ANTIMICROBIAL RESISTANCE; COMPARISON OF ESCHERICHIA COLI IN DIFFERENT AREAS OF LAHORE

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1 DR. QAMAR AZIZ MBBS, M.Phil. Assistant Professor, Department of Pathology, Baqai Medical College, Karachi. DR ZULFIQAR ALI M.B,B.S, M.Phil Associate Professor Independent Medical College Faisalabad ANTIMICROBIAL RESISTANCE; COMPARISON OF ESCHERICHIA COLI IN DIFFERENT AREAS OF LAHORE DR. MATEEN IZHAR MBBS, MRC PATH, Ph.D. Professor of Microbiology Shaikh Zayed Postgraduate Medical Institute Lahore. Dr. Vaqar Hassan Shah Demonstrator, Dept. of Pharmacology Baqai Medical College, Karachi. ORIGINAL PROF-1739 ABSTRACT Introduction: Since the development of antibiotics there is a growing concern about the increasing incidence of antibiotic resistance. As a result the therapeutic value of originally effective antibiotics become significantly reduced overtimes. Extensive data is available on antibiotic susceptibilities of hospital isolates but very little information is available about the susceptibilities of community strains. Design: Descriptive. Period: July 2004 to June Setting: Department of Microbiology, Shaikh Zayed Hospital Lahore. Hence the present study was design to assess the environmental load of the antibiotic resistance using fecal flora as an indicator of overall problem. It will also provide guidance in antibiotic protocol for antibiotic policy. Objective: Objective of the present study was to determine the developing resistance to β Lactam Antibiotics which is the commensal microbe of enteric tract. Materials & Methods: One hundred samples were collected from ten different areas of Lahore city ( samples from each area) and were inoculated on Mac Conkey s agar. Five morphologically distinct lactose fermenting colonies were selected & identified using standard laboratory methods. Five hundred different colonies of E.coli were identified and analyzed for their susceptibility to b-lactam antibiotic. Results: Out of 500 isolates, the resistant isolates with ampicillin (48), coamoxiclav (40) and cephradine (37) were detected, with cheaper oral agents high prevalence of resistance was detected. Conclusions: Ampicillin, co-amoxiclav and cephradine are not much useful for the treatment of urinary tract infection and septicemia caused by E-coli & other Members of fecal flora. Key words:e-coli, Resistance, b-lactam. INTRODUCTION chemistry, mechanism of action pharmacology and Pathogenic bacteria which cause waterborne infectious immunologic characteristics with cephalosporins, diseases are released into the water system via feces of monobactam, carbapenems and β-lactamase warm-blooded animals mainly human beings. To inhibitors. All are β-lactam compound, so named estimate sanitary condition in the water system, fecal 3 because of their unique four membered lactone ring. coliforms have been commonly used as an indicator of 1 fecal pollution. Aim & objective Objective of the present study was to determine the E.Coli is the most common cause of urinary tract developing resistance to β Lactam Antibiotics which is infection. It is the most abundant facultative anaerobe in the commensal microbe of enteric tract. the colon and faeces. E-coli causes a variety of diseases both within & outside the intestinal tract. It is the most MATERIALS & METHODS frequent cause of nosocomial urinary tract infection in 1. Sterile swabs to get sewage samples. both men and women. It may produce cystitis and 2. MacConkey s media (differential media) for pyelonephritis. It may also produce neonatal meningitis inoculation of the specimen and isolation of 2 and diarrohea. Escherichia coli (lactose fermenting colonies). 3. Biochemical media including. Betalactam antibiotics are penicillins and a) Triple Sugar Iron Agar cephalosporins. The penicillins share features of b) Sulphide Indole & Motility Media

