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Studies on Extended-Spectrum Β-Lactamase Producing Escherichia Coli and Klebsiella Pneumoniae

Thesis Info

Access Option

External Link

Author

Hussain, Masroor

Program

PhD

Institute

Quaid-I-Azam University

City

Islamabad

Province

Islamabad.

Country

Pakistan

Thesis Completing Year

2013

Thesis Completion Status

Completed

Subject

Natural Sciences

Language

English

Link

http://prr.hec.gov.pk/jspui/bitstream/123456789/2433/1/2550S.pdf

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676727290507

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This study was conducted to assess the prevalence of resistance genotypes of extended-spectrum and AmpC β-lactamase producing Escherichia coli and Klebsiella pneumoniae. Out of 632 samples, suspected for E. coli and K. pneumoniae, collected from different units of Pakistan Institute of Medical Sciences, Islamabad, Pakistan, the number of positive samples for E. coli and K. pneumoniae were 593 (93.8 %). Out of these 593 isolates, 61.6% (n=365) were identified as E. coli and 38.4% (n=228) were K. pneumoniae. Common age group for sample isolation was 13-25 years for both E. coli and K. pneumoniae, from which 29.9% of E. coli (n=109) and 27.6% of K. pneumoniae (n=63) were isolated. However, none of the age groups achieved statistical significance. Higher percentage of E. coli was isolated from females as compared to males, while the ratio of K. pneumoniae was higher in male patients (p=0.012). Most of the isolates were recovered from specimens collected from outdoor patients and were mainly from urine samples. ESBL production was detected in 46.20% (n = 274) of the 593 isolates by phenotypic method. Out of total 365 E. coli strains, 49.3% (n = 180) were found to be ESBL producers and 41.2% (n =94) of total 228 K. pneumoniae isolates, were ESBL producers. Statistical analysis indicated that age groups have significant association with the presence of ESBLs (p= 0.007) in E. coli isolates. No significant association was observed in ESBL producing K. pneumoniae with age, gender, sample source or origin. AmpC β-lactamase production was detected in 25.8% (n = 94) of the total 365 E. coli and 20.6% (n =47) of total 228 K. pneumoniae isolates. There was significant association between males (p=0.018) and samples collected from surgical ward (p=0.01) with AmpC positive status in E. coli isolates. No significant association (p=0.88) was found in AmpC producing K. pneumoniae and gender. However, like AmpC producing E. coli, isolation from surgical wards had a statistically significant association with AmpC positive K. pneumoniae (p=0.001). Out of these 593 isolates, 200 samples of the phenotypically confirmed ESBLs or AmpC producers, E. coli and K. pneumoniae, were processed for antibiotic susceptibility analysis and detection of the selected genes. Out of 200, 131 were E. coli and 69 were K. pneumoniae. The highest resistance (90.1%) was observed against sulphamethoxazole, followed by tetracycline (88.5%) and ciprofloxacin (80%) among E. coli isolates. In case of β-lactam antibiotics, high resistance (87.8%) was observed against cefotaxime and amoxicillin/clavulanic acid, followed by cefepime (81.7%) and aztreonam (79.4%). Out of the total 131 E. coli isolates, 100 (76.3%) were found resistant to ceftazidime having an MIC >32μg/ml. Highest resistance was observed in case of amoxicillin/clavulanic acid, in which 117 isolates (89.3%) were resistant, followed by cefotaxime (116, 89.3%). About 45 (34.3%) isolates of E. coli showed resistance to cefoxitin with a maximum range of 256 μg/ml. PCR amplification revealed that CTX-M-1 was the most frequently (77 isolates, 58.7%) detected ESBL gene group, followed by TEM (25 isolates, 19%) and SHV (19 isolates, 14.5%). CTX-M-9 group was observed in only 4 bacterial isolates. Among AmpC β- lactamases, MOX gene was detected in 19 (14.5%) E. coli isolates, CIT in 17 (13%), CMY gene in 7 (5%), EBC gene in 5 (4%), and 2 isolates showed FOX AmpC β-lactamases. A total of 26 different patterns of genes were detected in 112 E. coli isolates, while no candidate gene was found in 19 E. coli isolates. Among K. pneumoniae, higher resistance was observed in case of tetracycline (98.6%), amoxicillin/clavulanic acid (97.1%) and sulphamethoxazole (95.7%). In case of β-lactam antibiotics, cefoxitin was the most successful antibiotic showing resistance to 20 (29%) isolates, followed by ceftazidime and cefepime (69.6%) and aztreonam (75.4%). MIC results revealed that fifty isolates (72.5%) were found resistant to ceftazidime with a maximum range of 512 μg/ml, while 19 (27.5%) were found susceptible. Fifty six (81%) isolates were resistant to cefotaxime and 61 (88.4%) to amoxicillin/clavulanic acid. Cefoxitin was the most successful antibiotic, effective against 47 (68.1%) of the total 69 K. pneumoniae isolates tested CTX-M-1 type ESBLs were detected in 43 (62.3%) isolates, SHV in 9 (13%), TEM in 8 (11.6%) and CTX-M-9 in 2 isolates (3%). Six (9%) isolates showed CIT type AmpC genes while 4 (6%) had CMY, 3 (4%) each FOX and MOX and 2 (3%) had EBC type genes. Eighty genes showed amplification in 69 K. pneumoniae isolates. A total of 18 different patterns of genes were detected in K. pneumoniae in a total of 58 isolates, while in 11 isolates, no gene was detected. Our study showed that both class A and class C β- lactamases contributed to cephalosporin resistance in E. coli and K. pneumoniae, thereby limiting therapeutic options. Co-expression of these enzymes may further hinder the identification of ESBLs, which is a critical step for designing a successful treatment for multidrug-resistant E. coli and K. pneumoniae. Sequence analyses revealed 99-100% homology with already reported ESBL genes from around the world. However, mutations in CIT gene were found which indicates possible amino acid substitutions in more than one position
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مڈھلی گل

