Abstract
Problem statement: Resistance to third generation cephalosporins due to acquisition and expression of Extended Spectrum β-Lactamase (ESBL) among Gram-negative bacteria is on the increase. Infections involving extended spectrum beta lactamase bacteria are associated with significant morbidity and mortality. Therefore, infections due to ESBL isolates continue to pose a serious challenge to infection management worldwide. Since screening for ESBL is not a common practice in hospitals in Enugu state, this study was undertaken to characterize ESBL genes in K. pneumoniae strains from intensive care unit of the University of Nigeria Teaching Hospital (UNTH) Enugu. Approach: Over a period of 29 months, 57 patients out of 140 receiving treatment in the intensive care unit of the University of Nigeria Teaching Hospitals Enugu were found to be infected with extended-spectrum β-lactamase-producing strains of K. pneumoniae. Species identification of K. pneumoniae strains was performed by Standard Microbiology methods and re-confirmed by MALDI-TOF technology. Phenotypic characterization of Extended Spectrum Beta Lactamase (ESBL) was determined by double disc synergy test and presence of ESBL genes was determined by specific PCR. Results: All ESBL producers were positive in a PCR for blaCTX-M-1 cluster and on sequencing, blaCTXM-15 were found to be present. Genotypic characterization of extended spectrum beta-lactamase producing K. pneumoniae showed that all isolates carried CTX-M-15and SHV genes, 41(71.9%) carried aac (6’)-Ib-cr and blaOXA-1, 19(33%) carried blaTEM. ISEcp1 was found upstream and ORF 477 downstream of blaCTX-M. in all strains. Random amplified polymorphic DNA analysis grouped the strains into two clonal groups- A and B and majority of the strains belong to clonal group A (n = 42). Conclusion: This study shows for the first time the presence of ESBL genes in K. pneumoniae from the ICU of UNTH Enugu and therefore strongly butresses the need for regular screening for ESBL-producing bacteria in clinical specimen in ICU and other wards in Nigerian hospitals.
Highlights
Resistance to oxyimino-cephalosporins such as cefotaxime, ceftriaxone or ceftazidime is a growing problem in the treatment of nosocomial infections and is often caused by the production of Extended Spectrum β- Lactamases (ESBLs) (Paterson et al, 2003)
This study was undertaken to characterize Extended Spectrum Beta Lactamase (ESBL) genes in K. pneumoniae strains from intensive care unit of University of Nigeria Teaching Hospital (UNTH) Enugu
Collection of bacteria strains: Fifty-seven isolates of ESBL producing K. pneumoniae were isolated from 140 patients receiving treatment in the Intensive Care Units (ICU) of UNTH Enugu over a period of 29 months
Summary
Resistance to oxyimino-cephalosporins such as cefotaxime, ceftriaxone or ceftazidime is a growing problem in the treatment of nosocomial infections and is often caused by the production of Extended Spectrum β- Lactamases (ESBLs) (Paterson et al, 2003). Klebsiella became resistant to broad-spectrum β-lactam antibiotics due to the emergence and spread of plasmid-mediated βlactamases such as Extended Spectrum β-Lactamases (ESBLs) and has been associated with infection acquired in the Intensive Care Units (ICU) (Tenover and Hughes, 1996). An increasing emergence of multidrug resistance among Klebsiella pneumoniae nosocomial isolates has limited the therapeutic options for the treatment of the intra-hospital infections caused by this opportunistic pathogen. This study was undertaken to characterize ESBL genes in K. pneumoniae strains from intensive care unit of University of Nigeria Teaching Hospital (UNTH) Enugu
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