Magnitude and drug resistance profile of Extended Spectrum β-Lactamase (ESBL) producing gram negative bacteria from nasal swabs taken from health care workers and inanimate objects at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
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Date
2019-06
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Addis Abeba University
Abstract
Background
:
Hospital environment, inanimate objects and healthcare workers are likely to get
colonized with diverse group of microbial agents. Infections caused by gram negative bacteria
(GNB) are causing morbidity and mortality worldwide, gram negative bacteria which produce β-
lactamase can result in multidrug resistance. The production of extended-spectrum β-lactamases
(ESBLs) is an important mechanism which is responsible for the resistance to the thirdgeneration
cephalosporin.
Objective: The objective of this study was to determine the magnitude and drug resistance
profile of ESBL producing gram negative bacteria isolated from nasal swabs taken from health
care workers (HCWs) and inanimate objects at Tikur Anbessa Specialized Hospital.
Methods: Both prospective and retrospective cross sectional study were conducted from
December 2018 to February 2019.Isolates from samples collected from an on-going PhD project
were used for the purpose of the current study. The samples were taken from nasal swabs of
health care workers and inanimate objects. About 105and 216 isolates were randomly selected
from health care workers and inanimate objects respectively for further analysis. Biochemical
tests for identification and antimicrobial susceptibility test was done by disc diffusion method.
Screening of ESBLs was done using Cefotaxime (30ug, BD), Ceftazidime (30ug, NJ54, QB14),
ceftriaxone (30ug BD) discs. A combined disk diffusion test was used as confirmatory test. The
data were analyzed using SPSS software (version 20) and descriptive statistical tests were
performed
Results: Out of 105 isolates, 5 (4.8%) isolates were identified as Extended Spectrum
βlactamases
(ESBLs) producers, out of theses80% were Klebsiella spp (75% Klebsiella
rhinoscleromatis, 25% Klebsiella pneumoniae) and 20% were Entrobacter cloacae. Three (60%)
ESBL producing bacterial isolates were identified from Laboratory personnel and 2 (40%) were
from Medical doctors. From environmental samples, 33/216 (15.3%) isolates were found to be
ESBL producers based on the confirmatory test (combined disk method). Different ESBL
producing gram negative bacteria, were isolated from the various inanimate objects of TASH
including, Klebsiella ozaenae, Klebsiella oxytoca, Klebsiella pneumoniae, Klebsiella
rhinoscleromatis,Citrobacter_spp, Escherichia coli, Serriatia_spp and Acinetobacter_spp. ESBL
producing gram negative bacteria were found to be 100% resistant to ceftazidime and
ceftriaxone.
Conclusion: It is worrisome to detect ESBL producing gram negative bacteria from the
inanimate objects of TASH and the nasal cavity of some HCWs, calling for systematic screening
of inanimate objects for ESBL and other multidrug resistant bacteria in the hospital.
Furthermore, strengthening the infection prevention practice is vital to halt transmission of these
noxious bugs.
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Keywords
ESBL, Inanimate objects, HCWS