Fecal Carriage of ESBL-Producing E. coli and K. pneumoniae in Children in Guinea-Bissau: A Hospital-Based Cross-Sectional Study (original) (raw)
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Antimicrobial Resistance & Infection Control, 2023
Background Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (ESBL-KP) and Escherichia coli (ESBL-EC) present a high burden in both communities and healthcare sectors, leading to difficult-to-treat infections. Data on intestinal carriage of ESBL-KP and ESBL-EC in children is scarce, especially in sub-Saharan African countries. We provide data on faecal carriage, phenotypic resistance patterns, and gene variation of ESBL-EC and ESBL-KP among children in the Agogo region of Ghana. Methods From July to December 2019, fresh stool samples were collected within 24 h from children < 5 years with and without diarrhoea attending the study hospital. The samples were screened for ESBL-EC and ESBL-KP on ESBL agar and confirmed using double-disk synergy testing. Bacterial identification and an antibiotic susceptibility profile were performed using the Vitek 2 compact system (bioMérieux, Inc.). ESBL genes, blaSHV, blaCTX-M, and blaTEM were identified by PCR and further sequencing. Results Of the 435 children recruited, stool carriage of ESBL-EC and ESBL-KP was 40.9% (n/N = 178/435) with no significant difference in prevalence between children with diarrhoea and non-diarrhoea. No association between ESBL carriage and the age of the children was found. All isolates were resistant to ampicillin and susceptible to meropenem and imipenem. Both ESBL-EC and ESBL-KP isolates showed over 70% resistance to tetracycline and sulfamethoxazole-trimethoprim. Multidrug resistance was observed in over 70% in both ESBL-EC and ESBL-KP isolates. The blaCTX-M-15 was the most prevalent ESBL gene detected. blaCTX-M-27, blaCTX-M-14, and blaCTX-M-14b were found in non-diarrhoea stools of children, whereas blaCTX-M-28 was found in both the diarrhoea and non-diarrhoea patient groups. Conclusions The carriage of ESBL-EC and ESBL-KP among children with and without diarrhoea in the Agogo community with a high prevalence of blaCTX-M-15 is noteworthy, highlighting the importance of both the population as a possible reservoir. This study reports for the first time the ESBL gene blaCTX-M-28 among the studied populations in Ghana.
Scientific Reports, 2021
Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (EPE) is increasing worldwide, though less documented in low-income settings. Here we determined the prevalence of EPE infection and carriage, and patient factors associated with EPE-carriage among pediatric patients in three health care levels in Tanzania. Between January and April 2016, 350 febrile children (median age 21 months) seeking care at a university or a regional referral hospital, or a health centre in Moshi municipality, Tanzania, were included. Socio-demographic characteristics were collected using a questionnaire. Rectal swabs and blood cultures were collected from all children (n = 350) and urinary samples from 259 children at admission. ESBL-phenotype and antimicrobial susceptibility were determined for Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) isolates. Only one EPE case (E. coli) in blood and four in urine (one E. coli and three K. pneumoniae) were found, whereas (n = 90, 26%) of the children were colonized in feces (ESBL-E. coli; n = 76, ESBL-K. pneumoniae, n = 14). High resistance rates were seen in fecal ESBL-E. coli (n = 76) against trimethoprim-sulfamethoxazole (n = 69, 91%), gentamicin (n = 51, 67%), ciprofloxacin (n = 39, 51%) and chloramphenicol (n = 27, 35%) whereas most isolates were sensitive to amikacin (n = 71, 93%). Similar rates were seen for fecal ESBL-K. pneumoniae. Resistance to first line antibiotics were also very high in