Abstract
This study determined the prevalence of extended spectrum β-lactamase (ESBL) producing Gram negative bacilli (GNB) and its genetic variants in clinical infections in our setting. A total of 359 non-duplicate GNB were recovered from various clinical samples which were aseptically collected and processed following standard microbiological methods. Antibiotic susceptibility testing was carried out by standard disk diffusion method. ESBLs producers were confirmed by combination disk test and their genetic variants determined by polymerase chain reaction-based protocols. Among 359 GNB, 94 (26.2%) produced ESBL which were mainly distributed across genera as Citrobacter (n=27; 28.7%), Escherichia (n=25; 26.6%), Klebsiella (n=14; 14.9%) Enterobacter (n=12; 12.8%) and Proteus (n=5; 5.3%). Urine was the main source of ESBL producers (n-35; 37.2%) but ESBL production was most prevalent among isolates from sputum (35.7%). Among bacterial species, Klebsiella pneuminiae had the highest prevalence of ESBL-producing phenotypes (44.8%), followed by Enterobacter cloacae (38.5%), Citrobacter freundii (37.7%), Enterobacter aerogenes (36.8%) and Escherichia coli (29.8%). Seventeen bacteria (19.8%) had single ESBL genes while 69 (80.2%) had multiple genes of which 24 harboured blaTEM, blaSHV and blaCTX-M, 40 harboured blaCTX-M and blaTEM, three haboured blaCTX-M and blaSHV and two haboured blaTEM and blaSHV. Among the ESBL-producing strains, blaCTX-M was the most common harboured gene (74; 78.7%), closely followed by blaTEM (72; 76.6%). This study reveals a high prevalence of ESBL-producing bacteria which could complicate antibiotic treatment of clinical infections. There is a need for continuous antibiotic resistance surveillance to inform improved antibiotic stewardship and infection prevention and control.
Keywords: ESBL, Gram-negative bacilli, CTX-M, TEM, SHV, Hospital.
References
- Bouchillon SK, Badal RE, Hoban DJ, Hawser SP. Antimicrobial susceptibility of inpatient urinary tract isolates of gram-negative bacilli in the United States: results from the study for monitoring antimicrobial resistance trends (SMART) program: 2009-2011. Clin Ther. 2013;35: 872-877. doi:10/gfddvc
- Adeyankinnu FA, Motayo BO, Akinduti A, Akinbo J, Ogiogwa JI, Aboderin BW, Agunlejika RA. A Multicenter Study of Beta-Lactamase Resistant Escherichia coli and Klebsiella pneumoniae Reveals High Level Chromosome Mediated Extended Spectrum β Lactamase Resistance in Ogun State, Nigeria. Interdiscip Perspect Infect Dis. 2014;2014:1-7. doi:10/gb6rb7
- Idowu OJ, Onipede AO, Orimolade AE, Akinyoola L. Extended-Spectrum Beta-Lactamase Orthopedic Wound Infections in Nigeria. J Glob Infect Dis. 2011;3(3):211-215. doi:10/dp57zj
- Olowo-okere A, Ibrahim YKE, Olayinka BO. Molecular characterisation of extended-spectrum β-lactamase-producing Gram-negative bacterial isolates from surgical wounds of patients at a hospital in North Central Nigeria. J Glob Antimicrob Resist. 2018;14:85-89. doi:10/gffcpw
- Schwaber MJ, Carmeli Y. Mortality and delay in effective therapy associated with extended-spectrum -lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother. 2007;60(5):913-920. doi:10/cg7fvv
- Leylabadlo HE, Pourlak T, Bialvaei AZ, Aghzadeh M, Asgharzadeh M, Samadi Kafil H. Extended-Spectrum Beta-Lactamase Producing Gram Negative Bacteria in Iran: A Review. Afr J Infect Dis. 2017;11(2):39-53. doi:10.21010/ajid.v11i2.6
- Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrum-β-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrob Resist Infect Control. 2018;7(1):26. doi:10/gc3vcb
- Cheesbrough M. District Laboratory Practice in Tropical Countries Part II. Cambridge University Press 2006;113:319-329. doi:10/cgg3tg
- Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. CLSI document M100-S25. Wayne, PA: Clinical and Laboratory Standards Institute; 2015
- Monstein H-J, Östholm-Balkhed Å, Nilsson MV, Nilsson M, Dornbusch K, Nilsson LE. Multiplex PCR amplification assay for the detection of blaSHV, blaTEM and blaCTX-M genes in Enterobacteriaceae. APMIS. 2007;115(12): 1400-1408. doi:10/bchfb5
- Sid Ahmed M, Bansal D, Acharya A, Elmi A, Hamid JM, Sid-Ahmed AM, Chandra P, Ibrahim E, Sultan AA, Doiphode S, Bilai N, Deshmukh A. Antimicrobial susceptibility and molecular epidemiology of extended-spectrum betalactamase-producing Enterobacteriaceae from intensive care units at Hamad Medical Corporation, Qatar. Antimicrobial Resistance and Infection Control 2016; 5:4. doi 10.1186/s13756-016-0103-x
- Khawcharoenporn T, Vasoo S, Singh K. Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department. Emerg Med Int. 2013; 2013:258517. doi:http://dx.doi.org/10.1155/2013/258517
- Ouedraogo AS, Sanou M, Kissou A, Sanou SM, Salore H, Kabore F, Poda GEA, Aberkane S, Bouzinbi N, Sano I, Nacro, B, Sangare L, Carriere C, Decre D, Ouegraogo R, Jean-Pierre H, Sylvain G. High prevalence of extended-spectrum β-lactamase producing Enterobacteriaceae among clinical isolates in Burkina Faso. BMC Infect Dis. 2016;16:326. doi: 10.1186/s12879-016-1655-3
- Dijck, C. V, Vlieghe, E, Cox, J. A. Antibiotic stewardship interventions in hospitals in low-and middleincome countries: a systematic review. Bull World Health Organ 2018; 96, 266–280 doi: http://dx.doi.org/10.2471/BLT.17.203448
- De Jesus MB, Ehlers MM, Dos Santos RF, Kock MM. Understanding β-lactamase producing Klebsiella pneumoniae. InTechOpen. 2015; doi:5772/61852
- Multidrug-Resistant Organisms in Wound Management: State of the Science https://www.woundsource.com/blog/multidrug-resistant-organisms-in-wound-management-state-science
- Auta AS, Banwat SB, David S, Dangiwa DA, Ogbole E, Tor-anyiin AJ. Antibiotic Use in Some Nigerian Communities: Knowledge and Attitudes of Consumers. Trop J Pharm Res. 2013; 12 (6): 1087-1092
- Umadevi S, Kandhakumari G, Joseph NM, Kumar S, Easow JM, Stephen S, Singh UK. Prevalence and antimicrobial susceptibility pattern of ESBL producing Gram-negative bacilli. J Clin Diagn Res. 2011;5(2):236-239.
- Bevan ER, Jones AM, Hawkey PM. Global epidemiology of CTX-M β-lactamases: temporal and geographical shifts in genotype. J Antimicrob Chemother. 2017;72(8):2145-2155. doi:10/gffcq9
- Bali EB, Açık L, and Sultan N. Phenotypic and molecular characterization of SHV, TEM, CTX-M and extended-spectrum-lactamase produced by Escherichia coli, Acinobacter baumannii and Klebsiella isolates in a Turkish hospital. Afr J Microbiol Res. 2010;4(8):650-654.
Corresponding Author
Adeyemi Temitayo Adeyemo
Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria