Multidrug resistant and carbapenemase producing Enterobacteriaceae among patients with urinary tract infection at referral Hospital, Northwest Ethiopia

Eshetie, Setegn; Unakal, Chandrashekhar; Gelaw, Aschalew; Ayelign, Birhanu; Endris, Mengistu; Moges, Feleke

doi:10.1186/s13756-015-0054-7

Cited by 97 publications

(120 citation statements)

References 24 publications

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“…Likewise, 62% prevalence of ESBL in Enterobacteriaceae was detected in Uganda [10]. However, a study in Ethiopia reported that all Enterobacteriaceae from urinary tract infections were ESBL-positive [11]. In this study, majority of (75–85%) Enterobacteriaceae from blood, CSF and wound isolates were ESBL producer.…”

Section: Discussionmentioning

confidence: 65%

“…coli were reported in Ethiopia [12, 13]. Conversely, 100% ESBL-producers were reported from urinary tract infection in Ethiopia [11]. These variations might be due to difference in methods of ESBL detection and types of patients.…”

Section: Discussionmentioning

confidence: 99%

“…In Uganda, 62% of Enterobacteriaceae from clinical isolates were ESBL producer [10]. A study conducted in Gondar, Ethiopia reported that 100% of Enterobacteriaceae from urinary tract infections were ESBL producers [11]. However, other studies in different parts of Ethiopia reported that 36% of E .…”

Section: Introductionmentioning

confidence: 99%

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Extended-Spectrum beta (β)-Lactamases and Antibiogram in Enterobacteriaceae from Clinical and Drinking Water Sources from Bahir Dar City, Ethiopia

2016

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BackgroundThe spread of Extended-Spectrum beta (β)-Lactamases (ESBL)-producing Enterobacteriaceae has become a serious global problem. ESBL-producing Enterobacteriaceae vary based on differences in antibiotic use, nature of patients and hospital settings. This study was aimed at determining ESBL and antibiogram in Enterobacteriaceae isolates from clinical and drinking water sources in Bahir Dar City, Northwest Ethiopia.MethodsEnterobacteriaceae species were isolated from clinical materials and tap water using standard culturing procedures from September 2013 to March 2015. ESBL-producing-Enterobacteriaceae were detected using double-disk method by E-test Cefotaxim/cefotaxim+ clavulanic acid and Ceftazidime/ceftazidime+ clavulanic acid (BioMerieux SA, France) on Mueller Hinton agar (Oxoid, UK).ResultsOverall, 274 Enterobacteriaceae were isolated. Of these, 210 (44%) were from patients and 64 (17.1%) were from drinking water. The median age of the patients was 28 years. Urinary tract infection and blood stream infection accounted for 60% and 21.9% of Enterobacteriaceae isolates, respectively. Klebsiella pneumoniae was isolated from 9 (75%) of neonatal sepsis. The overall prevalence of ESBL-producing Enterobacteriaceae in clinical and drinking water samples were 57.6% and 9.4%, respectively. The predominant ESBL-producers were K. pneumoniae 34 (69.4%) and Escherichia coli 71 (58.2%). Statistically significant associations were noted between ESBL-producing and non- producing Enterobacteriaceae with regard to age of patients, infected body sites and patient settings (P = 0.001). ESBL-producing Enterobacteriaceae showed higher levels of resistance against chloramphenicol, ciprofloxacin and cotrimoxazole than non-ESBL producers (P = 0.001)ConclusionsESBL-producing Enterobacteriaceae coupled with high levels of other antimicrobials become a major concern for treatment of patients with invasive infections such as blood stream infections, neonatal sepsis and urinary tract infections. ESBL-producing Enterobacteriaceae were also detected in drinking water sources.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Extended-Spectrum beta (β)-Lactamases and Antibiogram in Enterobacteriaceae from Clinical and Drinking Water Sources from Bahir Dar City, Ethiopia

2016

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“…A recent study conducted in Gabon reported that 15.4 % of Enterobacteriaceae (and 49.4 % of all K. pneumoniae isolates) were ESBL producers [9]. Other available studies show a prevalence rate of ESBLs ranging from 4 % of Central African Republic [8] to 50 % of Tanzania [10,11]. General concepts for the treatment: importance of appropriate treatment, pharmacokinetic/pharmacodynamic (PK/PD) data, susceptibility test, and combination therapy There are a number of important issues for the reduction of mortality in patients with infections caused by MDR Enterobacteriaceae, including the underlying mechanism of resistance, the choice and timing of empiric or targeted treatment, dosing and infusion, duration of treatment, and monotherapy versus combination treatment [12].…”

