Epidemiology of extended-spectrum β-lactamase producing Escherichia coli from hospital settings in Yemen

Abstract

Introduction: Infection with Extended spectrum β-lactamases (ESBLs) producing bacteria is considered as serious health problem worldwide. The aim of this cross-sectional study was to investigate the prevalence of ESBL producing Escherichia coli in hospitalized patients and the risk factors contributed for its nosocomial infections in addition to the antibiotics susceptibility patterns of isolates from 130 inpatients collected in Al Thawra General Hospital and Al-Kuwait University Hospital in Sana’a city.
 Methodology: Antibiotic susceptibility testing and confirmation of ESBL production were performed according to the Clinical and Laboratory Standards Institute guidelines.
 Results: Out of 130 E. coli isolates, 44 (33.8%) were ESBLs producers, the majority of ESBLs producers were in wound exudates samples (52.2%). The highest significant rates were among the elderly, patients with previous hospitalization, patients who have stayed in hospital more than 22 days, patients who have taken third generation cephalosporins as treatment and diabetic patients. All ESBL-producing isolates were resistant to amoxicillin, trimethoprim-sulfamethoxazole and the third generation cephalosporins (100%). Resistance to other antimicrobial agents among these isolates was: amoxicillin-clavulanic acid (90.9%), nalidixic acid (95.5%), ciprofloxacin (90.9%), ofloxacin (88.6%) and tetracycline (54.5%). The most effective antibiotics in vitro for both types of isolates (ESBL producing and non ESBL producing E. coli) were Imipenem (100%), Amikacin (75%) and (93.0%), respectively, and Pipracillin-tazobactam (68.2%) and (88.4%), respectively.
 Conclusion: ESBLs detection tests must be performed as routine work in all hospitals and laboratories. Furthermore, a strict adherence of infection control policies and procedures with continuous antibiotics resistance surveillance are important to prevent nosocomial infections.

Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of β-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000–2020

“…These studies demonstrated slightly higher levels of resistance to various antimicrobials. For example, between 2014 and 2018, the resistance to cefuroxime was 95%, amoxycillin-clavulanate 90.9%, ciprofloxacin 90.9%, meropenem 95% and imipenem 95% [ 63 , 64 ]. The increase in antibiotic resistance in these isolates was also justified by the detection of β-lactamases.…”

“…Studies from Yemen revealed the phenotypic prevalence of ESBLs in E. coli and ESKAPE pathogens. These studies showed that during the study period the phenotypic prevalence of ESBL increased from 33% to 100% [ 63 , 64 ]. Furthermore, analysis based on PCR studies was also undertaken.…”

The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review

“…Three studies were conducted in Lebanon (Beirut and Byblos) [ 22 , 23 ], two in Iraq (Baghdad and Kurdistan) [ 24 , 25 ], one in Jordan (Ar Ramtha) [ 26 ], one in Palestine (Gaza) [ 27 ] and one in Yemen (Sana’a) [ 28 ]. The study population (total of 5833 participants) was composed of: 1- Syrian refugees with acute conflict injuries [ 26 ], 2- military and civilian populations with conflict-inflicted injuries [ 24 ], and 3- either civilians or undetermined populations in the five remaining studies.…”

“…The study population (total of 5833 participants) was composed of: 1- Syrian refugees with acute conflict injuries [ 26 ], 2- military and civilian populations with conflict-inflicted injuries [ 24 ], and 3- either civilians or undetermined populations in the five remaining studies. The results consisted of three retrospective chart reviews [ 23 – 25 ], one cross-sectional study [ 28 ], one case-control study [ 27 ], one nested case-control [ 22 ] and two prospective cohorts [ 22 , 26 ]. All studies were hospital-based but only three were multicenter, and half of the studies were conducted in intensive care units with or without including other hospital wards [ 22 , 24 , 27 ].…”

“…All studies were hospital-based but only three were multicenter, and half of the studies were conducted in intensive care units with or without including other hospital wards [ 22 , 24 , 27 ]. Five studies investigated the burden of only one bacterial species [ 22 , 23 , 27 , 28 ]. The most studied organism was Acinetobacter baumanii ( n = 5), followed by Staphylococcus aureus ( n = 4), and Escherichia coli ( n = 3).…”