Table 5.

7 Screening for ESBL production using different screening agents Screening Agents Ceftriaxone (30g) Cefpodoxime (10g) Ceftazidime (30g) Cefotaxime (30g) Aztreonam (30g) Screening Criteria 25mm 17mm 22mm 27mm 27mm No. of confirmed ESBL producers 68 1 68 1 62 7 68 1 65 4 Sensitivity (%) positive predictive value (PPV) 73.9 72.3 80.5 76.4 70.7

ESBL Screening Screen positives Screen negatives Screen positives Screen negatives Screen positives Screen negatives Screen positives Screen negatives Screen positives Screen negatives 92 18 94 16 77 33 89 21 92 18

98.6 98.6 89.9 98.6 94.2

Table 5. 8 Patterns of ESBL production according to the use of various combination disks No. of S.N Combination Criteria for suspected ESBL producers CPD (10g) 1 CPD (10g) plus CV (1g) CAZ (30g) 2 CAZ (30g) plus CV (10g) CTX (30g) 3 CTX (30g) plus CV (10g) Increase in zone size of 5 mm with 1 of the combination disks 69 110 62 69 41 65 disks (CD) Assay confirmation No. of confirmed cases Total confirmed cases Negative cases after confirmation

CPM (30g) 4 CPM (30g) plus CV (10g)

CPD-Cefpodoxime, CAZ-Ceftazidime, CTX-Cefotaxime, CPM-Cefepime, CV-Clavulanate

69

S. N

Organisms

Total isolates

No. of MDR strains 84 28 7 15 6 2 1 3 3 16 164

No.of suspected ESBL producers 75 7 4 10 2 1 1 3 1 6 110

No. of cases confirmed (%) 60 (80) 4 (57.1) 2 (50) 1 (10) 0 (0.0) 1 (100) 0 (0.0) 1 (33.3) 0 (0.0) 0 (0.0) 69 (62.7)

Negative cases on confirmation 15 3 2 9 2 0 1 2 1 6 41 (38.3)

1 2 3 4 5 6 7. 8 9 10

E. coli K. pneumoniae K. oxytoca Acinetobacter spp. Ps. aeruginosa P. mirabilis P. vulgaris Citrobacter freundii Providencia spp. S. aureus TOTAL

133 30 13 22 10 3 1 3 4 29 248

Table 5.6 Profile of ESBL producing bacterial strains from different samples

Table 3: Pattern of urine culture results S.N. 1. 2. Growth Significant bacteriuria No growth Total No. of samples 80 272 352 Percentage of samples 22.7 77.3 100.0

Table 8: Correlation of pyuria with culture result Pyuria Significant (5WBC/HPF) Insignificant (<5WBC/HPF) Total 80 (22.7) 272 (77.3) 352 (100.0) 3 (1.2) 250 (98.8) 253 (71.9) Culture positive (%) 77 (77.8) Culture negative (%) 22 (22.3) Total (%) 99 (28.1)

Table 9: Correlation of haematuria with culture result Haematuria Significant (3RBC/HPF) Insignificant (<3RBC/HPF) Total 80 (22.7) 272 (77.3) 352 (100.0) 61 (20.1) 243 (79.9) 304 (86.4) Culture positive (%) 19 (39.6) Culture negative (%) 29 (60.4) Total (%) 48 (13.6)

Table 11: Antibiotic Susceptibility Pattern of Gram negative bacteria S.N. Antibiotics used Total no. of isolates Susceptibility Pattern Resistant No. 1. 2. 3. 4. 5. 6. 7. 8. Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin 75 75 75 75 75 75 75 75 71 16 22 33 13 13 33 22 % 94.7 21.3 29.3 44.0 17.3 17.3 44.0 29.3 Moderate No. 0 2 2 0 2 7 1 3 % 0 2.7 2.7 0 2.7 9.3 1.3 4.0 Susceptible No. 4 57 51 42 60 55 41 50 % 5.3 76.0 68.0 56.0 80.0 73.0 54.7 66.7

Table 12: Antibiotic Susceptibility Pattern of Gram positive bacteria S.N. Antibiotics used Total no. of isolates Susceptibility Pattern Resistant No. 1. 2. 3. 4. 5. 6. 7. Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Cloxacillin Erythromycin Nitrofurantoin 5 5 5 5 5 5 5 1 1 0 1 2 1 0 % 20.0 20.0 0 20.0 40.0 20.0 0 Moderate No. 0 0 1 0 0 0 0 % 0 0 20.0 0 0 0 0 Susceptible No. 4 4 4 4 3 4 5 % 80.0 80.0 80.0 80.0 60.0 80.0 100.0

8.

