Abstract
BackgroundThe global emergence and spread of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae have been threatening the ability to treat an infection. Hence, this study aimed to determine the prevalence of ESBL-producing and multi-drug resistance (MDR) Enterobacteriaceae (ESBLs-E) from different clinical specimens in Addis Ababa, Ethiopia.MethodsA cross-sectional study was conducted from January 1 to May 30, 2017. A total of 426 Enterobacteriaceae isolates were identified from clinical specimens. The isolates were collected from four laboratories. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on Muller Hinton agar (MHA). All Enterobacteriaceae were screened for ESBLs production using cefotaxime and ceftazidime as per CLSI guideline. Each ESBL screening positive Enterobacteriaceae were confirmed by a combination disk test (CDT). Data were entered and analyzed by using SPSS version-20.ResultThe most frequent Enterobacteriaceae were E. coli 228 (53.5%) and K. pneumoniae 103 (24.1%). The magnitude of ESBLs-E was 57.7% (246/426). The highest frequencies of ESBLs-E were observed in blood specimesns (84.4%) and the highest ESBLs production was observed in K. pneumoniae (85.4%). The highest resistance level was seen to sulfamethoxazole-trimethoprim (77.0%), amoxicillin with clavulanic acid (71.6%), cefotaxime (62.2%), cefepime (60.3%) and ceftazidime (60.8%). The overall magnitude of multi-drug resistance (MDR) level was 68.3%. Of ESBLs-E, 96.3% of them were MDR (P < 0.001).ConclusionThere was a high prevalence of ESBLs-E and MDR isolate in Addis Ababa. Most of ESBLs-E was isolated primarily in blood and urine. The highest ESBLs production was observed among K. pneumoniae. Hence, strong infection control strategies must be implemented in hospital settings of the country.
Highlights
Enterobacteriaceae are Gram-negative, facultative anaerobes, and non-sporing bacilli
The results indicate that these antibiotics were the most active treatment of choice for extended-spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae
Our finding is comparable with the study conducted in Israel, which showed that 75% of ESBL-producer isolates were non-susceptible to gentamicin, 70% to trimethoprim-sulfamethoxazole and 59% to ciprofloxacin [9], and comparable with studies in Burkina Faso (45% to trimethoprim-sulfamethoxazole, 89% to gentamicin, 80% to ciprofloxacin) [25], Ghana (92.6% to trimethoprim-sulfamethoxazole, 91.2% to gentamicin, 41.1% to ciprofloxacin) [27], Nepal (90.7% to ciprofloxacin, 90.4% to trimethoprim-sulfamethoxazole, 63.12% to gentamicin) [34], and central India (50% to gentamicin, 87.5% to ciprofloxacin, 94.6% to trimethoprim-sulfamethoxazole) [25]. These findings indicate that ESBL-producing Enterobacteriaceae were the major cause of resistance to various antibiotics classes, as these bacteria are typically nosocomial
Summary
Enterobacteriaceae are Gram-negative, facultative anaerobes, and non-sporing bacilli. These bacteria have become one of the most important causes of nosocomial and community-acquired infections. Increasing rates of antimicrobial resistance have become a worldwide problem predominantly caused by Gram-negative bacteria, the Enterobacteriaceae [1, 2]. Beta-lactam drugs such as extended-spectrum penicillins, cephalosporins, monobactams, carbapenems, fluoroquinolones (e.g. ciprofloxacin) and aminoglycosides (e.g. gentamicin) are among the most prescribed antibiotics to treat infections caused by Enterobacteriaceae. ESBL-producing Enterobacteriaceae are important members of antibiotic-resistant bacteria that cause hospital and community-acquired infections [3, 4]. The global emergence and spread of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae have been threatening the ability to treat an infection. This study aimed to determine the prevalence of ESBL-producing and multi-drug resistance (MDR) Enterobacteriaceae (ESBLs-E) from different clinical specimens in Addis Ababa, Ethiopia
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