Surveillance of Phenotypic Extended Spectrum Beta-Lactamase Resistance in Blood Isolates at a Hospital in East Trinidad

Abstract

Background The Centres for Disease Control and Prevention (CDC) and World Health Organization (WHO) list extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae as serious threats and priority pathogens. This study identified phenotypic resistance patterns to these pathogens in east Trinidad, West Indies. We also aimed to set up and test a pilot surveillance system aligned to WHO’s Global Antimicrobial Surveillance System (WHO-GLASS). Methods Two key bacterial isolates, Escherichia coli and Klebsiella pneumoniae were used and one specimen, blood, was used to test a pilot surveillance system. Data for resistance patterns, for Sangre Grande Hospital (SGH), for ESBL producing E. coli and K. pneumoniae were downloaded from the Microscan Autoscan© for the period 2013 – 2016. ESBL presence in bacteria resistant to Cefotaxime (CTX), Ceftazidime (CAZ) and Ceftriaxone (CRO) were recorded. Data were stored in a Microsoft Excel© spreadsheet and inputted into IBM© SPSSv22. Data were displayed as resistance percentages for the year. No patient data were collected. Simple descriptive statistics were used. Results The number of organisms recovered from the database for the period 2013 to 2016 were:134E. coli and 59K. pneumoniae. Phenotypic resistance rates for ESBLs for 2013 to 2016 were: Ecoli: 2013: Resistance ranged from 22.2-29.6% with maximum resistance seen for CTX. 2014: Resistance ranged from 12.9- 22.2%, with maximum resistance seen for CRO. 2015: Resistance ranged from 21.4- =26.2%, with maximum resistance seen for CTX. 2016: Resistance ranged from 29.4- 32.4%, with maximum resistance seen for CRO and CTX. K pneumoniae: 2013: Resistance was 40% for all 3rd generation Cephalosporins. 2014: Resistance was 16.7% for all 3rd generation Cephalosporins. 2015: Resistance was 16.7% for all 3rd generation Cephalosporins. 2016: Resistance ranged from 52.6 – 63.2%, with maximum resistance seen for CAZ. Conclusion Phenotypic resistance rates in K. pneumoniae and E. coli were generally high. There was an overall increase in resistance from 2013 to 2016 for both K. pneumoniae and E. coli with greater resistance being seen in K. pneumoniae.