Oxacillin

40.0

60.0

Table13: Antibiotic Susceptibility Pattern of bacterial isolates S.N. Organisms isolated Escherichia coli N=39 Antibiotics used Antibiotic Susceptibility Pattern Resistant Moderate Susceptible No. % No. % No. % 38 8 12 18 7 4 21 13 97.4 20.5 30.8 46.2 18.0 10.3 53.9 33.3 0 1 1 0 2 2 0 2 0 2.6 2.6 0 5.1 5.1 0 5.1 1 30 26 21 30 33 18 24 2.6 77.0 66.7 53.9 77.0 84.6 46.2 61.5

1.

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

2.

Klebsiella pneumoniae N=15

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

13 4 4 6 3 4 5 4

86.7 26.7 26.7 40.0 20.0 26.7 33.3 26.7

0 0 1 0 0 1 1 1

0 0 6.7 0 0 6.7 6.7 6.7

2 11 10 9 12 10 9 10

13.3 73.3 66.7 60.0 80.0 66.7 60.0 66.7

3.

Klebsiella oxytoca

Ampicillin Ceftriaxone

3 1

100.0 33.3

0 0

0 0

0 2

0 66.7

N=3

Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

2 2 1 0 3 2

66.7 66.7 33.3 0 100.0 66.7

0 0 0 0 0 0

0 0 0 0 0 0

1 1 2 3 0 1

33.3 33.3 66.7 100.0 0 33.3

4.

Proteus mirabilis N=6

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

6 1 0 2 0 0 0 0

100.0 16.7 0 33.3 0 0 0 0

0 1 0 0 0 3 0 0

0 16.7 0 0 0 50.0 0 0

0 4 6 4 6 3 6 6

0 66.7 100.0 66.7 100.0 50.0 100.0 100.0

5.

Proteus vulgaris
N=5

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

4 1 1 2 1 1 1 0

80.0 20.0 20.0 40.0 20.0 20.0 20.0 0

0 0 0 0 0 1 0 0

0 0 0 0 0 20.0 0 0

1 4 4 3 4 3 4 5

20.0 80.0 80.0 60.0 80.0 60.0 80.0 100.0

N=5

6.

Enterobacter spp. N=3

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

3 0 1 1 0 1 1 1

100.0 0 33.3 33.3 0 33.3 33.3 33.3

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 3 2 2 3 2 2 2

0 100.0 66.7 66.7 100.0 66.7 66.7 66.7

7.

Citrobacter freundii N=2

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

2 0 1 1 0 1 1 1

100.0 0 50.0 50.0 0 50.0 50.0 50.0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 2 1 1 2 1 1 1

0 100.0 50.0 50.0 100.0 50.0 50.0 50.0

8.

Acinetobacter spp. N=1

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole

1 1 1 1

100.0 100.0 100.0 100.0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

1 1 1 1

100.0 100.0 100.0 100.0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

9.

Alcaligenes spp. N=1

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Gentamicin Nitrofurantoin Norfloxacin Ofloxacin

1 0 0 0 0 1 0 0

100.0 0 0 0 0 100.0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 1 1 1 1 0 1 1

0 100.0 100.0 100.0 100.0 0 100.0 100.0

10.

S. aureus N=1

Ampicillin Ceftriaxone Ciprofloxacin Cotrimoxazole Cloxacillin Erythromycin Nitrofurantoin Oxacillin

0 0 0 1 1 0 0 1

0 0 0 100.0 100.0 0 0 100.0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

1 1 1 0 0 1 1 0

100.0 100.0 100.0 0 0 100.0 100.0 0

11.

CoNS.

Ampicillin

25.0

75.0

N=4

Ceftriaxone Ciprofloxacin Cotrimoxazole Cloxacillin Erythromycin Nitrofurantoin Oxacillin

1 0 0 1 1 0 1

25.0 0 0 25.0 25.0 0 25.0

0 1 0 0 0 0 0

0 25.0 0 0 0 0 0

3 3 4 3 3 4 3

75.0 75.0 100.0 75.0 75.0 100.0 75.0