ISOLATION AND IDENTIFICATION OF SOME BACTERIA PATHOGENS FROM CLINICAL SAMPLES IN A HEALTH CENTRE IN UMUAHIA

CHAPTER ONE

1.0 INTRODUCTION

Klebsiella is well known to most clinicians as a cause of community-acquired bacterial pneumonia, occurring particularly in chronic alcoholics (Jemima and Verghese, 2009) and showing characteristic radiographic abnormalities due to a severe pyogenic infection which has a high fatality rate if untreated. The vast majority of Klebsiella infections, however, are associated with hospitalization. As opportunistic pathogens, Klebsiella spp. primarily attack ‘immuno-compromised’ individual who are hospitalized and suffer from severe underlying diseases such as diabetes mellitus or chronic pulmonary obstruction. Nosocomial Klebsiella infections are caused mainly by Klebsiella pneumoniae, the medically most important species of the genus. To a much lesser degree, K. oxytoca has been isolated from human clinical specimens. It is estimated that Klebsiella sp. causes 8% of all nosocomial bacterial infections in the United States and in Europe. No great geographical variations in frequency have been noted. In the United States, Klebsiella accounts for 3 to 7% of all nosocomial bacterial infections, placing them among the eight most important infectious pathogens in hospitals (Hornick et al., 1992), and data collected from the United Kingdom  and from Germany  are remarkably similar to those reported by the Centers for Disease Control and Prevention (CDC 2005). The urinary tract is the most common site of infection. Klebsiella accounts for 6 to 17% of all nosocomial urinary tract infections (UTI) and shows an even higher incidence in specific groups of patients at risk, e.g., patients with neuropathic bladders or with diabetes mellitus (Yan et al, 2009). As a cause of nosocomial gram-negative bacteremia, Klebsiella is second only to Escherichia coli. In pediatric wards, nosocomial Klebsiella infections are especially troublesome—particularly in premature infants and intensive care units. Klebsiella species are often the pathogens involved in neonatal sepsis, in both early-manifestation and late-manifestation infections (Ananthakrishnan et al., 2000). Due to the extensive spread of antibiotic-resistant strains, especially of extended-spectrum b-lactamase (ESBL)-producing strains, there has been renewed interest in Klebsiella infections.

Klebsiella species are known to cause a variety of human infections such as pneumonia (Podschum et al, 1998), septicaemia (Shubha and Ananthan, 2002), urinary tract infections, rhinoscleroma, ozaena and other soft tissue infections (Podschum  and Ullmann, 1998). Klebsiella sp. are usually opportunistic pathogens found in the environment, on mammalian mucosal surfaces and on the hands of hospital personnel with the principal pathogenic reservoirs being the gastrointestinal tract of humans (Ananthakrishnan et al., 2000). Different Klebsiella species may be responsible for different types of infections, and may also differ with the site of the infection. The various species of Klebsiella sp.  may exhibit different levels of susceptibility to antibiotics employed in treatment and also disinfectants used for cleaning purposes in the hospital (Jemima and Verghese, 2009). However, Klebsiella sp. and many other pathogenic agents are rarely identified to species level in many hospitals in Ghana due to the cost and special skills involved. Hence antibiotics are administered to treat these infections without considering the species responsible for particular infection.

Klebsiella infections are caused mainly by K. pneumonia and K. oxytoca. They are opportunistic bacterial pathogens associated with nosocomial infections such as urinary tract infection (UTI), pneumonia and septicemia (Podschum et al 1998). For the first time in 1998, a new type of invasive K. pneumoniae emerged in Taiwan, which was typically presented as a community-acquired primary liver abscess (Yan J.J. 2009). Several reports, especially from the Asia Pacific region and the United States, have also shown that this pathogen has become the predominant cause of liver abscess (Chung et al. 2007). A new virulence gene which is mucoviscosity associated gene A (magA), has recently been identified in this pathogen. magA is detected in a vast majority of K. pneumoniae liver abscess isolates and is associated with hypermucoviscosity (HV) and resistance to killing by human serum and phagocytosis (Lee et al. 2007). Based on many recent reports all indicating the emergence-Drug resistance worldwide data shows that there is an increasing resistance among uropathogens to conventional drugs. Resistance has emerged even to newer, more potent antimicrobial agents (Jones, R.N et al., 2001). The epidemiology and the resistant patterns show a regional variability and prove to have a continuous change of frequency, due to excessive use of antibiotics. Studies show that the risk factors play an important role, for the emergence of the antibiotics resistance. Some of them are due to the mal-administration of the antibiotics in the past history, renal malformations associated and the frequent use of antibiotics for the prophylaxis of recurrent infections. However, many reports have indicated the presence of multidrug resistance in organisms causing UTIs.

  AIMS

To evaluate the prevalence and antibiogram of Klebsiella spp in clinical samples as this will be of local clinical relevance in the management of infections caused by the organism.

   OBJECTIVES

i. To isolate and identify Klebsiella sp. from clinical specimen.

ii. To determine the prevalence of Klebsiella sp. among the clinical specimens.

iii. To determine the antibiogram of Klebsiella sp. isolated from clinical specimens in Abia State Specialist Hospital (ASH). 

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