Prevalence and risk factors of extended-spectrum β-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia

Abstract

Objective: To estimate the prevalence and associated risk factors of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL) in King Khaled General Hospital, Saudi Arabia. Methods:A twelve -month retrospective study for the presence of ESBL producing Enterobacteriaceae infection was performed by using the Microbiology and Infection Control Departments' database. For all the collected specimens, microbiological identification and antimicrobial sensitivity testing were done using MicroScan WalkAway system and then confirmed by API 20E and E-test respectively. Results:The prevalence of ESBL producing Enterobacteriaceae infection among studied patients was 22%. The most common types of infections were urinary tract infections representing 59.2%. Previous use of antibiotics, urinary catheter, mechanical ventilation, previous hospitalization, previous intensive care unit admission and nosocomial origin of infection were significant risk factors for acquiring infection. Amikacin had the highest activity against ESBL producing isolates, whereas 20% of isolates were resistant to carbapenems Conclusions:The study revealed that prevalence of ESBL producing Enterobacteriaceae infection was relatively high. Our findings suggest that invasive devices, the use of antibiotics, prolonged hospitalization especially in the intensive care unit increases the risk of acquiring such infections. A strict antibiotic policy should be addressed especially with observed emergence of carbapenem resistance. Continuous review of need to invasive devices and strict compliance with basic infection control measures are mandatory to limit the spread of ESBL Enterobacteriaceae. Bulgular: Çalışmaya alınan hastalarda GSBL üreten Enterobacteriaceae prevelansı % 22 olarak bulundu. En sık karşılaşılan enfeksiyon % 59,2 ile üriner sistem enfeksiyonu idi. Antibiyotik kullanımı, üriner kateterizasyon, mekanik ventilasyon, daha önce hastanede yatış, yoğun bakım ünitesinde tedavi görme ve enfeksiyonun hastane kaynaklı olması GSBL üreten Enterobacteriaceae ile enfeksiyon gelişmesi için risk faktörleri olarak bulundu. GSBL üreten bakterlere karşı en etkin antibiyotik amikasinken, izolatların % 20'sinde karbapenemlere karşı direnç saptandı. Sonuçlar:Bu çalışmanın sonuçları GSBL üreten Enterobacteriaceae oranının yüksek olduğunu göstermektedir. Bulgular; antibiyotik kullanımı, invaziv işlemler ve özellikle yoğun bakım ünitesine olmak üzere uzamış hastane yatışının GSBL üreten bakterilerle enfeksiyon gelişme riskini artırdığını göstermektedir. Gözlenen yüksek karbapenem direnç oranı antibiyotik kullanımıyla ilgili etkin politikalar oluşturulması gerektiğini ortaya koymaktadır. GSBL üreten Enterobacteriaceae yayılmasının engellenmesi için kullanılan invaziv cihazlara ihtiyacın sürekli olarak değerlendirilmesi ve temel enfeksiyon kontrol önlemlerine etkin şekilde uyulması gerekmektedir.

Prevalence and Risk Factors of Extended Spectrum Beta-Lactamase-Producing Uropathogens among UTI Patients in the Governmental Hospitals of North West Bank: A Cross-Sectional Study

“…In addition, ESBL positivity also was not significantly associated with age (P-value=0.056) as opposed to a report by Jesus Rodriguez-Bano who found that older age in male patients (OR,1.03; 95% CI, 1.03-1.05) was a risk factor [25]. While OK Azap and Kandeel A did not find age as a risk factor (P-value=0.952 [27,14].…”

“…Similar to what was observed by Kandeel. A in a study conducted in Saudi Arabia and Dong Sup Lee in Korea [10,14]. Going to malignancy, in the current study, it was not significantly associated with UTI-ESBL.…”

“…The rate of ESBLs production in bacterial species differs greatly all over the world, and rapidly changing from time to time [14]. The prevalence of ESBL was reported to be over 10% in east Europe, 3.5% in Canada, 7.5%-41% in Persian Gulf region and 20-48.8% in Asia [15][16][17][18][19].…”

Molecular Characterization of Extended-Spectrum β-Lactamase Enterobacteriaceae Isolated from Egyptian Patients with Community- and Hospital-Acquired Urinary Tract Infection

“…6,27 In Saudi Arabia and Tanzania, a higher frequency of ESβL-induced UTIs was found to be hospitalacquired compared with community-acquired infections (67% and 64%, respectively). 6,28 The high frequency of ESβL, especially among community-acquired UTIs, in our study is Extended-spectrum β-lactamase isolates were extremely resistant to cefepime and amoxicillin-clavulanic acid, and susceptible to carbapenems. All ESβL E. coli isolates 19 were sensitive to fosfomycin.…”

Multiple Renal Abscesses due to ESBL Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Causing Acute Pyelonephritis and Bacteremia: A Case Report with a Good Outcome (No Drainage Required)

“…High level of carbapenem resistance had been observed in one study which was 20% [10]. In another study in the central region in Saudi Arabia, 57% of ESBL-producing E. coli isolates were of community origin [11].…”