کامرس دا طالب علم ہوون دے باوجود ساہت، قدرتی منظر تے سہپن وچ میری دل چسپی بال پن توں ای سی۔ایہو کارن اے کہ میں باقاعدہ لکھنے توں پہلے سارا پاکستان خاص کر شمالی علاقہ جات دی یاترا تِن سو تو ں وی ودھ وار کیتی۔ بہت سارے لکھاری تے کویاں نال سنگت وی رہی تے جدوں پہلا لیکھ اخبار وچ چھپیا تاں متراں ولوں ملی ہلا شیری کان ساہت وچ دلچسپی ڈونگھی ہوندی گئی۔ پنجابی ساہت دیاں لکھتاں پڑھ تے اوہناں دے لکھاریاں نوں مل کے خوشی محسوس کردا ساں۔سلطان کھاروی نال وی میرا سمبھندھ ساہت پاروں ہویا۔ پہلی ملاقات دا قائم ہویا تاثر اج تائیں برقرار اے۔ اوہ اک درویش صفت منکھ نیں۔ سب نال پیار کرن والے تے یاراں دے یار، اُچ کوٹی کوی، پارکھ تے کھوج کارنیں۔ اوہناں دے سریر وچ اک بھڑکائو روح دا واس ہے جو اوہناں نوںٹک کے بہن نہیں دیندی۔ ہر ویلے کسے نہ کسے کم وچ رجھے رہندے نیں۔

میں اپنے کول موجود آپ دیاں لکھتاںنوںگوہ نال پڑھیا تے پڑھن توں بعد اوہناں دی شخصیت تے فن دی جو مورت من اندر ابھری میں انتہائی ایمان داری نال اکھراں دی لڑیاں وچ پرو کے تہاڈے ساہمنے رکھ دتا اے۔ میں کتھوں تائیں اپنے سرنانویں نال انصاف کر سکیاں ہاں، ایہہ گل تساں مینوں دسنی اے۔ تہاڈے وچاراں دا اڈیکن ہار۔

