Incidence and antibiogram of β lactamases-producing citrobacter freundii recovered from clinical isolates in Peshawar, Pakistan

Abstract

Citrobacter freundii, a common cause of nosocomial infections leading to diarrhea, urinary tract infection and meningitis, is increasingly becoming multidrug resistant. The current study was aimed to determine the prevalence and antibiotic susceptibility pattern of extended spectrum β-lactamases producing C. freundii clinical isolates. A total of 2950 clinical samples were collected from both hospitalized and non-hospitalized patients of Khyber Teaching Hospital (KTH), Peshawar, and processed by for isolation of C. freundii followed by phenotypic detection of β-lactamases and antimicrobial susceptibility profile. Our results indicated that a total of 130(4.40%;130/2950) samples were positive for C. freundii comprised of urine 58.46%, pus 33.85% and wounds 7.69%, respectively. More samples from females (n=70) than males (n=60) with majority (43.08%) from age group 21-40 years were found positive for C. freundii. Of the 130 isolates, 28 (21.53%) were ESBL producers comprised of 10 (35.71%) from males and 18(64.29%) from females with majority recovered from age group of 21-40 years (57.14%). Furthermore, 10(7.69%) isolates were metallo-β lactamase (MBL) producers containing 4(40%) from males and 6(60%) from females with majority from age group of 41-60 years (60%). Of the ESBL producers, 78.57%, 71.42%, 64.29%, and 42.86% isolates displayed resistance against trimethoprim-sulphamethoxazole, levofloxacin, ciprofloxacin and piperacillin-tazobactam, respectively, while, tygacil and colistin showed 100% susceptibility. On the other hands, 60%, 80%, 40% and 20% of metallo-β lactamase producers were found resistant to trimethoprim-sulphamethoxazole, levofloxacin, ciprofloxacin and piperacillin-tazobactam, respectively. Overall, current results show a high number of isolates resistant to commonly used drugs, and hence appropriate usage of antibiotics must be ensured to avoid further dissemination.