Antimicrobial resistance patterns of phenotype Extended Spectrum Beta- Lactamase producing bacterial isolates in a referral hospital in northern Tanzania (original) (raw)
Related papers
2013
Background: Extended-Spectrum β-Lactamase (ESBL) producing Enterobacteriaceae have become widespread in hospitals and are increasing in community settings where they cause a variety of infections. In addition to hydrolyzing most beta-lactam agents, bacteria harboring these enzymes display resistance to other unrelated antimicrobial agents and thus often pose a therapeutic dilemma. Though these resistance patterns have been studied elsewhere within Africa, such data from hospitals in Kenya are scanty. We therefore undertook to determine these patterns at the Aga Khan University hospital by studying multidrug resistant Escherichia coli and Klebsiella pneumoniae isolates from patients' samples. Findings: A total of 159 isolates (109 E. coli and 50 K. pneumoniae) were confirmed as ESBL producers and tested against eighteen antimicrobials. The proportion of resistant isolates was high (>80%) for the antimicrobials tested with the exception of the carbapenems (<1%), nitrofurantoin (23%) and gentamicin (63%). Klebsiella pneumoniae had a higher proportion of isolates resistant to ceftazidime, gentamicin and nitrofurantoin (P < 0.05) than E. coli which had a higher proportion of isolates resistant to ciprofloxacin, levofloxacin and tetracycline (P < 0.05). Conclusions: In our study, antimicrobial coresistance is common in ESBL producers; however resistance to carbapenems is low and these drugs would be the appropriate empiric therapy for serious or life threatening systemic infections. Nitrofurantoin retains good activity among the multidrug resistant isolates and can be the drug of choice for non-complicated urinary tract infections due to ESBL producing E. coli.
BMC Research Notes, 2010
Background: Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among Escherichia coli and Klebsiella spp from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Findings: A total of 270 E.coli and Klebsiella spp urinary pathogens from children and adults isolated from January to March 2010 were included in the study. E. coli and Klebsiella spp isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were E. coli and 132 (48.9%) were Klebsiella spp. ESBL was detected in 122 (45.2%) of all the isolates. ESBL-producing E. coli strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL-producing Klebsiella spp strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (P < 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001). Conclusions: High prevalence of ESBL-producing E. coli and Klebsiella spp strains was found among inpatients and children. Most of the ESBL-producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.
Background: Extended-Spectrum β-Lactamase (ESBL) producing Enterobacteriaceae have become widespread in hospitals and are increasing in community settings where they cause a variety of infections. In addition to hydrolyzing most beta-lactam agents, bacteria harboring these enzymes display resistance to other unrelated antimicrobial agents and thus often pose a therapeutic dilemma. Though these resistance patterns have been studied elsewhere within Africa, such data from hospitals in Kenya are scanty. We therefore undertook to determine these patterns at the Aga Khan University hospital by studying multidrug resistant Escherichia coli and Klebsiella pneumoniae isolates from patients' samples. Findings: A total of 159 isolates (109 E. coli and 50 K. pneumoniae) were confirmed as ESBL producers and tested against eighteen antimicrobials. The proportion of resistant isolates was high (>80%) for the antimicrobials tested with the exception of the carbapenems (<1%), nitrofurantoin (23%) and gentamicin (63%). Klebsiella pneumoniae had a higher proportion of isolates resistant to ceftazidime, gentamicin and nitrofurantoin (P < 0.05) than E. coli which had a higher proportion of isolates resistant to ciprofloxacin, levofloxacin and tetracycline (P < 0.05). Conclusions: In our study, antimicrobial coresistance is common in ESBL producers; however resistance to carbapenems is low and these drugs would be the appropriate empiric therapy for serious or life threatening systemic infections. Nitrofurantoin retains good activity among the multidrug resistant isolates and can be the drug of choice for non-complicated urinary tract infections due to ESBL producing E. coli. Keywords: Extended-spectrum beta lactamases, Escherichia coli, Klebsiella pneumoniae, antimicrobial susceptibility, empiric therapy
Infection and Drug Resistance, 2022
Background: Multi-drug resistant Enterobacteriaceae (MDR-E), primarily extended-spectrum beta-lactamase producers (ESBLs), have emerged as a major public health concern. This study aimed to determine the prevalence of multi-drug resistance and extendedspectrum beta-lactamase-producing Enterobacteriaceae among hospitalized patients presumptive for bacterial infections at Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Methods: A hospital-based cross-sectional study was conducted from January to May 2021. A total of 384 hospitalized patients presumptive for bacterial infections were included in the study. Urine, wound, blood, stool, and sputum samples were collected and cultured on MacConkey agar, Cysteine Lactose Electrolyte Deficient medium, and Blood agar. Identification was done using a panel of biochemical tests. The antimicrobial susceptibility test was done by disc diffusion. Screening of ESBL production was done by using cefotaxime and ceftazidime and confirmed by the combination disk method per clinical laboratory standard institute guidelines. Data analysis was performed by Statistical Package for Social Sciences software version 25, and a P-value ≤0.05 was considered as statistically significant. Results: Out of 384 study participants, a total of 164 Enterobacteriaceae were isolated. The overall multi-drug resistance rate (MDR) was 92.1%. The overall prevalence of ESBL-PE was 104 (63.4%). E. coli 50 (30.5%) and K. pneumoniae 24 (14.6%) were the predominant ESBL producers. The highest ESBL producers E. coli (13.4%) and K. pneumoniae (6.1%) were isolated from urine sample. History of antibiotic use for the last three months (P-value=0.01), admission in neonatal intensive care unit (P-value=0.02), history of hospital stays (P-value=0.01), and chronic disease (P-value=0.04) showed statistically significant association with ESBL-PE infection. Conclusion: The prevalence of MDR-E and ESBL-PE was high. Therefore, strong infection prevention and control measures and careful selection of antibiotics are needed in the study area to block the transmission and infection in the healthcare setting.
