CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(03): 329-335
DOI: 10.1055/s-0042-1744239
Original Article

Phenotypic Detection of ESBL, AmpC, MBL, and Their Co-occurrence among MDR Enterobacteriaceae Isolates

1   Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
1   Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
2   Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
2   Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
3   Department of Microbiology, Assam Down Town University, Guwahati 781026, Assam, India
4   Microbial Resource Division, Institute of Bioresources and Sustainable Development (IBSD) Sikkim Centre, DBT, Tadong, Gangtok, Sikkim, India
› Author Affiliations
Funding None.


Background Emergence of extended-spectrum beta-lactamases (ESBLs), AmpC β-lactamases, and metallo-β lactamases (MBL), and their co-existence among members of Enterobacteriaceae pose newer diagnostic and therapeutic challenges. The present study examines the ESBL, AmpC, and MBL production by various phenotypic methods and their co-occurrence among the multidrug-resistant (MDR) Enterobacteriaceae clinical isolates.

Materials and Methods Four hundred non-repetitive Enterobacteriaceae clinical isolates were collected from the Central Referral Hospital, Sikkim. The isolates were used for identification and their antibiotic susceptibility tests were performed according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL was detected by double-disc synergy test (DDST) and phenotypic confirmatory disc-diffusion test (PCDDT), AmpC detection by AmpC E-test, and boronic acid disc diffusion (BD) test. MBL was detected using the imipenem–imipenem/EDTA disc and carba-NP tests.

Results Around 76% were considered MDR. ESBL was seen in 58% and 50.4% based on DDST and phenotypic confirmation disc-diffusion test (PCDDT), respectively. AmpC was detected in 11.8% and 13.1% using a commercial E-test and boronic acid test, respectively. MBL were identified in 12.8% and 14.8% based on MBL imipenem-EDTA and carba-NP tests, respectively. Co-occurrence of ESBL and AmpC, ESBL and MBL, AmpC and MBL was seen in 5.2%, 11.5%, 1.3%, respectively, whereas a combination of these three β-lactamases was observed in only 0.3% of 304 MDR isolates.

Conclusion The findings highlight a high prevalence of β-lactamases and their co-production among the Enterobacteriaceae, mainly in Klebsiella pneumoniae and Escherichia coli isolates. The study further highlights the necessity to identify the MDR β-lactamases stains for effective therapy in severe as well as mild bacterial infections, thereby enabling to reduce the risk of MDR in hospital and community settings.

Ethical Approval

The present study protocol was reviewed and approved by the Institutional Ethics Committee, SMIMS (SMIMS/IEC/2018–033). Informed consent was taken from the study participants. The privacy of the information taken was retained by omitting names and other personal details from the extraction sheet.

Author's Contributions

Salvia T. and Dolma K.G. contributed to conceptualization and design. Salvia T., Khandelwal B., and Dolma K.G. contributed to data acquisition. Salvia T., Khandelwal B., and Dhakal O.P. contributed to data analysis and interpretation. Salvia T. contributed to writing the original draft. Laishram S. Singh, Salvia T., and Dolma K.G. contributed to drafting and revising the manuscript. Laishram S. Singh and Dolma K.G. gave the final approval for publishing.

Publication History

Article published online:
20 April 2022

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