fecal E. coli not producing ESBL. No sociodemographic factor was associated with EPE-carriage. Children colonized with EPE were younger than 12 months (n = 43, 48%) and often treated with antibiotics (n = 40, 44%) in the previous two months. After adjustment for age children admitted to the intensive care unit had higher odds of EPE fecal carriage compared with those in the general wards (OR = 3.9, 95%CI = 1.4-10.4). Despite comparatively high rates of fecal EPE-carriage and previous antibiotic treatment, clinical EPE cases were rare in the febrile children. The very high resistant rates for the EPE and the
Journal of bacteriology and mycology, 2023
Introduction: Extended-Spectrum Β-Lactamase (ESBL) mediating resistance in Enterobacterales is a global public health issue, especially in Low-and Middle-Income Countries (LMICs) such as Cameroon. ESBL-producing Enterobacterales reduce therapeutic options and lead to the use of last resort drugs such as carbapenems even in vulnerable populations like children under five years. This study aims at determining the phenotypic and genotypic characteristics of ESBL-producing Escherichia coli (ESBL-Ec) isolated from children under five years with and without diarrhoea in two health care facilities in Dschang. Materials and Methods: A cross-sectional study was conducted from 3 February to 19 May 2022 in two hospitals in the city of Dschang, Cameroon. Stool collected were cultured on Eosine Methylen Blue (EMB) medium. Enterosystem 18R kit was used for bacterial identification. Evaluation of the resistance patterns and detection of ESBL production were performed with, the Kirby Bauer disk diffusion method and CHROMagar® ESBL medium, respectively. The genomic DNA of ESBL-Ec was extracted using the boiling method and subjected to conventional and multiplex PCRs for detection of bla SHV , bla CTX-M and bla TEM genes. Data were entered into Excel TM 2016. Epi info and R software were used for statistical analyses with a p-value <0.05 considered statistically significant. Results: Out of the 125 children enrolled, 67.2% (84/125) were colonized by E. coli. Among these, 57.14% (48/84) were colonized by ESBL-Ec. The prevalence of ESBL-Ec per hospitals, was higher in H1 than that of H2 although without statistical significance (60.42% vs 39.58%, p=0.24). ESBL-Ec isolates showed high levels of resistance to amoxicillin-clavulanic acid (96.22%), cefotaxime (75.47%), ceftriaxone (73.58%), ofloxacin (67.92%), levofloxacin (56.6%) and ciprofloxacin (54.71%). The majority of ESBL-Ec isolates (52.83%; 28/53) were co-producers of bla CTX-M and bla TEM. Conclusion: Infection prevention and control measures coupled with antimicrobial stewardship strategies need to be strengthened to reduce emergence and dissemination of ESBL-Ec among this vulnerable population.
Antibiotics
The proportions and similarities of extended-spectrum β-lactamase (ESBL) producing K. pneumoniae (ESBL-KP) and E. coli (ESBL-EC) carrying multiple ESBL genes is poorly known at our setting. This study investigated the existence of multiple ESBL genes (blaCTX-M, blaTEM, and blaSHV) among ESBL-KP and ESBL-EC concurrently isolated from clinical, colonization, and contamination samples from neonatology units in Mwanza-Tanzania. Twenty and 55 presumptive ESBL-EC and ESBL-KP, respectively, from a previous study archived at −80 °C were successfully recovered for this study. Isolates were screened and confirmed for production of ESBLs by phenotypic methods followed by multiplex PCR assay to determine ESBL genes. All (100%) and 97.3% of presumptive ESBL isolates were phenotypically confirmed by Clinical and Laboratory Standards Institute (CLSI) and modified double-disc synergy methods, respectively. About 93.3% (70/75) of phenotypically confirmed ESBL isolates had at least one ESBL gene, whe...