Journal of Biology Agriculture and Healthcare, 2014
One of the major challenges facing health professionals is the prevalence of antibiotic resistance. Most Gramnegative bacteria produce beta-lactamases which are enzymes that in-activate β-lactams. Recent publications suggested that extended spectrum beta-lactamase production in E. coli and K. pneumoniae is one of the main causes of antimicrobial resistance in penicillins, cephalosporins and some non-beta-lactam antibiotics in Accra. This present work sought to determine the resistance profile of antimicrobials to non-ESBL-producing isolates in Accra. The 400 K. pneumoniae and E. coli isolates were screened for non-ESBL-producing strains using the combined disk method. The minimum inhibition concentration for 17 antibiotics was determined using Vitek 2 Compact System (bioMérieux, Marcy I'Etoile, France). Among the 400 total bacterial isolates, 198 (49.5%) were non-ESBL producers. Co-resistances to ampicillin (66.7%), piperacillin (59.1%), tetracycline (77.8%) and trimethoprim/sulphamethoxazole (68.2%) have been collaborated in this work. The increasing rise in resistance to the beta-lactam/beta-lactamase inhibitor combination antibiotics such as amoxicillin/clavulanic acid (13.6%) and piperacillin/tazobactam (18.7%) is problematic since they have become the empirical drug of choice for treating most infections. The steady increase in resistance to gentamicin (17.2%) as well as the floroquinolones such as ciprofloxacin (39.4%) and norfloxacin (34.9%) is alarming. In the absence of ESBLs, cephalosporins generally have been effective in treating infections caused by enterobacteria. Nitrofurantoin remains reliable for managing non-life threatening urinary tract infections. Amikacin and imipenem continue to be effective thirdline treatment options for Gram-negative bacteria infections. As antibiotic resistance increases and the development of new antimicrobials declines, it is imperative that we use antimicrobials that are still effective rationally. Evidence based antibiotic prescriptions and usage as well as regular evaluation of antibiotic resistance will help to control the spread of antibiotic resistance in Accra, Ghana.
Journal of Natural Sciences Research - IISTE, 2013
Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta lactamases commonly found in the Enterobacteriaceae that are capable of hydrolysing β-lactams except carbapenems and cephamycins. ESBLs confer resistance to several non-ß-lactam antibiotics. ESBL-producing organisms appear susceptible to cephalosporins in vitro using conventional breakpoints but ineffective in vivo. This work sought to determine the occurrence of ESBL in E. coli and K. pneumoniae and their antibiotic resistance profile. Four hundred K. pneumoniae and E. coli non-duplicate isolates were collected at the Central Laboratory of Korle Bu Teaching Hospital and Advent Clinical Laboratories. They were definitively identified and their minimum inhibition concentration and antibiotic sensitivity testing for 17 antibiotics were determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France). The isolates were confirmed as ESBL-producing strains using the Combination Disk Synergy Method. The results indicated that 202 (50.5%) of the bacterial isolates were ESBL-producing phenotypes with high resistant to gentamicin, ciprofloxacin, tetracycline and trimethoprim/sulfamethoxazole indicating 82.2%, 79.7%, 70.8% and 97% resistant rates respectively. imipenem and amikacin were the antibiotics of choice with 99% and 94.1% susceptibility rates (MIC90 of ≤1µg/ml and 4µg/ml respectively). It is imperative to routinely detect ESBL-phenotypes in health facilities, implement appropriate antibiotic administration policy and infection control measures in the hospitals.