2 2 c) Kliger Iron Agar resistance to amoxiclav was 40, resistance to 4. Muller Hinton agar for sensitivity testing. cephradine was 37 very few isolates showed 5. Antibiotic discs. resistance to cefurixome 12. No resistance was observed against fourth generation cephalosporins Reagents (Table I & II).Prevalence of resistance to both ampicillin Ÿ Staining Material for Gram Staining. and co-amoxiclav was moderately high 48 and 40 Ÿ Method Kovacs Reagent for Indole Test. respectively. Resistance to ampicillin was highest in Shadbagh Area 70 whereas; it was lowest in Cantt. Area 20, in other eight areas resistance to ampicillin Sample Collection and Transportation to the ranged from Prevalence of co-amoxiclav Laboratory resistant isolates was also lowest in Cantt. Area 18 and Source of bacterial isolate in this study is Sewage. was highest in Madina Colony and Chung 50. In other Specimens were collected from Sewage in different area, its ranged from No resistance to pipracillin areas of Lahore. One hundred samples collected from was observed (Table-I). ten different areas of Lahore city ( Samples from each area). Samples were collected with the help of sterile First generation cephalosporins swabs and were transferred to the Microbiology Overall resistance to cephradine was recorded 37, Laboratory, Shaikh Zayed Hospital Lahore. resistance was found about 50 highest in Madina (N-500) Colony, Wahdat Colony and Chung while it was lowest in Cantt. Area 16 in other six area resistance ranged from CULTURING THE SAMPLES MacConkey s agar and selenite-f broth were inoculated by the swabs. Both plates and broths were incubated Second generation cephalosporins O aerobically at 37 C for hours. Selenite-F broth was Overall resistance to cefuroxime was 12. The isolates subcultured on XLD agar. from Cantt. Area showed no resistance to cefuroxime while the isolates from Chung and Allama Iqbal Town IDENTIFICATION OF ESCHERICHIA COLI showed a resistance of 20 highest, In other area its From MacConkey s agar, five morphologically distinct ranged from lactose fermenting colonies were selected and identified using standard laboratory methods which included: 3rd generation cephalosporins over all resistance to cefatoxime was 3.6. Isolates from Chung area showed Gram Staining 4 20 (highest) resistance while the isolates form muslim Triple sugar iron medium 5 town, wahdat colony, jail road, cantt madina colony, Indole & motility tests 6 allama iqbal town & Shadbag showed no resistance. In other area it ranged from 6 to non of the isolates showed resistance to cefatazidime and ceftriaxone. Results Rapidly emerging nosocomial pathogens and the problem of multi-drug resistance necessitates periodic 4th generation cephalosporins review of isolation patterns and sensitivity in surgical No resistance was observed against 4th generation 7 practice. cephalosporins (cefpirome & cefiopime). (Table-II). According to the present study susceptibility of E.Coli strains obtained were determined for b-lactam antibiotics the study shows that out of 500, total resistant to ampicillin were 48, whereas the prevalence of DISCUSSION Antibiotic resistance is a matter of great concern since the introduction of antibiotic have changed the conditions but resistance to newly introduced antibiotics is also developing. There is a good data for antibiotics

3 3 res i s t ance in hospitalized patients; but very little information is available about the prevalence of antibiotic resistance in the

4 4 8,9 community. These data are mainly from the developed countries. In Pakistan, there is no data available for the Similar study was also performed on fecal samples of prevalence of antibiotic resistance in the community. healthy volunteers of two different towns Grula and Furthermore, the previous studies regarding antibiotic Marida of Venezuela. resistance were mainly performed on the healthy volunteers. In this study, Escherichia coli isolated from Comparison of present study with previous studies the sewage was used as an indicator of resistance in the High incidence of resistance to antimicrobial agents in community. E.Coli is a member of normal fecal flora and the developing nations is mainly due to over crowding, is capable of transferring resistance to the other fecal poverty and irrational use of antibiotics and their flora via plasmid mediated mechanism. Because it is the availability without prescription. 11 largest reservoir of antibiotic resistant determinants. Advantage of using sewage sample is that not only it Resistance to ampicillin in the present study was almost represents the human fecal flora but also flora from the comparable to prevalence of resistance to ampicillin animal birds and poultry sources get represented. (amoxicillin) in Merida (39) Grula 46 and Qinpu China 47, whereas the resistance to ampicillin was In the present study, a moderately high prevalence of very high in caracas (85). Relatively lower resistance to resistance in fecal E.Coli to ampicillin, co-amoxiclav and ampicillin was detected in southeast of Netherland cephradine were observed. A significant difference (28), Boston 23, Weert 8.4 and Roermond between Cantt. Area (Socio-economically Rich) and (12.4). other area was found for ampicillin, co-amoxiclav and cephradine, this resistance percentage for ampicillin was In the present study, a high incidence of resistance to co- 20 as compared to the other areas where its was from amoxilclav (augmentin) 37 was observed whereas no resistance to co-amoxilclav was observed in weert and roermond (Table I). Similarly the prevalence of resistance to co-amoxiclav and cephradine was 18 and 16 respectively in Cantt The above data from the previous studies revealed that Area which was very low when compared to the resistance to ampicillin (amoxicillin) in the developing resistance in other area which ranged from in 12 countries like Venezuela Caracas and Qinpu was Madina Colony, Whadat Colony, chung and Shadbag the higher or equivalent to that present study while it was low 12 thickly populated areas mixed middle and lower class in Boston, Weert and Roermond which are the areas of population. It is most likely due to lack of awareness developed nation. Low prevalence of resistance to about antibiotic use, low literacy rate, use of substandard antibiotics in the developed countries is mainly due to antibiotics and rather misuse antibiotics. Studies rational use of antibiotics in these countries. performed in different parts of the world among them the 12 study performed provides the prevalence of antibiotic It has also been observed that there is high prevalence of resistant fecal E.Coli in healthy children in Boston (USA). Similar study performed on fecal samples taken from 13 students in South East of Netherland. Two years later Bonten et al detected the prevalence of antibiotic resistance E.Coli in stool samples of healthy volunteers 8 from maastricht and Zwolle Netherland. London also determined the prevalence of antibiotic resistant fecal Escherichia coli by healthy volunteers from two cities 14 Weert & Roermond Netherlands. resistance to co-amoxiclav and cephradine in the present study which is higher than the other studies performed in developing countries, these differences can be justified because the samples were obtained in this study from the sewage which contained fecal floral of not only human but also animal. In contrast, the samples used in previous studies were fecal matter from healthy volunteers. Copyright 28 Jan, REFERENCES 1. K. Miyanaga, T. Hijikata, C. Furukawa, Hajime Unno,

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