Abstract
Introduction and Aim: Carbapenem resistance among species of Enterobacteriaceae has emerged as a global public health problem that adds to the high cost of care, severity and high mortality of otherwise straightforward infections. Governments around the world are devoting efforts to combat this important threat. The present study was undertaken in our setting to detect and characterize carbapenem resistance among Enterobacteriaceae. Methodology: Confirmed species of Enterobacteriaceae isolated from 225 patients that were admitted in various units of University of Maiduguri Teaching Hospital (UMTH) Maiduguri were screened for carbapenem resistance with meropenem and ertapenem disc (10 μg, Oxoid, England) using clinical and laboratory standards institute (CLSI) breakpoints. Suspected carbapenemase producers were subjected to confirmation using Modified Hodge Test method. Detection of the carbapenemase genes was done by multiplex PCR using KPC, NDM-1 and VIM primers. Results: A total of 225 clinical isolates of Enterobacteriaceae comprising 73 (32.4%) of Klebsiella pneumoniae, 61 (27.1%) of Escherichia coli, 21 (9.3%) of Proteus mirabilis, 18 (8.0%) of Klebsiella oxytoca, 13 (5.8%) of Morganella morganii, 12 (5.3%) of Citrobacter freundii, 12 (5.3%) of Serratia marcescens, 7 (3.1) of Enterobacter aerogenes, 3 (1.4%) of Klebsiella ozaenae, 3 (1.4%) of Hafnia alvei and 2 (0.9%) of Citrobcter sedlakii were isolated. A total of 28 (12.4%) of the isolates screened positive as carbapenemase producers. All the 28 screened isolates were further subjected to confirmation using the Modified Hodge Test for which 23 (10.2%) were confirmed resistant. Therefore a prevalence of 10.2% for carbapenem resistance was recorded in this study. Based on multiplex polymerase chain reaction, the various percentage genotypes of the carbapenemase producers were: 11 (47.8%) for KPC, 2 (8.7%) for VIM while 5 (21.7%) isolates have co-existence of the NDM-1 and VIM genes. However, 5 (21.7%) of the isolates have none of the genes screened for in them. The occurrence of carbapenemase genes among species of Enterobacteriaceae was as follows: 6 (33.3%) for Klebsiella pneumoniae, 4 (22.2%) for Escherichia coli, 4 (22.2%) for Proteus mirabilis, 3 (16.7%) for Serratia marcescens and then 1 (5.6%) for Klebsiella oxytoca. Conclusion: Despite the low use of carbapenem agents in the study area, carbapenem resistance was documented. This calls for an ongoing surveillance and infection control practices of this and other emerging resistance threat in all health centers of Nigeria. Irrational use of antibiotics must be discouraged so as to reduce this resistance threat. Antibiotic stewardship program should be established in all tertiary health centers of Nigeria.
Highlights
Introduction and AimCarbapenem resistance among species of Enterobacteriaceae has emerged as a global public health problem that adds to the high cost of care, severity and high mortality of otherwise straightforward infections
All the 225 species of Enterobacteriaceae were screened for carbapenem resistance using meropenem and ertapenem disc. 22 (9.7%) of the various species of Enterobacteriaceae were resistant to meropenem while 28 (12.4%) were resistant to ertapenem
The confirmatory test (Modified Hodge test) detected 23 (10.2%) as carbapenemase producers out of the 28 screened carbapenem resistant Enterobacteriaceae. This means that a prevalence of 23 (10.2%) was detected from this study. This was slightly lower than a prevalence of 14.0% recorded in Kano by Yusuf et al among species of Enterobacteriaceae with the highest prevalence found among Klebsiella pneumoniae (16.7%), followed by Proteus species (16.0%), and Escherichia coli (12.5%) while no carbapenemases were detected in Serratia species [14]
Summary
Introduction and AimCarbapenem resistance among species of Enterobacteriaceae has emerged as a global public health problem that adds to the high cost of care, severity and high mortality of otherwise straightforward infections. The carbapenems, namely: imipenem, meropenem, ertapenem and doripenem became the antimicrobials of last resort used in treating infections due to these highly drug resistant bacteria [2]. These antimicrobial agents became crucial in the management of life threatening healthcare associated and community acquired infections. The consequence of this widespread use of carbapenems was the emergence of the first carbapenemase producing Enterobacteriaceae (CRE) in 1993 [1]. The present study was undertaken to detect and characterize CRE from a major reference centre in northeastern Nigeria using both the phenotypic and genotypic methods
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