                                                                                                                ڈاکٹر محمد ایوب

                                                                                                                فیصل آباد

A Post Structural Inquiry into Female Esl Learners’ Gender Identities at a Public University in Pakistan

The present study investigates how English language learning interacts with the gender identities and roles of female learners at the University of Sindh, Jamshoro, Pakistan. Who learns what and how, is influenced by the learners’ gendered and sexualized identities (Pavlenko, 2004). Language learners have to navigate power relations within the classroom and their specific communities and develop understanding of their limitations and opportunities within these communities. Institutional practices and gender ideologies inhibit their access to networks which in turn affect their linguistic output and interactional opportunities. Within Interpretive epistemological framework eight female learners of final year (fourth year) Linguistics studying at IELL were interviewed and observed twice during one year to gather data for the present study. From the data it appeared that Pakistani females’ access to linguistic resources is mediated by cultural norms and societal expectations. Throughout their academic journeys the learners’ agency remained active due to which they were able to invest in their ESL learning and challenge socially imposed identities on them.

Regional Integration and Liberal Economic Order in Saarc: A Case Study of Trade Relations Between Pakistan and India under Safta Regime 1997-2015

The South Asian Association for Regional Cooperation (SAARC) was established in 1985 with the aim to accelerate economic growth and social progress in the region. It was assumed by the proponents of SAARC that wealthier South Asia would be peaceful and powerful politicoeconomic entity, because increase in wealth and economic cooperation among states would improve human development index and decrease intra state political conflictsin South Asia. SAARC initiated trade liberalization policies since 1994 when SAARC preferential trade agreement was signed. Though the scope of trade liberalization was limited in the purview of SAPTA due to its positive list approach to intraregional trade, yet it paved the way for SAARC Free Trade Area (SAFTA). The establishment of SAFTA in 2004, boosted up the morale of SAARC and it started to visualize complete economic integration in South Asia in near future. However, SAFTA have not meet to its expected results and volume of intraregional trade is still low and the goal of wealthier South Asia is still far away. In this context, this study is outlined to analyze the liberal economic dimension of SAARC. It highlights the evolutionary process of trade liberalization in the region of South Asia and analytically evaluates the contribution of SAARC towards economic integration of South Asia. In addition it highlights the international economic scenario in which the establishment of Free Trade Area had become desirable for SAARC member countries. For this purpose, the study emphasizes on three major research questions; why the liberal economic practices are desirable in SAARC? Why SAFTA has not been fully implemented yet? And what are the major hindrances in the establishment of Free Trade regime in SAARC? To evaluate the effectiveness of SAFTA, study emphasizes on the Pakistan – India trade relations under SAFTA regime for in-depth analysis. This part of the study uses comparative approach. It includes a comparison between overall economic structure of Pakistan and India and comparison of bilateral trade trend between India and Pakistan before and after SAFTA through using statistical data. Further it covers all economic and noneconomic hindrances to bilateral trade between Pakistan and India. During the study, primary data is collected through structured survey and open ended interviews from stakeholders. For static analysis, data is gathered from internationally recognized databases of World Bank, UNTACD, WTO and World Economic Forum. The study finds out that regional integration without trade liberalization is impossible. SAARC is working on the agenda of economic integration in South Asia through its apex body, SAARC Chamber of Commerce and Industry; though the process of integration is slow but it is steady. In the age of globally integrated trading system, protectionism will no more a good choice to protect domestic industries. South Asian countries will have to reform their domestic macro-economic policies for implementing trade competitiveness measures in their respective states. Regional connectivity and trade facilitation measures under SAFTA has boosted up the foreign direct investment to South Asia. Further, this study finds out that power asymmetries in SAARC have make the process of trade liberalization slow, India will has to reconsider its role in SAARC as through showing its hard and soft power, it has disrupt the trade negotiation process on the platform ofSAARC on many occasions. However, the study contributes to understand the relation between regional integration and liberal economic order in the purview of SAARC.