Emergence of metallo-b-lactamase producing gram-negative bacteria in a hospital with no history of Carbapenem usage in northwest Nigeria

Abstract

Carbapenems are among the antibiotics of last resort against infections caused by antibiotic resistant bacteria. However, resistance to this important class of antibiotic is on the increase due to expression of metallo-betalactamases (MBLs). This study investigated the occurrence of MBL-producing bacteria in a healthcare facility in Sokoto, