). In the present study, 5 isolates [50%]out of 10 MBLs were resistant to all the 11 antibiotics which were tested. The presence of MBLs in the pandrug resistant isolates was already observed by Jaykumar S (4). In our study, none of the isolates had coproduced both ESBL and MBL. This was in agreement with the findings of Renata Picao et al (18).

Our study underlines the unique problem of ESBL and MBL mediated resistance, which has created a therapeutic challenge for the clinicians and microbiologists. To overcome the problem of emergence and the spread of multidrug resistant P. aeruginosa, a combined interaction and cooperation between the microbiologists, clinicians and the infection control team is needed. We recommend the routine surveillance of antibiotic resistance in the hospital.

References

1.
Ibukun A, Tochukwu N, Tolu O. Occurrence of ESBL and MBL in clinical isolates of Pseudomonas aeruginosa From Lagos, Nigeria. Journal of American Science 2007; 3(4) : 81-85.
2.
Bradford PA. Extended spectrum ß-lactamases in the 21st century: The characterization, epidemiology and the detection of this important resistance threat. Clin. Microbiol. Rev 2001; 14: 933-951.
3.
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