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Background   Escherichia coli  and  Klebsiella pneumoniae  are the major bacterial pathogens being isolated and reported from mid stream urine (MSU) specimens, globally. These uropathogens are mostly implicated as the major extended spectrum beta-lactamase (ESBL) producers, severely limiting the therapeutic management in cases of urinary tract infections. Limited studies had been reported from Nepal investigating the ESBL producers among uropathogens. This study was designed to assess the prevalence of ESBL producing  E.coli  and  K. pneumoniae  in urinary isolates at a centrally located major tertiary care hospital in Kathmandu valley, Nepal.    Methods  Between September 2011 and May 2012, during the nine months period, 6308 MSU specimens were collected aseptically from the same number of clinically suspected patients of urinary tract infections. The samples were cultured on MacConkey agar and blood agar. The isolates with significant bacteriuria (10 5  CFU / ml) were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs alongwith ceftriaxone on  E.coli  and  K. pneumoniae  isolates by Kirby Bauer disc diffusion method as per the recommendations of CLSI. On initial screening with ceftriaxone (30 μg) disc showing resistance was then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 ug) and ceftazidime + clavulanic acid (30 μg + 10ug) disc as per guidelines of CLSI (2011).    Results  Out of a total of 6308 MSU specimens investigated for significant bacteriuria,  E.coli  isolates were 444 (7.04%) and  K.pneuminiae  were 145 (2.3%) making a total of 589 (9.34%). Initial screening with ceftriaxone disc revealed 155 isolates of  E.coli  and 70 isolates of  K.pneumoniae  to be resistant. Further testing by PCDDT method showed 60/444 (=13.51%) of  E. coli  and 24/145 (=16.55%) of  K. pneumoniae  isolates to be confirmed ESBL producers. These ESBL – producer uropathogens showed high degree of resistance to ceftriaxone (100.0%), amoxycillin, fluoroquinolones and co-trimoxazole.    Conclusion  An emerging and moderately high prevalence of ESBL-producing  E. coli  and  K. pneumoniae  was observed and confirmed in the urinary isolates investigated. It is essential to have a regular and routine monitoring of ESBL producing clinical isolates in laboratory practice.

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Prevalence of extended spectrum beta lactamase producing Escherichia coli and Klebsiella pneumoniae urinary isolates in a tertiary care hospital in Kathmandu, Nepal