Community acquired multi-drug resistant clinical isolates of Escherichia coli in a tertiary care center of Nepal

Background: Multi-drug resistance (MDR) in Gram-negative organisms is an alarming problem in the world. MDR and extensively-drug resistance (XDR) is in increasing trend due to the production of different types of beta (beta)-lactamases. Thus the aim of this study was to document the incidence of MDR and XDR in clinical isolates of Escherichia coli and also to find out the enzymatic mechanisms of beta-lactam antibiotics resistance. Methods: Two hundred clinical isolates of Escherichia coli (E. coli) identified by standard laboratory methods were studied. Antibiotic susceptibility profile was performed for all the isolates and the suspected isolates were phenotypically tested for the production of extended spectrum beta-lactamase (ESBL), metallo beta-lactamase (MBL) and AmpC beta-lactamase (AmpC) by recommended methods. Results: Around three-fourth (78%) of the total isolates were multi-drug resistant. ESBL, MBL and AmpC production was found in 24%, 15% and 9% of isolates respectively. Amikacin, chloramphenicol and colistin were found to be the most effective antibiotics. Conclusions: High percentage of MDR was observed. beta-lactamase mediated resistance was also high. Thus, regular surveillance of drug resistance due to beta-lactamases production and infection control policy are of utmost importance to minimize the spread of resistant strains.