Prevalence and Risk Factors Associated with Extended-spectrum β-lactamase-Producing Bac­teria among Pregnant Women Attending Three Secondary Health Care Facilities in Nigeria

Abstract

Background: Extended- spectrum beta-lactamases (ESBL) are enzymes produced by members of the En­terobacteriaceae which can hydrolyse the beta-lactam antibiotics like penicillins and cephalosporins and thereby confer antibiotic resistance on strains producing them. Bacterial isolates producing ESBLs have spread around the world. The ESBLs are encoded by several genetic elements on the chromosome and plas­mids. This study was carried out to determine the prevalence of ESBL producing Gram-negative bacteria and their risk factors in pregnant women attending antenatal care at three General Hospitals in Akwa Ibom State, Nigeria. Methods: 660 urine specimens were collected from the women between July and December 2018. The specimens were inoculated on MacConkey agar and incubated at 370C for 24h. The biochemical characteri­sation of the isolates was done using the Microbact 24E (Oxoid Ltd, UK). Antibiotic susceptibility testing was done by the Kirby-Bauer disc agar diffusion method. The isolates were tested for the production of ESBL using a Double Disc. Synergy test and CHROMagar ESBL Results: A total of 252 isolates comprising 231(92%) ESBL producers were recorded. In this study, Entero­bacter cloacae was the most frequently isolated ESBL producer (25.7%), followed by Escherichia coli (20.2%) and Klebsiella pneumoniae (16.3 %). The most relevant risk factors for ESBL producing bacteria were previous use of antibiotics (p< 0.05), personal hygiene (p< 0.05) and history of catheterisation (p< 0.05). Conclusion: This calls for urgent public health measures to implement antimicrobial resistance stewardship to mitigate against the potential adverse effects of the spread of resistant bacteria which are vital in manag­ing severe bacterial infections