Prevalence of 3rd Generation Cephalosporin Resistant (3GC-R) Bacteria from Tertiary Care Hospital of Lahore, Pakistan

Abstract

This study aims to generate a month-wise resistance profile of the third-generation cephalosporin-resistant isolates through bacterial identification, biochemical characterization, and phenotypic detection tests.  One-year retrospective cross-sectional study was conducted from February 2022 to January 2023 to detect third-generation cephalosporin-resistant isolates. Clinical specimens were collected and bacterial species were isolated from these samples through morphological identification and biochemical characterization. Antibiotic susceptibility testing was performed followed by phenotypic detection tests including double-disc synergy test, combination disc test and Epsilometer test. Phenotypic tests were performed to detect Extended-spectrum beta-lactamases production.  A total of 2,808 specimens were processed and subjected to biochemical characterization indicating that 2,594 (92%) clinical samples show third-generation cephalosporin resistance. Urine 17% (n=445) and pus 16% (n=412) were the most frequent specimens. A total of 3,053 strains were isolated from these specimens. The most prevalent one was Escherichia coli 35% (n=1,063) followed by Pseudomonas spp. 22% (n=659). The largest number of isolates were resistant to antibiotics including cefepime 86% (n=2,229), co-trimoxazole 86% (n=2,240), and ciprofloxacin 83% (n=2,148).  This study shows a high prevalence of clinical isolates against third-generation cephalosporins. The emergence of third-generation cephalosporin resistance increases drastically over time. Proper surveillance systems, health policies, appropriate monitoring and the right use of antibiotics help to combat accelerated resistance.