Occurrence and significance of fluoroquinolone-resistant and ESBL-producingEscherichia coliandKlebsiella pneumoniaecomplex of the rectal flora in Ghanaian patients undergoing prostate biopsy

Abstract

Background Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B) Objectives We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. Methods From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Results Overall, 86.4% (n = 312/361) and 62.6% (n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n = 289/483) of the FQ-resistant and 66.0% (n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. Conclusions The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.

Extended-spectrum beta-lactamases in clinical isolates of Escherichia coli and Klebsiella pneumoniae recovered from patients at the Tamale Teaching Hospital, Ghana

“…The high antibiotic resistance levels recorded in the present study (in which the isolates investigated were collected nearly eight years ago) are similar to those observed among Enterobacterales in several other studies conducted in Ghana, both older [11,13,24], and newer ones [32][33][34][35][36][37]. That the high AMR levels observed in this study are similar to those in these newer studies [32][33][34][35][36][37] suggests that the AMR situation in the country has been sustained, or possibly been exacerbated over the period, and could probably get worse. A meta-analysis may be needed to quantify the dynamics in the AMR problem in the country in the last decade or two; this could be done in other regions noted as hotspots for AMR occurrence.…”

“…In the present study, however, all the isolates were susceptible to meropenem. Meropenem maintains high efficacy against multidrug pathogens in Ghana [35,39]. Meropenem is a more expensive antibiotic, and reserved by the Ghana Treatment Guidelines as a last resort for serious infections.…”

Klebsiella pneumoniae ST147 harboring bla NDM-1 , multidrug resistance and hypervirulence plasmids

“…In Ghana, Labi et al ( 39 ) reported that K. pneumoniae made up 49.7% of the total microorganisms of the 1.0 incidence of bloodstream infections in hospitalized neonates per 100 person days. Furthermore, multidrug-resistant K. pneumoniae incidence contributed to 3.1% of rectal flora in patients undergoing prostate biopsy ( 40 ).…”