Magnitude of Extended Spectrum Beta-lactamase producing Multidrug Resistant Enterobacteriaceae Isolates from Patients Attending Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
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Date
2020-02
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Addis Ababa University
Abstract
Introduction: Multidrug resistant (MDR) bacteria constitute a global emergency. Of which extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) have become the most common type. ESBL-PE are important causes of serious infections in the community as well as in hospital settings.
Objective: To determine the magnitude and patterns of resistance of extended Spectrum βlactamase producing Enterobacteriaceae isolates from patients attending Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
Methods: A cross sectional study was carried out to identify and characterize antimicrobial susceptibility pattern of Enterobacteriaceae isolates from TASH between July 2018 to November 2019. A total of 287 Enterobacteriaceae isolates were isolated from different specimens: blood, urine, wound site discharge, body fluids were analyzed using blood agar,MacConkey, Xylose lysine deoxycholate and salmonella shigella agar(SSA). Bacterial
species identification was carried out using standard biochemical tests. Antimicrobial susceptibility testing and detection of ESBL production was performed using standard antibiotics on Muller Hinton agar using disk diffusion method and a combination disc method following 2018 CLSI guideline.
Results: The overall magnitude of ESBL production was 62.7% (n=180/287). Female had higher proportion of ESBL positivity (66.1%, n=84/127) than male patients (60%, n=96/160). Among the Enterobacteriaceae isolates tested, 81 (72.3%) of the 112 K. pneumoniae, 21 (65.5%) of 32 K. oxytoca and 61 (58.7%) of 104 E.coli were ESBL producers. Comparable ESBL production by 158 (64.5 %) of 245 isolates from in patients and 22 (52.4%) of 42 isolates from outpatient was observed. There was no significant association between
hospitalization and ESBL production (P=0.136, OR=0.606, 95 % CI). However, when we compare ESBL production of isolates from different wards a high ESBL production was noted among isolates from pediatrics ward 57(31.7%) of 180 isolates. The ESBL producing isolates showed highest and lowest level of resistance to ampicillin and amikacin 96.9% and 9.0 %, respectively. Two-hundred sixty four (91.9%) of the 287 isolates had MDR pattern.
Conclusion: Significantly all isolates of Enterobacteriaceae showed higher rate of resistance to all tested antibiotics. But amikacin was found most effective for ESBL producers and nonproducers. High rate of ESBL and high numbers of MDR organisms were isolated among Enterobacteriaceae. Therefore, strengthening of monitoring antibiotics resistance in addition to regulation of the spread of resistance genes and preparing strong policies for monitoring
utilization of antibiotics is required.
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Keywords
Enterobacteriaceae, Extended spectrum Beta-lactamase, Multidrug Resistant (MDR