Multidrug resistance and extended-spectrum beta-lactamase producing Gram-negative bacteria from three Referral Hospitals of Amhara region, Ethiopia

Abstract

Background Multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Gram-negative bacteria (GNB) has become a public health threat worldwide. This threat is worse in developing countries where there is high infectious disease burden and spread of antimicrobial resistance co-exist. The aim of the present study was, therefore, to assess MDR, ESBL and carbapenemase producing GNB from patients attending three selected referral hospitals in Amhara region. Methods A cross-sectional study was conducted from December 2017- April 2018 at the University of Gondar Comprehensive Specialized Hospital, Dessie Referral Hospital and Debre Markos Referral Hospital of Amhara national regional state. A total of 833 study subjects were recruited using a convenient sampling technique. Clinical samples such as blood, urine, stool, wound, abscess, ear discharge, nasal discharge, cervical discharge and body fluid specimens were aseptically collected. Culturing for identification of bacteria and determination of drug susceptibility testing were done following standard microbiological techniques. Selected MDR isolates were phenotypically assessed for ESBL and carbapenemase production. Results Of the 833 clinical samples cultured for bacterial growth, 141 (16.9%) were positive for GNB. The most common GNB identified were E. coli 46 (32.6%), Klebsiella spp. 38 (26.5%) and Proteus spp. 13 (9.2%). The overall MDR prevalence was 121 (85.8%). Among the total isolates, 137 (97.2%) were resistant to ampicillin followed by cotrimoxazole 115 (81.6%), amoxicillin-clavulanic acid 109 (77.3%), cefixime 99 (70.2%), cefepime 93 (66.0%) and tetracycline 91 (64.5%). The extended-spectrum beta-lactamase producing GNB were 69/124 (55.6%). Of which Klebsiella spp. 19 (15.3%) and E. coli 17 (13.7%) were common ESBL producers. Carbapenemase-producing isolates were 8/51(15.7%). Of which Enterobacter, Klebsiella and E. coli were common carbapenemase producers. Conclusion and recommendation Multi-drug resistance and ESBL producing isolates in the present study were high. E. coli and Klebsiella spp. were the most common ESBL producing GNB. Klebsiella spp., Enterobacter spp., E. coli and Citrobacter spp. were typical carbapenemase-producing isolates. Continuous monitoring, antibiotic stewardship and molecular detection of the gene responsible for drug resistance are important means to reduce the spread of drug-resistant pathogens.

Detection and phenotypic characterization of carbapenem non susceptible gram-negative bacilli isolated from clinical specimens

“…The total resistance profile of Enterobacterales to extended-spectrum cephalosporins ranges from 57.7% to 80.8%, which marginally agrees with results of study conducted by Beyene et al 73.5% to 73.9% [19], but higher than the study findings of Teklu et al (60.3% to 62.2%) [31] and Moges et al (60.3% to 66%, in 2021) [25] lower than the study finding by Moges et al (87.2% to 96.6%, in 2019) [26], The geographical location, study time, and quantity of samples analyzed could all be factors in the reported discrepancy. Extended spectrum cephalosporin resistance was found in 17.5% of clinical Enterobacterales isolates studied in North America and Europe between 2016 and 2018 [40], the observed discrepancy could be attributed to the study's large geographical scope, infection control techniques used in those settings, the number of samples tested, and so on.…”

“…The dominant carbapenemase-producing gram-negative bacilli were Klebsiella Pneumoniae 8.3%[9/109] followed by Acinetobacter species 6.8% [5/74], the study results marginally coincides with the findings of the following researchers which demonstrated the dominant prevalence of carbapenemase-producing Klebsiella pneumoniae: Beyene et al Klebsiella pneumoniae 5.6% [19], Melese et al Klebsiella pneumoniae 10.5%[24], Moges et al Klebsiella pneumoniae 5.8%[25], Moges et al Klebsiella pneumoniae 10.1%[26], Lopez-Hernandez Klebsiella pneumoniae 45% [29].The present study disagrees with finding by Okoche et al, which showed E. coli as the highest carbapenemase-producing organisms[28], The discrepancy could be explained by the fact that they utilized Boronic acid-based inhibition, a modified Hodge and EDTA double combination disk test, the number of samples analyzed, and a different geographical location. , etc.The highest number of carbapenemase producing isolates were recovered from urine samples 13/23(56.5%), which strongly disagrees with the results of study conducted by Moges et al in which the highest number of carbapenemase producing isolates was recovered from blood samples 22/24(91.6%)[25],The prevalence of MDR was 45.2% which is much lower than the study conducted at Ethiopian Public Health Institute, Ethiopia by Beyene et al 94.5%[19], three referral hospitals, Ethiopia by Moges et al 85.8%[25], Felegehiwot Hospital, Ethiopia by Moges et al 80% and by Alebel et al 81.1%[26,30], Addis Ababa, Ethiopia by Teklu et al 68.3%[31], North Iran by Hemmati 62.8%[32], and Jimma medical center, Ethiopia by Biset et al 56.67%[33]. The variation might be due to the study population, the number of isolates assessed, the technique utilized, etc.…”

“…Ethiopia by Moges et al15.7%[25], Felegehiwot Hospital, Ethiopia by Moges et al 16.2%[26], Sidama, Ethiopia by Alemayehu et al 9%[27], Mulago National Referral Hospital, Uganda by Okoche et al 22.4%[28], and data from laboratories in Spain by Lopez-Hernandez et al 62%[29]. The variation might be due to the technique utilized, modified carbapenem inactivation method was utilized in our investigation unlike other investigators who used the modified Hodge test, the number of bacterial isolates analyzed, geographic location.…”

High Rate of Multidrug-resistance Among Clinical Isolates of Gram-negative Bacteria in Hospitalized Patients With Febrile Diseases in Central Ethiopia

“…As previously described from Uganda, MDR GNB are the main cause of sepsis in febrile cancer patients with more than 50% of the sepsis episodes being caused by E. coli infections (15). Similar to these ndings and to the ndings of Wasihun et al (2015) and Moges et al (2021) from northern Ethiopia (16, 17), E. coli was the most prevalent isolated GNB in our study.…”

Etiology of Neonatal Bacterial Meningitis and Their Antibiotic Susceptibility Pattern at the University of Gondar Comprehensive Specialized Hospital, Ethiopia: A Seven-Year Retrospective Study

“…44 Recent data from three hospitals in Amhara region, Ethiopia, also showed that 37.2% and 16.7% of K. pneumoniae isolates were ESβL and carbapenemase producers, respectively. 45…”