Fecal Carriage of Extended-Spectrum Beta-lactamase and Carbapenemase-Producing Enterobacteriaceae Among Hospitalized Patients at Debre Berhan Comprehensive Specialized Hospital, North Shoa, Amhara Regional State, Ethiopia.
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Date
2021-06
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Addis Ababa University
Abstract
Background: The rapid spread of extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) has become a major public health issue. Gastrointestinal carriage of ESBL and CPE are the significant risk factors for infection and dissemination of resistance clones in the hospital. Therefore, conducting research on the carriage rate of ESBL and carbapenemase-producing Enterobacteriaceae is very important to prevent
nosocomial infection and the spread of antimicrobial-resistant bacteria in the hospital setting.
Objective: To determine the fecal carriage of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae among hospitalized patients at Debre Berhan Comprehensive Specialized Hospital, North Shoa, Amhara Regional State, Ethiopia.
Methods: A hospital-based cross-sectional study was conducted among 383 hospitalized patients from November 2020 to March 2021. Stool sample or rectal swab was aseptically collected and cultured on MacConkey agar and Xylose lysine deoxycholate agar. The isolated Enterobacteriaceae were further identified by conventional biochemical tests. Screening of ESBL
production was done by using cefotaxime and ceftazidime. All Enterobacteriaceae were screened for carbapenemase production using meropenem and imipenem. Confirmation of ESBL production was done using the combination disk method. Carbapenemase production was confirmed by a rapid Carba NP test. Data was entered using Epi data version 3.1 then analyzed using Statistical Package for Social Sciences software version 25. P-value ≤ 0.05 was considered as statistically significant.
Results: A total of 347 Enterobacteriaceae were isolated. The overall magnitude of ESBL-PE and CPE was 47.3% (n=164/347) and 5.5% (n=19/347) respectively. The predominant extendedspectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) were E. coli 25.9%
(n=90/347) and K. pneumoniae 15.9% (n=55/347). K. pneumoniae 3.5% (n= 12/347) was the highest carbapenemase producer. The overall multidrug resistance rate was 87.8% (n=305/347). The highest resistance was observed to ampicillin (98.3%), followed by gentamicin (80.7%), and tetracycline (73.3%) respectively. History of antibiotic use in the past 3 months (p≤0.000),
admission in a neonatal intensive care unit (p=0.023), and presence of chronic disease (p≤0.000) were independently associated with fecal carriage of ESBL-PE. History of hospitalization in the past 12 months showed statistical significance with fecal carriage of CPE (p= 0.02).
Conclusion and Recommendation: The magnitude of ESBL-PE and CPE was high in the study area. Therefore, strict infection control measure is needed in the study area to limit the infection and dissemination of these pathogens. Meropenem, imipenem, and chloramphenicol were active against ESBL-PE.
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Keywords
Fecal carriage, ESBL, carbapenemase, Enterobacteriaceae, Debre Berhan, Ethiopia, hospitalized patients