International Journal of Infectious Diseases
Objectives: Infections caused by multidrug-resistant Enterobacterales pose a significant challenge to clinical patient care, particularly in resource-constrained settings where epidemiological data on antimicrobial resistance are scarce. The aim of this study was to determine the prevalence of extended spectrum beta-lactamase-(ESBL)-producing Klebsiella pneumoniae among clinical samples from a teaching hospital in Bouaké, central Côte d'Ivoire. Methods: Clinical specimens were collected from sterile and non-sterile body sites and were subjected to microbiological diagnostics (April 2016-June 2017). The antimicrobial susceptibility patterns of K. pneumoniae were analysed using automated resistance testing and double-disk diffusion to test for ESBL production. Multiplex PCR was carried out to determine the presence of the resistance-conferring genes bla CTX-M , bla SHV and bla TEM . Results: A total of 107 isolates were included, most of which were obtained from bloodstream (39%; n = 42) and urinary tract infections (39%; n = 42). Among all K. pneumoniae isolates, 84% (n = 90) were ESBL producers, many of which were also not susceptible to sulfonamides (99%), quinolones (81%) and aminoglycosides (79%). The majority of ESBL-producing strains harboured all three investigated bla genes. Conclusion: The high prevalence of ESBL-producing K. pneumoniae in clinical isolates from Côte d'Ivoire calls for revised empirical treatment regimens in critically ill patients with suspected Gram-negative infections, and the establishment of antimicrobial resistance surveillance systems.
The Journal of Infection in Developing Countries, 2014
Introduction: The increasing frequency and antibiotic resistance among extended-spectrum β-lactamases (ESBLs)-producing bacteria are posing a serious threat. This study sought to investigate the frequency and antibiotic susceptibility of ESBL-producing E. coli and K. pneumoniae at a tertiary care hospital. Methodology: Data were collected from samples sent to the microbiology laboratory between 2006 and 2010 at King Khalid University Hospital, Riyadh. ESBLs were confirmed using Etest strips of cefotaxime/cefotaxime + clavulanic acid, ceftazidime/ceftazidime + clavulanic acid, and cefepime/cefepime + clavulanate. Results: Out of 17,105 samples, 1,076 (6.3%) ESBL-producing isolates of E. coli (808) and K. pneumoniae (268) were confirmed. Among these, 680 (63.2%) isolates were found in urine samples, followed by 287 (26.7%) in superficial swabs, deep wounds swabs, tissues and sterile body fluids, 71 (6.6%) in respiratory, and 38 (3.5%) in blood samples. The overall frequency rates of ESBL E. coli and K. pneumoniae were 6.6% and 5.5%, respectively. The frequency of ESBL-producing E. coli and K. pneumoniae increased significantly during the study period. E. coli resistance against cotrimoxazole was 71.1%, followed by ciprofloxacin (68.2%) and gentamicin (47%). Similarly, 62.7% of K. pneumoniae isolates were resistant to gentamicin, 59.5% to cotrimoxazole, and 49.8% to ciprofloxacin. There was no statistically significant change in antimicrobial resistance over the study period. Conclusions: Although the frequency rates of ESBL-producing E. coli and K. pneumoniae increased, no change in the anti-microbial susceptibility was observed over the study period.
The aim of this study is to study the prevalence of extended spectrum b-lactamase (ESBL)-producing Escherichia coli (ESBL-E) and Klebsiella pneumoniae (ESBL-K) and the clonality of isolates causing nosocomial infections in our hospital. Materials and methods A cross-sectional study was conducted; clinical isolates of E. coli and K. pneumoniae were screened for ESBL production. In addition, the clonal relationship of nosocomial ESBL-E and ESBL-K was studied by biotyping and antimicrobial susceptibility testing, which was confirmed by pulsed-field gel electrophoresis. Results Of the 5976 clinical specimens (3048 blood, 1296 urine, 924 sputum, 312 pus, 396 other types of specimens) submitted for bacterial culture, a total of 156 E. coli and 300 K. pneumoniae were isolated. ESBL-E and ESBL-K represented 86% and 68.3%, respectively, of the total E. coli and K. pneumoniae. Antimicrobial susceptibility testing to non-b-lactam agents, including amikacin, gentamicin, cotrimoxazole, and ciprofloxacin, for ESBL-E were 75.7, 79.4, 19.7, and 100%, respectively, and for ESBL-K were 66.5, 42, 24.3, and 31%, respectively. Ten (7.5%) of the 134 ESBL-E and 29 (15%) of the 192 ESBL-K proved to be identical by biotyping and antimicrobial susceptibility testing. Pulsed-field gel electrophoresis of the identical isolates revealed two and seven clones, respectively. Conclusion The results of this study suggest the endemicity of ESBL-producing K. pneumoniae and E. coli strains and the dissemination of a plasmid rather than the occurrence of a clonal outbreak during the study period.
