Abstract
Extended Spectrum Beta Lactamase (ESBL) producing Escherichia coli is a global cause of life threatening infections. We determined the presence of ESBL and carbapenemase production in clinical isolates of E. coli and their antibiotic susceptibility. Clinical isolates of community and hospital acquired E. coli from 220 patients seen at a tertiary hospital were evaluated. Antibiotic susceptibility testing was by the modified Kirby-Bauer protocol while ESBL production was determined by the Double Disk Synergy Test (DDST). Carbapenem resistance was confirmed by the Modified Hodge Test. Of the 220 isolates, 122 (55.5%) were from females; 41 (18.6%) were ESBL positive. About 90% of the ESBL producing isolates were resistant to nine of the 15 antimicrobial agents tested. However, only one (2.4%) of the 41 ESBL producing isolates exhibited carbapenem resistance. The ESBL negative isolates were susceptible to Meropenem (100%), Cefepime (97.8%), Ceftriaxone (96.6%) and Cefotaxime (96.6%). All the ESBL producing isolates harbored detectable plasmids with sizes ranging from 2322 to 23,130 base pairs. Our findings show that although multidrug resistant ESBL producing E. coli are prevalent in both the hospital and the community in this environment, carbapenem resistance is still low. We recommend that institutions develop guidelines for the early phenotypic detection of ESBLs and carbapenem resistance.
Highlights
Paul Ehrlich described the concept of antimicrobial agents as “magic bullets” for killing microbes [1] [2]
We recommend that institutions develop guidelines for the early phenotypic detection of Extended Spectrum Beta Lactamase (ESBL) and carbapenem resistance
Extended spectrum beta lactamase (ESBL) enzymes which are mainly produced by Escherichia coli (E. coli) and K. pneumoniae render these antibiotics ineffective when used to treat infections caused by ESBL producing organisms, increasing morbidity and mortality as well as the cost of therapy [4]
Summary
Paul Ehrlich described the concept of antimicrobial agents as “magic bullets” for killing microbes [1] [2]. Carbapenems are cell wall synthesis inhibiting antibiotics just like penicillins and cephalosporins with a different chemical structure. They have the characteristic penicillin-like five membered beta lactam ring, but differs at the sulfur at position C-1 which is replaced with a carbon atom and an introduction of a double bond between C-2 and C-3 of the ring [5]. Reports from several studies already show presence of carbapenemases conferring resistance to the carbapenems, a situation that is potentially devastating [5] [6]. The situation is disturbing as this could be applicable and more devastating in developing countries like Nigeria, made even worse because there are no institutionalized surveillance for resistant organisms. We determined the prevalence, distribution and plasmids in clinical isolates of ESBL and carbepenemase producing E. coli and assessed the patterns of susceptibilities to commonly used antimicrobial agents in a Northern Nigerian tertiary hospital
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