Detection and phenotypic characterization of carbapenem non susceptible gram-negative bacilli isolated from clinical specimens

Abstract

Background Multi-drug resistant, extremely drug-resistant, pan-drug resistant, carbapenem-resistant, and carbapenemase-producing gram-negative bacteria are becoming more common in health care settings and are posing a growing threat to public health. Objective The study was aimed to determine the magnitude of multi-drug resistant, extremely drug-resistant, carbapenem non-susceptible, and carbapenemase-producing gram-negative bacilli at Ethiopian Public Health Institute. Materials and methods Prospective cross-sectional study was conducted from June 30, 2019, to May 30, 2020, at the national reference laboratory of the Ethiopian Public Health Institute. Clinical samples were collected, inoculated, and incubated in accordance to standard protocol for each sample. Antimicrobial susceptibility testing was done using Kirby Bauer disk diffusion. Identification was done using the traditional biochemical method. Multidrug-resistant and extensively drug-resistant were classified using a standardized definition established by European Centers for Disease prevention and control and the United States Centers for Disease prevention and control experts. Carbapenemase production was confirmed by modified carbapenem inactivation and a simplified carbapenem inactivation method. Meropenem with EDTA was used to differentiate serine carbapenemase and Metallo β-lactamase. Results A total of 1337 clinical specimens were analyzed, of which 429-gram negative bacilli isolates were recovered. Out of 429 isolates 319, 74, and 36 were Enterobacterales, Acinetobacter species, and P. aeruginosa respectively. In our study, the prevalence of Multidrug-resistant, extensively drug-resistant, Carbapenemase-producing, and carbapenem non-susceptible Gram-negative bacilli were, 45.2%, 7.7%, 5.4%, and 15.4% respectively. Out of 66 isolates screened for Carbapenemase, 34.8% (23/66) were Carbapenemase enzyme producers. Ten out of twenty-three Carbapenemase-positive organisms were Metallo-beta-lactamase producers. Thirteen out of twenty-three isolates were serine carbapenemase producers. Three out of 13 serine Carbapenemase positive organisms were Klebsiella pneumoniae Carbapenemase. Conclusion The finding from this study revealed a high prevalence of Multidrug-resistant, extremely drug-resistant, carbapenemase-producing gram-negative bacteria, particularly among Intensive care unit patients at the health facility level, this necessitates a robust laboratory-based antimicrobial resistance monitoring and infection prevention and control program.

A spectrum of non-spore-forming fermentative and non-fermentative Gram-negative bacteria: multi-drug resistance, extended-spectrum beta-lactamase, and carbapenemase production

“…The most concerning finding in this study was that E. coli, K. pneumoniae, A. baumannii, and P. aeruginosa were almost all of the pathogens classified as serious life-threatening pathogens (ESKAPE) by WHO, 2019. Our result concurs with the reports of many local studies (Beyene et al, 2019;Abdeta et al, 2021) and global studies (Agyepong et al, 2018;Makanjuola et al, 2018). Furthermore, cases of infections caused by infrequently isolated bacteria, including Burkholderia cepacia, Cupriavidus pauculus, Stenotrophomonas matophilia, Methylobacterium.…”

“…The poor regulatory system for antimicrobial agents over the counter and the supply of substandard antimicrobials are some of the other factors that facilitate the spread of drug-resistant bacteria (Osei-Safo et al, 2016;Sharma et al, 2017). Studies conducted in Africa, including Ethiopia, have demonstrated a mounting prevalence of Gramnegative bacteria resistant to commonly prescribed antibiotics (Kariuki and Dougan, 2014;Beyene et al, 2019;Tafese et al, 2020;Abdeta et al, 2021;Moges et al, 2021). Poor drug regulatory systems, a lack of established antibiotic stewardship, and a lack of laboratory testing capacities in Ethiopia dictate continuous surveillance studies on the level of drug resistance, the phenotypic profile of ESBLase, and carbapenemase producing GNB in different health settings.…”

Epidemiology, antimicrobial resistance profile and management of Carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

“…Those who frequently consumed alcohol, such as beer and tela, and were infected with K. pneumoniae had a greater likelihood of developing severe symptoms, accounting for 42.9% of the patients. These ndings are consistent with many related studies [1,3,6,16,17,34,36,39].The maternal sepsis incidence and treatment of K. pneumoniae vary by region. This could be due to different factors such as sample type, geographic location, patient demographics, immune status, and co-infections, can affect the magnitude and strain type of this bacterium, which is consistent with our ndings in ve tertiary hospitals [10,15,24,35,37].…”

“…Without addressing the rapid spread of CRKP strains, there may not be alternative treatments available in the near future. These ndings are consistent with many studies carried out in other counties [34][35][36][37]. On the other hand, this bacterium is one of the most commonly acquired both nosocomial and community infections and is highly spreading and developed antimicrobial resistance in the worldwide [10-14, 23, 24].…”

“…In cases of severe maternal sepsis, physicians often use a combination of two or three cephalosporins, carbapenems, aminoglycosides, and polymyxins [31][32][33]. If these antimicrobial agents fail, the recommended treatment for maternal sepsis is tigecycline combination therapy with avibactam/ceftazidime, or imipenem/meropenem caused by MDR-/XDR-/PDR-K. pneumoniae [34][35][36][37].…”