Abstract
BackgroundBeta-lactamase enzymes-producing Enterobacteriaceae have emerged in many hospital settings resulting in poor treatment outcomes. We aimed to determine resistant patterns of Beta-lactamase enzymes among Enterobacteriaceae collected from referral hospitals in Khartoum state, Sudan.MethodsA total of 168 Enterobacteriaceae recovered from clinical samples of patients during May 2014 to February 2015. Identification and susceptibility testing of the isolates were performed as per standard methods. Double-disk synergy test was applied to determine the presence of extended-spectrum β-lactamase (ESBL) production. AmpC beta-lactamases and carbapenemase were screened using AmpC disk test and the modified Hodge test, respectively.ResultsESBL-producing Enterobacteriaceae represented 45.2%, with a higher rate among K. pneumoniae. AmpC beta-lactamase detected as 49.3%, with peak levels among Acinetobacter baumannii (A. baumannii) (83.3%) and Enterobacter cloacae (75%). Carbapenemase production was found among 74.5% of isolates, with high rates among A. baumannii (89%) and K. pneumoniae (78%). Overall Enterobacteriaceae, highest resistance rates were found in penicillins and cephalosporins agents. Amikacin and imipenem revealed good activities against most of the isolates, except for A. baumannii (66.7% and 75%, respectively). E. coli yielded high resistance rates for amoxicillin (98.8%), amoxicillin-clavulanic acid (93.8%), cefotaxime (93.8%), and ciprofloxacin (76.5%). Moderate resistance rates were observed among K. pneumoniae for ciprofloxacin (61.5%), nitrofurantoin (57.7%) and cefoxitin (40.4%).ConclusionsESBL, AmpC beta-lactamase and carbapenemase-producing Enterobacteriaceae are emerging and may contribute to increasing antimicrobial resistance in Sudan. Phenotypic screening of such enzymes is rapid and straightforward and should be simultaneously done and carried out routinely in our hospitals.
Highlights
Members of Enterobacteriaceae continue to be an essential cause of several healthcare-associated infections [1]
AmpC beta-lactamase detected as 49.3%, with peak levels among Acinetobacter baumannii (A. baumannii) (83.3%) and Enterobacter cloacae (75%)
Carbapenemase production was found among 74.5% of isolates, with high rates among A. baumannii (89%) and K. pneumoniae (78%)
Summary
Members of Enterobacteriaceae continue to be an essential cause of several healthcare-associated infections [1]. Antimicrobial resistance among these Gram-negative rods is increasing on a worldwide basis, especially resistance against β-lactam agents due to the development of β-lactamase enzymes [2]. Β-lactamase-producing Enterobacteriaceae are commonly cross-resistant to other classes of antibiotics, such as fluoroquinolones, trimethoprim/sulfamethoxazole, and aminoglycosides, which results in limited therapeutic options to treat infections caused by these pathogens [3]. Carbapenemases are β-lactamases and able to hydrolize β-lactam antibiotics, including carbapenems and become a significant resistance mechanism in Enterobacteriaceae [6]. Beta-lactamase enzymes-producing Enterobacteriaceae have emerged in many hospital settings resulting in poor treatment outcomes. We aimed to determine resistant patterns of Beta-lactamase enzymes among Enterobacteriaceae collected from referral hospitals in Khartoum state, Sudan
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