A Cross Sectional Study Highlighting the Sensitivity Patterns and Incidence of Extended Spectrum Beta Lactamase Producing Klebsiella oxytoca in Patients with Urinary Tract Infection

Background and objective: Urinary tract infections (utis) due to multi-drug resistant Klebsiella oxytoca are increasing worldwide and have become a major public health problem. The aim of this study was to determine the current and local antimicrobial susceptibility pattern and frequency of ESBL positive strain of urinary K.oxytoca isolates. Material and methods: This is cross sectional observational and multicenter study with the use of non-probability sampling technique. Duration of the study was February 2015 to 2016. Sample size was calculated by the prevalence of 20% with the level of significance 0.05. The ethical approval was taken from Baqai medical university Karachi. In this study 600 presumptively Klebsiella oxytoca were collected in urine samples. For confirmation of isolates they were sub cultured on MacConkey and Cystine lactose electrolyte deficient (CLED) agar plates. On the subsequent day colony morphology were observed and gram staining was performed. For biochemical identification Rap ID ONE of Remel company kits were used. A total 600 isolates of K.oxytoca from urine sample were taken from different microbiology laboratory of Karachi. Isolates were further confirmed by morphological and biochemical identification (rapid ONE). Confirmed K.oxytoca isolates were subjected to antibiotic sensitivity testing by Kirby Bauer disc diffusion method and ESBL identification by CLSI guidelines by using the Cephalosporins (cefotaxime), Amoxycillin-clavulanic acid and Aztreonam discs. Results: During the study period after morphological biochemical identification and sample size calculation, only urinary 247 were confirmed as K.oxytoca. Out of which 166 (67%) containing adult female were isolated. Children (male and female) and adult male isolated samples were approximately equal with 41 (17%) and 40 (16%). The most effective antibiotic were imipenem (94.7%), amikacin (92.3%), nitrofurantoin (84.6%), piperacillintazobactam (83.4%), gentamicin (65.5%) and amoxycillin-clvulanic acid (51.4%). These drugs show good result in both ESBL and non- ESBL strain of K.oxytoca. Results showed that 74 (29.95%) were ESBL positive with higher frequency in adult males 21(52.5%). Conclusions: K.oxytoca was resistant to Third generation Cephalosporins. Our results showed higher incidence of ESBL-positive isolates. The antibiotic showing greater effectiveness toward K.oxytoca in both ESBL and non-ESBL isolates were imipenem and amikacin. Keywords: Klebsiella oxytoca; UTI; Amikacin; Imipenem; Nitrofurantoin; ESBL