Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania

Abstract

BackgroundPublished data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among Escherichia coli and Klebsiella spp from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania.FindingsA total of 270 E.coli and Klebsiella spp urinary pathogens from children and adults isolated from January to March 2010 were included in the study. E. coli and Klebsiella spp isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were E. coli and 132 (48.9%) were Klebsiella spp. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing E. coli strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing Klebsiella spp strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (P < 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001).ConclusionsHigh prevalence of ESBL-producing E. coli and Klebsiella spp strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.

Antibiotic Resistance Trends and The ESBL Prevalence of Escherichia coli and Klebsiella spp Urinary Isolates in In-and Outpatients in a Tertiary Care Hospital in Istanbul, 2004 - 2012

“…Similar results were reported from Netherlands (26). However, a study carried out in Tanzania, reported a high rate for the trimethoprim-sulfamethoxazole and a lower rate for nitrofurantoine (22).…”

“…The amikacin (10.9% resistance) was the most effective antibiotic. A study in Tanzania also showed similar results (22). In other studies which conducted in Italy (30), Brazil (14), and Nepal (29), the resistance rates were lower compared to our results.…”

Prevalence and antimicrobial susceptibility patterns of uropathogenic E. coli among people in Zakho, Iraq

“…30 In our study, E. coli isolates were various in their susceptibility to different antibiotics belonging to different groups. All isolates were 100% resistant to penicillin, ampicillin and aztreonam, whereas, all isolates were 100% susceptible to imipenem and meropenem.…”

Bacteria isolated from bloodstream infections at a tertiary care hospital in Dar es Salaam, Tanzania - antimicrobial resistance of isolates

“…strains from urine samples, and most of the ESBL-producing isolates were MDR, limiting available therapeutic choices. 1 We are currently conducting another prospective study to monitor the trends of MRSA and to determine the presence of MDR. These results, together with the previous ones, will guide antimicrobial prescribing practice by our clinicians.…”