Extended-spectrum Beta-lactamase producing Enterobacteriaceae in clinical specimens at selected Microbiology Laboratories, Addis Ababa, Ethiopia

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Addis Ababa Universty


Background: The current estimated number of deaths worldwide due to drug-resistant infections is about 700,000 each year. The emergence and spread of Extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae becomes one of the serious health problems globally. Objective: To determine the magnitude of Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLs-E) in different clinical specimens at selected microbiology laboratories, Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted from January 1 to May 30, 2017. A total of 426 Enterobacteriaceae isolates were collected from four bacteriology laboratories using tryptose soya broth with 20% glycerol. Fresh colonies of the isolates were recovered using MacConkey and 5% sheep blood agar plate. Antimicrobial susceptibility testing was performed on Muller Hinton agar. All Enterobacteriaceae were screened for ESBLs production using cefotaxime and ceftazidime as per Clinical and Laboratory Standards Institute (CLSI) guideline. Each ESBLs specious Enterobacteriaceae were confirmed by combination disk test (CDT) and double disk synergy test (DDST). The sensitivity, specificity, positive and negative predictive value of DDST was calculated. Data was entered and analyzed using SPSS version 20. Results: The most frequent Enterobacteriaceae were E. coli 228 (53.5%) and K. pneumoniae 103 (24.1 %). The magnitude of ESBLs-E was 246 (57.7%) by CDT and 224 (52.6%) by DDST. The highest frequencies of ESBLs-E were observed in blood specimen (84.4%) (P < 0.05) and the highest ESBLs production was observed in K. pneumoniae (85.4%). Highest resistance level was seen to sulfamethoxazole-trimethoprim (77.0%), augumentin (71.6%), cefotaxime (62.2%), cefepime (60.3) and ceftazidime (60.8%). The resistance to meropenem, amikacin and cefoxitin were 5.2%, 13.8% and 25.1% respectively. The overall magnitude of multi-drug resistance (MDR) level was 68.3%. Of ESBLs-E, 96.3% were MDR (P < 0.05). The sensitivity, specificity, PPV and NPV of DDST was 91.1%, 100%, 100% and 46.3% respectively. Conclusion: There was a high magnitude of ESBLs producing Enterobacteriaceae and MDR. Hence, the control of ESBLs should be a high priority. The better antibiotics for ESBLs producing Enterobacteriaceae were meropenem and amikacin. ESBLs detection by DDST routinely can help for infection control and timely treatment of a patient with best antibiotics.



Extended-spectrum beta-lactamase, Multi-drug Resistance, Enterobacteriaceae, Clinical specimens, Combination disk test, Double disk synergy test, Ethiopia