Abstract
Background Klebsiella pneumoniae and Escherichia coli are the major extended-spectrum β-lactamase- (ESBL-) producing organisms increasingly isolated as causes of complicated urinary tract infections and remain an important cause of failure of therapy with cephalosporins and have serious infection control consequence. Objective To assess the prevalence and antibiotics resistance patterns of ESBL-producing Escherichia coli and Klebsiella pneumoniae from community-onset urinary tract infections in Jimma University Specialized hospital, Southwest Ethiopia, 2016. Methodology A hospital-based cross-sectional study was conducted, and a total of 342 urine samples were cultured on MacConkey agar for the detection of etiologic agents. Double-disk synergy (DDS) methods were used for detection of ESBL-producing strains. A disc of amoxicillin + clavulanic acid (20/10 µg) was placed in the center of the Mueller–Hinton agar plate, and cefotaxime (30 µg) and ceftazidime (30 µg) were placed at a distance of 20 mm (center to center) from the amoxicillin + clavulanic acid disc. Enhanced inhibition zone of any of the cephalosporin discs on the side facing amoxicillin + clavulanic acid was considered as ESBL producer. Results In the current study, ESBL-producing phenotypes were detected in 23% (n = 17) of urinary isolates, of which Escherichia coli accounts for 76.5% (n = 13) and K. pneumoniae for 23.5% (n = 4). ESBL-producing phenotypes showed high resistance to cefotaxime (100%), ceftriaxone (100%), and ceftazidime (70.6%), while both ESBL-producing and non-ESBL-producing isolates showed low resistance to amikacin (9.5%), and no resistance was seen with imipenem. In the risk factors analysis, previous antibiotic use more than two cycles in the previous year (odds ratio (OR), 6.238; 95% confidence interval (CI), 1.257–30.957; p = 0.025) and recurrent UTI more than two cycles in the last 6 months or more than three cycles in the last year (OR, 7.356; 95% CI, 1.429–37.867; p = 0.017) were found to be significantly associated with the ESBL-producing groups. Conclusion Extended-spectrum β-lactamases- (ESBL-)producing strain was detected in urinary tract isolates. The occurrence of multidrug resistance to the third-generation cephalosporins, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracyclines is more common among ESBL producers. Thus, detecting and reporting of ESBL-producing organisms have paramount importance in the clinical decision-making.
Highlights
Drug-resistant microbes of all kinds can move among people and animals, from one country to another without notice
ESBL-producing organisms are frequently exhibiting resistance to other antimicrobial classes such as fluoroquinolones, aminoglycosides, and trimethoprimsulfamethoxazole due to associated resistance mechanisms, which may be either chromosomally or plasmidencoded [3,4,5,6]. e widespread use of third-generation cephalosporin was believed to be the major cause of mutations in these enzymes that leads to the emergence of plasmid-encoded ESBLs. ese ESBLs were transferred between bacteria by plasmids, which were in turn spread by clonal distribution between hospitals and countries through patient mobility [7]
In recent years, ESBLproducing Enterobacteriaceae isolates have shifted from the hospital to the community or have been recognized in community patients who had no prior contact with the healthcare system [17]
Summary
Drug-resistant microbes of all kinds can move among people and animals, from one country to another without notice. Ey is a worrying global public health issue as infections caused by such enzyme-producing organisms are associated with a higher morbidity and mortality and greater fiscal burden. E widespread use of third-generation cephalosporin was believed to be the major cause of mutations in these enzymes that leads to the emergence of plasmid-encoded ESBLs. ese ESBLs were transferred between bacteria by plasmids, which were in turn spread by clonal distribution between hospitals and countries through patient mobility [7]. Erefore, this study was conducted to determine the prevalence and antimicrobial resistance pattern of ESBLproducing Escherichia coli and Klebsiella pneumoniae isolated from community-onset UTI patients at Jimma University Specialized Hospital, Southwest Ethiopia In comparison with the rest of the world, there is generally a lack of comprehensive data regarding ESBLproducing Enterobacteriaceae in African countries. e real situation of antibiotic resistance is not clear since ESBLproducing organisms as well as non-ESBL producers are not routinely cultured and their resistance to antibiotics cannot be tested. erefore, this study was conducted to determine the prevalence and antimicrobial resistance pattern of ESBLproducing Escherichia coli and Klebsiella pneumoniae isolated from community-onset UTI patients at Jimma University Specialized Hospital, Southwest Ethiopia
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