Background. Extended-spectrum β-lactamase (ESBL)- and AmpC-β-lactamase-producing Enterobacteriaceae have recently emerged as a public threat in the treatment of nosocomial as well as community-acquired infections. Very little information is currently available about its existence in Nepal. We, therefore, aim to determine the prevalence of ESBL and AmpC-β-lactamase-producing Enterobacteriaceae and also to determine their drug resistance pattern. Methods. During a 6-month period (November 2014–April 2015), a total of 190 stool specimens from 190 participants were obtained from different population. Of the total 260 fecal isolates, 152 from outpatient department (OPD) and 108 from healthy volunteer were collected. Stool specimens were cultured and enterobacterial isolates were subjected to antimicrobial susceptibility tests according to the standard microbiologic guidelines. ESBL was screened using ceftazidime (CAZ, 30 μg) and cefotaxime (CTX, 30 μg) disks and confirmed by double-disk synergy test. AmpC-β-lactamase enzyme production was detected by the aminophenylboronic acid inhibitor-based detection method. Antibiotic susceptibility test was performed for ESBL-positive isolates as per the Kirby-Bauer disk diffusion method, and interpretation was done according to CLSI (Clinical and Laboratory Standard Institute). Results. The prevalence of ESBL, AmpC-β-lactamases, and coproducer (ESBL + AmpC-β-lactamase) producing Enterobacteriaceae in OPD participants were 30.92%, 18.4%, and 13.81%, respectively, while 25%, 6.4%, and 1.8% in healthy population. ESBL-producing E. coli was 70.2% followed by K. pneumoniae (12.7%), and among AmpC-β-lactamase producer, E. coli were detected in half of the isolates (14/28, 50.0%) among OPD patients. Similarly, E. coli remained the most frequent ESBL producers 21/27 (77.8%) followed by K. pneumoniae 4/27 (14.21%) in healthy participants, and K. pneumoniae 5/7 (71.42%) and C. freundii 2/7 (28.57%) were detected highest among AmpC-β-lactamase-producing isolates. All isolates were highly sensitive (100%) to imipenem in both OPD and healthy participants. Conclusion. Our study revealed a high prevalence of ESBL- and AmpC-β-lactamase-producing enteric pathogen in Nepalese OPD and healthy population. The significant increase of these isolates and increased rate of drug resistance indicates a serious threat that stress the need to implement the surveillance system and a proper control measure so as to limit the spread of ESBL-producing Enterobacteriaceae (ESBL-PE) in both OPD as well as in community. Therefore, healthcare providers need to be aware that ESBL- and AmpC-β-lactamase-producing strains are not only circulating in hospital environments but also in the community and should be dealt with accordingly.

中文翻译：

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在尼泊尔健康社区和门诊 (OPD) 患者中携带产超广谱-β-内酰胺酶和 AmpC-β-内酰胺酶的肠杆菌科 (ESBL-PE)。

背景。产生超广谱β -内酰胺酶 (ESBL) 和 AmpC- β -内酰胺酶的肠杆菌科最近已成为治疗医院和社区获得性感染的公共威胁。目前关于它在尼泊尔存在的信息很少。因此，我们旨在确定产生 ESBL 和 AmpC - β-内酰胺酶的肠杆菌科细菌的流行率，并确定它们的耐药模式。方法. 在 6 个月期间（2014 年 11 月至 2015 年 4 月），从不同人群中获得了来自 190 名参与者的总共 190 份粪便标本。在总共260个粪便分离物中，152个来自门诊部（OPD），108个来自健康志愿者。根据标准微生物学指南，对粪便标本进行培养，并对肠杆菌分离物进行抗菌药敏试验。使用头孢他啶 (CAZ, 30 μg ) 和头孢噻肟 (CTX, 30  μg ) 圆片筛选 ESBL， 并通过双圆片协同试验确认。AmpC- ββ-内酰胺酶的产生是通过氨基苯硼酸抑制剂为基础的检测方法检测的。ESBL阳性菌药敏试验按照Kirby-Bauer纸片扩散法进行，判读依据CLSI（Clinical and Laboratory Standard Institute）。结果。OPD 参与者中产生肠杆菌科细菌的 ESBL、AmpC- β-内酰胺酶和副产物（ESBL + AmpC- β-内酰胺酶）的患病率分别为 30.92%、18.4% 和 13.81%，而 25%、6.4% 和 1.8%在健康人群中。产 ESBL 的大肠杆菌占 70.2%，其次是肺炎克雷伯菌(12.7%)，在 AmpC- β-内酰胺酶生产者中，在 OPD 患者中，有一半的分离株（14/28，50.0%）检出大肠杆菌。同样，在健康参与者中，大肠杆菌仍然是最常见的 ESBL 生产者 21/27 (77.8%)，其次是肺炎克雷伯菌4/27 (14.21%)，肺炎克雷伯菌5/7 (71.42%) 和弗氏梭菌2 /7 (28.57%) 在产生 AmpC- β-内酰胺酶的分离物中检测到最高。在 OPD 和健康参与者中，所有分离株都对亚胺培南高度敏感 (100%)。结论。我们的研究揭示了 ESBL- 和 AmpC- β的高患病率-尼泊尔OPD和健康人群中产生内酰胺酶的肠道病原体。这些分离株的显着增加和耐药率的增加表明存在严重威胁，需要实施监测系统和适当的控制措施，以限制产 ESBL肠杆菌科(ESBL-PE) 在 OPD 中的传播以及在社区中。因此，医疗保健提供者需要意识到，产 ESBL 和 AmpC - β-内酰胺酶的菌株不仅在医院环境中传播，而且在社区中传播，应进行相应处理。