Antimicrobial Resistance Patterns, Extended-Spectrum Beta-Lactamase Production, and Associated Risk Factors of Klebsiella Species among UTI-Suspected Patients at Bahir Dar City, Northwest Ethiopia

Abstract

Introduction. Klebsiella species cause pneumonia, UTI, and septicemia in human beings. Beta-lactam drugs are used extensively to treat patients infected with Klebsiella, but most of the Klebsiella species are resistant to third- and fourth-generation cephalosporins and monobactams to which data are scarce in the study area. Objective. To determine the prevalence, antimicrobial resistance, ESBL production, and associated risk factors of Klebsiella species among UTI-suspected patients in Bahir Dar City, Northwest Ethiopia. Methods. A multi-institution-based prospective cross-sectional study was conducted from January to May 2019. Midstream urines were collected from 385 patients and inoculated onto CLED and MacConkey agars. Identification of growth was done by a battery of biochemical tests. Antimicrobial resistance and ESBL production patterns were determined by using the disc-diffusion method on Mueller–Hinton agar. Quality of data was maintained by following SOPs and using Klebsiella pneumoniae (ACTT700603). Logistic regression statistical analysis was done using the SPSS, version 25, statistical package. A p value ≤ 0.05 was considered statistically significant. Results. The median age of the study participants was 32 years. Majority of them were female, urban residents, and unable to read and/or write. The total Klebsiella species detected were 38 (9.9%). Of which, 25 (65.8%) were Klebsiella pneumoniae, followed by 6 (15.8%) Klebsiella ozaenae. 20 (80%), 19 (76%), and 19 (76%) Klebsiella pneumoniae showed resistance to amoxicillin/clavulanic acid, ampicillin, and cotrimoxazole, respectively. All K. oxytoca were resistant to ampicillin, and all K. rhinoscleromatis were resistant to cefoxitin and cefotaxime. Klebsiella species that showed resistance to ≥3 antimicrobials were 26 (68%). ESBL-producing Klebsiella species were 10 (26.3%). Patients who had history of antibiotic use, hospitalization, and tight dressing habit had more risk of getting UTI ( p < 0.05 ) than their counterparts. Conclusions. Overall UTI prevalence in our study was lower than that of previous Ethiopian studies. High MDR and ESBL-producing Klebsiella species were detected. Patients’ history of antibiotic use, hospitalization, and tight dressing habit were risk factors for UTI. It calls up for improving prevention/control systems of Klebsiella species.

Prevalence of ESBL genes in Klebsiella pneumoniae from individuals with community-acquired urinary tract infection in rural communities of Enugu State, Nigeria

“…In this study, the overall prevalence of samples showing positive ESBL genes among the participants was 10 (12.99%), of which 3 (30%) were from males, whereas 7(70%) were from females. This finding is lower than the report on a work done in Bahir Dar City, Northwest Ethiopia [15], which gave ESBL Klebsiella prevalence rate of 10 (26.3%), however, the findings of this study is slightly higher than a similar work done in community on-set UTI in China, where a 110 (6.3%) ESBL Klebsiella pneumoniae was obtained [16]. The variation in prevalent rate can be attributed to antibiotic usage and exposure to mobile pool of antimicrobial resistance genes (ESBL) in hospital settings, as pointed out by researchers [17], [18].…”

Study of Antibiotic-resistant Bacteria Isolated from Children with Urinary Tract Infection

“…The previous study pointed to samples were positive for bacterial culture for the (1-5) year, which was 10% and negative was 80%, while the age from (6-15) year was 16% and negative bacterial culture was 82%. 11 The results note that the age (less than year-5) year had the highest incidence of UTI and females more than males, which may be due to the physiological nature of the urinary system compared to the male urinary system, the high prevalence of UTI in females is unequivocally due to anatomical factors such as short urology and near the vagina opening from the anus that shortens the distance that bacteria must travel to reach the bladder and poor personal hygiene. 11 Table 4 shows the number and percentages of genera isolated from positive samples, with the results of the current study showing that E. coli was the highest at 27 (49.09%), followed by K.…”

“…11 The results note that the age (less than year-5) year had the highest incidence of UTI and females more than males, which may be due to the physiological nature of the urinary system compared to the male urinary system, the high prevalence of UTI in females is unequivocally due to anatomical factors such as short urology and near the vagina opening from the anus that shortens the distance that bacteria must travel to reach the bladder and poor personal hygiene. 11 Table 4 shows the number and percentages of genera isolated from positive samples, with the results of the current study showing that E. coli was the highest at 27 (49.09%), followed by K. spp., with 14 (25.45%) then each of S. aureus, Proteus spp., Citrobacter spp., Enterobacter spp., Pseudomonas spp.…”

“…Samples 55 were positive for bacterial culture, and by (28.06% ) (Figure 1) and included the age (less than one year), with 12 females (41.37%) and males 17 (58.62%) and the age (1--5) year, the females was 12 (70.85%) and males 5 (29.41%), the age (6-10) year and (11)(12)(13)(14)(15) year the number of females with UTI was 8 (100%) and 1 (100%) as shown in Table 3.…”

Extended-spectrum beta-lactamase and Antibiotic susceptibility pattern in uropathogens.

“…19 In another investigation, ESBLproducing Klebsiella pneumoniae demonstrated 100% resistance to amoxicillin/clavulanic acid, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamycin, nitrofurantoin, cefoxitin, cefotaxime, ceftazidime, and meropenem (20 percent ). 20 Penicillin, cephalosporins, trimethoprimsulfamethoxazole, quinolones, carbapenems, aminoglycosides, 2nd, and 3rd generation cephalosporins were the most active compounds against these uropathogens, according to an analysis of non-ESBL generating strains' susceptibility to the antibiotics utilised (E. coli and K.pneumoniae). 21 The finding in our study is similar to the above study.…”