International Journal of Biological and Chemical Sciences
Early diagnosis and probabilistic antibiotic therapy based on known bacterial ecology and antibiotic sensibility can reduce mortality and morbidity in pathologies caused by a bacterial infection. This study aimed at determining the prevalence and risk factors of extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli isolated from blood cultures of neonates and infants population. We conducted a cross-sectional study during which pathogenic bloodstream isolates were identified. Antibiotic susceptibility test was performed on Escherichia coli isolates and phenotypic confirmation of ESBL production by Escherichia coli was performed by a double-disc synergy test. Over the course of this study, 298 blood cultures were performed and 129 (43.3%) positive cultures were obtained. Of the 129 bacterial isolates, 90 (69.7%) were Escherichia coli and 39 (30.2%) were other bacteria strains that included Klebsiella oxytoca, Streptococcus pneumonia, and Coagulase-negative staphylococci. ...
African Health Sciences, 2021
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. pneumoniae 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 spectrum 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 the antimicrobials tested, cefotaxime demonstrated the highest rates of resistance (100%) for both ESBL-producing E. coli and K. pneumoniae. Fifty-four isolates of ESBL-producing E. coli showed a high level of resistance to amoxicillin clavulanic acid (83.3%), ciprofloxacin (83.3%), and ceftazidime (79.6%). ESBL-positive K. pneumoniae isolates were highly resistant to ciprofloxacin (75%), and amoxicillin clavulanic acid (83.3%). Cefoxitin (62.5%) and gentamicin (66.7%) showed substantially higher rates of resistance against these isolates while all 24 strains were resistant to imipenem. Conclusion: This study indicated the prevalence of ESBL-positive Gram-negative pathogens in these study sites and also demonstrated their resistance to a few antibiotics. This highlights the need for new antimicrobials that are potent and improved policy on use of antibiotics.
Macedonian Journal of Medical Sciences, 2009
Aim. The objectives of this study were to determine the prevalence and antibiotic susceptibility patterns of extended-spectrum β-lactamases (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Material and methods. E. coli and K. pneumoniae were obtained from all clinical samples of hospitalized children. Results. During one year period, 212 strains of E. coli and 103 strains of K. pneumoniae were isolated. Of these, the ESBL production was observed in 26 (11.8%) isolates of E. coli and 25 (24.3%) isolates of K. pneumoniae. ESBLproducing E. coli isolates were commonly recovered from the respiratory tract (21.4%) and urine (7.2%). ESBL-positive K. pneumoniae was commonly recovered from urine (38.5%) and respiratory tract (18.7%). ESBL-positive E. coli isolates were more susceptible to AMC (76%) and SXT (50%), than were the isolates of ESBLpositive K. pneumoniae (40% and 32%). Considering aminoglycosides, 92% of ESBL-positive E. coli and 60% of ESBL-positive K. pneumoniae were susceptible to amikacin vs. 23% and 40% of ESBL-positive E. coli and K. pneumoniae strains to gentamicin. ESBL-positive K. pneumoniae strains were more susceptible to ciprofloxacin (84%) than ESBL-positive strains of E. coli (38%). Cefepime shows the best in vitro activity of tested cephalosporins (58% for E. coli and 72% for K. pneumoniae). All isolates were susceptible to imipenem. Conclusion. ESBL-producing E. coli and K. pneumoniae are present in our hospital environment. It's necessary and useful to perform screening and confirmatory tests for phenotypic detection of those organisms in a routine work. Most of ESBL-producers are resistant to many classes of antibiotic, resulting in limited treatment options.