Introduction: High proportions of E. coli and Klebsiellae isolates at Komfo Anokye Teaching Hospital (KATH) have developed resistance to the commonly prescribed antimicrobial drugs, but the cause of which is unknown. Detailed data upon which to advocate control interventions are scanty. This study determined the prevalence of ESBL Klebsiellae and E. coli at KATH, so as to establish the linkage (if any) between ESBL production and drug resistance to antimicrobials drugs at the Komfo Anokye Teaching Hospital. Method: 405 isolates consisting of 156 E. coli strains and 234 Klebsiella pneimoniae and 15 Klebsiella oxytoca were collected and tested for their antimicrobial susceptibility, ESBL production and the ESBL genotypes were determined by PCR. Results: High proportions of isolates were resistant to the β-lactam antibiotics with ampicillin recordeing 391 (91.7%) resistance followed by cefpodoxime 299 (73.8%), cefuroxime 286 (70.6%), ceftriaxone 224 (55.3%) and then cefotaxime 195 (48.1%). Proportion of isolates resistant non β-lactams tested ranged from 61%-79%. ESBL producers had higher resistance proportions than non-ESBL producers. ESBL prevalence range from 49.4% in E coli, 61.5% in Klebsiella kpeumoniae to 86.7% in Klebsiella oxytoca. ESBL genotypes TEM, CTX-M were found in 151(64.5) isolates while 70(29.9) acquired the three ESBL genotypes. Conclusion: The widespread prevalence of ESBL producing E. coli and Klebsiellae call for immediate intervention strategies to prevent further spread. Training of laboratory personnel on phenotypic testing of ESBLs in addition to training clinical staff and prescribers on ESBL issues are advocated.
2021
The aim of this study was to determine the resistance patterns and ESBLs production among clinical isolates of Escherichia coli and Klebsiella pneumoniae in two government hospitals of Delta State, Nigeria. Urine, blood and wound samples were aseptically collected from hospitalized patients, bacteriologically processed and isolates identified using standard protocols. Antimicrobial susceptibility testing was determined by disc diffusion method. The plasmid DNA of Multidrug resistance (MDR) isolates were extracted by alkaline lysis method. Phenotypic ESBL production of the MDR isolates was done by Double Disc Synergy Test (DDST) while PCR was used to detect blaCTX-M, blaSHV and blaTEM among isolates. A total of 217 isolates were obtained, of which 161(74.2%) and 56(25.8%) were Escherichia coli and Klebsiella pneumoniae respectively. The antimicrobial resistance varied from one location to another. All isolates obtained from blood of general hospital Warri (GHW) were 100% resistant to...
African Health Sciences
Background: Escherichia coli and Klebsiella pneumoniae are commonly implicated in urinary tract infections accounting for majority of the antimicrobial resistance encountered in hospitals. Objectives: To determine the prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamases (ESBLs) producing E. coli and K. pneumoniae among patients in Anyigba, Nigeria. Methods: This hospital-based cross-sectional study was conducted using urine samples from 200 patients of Grimmard Catholic hospital and Maria Goretti hospital. Urine samples were processed to identify ESBL-producing E. coli and K. pneu- moniae using standard microbiological techniques. Isolates were then tested against antimicrobial agents. Results: A total of 156 bacterial isolates were recovered consisting 128 of E. coli and 28 of K. pneumoniae. Extended spec- trum beta-lactamases production was observed in 69% of E. coli and 31% of K. pneumoniae. These pathogens were resistant to 3 or more antibiotics. Of t...
Journal of Biology, Agriculture and Healthcare. Vol. 4, No. 14, 2014
Abstract One of the major challenges facing health professionals is the prevalence of antibiotic resistance. Most Gramnegative bacteria produce beta-lactamases which are enzymes that in-activate β-lactams. Recent publications suggested that extended spectrum beta-lactamase production in E. coli and K. pneumoniae is one of the main causes of antimicrobial resistance in penicillins, cephalosporins and some non-beta-lactam antibiotics in Accra. This present work sought to determine the resistance profile of antimicrobials to non-ESBL-producing isolates in Accra. The 400 K. pneumoniae and E. coli isolates were screened for non-ESBL-producing strains using the combined disk method. The minimum inhibition concentration for 17 antibiotics was determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France). Among the 400 total bacterial isolates, 198 (49.5%) were non-ESBL producers. Co-resistances to ampicillin (66.7%), piperacillin (59.1%), tetracycline (77.8%) and trimethoprim/sulphamethoxazole (68.2%) have been collaborated in this work. The increasing rise in resistance to the beta-lactam/beta-lactamase inhibitor combination antibiotics such as amoxicillin/clavulanic acid (13.6%) and piperacillin/tazobactam (18.7%) is problematic since they have become the empirical drug of choice for treating most infections. The steady increase in resistance to gentamicin (17.2%) as well as the floroquinolones such as ciprofloxacin (39.4%) and norfloxacin (34.9%) is alarming. In the absence of ESBLs, cephalosporins generally have been effective in treating infections caused by enterobacteria. Nitrofurantoin remains reliable for managing non-life threatening urinary tract infections. Amikacin and imipenem continue to be effective thirdline treatment options for Gram-negative bacteria infections. As antibiotic resistance increases and the development of new antimicrobials declines, it is imperative that we use antimicrobials that are still effective rationally. Evidence based antibiotic prescriptions and usage as well as regular evaluation of antibiotic resistance will help to control the spread of antibiotic resistance in Accra, Ghana.