Multivariate analysis of risk factors for ESBL and AmpC producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care Hospital in Karnataka: A case control study

Aaftab G.P; Asha B Patil; Shobha Medegar

Multivariate analysis of risk factors for ESBL and AmpC producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care Hospital in Karnataka: A case control study

Original Article

Author Details : Aaftab G.P, Asha B Patil, Shobha Medegar

Volume : 5, Issue : 1, Year : 2018

Article Page : 1-6

https://doi.org/10.18231/2394-5478.2018.0001

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Abstract

Introduction: Extended spectrum β-lactamase (ESBL) and AmpC producing organisms pose unique challenges to clinical microbiologists, clinicians, infection control professionals.
The objective of the present study was to analyze the risk factors that will help in identifying those at risk of acquiring infection by ESBL and/or AmpC producing organisms thereby making appropriate changes in the choice of antimicrobial therapy and minimizing treatment failures.
Materials and Methods: Risk factors were evaluated using a retrospective Case control design. 100 patients with infections due to ESBL and/ or AmpC producing E.coli or K. pneumoniae were employed as cases. These were matched with 100 patients with non ESBL- non AmpC producing organisms (Controls). Univariate and Multivariate logistic regression analysis was performed to identify variables associated with becoming a case.
Results: Out of the total 100 cases, E.coli 61 (61%) was the predominant ESBL and/or AmpC producer, followed by Klebsiella pneumonia 39 (39%). In the multivariate analysis, we found that duration of hospital stay for more than 5 days (OR=0.16, P=0), stay in ICU (OR=2.98, P=0.02) and prior treatment with antibiotics (OR=2.81, P=0.003) were statistically significant risk factors associated with acquisition of ESBL/AmpC producers. We also found invasive procedures like usage of urinary catheter (OR=3.34, P<0.005), central venous catheter (OR=3.35, P=0.018), intravenous catheter (OR=7.38, P<0.005) and other surgical procedures (OR=3.14, P=0.0002) contributed significantly to the spread of ESBL/AmpC producers.
Conclusion: ESBL and AmpC producing strains were found to show higher rates of resistance to various class of antibiotics when compared to non ESBL and AmpC producers. Knowledge on risk factors of infection helps physicians in framing appropriate empirical antibiotic policies.

Keywords: AmpC resistance, Case control, Extended spectrum beta lactamases, Risk factors.

How to cite : G.p A, Patil A B, Medegar S, Multivariate analysis of risk factors for ESBL and AmpC producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care Hospital in Karnataka: A case control study. Indian J Microbiol Res 2018;5(1):1-6

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