Phenotypic Characterization and Antibiotic Resistance Patterns of Extended-Spectrum β-Lactamase- and AmpC β-Lactamase-Producing Gram-Negative Bacteria in a Referral Hospital, Saudi Arabia

Abstract

Background. Emergence of pathogenic bacteria carrying β-lactamase-resistant determinants has become a major health problem in the hospital setting. The study aimed to determine antibiotic-resistant patterns and frequency of extended-spectrum β-lactamase- (ESBL-) producing Gram-negative bacteria (GNB) and AmpC β-lactamase-producing GNB. Methodology. A prospective cross-sectional study was conducted during a period from September 2017 to August 2018 at King Abdullah Hospital, Bisha Province, Saudi Arabia. GNB (n = 311) were recovered from patients’ clinical specimens including sputum, urine, wound pus, blood, tracheal aspirates and high vaginal swabs, umbilical discharge, eye discharge, and cerebrospinal fluids. Isolates were identified by the Phoenix identification system. Antimicrobial susceptibility was tested by the Kirby–Bauer disk procedure. Phenotypic characterization of ESBLs and AmpC β-lactamases was performed utilizing the double-disk synergy test and inhibitor-based method, respectively. Associations with outcome measures were determined by simple descriptive statistics and a chi-square test. Results. Out of 311 GNB isolates, the frequency of ESBL and AmpC β-lactamase producers was 84 (27%) and 101 (32.5%), respectively. Klebsiella pneumoniae and Escherichia coli were common ESBL producers. AmpC β-lactamases predominate among Acinetobacter spp. and Pseudomonas aeruginosa. Coproduction of ESBLs and AmpC β-lactamases was found in 36 (11.6%) isolates, with very close relative frequencies among K. pneumoniae, Acinetobacter spp., and P. aeruginosa. β-Lactamase producers were predominantly found in the surgical department (56.5%) and ICUs (44.2%). ESBL producers revealed high resistance for cefuroxime (96.4%), cefotaxime (92.9%), and trimethoprim/sulfamethoxazole (90.5%). The resistance rates were significantly higher among ESBL producers than nonproducers for cephalosporins (p<0.001), amoxicillin/clavulanate (p<0.001), piperacillin/tazobactam (p=0.010), nitrofurantoin (p=0.027), aztreonam (p<0.001), ciprofloxacin (p=0.002), and trimethoprim/sulfamethoxazole (p<0.001). Significantly higher (p<0.05) resistance rates were observed among AmpC β-lactamase producers than nonproducers for all tested antibiotics. Conclusions. This finding showed a high prevalence of ESBL- and AmpC β-lactamase-producing GNB in our hospital. Quality control practice and routine detection of β-lactamase producers before deciding on antibiotic therapy are advocated.

Short Communication: Laboratory survey of extended spectrum beta-lactamase producing enterobacteriaceae in clinical infections among hospitalised patients at LAUTECH Teaching Hospital, Ogbomoso, Nigeria

“…Considering only patients with enterobacteriaceae infection, Iroha et al, in Nigeria reported 20.3% ESBL rate (12) while Ibrahim et al, in Saudi Arabia reported 27% (14). In the current study, we report a rate of 13.4%, which is similar to 12% rate reported by Obebe et al, (13) in the same geographical region as ours.…”

“…The prevalence rate of 1.1% among hospitalised patients for clinical infectio n cause by ESBL producing enterobacteriaceae in this survey appears relatively low because the rate was calculated in relation to all hospitalised patients (with and without infections) during the survey period, which gives a true reflection of the prevalence in our facility. However, most studies on ESBL producing enterobacteriaceae usually report prevalence among only infected or colonised hospitalised patients, which tends to over-estimate the true prevalence (12)(13)(14).…”

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

“…In comparison to β-lactam and beta-lactamase inhibitors (amoxicillin-clavulanic acid and piperacillin-tazobacam) resistance for standalone cephalosporins, such as cefuroxime, cefotaxime, ceftazidime, and cefepime was considerably high. Similarly, increased resistance rates were observed for aminoglycosides (gentamicin and amikacin), and quinolones (ciprofloxacin) compared to relatively lower resistance to carbapenem, imipenem and meropenem, shown in Table 1 [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

Resistance Patterns and Phenotypic Detection of β-lactamase Enzymes among Enterobacteriaceae Isolates from Referral Hospitals in Khartoum State, Sudan

“…In the recent years, β-lactamase-producing Enterobacteriaceae are accountable for various health-associated infections, leading to higher mortality rates and medical costs than non-β-lactamase-producers [3]. There are different types of mechanisms by which Enterobacteriaceae can confer resistance to wide range of antimicrobial agents including, penicillins, cephalosporins, carbapenems and aztreonam but are inhibited by clavulanic acid [3,4]. However, β-lactamase-producing Enterobacteriaceae are commonly cross-resistant to other classes of antibiotics, such as fluoroquinolones, trimethoprim/sulfamethoxazole, and aminoglycosides, which results in limited therapeutic options to treat infections caused by these pathogens [3].…”