Section: Epidemiology Of Multi-drug Resistant (Mdr) Enterobacteriaceamentioning

confidence: 96%

Epidemiology and Treatment of MDR Enterobacteriaceae

Bassetti

Pecori

Sibani

et al. 2015

Curr Treat Options Infect Dis

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Opinion statementThe major progress in the history of medicine represented by the discovery of antibiotics is nowadays compromised by the universal spread of antibiotic resistance. World Health Organization (WHO) lists third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae and carbapenem-resistant K. pneumoniae in a group of seven bacteria of international concern, responsible for both healthcare-associated and community-acquired infections. Patients infected by these pathogens have limited therapeutic options, worse clinical outcomes, increased mortality rates, and a higher healthcare resources consumption. In infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, appropriate monotherapy is effective and carbapenems are the drugs of choice; however, β-lactams/β-lactamase inhibitors (BLBLIs) are regarded as an alternative mainly in patients without severe infections, with E. coli bacteremia with urinary source or with low minimum inhibitory concentrations (MICs). For infections caused by carbapenem-resistant Enterobacteriaceae (CRE), where the predicted mortality rate of patients is high, a combination antimicrobial treatment should be preferred. Many important variables in the treatment such as the role of high dosages and loading doses, the variable degrees of dosage reduction for impaired renal function, and the inclusion of carbapenems or tigecycline are a matter of debate. Despite the obscure vision provided by a notable number of meta-analyses, tigecycline is an effective and safe option for the treatment of MDR Enterobacteriaceae, as part of a combination regimen in case of infections caused by CRE, where a higher dosage (200 mg/daily) should be preferred. Colistin is the most active in vitro agent against CRE. Despite clinical data about the efficacy of fosfomycin against MDR Enterobacteriaceae are limited, this molecule represents an interesting option for the treatment of lower urinary tract and even systemic infections caused by difficult-to-treat Gram-negative pathogens. Based on in vitro studies, ceftolozane-tazobactam and ceftazidime-avibactam will represent very interesting new drugs for the treatment of ESBL-producing and CRE infections, respectively.

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“…The range of clinical symptoms of the infection is different from asymptomatic bacteriuria to bladder inflammation, pyelonephritis, septic shock, and defects in several organs (1,2). Both hospitalacquired and community-acquired urinary tract infections can lead to serious complications such as urinary tract disorders, uremia, hypertension, and even death (3).…”

Section: Contextmentioning

confidence: 99%

Prevalence of Cotrimoxazole Resistance Uropathogenic Bacteria in Iran: A Systematic Review and Meta-Analysis

Rezaee

Ghafourian

Sayehmiri

et al. 2018

Arch Clin Infect Dis

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Context: Cotrimoxazole is one of the antibiotics commonly used to treat urinary tract infections. The widespread use of this drug has led to increased resistance to cotrimoxazole among urinary tract pathogens. This study aimed to investigate the cotrimoxazole resistance pattern of uropathogenic bacteria by a systematic review and meta-analysis method.Evidence Acquisition: Several databases including PubMed, Web of Science, Scopus, Google Scholar, Iran Medex, Magiran, IranDoc, MedLib, and SID were searched. From a total of 171 papers published from different regions of Iran from 1992 to May 2015, 67 were included in this study. To assess the quality of the study, the STROBE (strengthening the reporting of observational studies in epidemiology) checklist was employed. The I 2 index was used to determine heterogeneity and a random effects model to analyze the data. Results:The results showed that the prevalence of urinary tract infection was several times higher in women than in men. The most common pathogens causing urinary tract infections were E. coli 64%, Klebsiella 12%, Staphylococcus 10%, and Enterobacter (6%). The prevalence of cotrimoxazole resistance was as follows: E. coli 62% (95%CI: 60 -65), Klebsiella 54% (95% CI: 45 -62), Staphylococcus 55% (95% CI: 47 -63), and Enterobacter 52% (95% CI: 33 -70). Cotrimoxazole resistance in different studies varied from 22% in Arak to 88% in Ahvaz. Conclusions:Gram-negative bacilli, particularly Escherichia coli, were the most common bacteria causing urinary tract infections. The majority of strains were resistant to cotrimoxazole. According to the findings, cotrimoxazole is not recommended as the firstline drug for the treatment of urinary tract infections in Iran.Keywords: Urinary Tract Infections, Gram-Negative Bacteria, Gram-Positive Bacteria, Cotrimoxazole, Antimicrobial Resistance, Meta-Analysis ContextUrinary tract infection (UTI) is the most common bacterial infection with the high economic burden that affects a large number of populations. The range of clinical symptoms of the infection is different from asymptomatic bacteriuria to bladder inflammation, pyelonephritis, septic shock, and defects in several organs (1, 2). Both hospitalacquired and community-acquired urinary tract infections can lead to serious complications such as urinary tract disorders, uremia, hypertension, and even death (3). It is the most common infection among patients admitted to hospitals and laboratories. It can be observed in all age groups and in both genders although it is more likely to occur among young women (4). Studies have indicated that about 50% of women and 12% of men suffer from urinary tract infection throughout their life (5). Moreover, 20 -30% of women experience a recurrence of this infection during 6 -12 months (5, 6). Therefore, this is a major public health problem (7). Throughout the world, about 150 million people are diagnosed with a UTI each year (8). In most cases, bacterial agents, especially Gram-negative bacteria such as E. coli, are the cause of t...

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Multidrug resistant and carbapenemase producing Enterobacteriaceae among patients with urinary tract infection at referral Hospital, Northwest Ethiopia

Cited by 97 publications

References 24 publications

Extended-Spectrum beta (β)-Lactamases and Antibiogram in Enterobacteriaceae from Clinical and Drinking Water Sources from Bahir Dar City, Ethiopia

Extended-Spectrum beta (β)-Lactamases and Antibiogram in Enterobacteriaceae from Clinical and Drinking Water Sources from Bahir Dar City, Ethiopia

Epidemiology and Treatment of MDR Enterobacteriaceae

Prevalence of Cotrimoxazole Resistance Uropathogenic Bacteria in Iran: A Systematic Review and Meta-Analysis

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