Introduction: Klebsiella pneumoniae are among the most common cause of urinary tract infections such as cystitis and pyelonephritis. These multi-drug resistant K. pneumoniae are producers of extended spectrum beta-lactamases (ESBL) that are capable of hydrolyzing beta-lactams and non-beta-lactams. This laboratory-based study sought to establish the increase of ESBL-producing K. pneumoniae in multi-drug resistant urinary tract infections and determine the effective antibiotic treatment options. Methods: One hundred and seventy five K. pneumoniae isolates obtained from urine cultures were randomly collected and the combined disc synergy method was used to determine the ESBL-producing K. pneumoniae. The Vitek 2 system (bioMérieux, France) was used to perform antimicrobial susceptibility testing of 17 commonly used antibiotics. The data from the work was collated and statistically analysed using the chi-square test and Mann-Whitney U test. P values < 0.05 were considered significant. Results: Of the 175 K. pneumoniae responsible for urinary tract infections, 73.7% were producing ESBL suggesting that most urinary tract infections caused by K. pneumoniae will be multi-drug resistant. The antimicrobial resistance differences between ESBL-producing and non-ESBL-producing Klebsiella pneumoniae indicated a significance difference with p < 0.05. This study indicated that imipenem and amikacin are the antibiotic of choice for the treatment of multi-drug resistant urinary tract infections caused by ESBL-producing K. pneumoniae. Cephalosporins and nitrofurantoin are suitable for the treatment of urinary tract infections due to non-ESBL-producing K. pneumoniae. Conclusion: This study indicated that imipenem (carbapenem) and amikacin are the antibiotic of choice for the treatment of multi-drug resistant urinary tract infections caused by ESBL-producing K. pneumoniae. The third and fourth generation cephalosporins and nitrofurantoin are suitable for the treatment of urinary tract infections due to non-ESBL-producing K. pneumoniae. Rational use of antibiotics and evidence based antibiotic prescription will help to control the spread of resistance by ESBL-producing K. pneumoniae. There is the need to intensify research in the use of natural products to treat multi-drug resistant urinary tract infections emanating from ESBL-producing K. pneumoniae
Klebsiella pneumoniae are one of the most common cause of multi-drug resistant urinary tract infections such as cystitis and pyelonephritis. Extended-spectrum beta-lactamases are plasmid-mediated enzymes commonly found in the Klebsiella pneumoniae and other Gram negative bacteria. They are capable of hydrolysing beta-lactams except carbapenems and cephamycins. Extended-spectrum beta-lactamases also confer resistance to several nonbeta-lactam antibiotics, limiting treatment options for urinary tract infections caused by extended-spectrum betalactamases -producing K. pneumoniae. This study determined the in vitro efficacy of Alchornea cordifolia on extended-spectrum beta-lactamases -producing K. pneumoniae. Serial dilutions of the ethanolic extract of the leaves were prepared and tested against the extended-spectrum-beta-lactamases-producing K. pneumoniae. The phytochemical screening was performed to determine the antibacterial compounds. The Christmas bush leaves extracts concentrations ranging from 50 mg/ml -200 mg/ml showed significant active diameter zone of inhibition. The ethanolic extract of A. cordifolia leaves had minimum inhibition concentration and minimum bactericidal concentration of 3.13 mg/ml indicating significant antibiotic activity against the ESBL isolates. The phytochemical screening of the Christmas bush leaves showed the presence of antimicrobial phytochemicals such as flavonoids. Ethanolic extracts of Christmas bush leaves is proving to be efficacious against multi-drug resistant urinary tract infections. This offers hope for the development of effective antibiotics due to the presence of flavonoids in the A. cordifolia leaf extracts. Therefore, there is the need to determine the toxicological effect and clinical trials of the active antimicrobial compounds isolated in the leaf extracts of A. cordifolia shrub.
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