Antimicrobial resistance patterns in extended-spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae isolates in a private tertiary hospital, Kenya

Abstract

Background: Extended-Spectrum β-Lactamase (ESBL) producing Enterobacteriaceae have become widespread in hospitals and are increasing in community settings where they cause a variety of infections. In addition to hydrolyzing most beta-lactam agents, bacteria harboring these enzymes display resistance to other unrelated antimicrobial agents and thus often pose a therapeutic dilemma. Though these resistance patterns have been studied elsewhere within Africa, such data from hospitals in Kenya are scanty. We therefore undertook to determine these patterns at the Aga Khan University hospital by studying multidrug resistant Escherichia coli and Klebsiella pneumoniae isolates from patients' samples. Findings: A total of 159 isolates (109 E. coli and 50 K. pneumoniae) were confirmed as ESBL producers and tested against eighteen antimicrobials. The proportion of resistant isolates was high (>80%) for the antimicrobials tested with the exception of the carbapenems (<1%), nitrofurantoin (23%) and gentamicin (63%). Klebsiella pneumoniae had a higher proportion of isolates resistant to ceftazidime, gentamicin and nitrofurantoin (P < 0.05) than E. coli which had a higher proportion of isolates resistant to ciprofloxacin, levofloxacin and tetracycline (P < 0.05). Conclusions: In our study, antimicrobial coresistance is common in ESBL producers; however resistance to carbapenems is low and these drugs would be the appropriate empiric therapy for serious or life threatening systemic infections. Nitrofurantoin retains good activity among the multidrug resistant isolates and can be the drug of choice for non-complicated urinary tract infections due to ESBL producing E. coli.

Prevalence of aerobic pathogenic bacteria isolated from patients with burn infection and their antimicrobial susceptibility patterns in Al-Najaf City, Iraq- a three-year cross-sectional study.

“…Extended spectrum beta-lactamases (ESBLs) have been reported as one of the most important hospital-acquired infections such as burn infection and bacteremia 9,55 . Most bacteria harboring ESBLs are usually resistant to beta-lactam antibiotics and other classes of antimicrobials 56 . These enzymes are carried in and transferred from bacteria to bacteria by plasmids 57,58 .…”

Antimicrobial Susceptibility Profile of Extended Spectrum β-Lactamase (ESBL) Producing Escherichia coli from Various Clinical Samples

“…In a study conducted by Ankur et al on clinical isolates of ESBL producing E. coli , resistance found to amikacin was 14.7%, gentamicin 66.7%, trimethoprim/sulfamethoxazole 79.1%, and ciprofloxacin 93.8% 25. Maina et al documented a higher proportion of isolates resistant to ciprofloxacin, levofloxacin, and tetracycline, and approximately 100% sensitivity to carbapenems 26. Al-Zarouni et al also demonstrated high resistance rates to fluoroquinolones and cephalosporins and higher susceptibility rates to carbapenems and amikacin 27…”

Antimicrobial Resistance Pattern of Uropathogenic Escherichia coli and Klebsiella species Isolated in a Tertiary Care Hospital of Sylhet

“…These findings are similar to the result of Sarkar et al 22 , who found similar resistance pattern (78.9% & 64% respectively). Besides, there are more studies 23,24 with similar results indicating high level resistance to ciprofloxacin. This increased resistance might be due to widespread indiscriminate use, their oral route of ORIGINAL ARTICLE administration, easy availability and affordability of ciprofloxacin over the country.…”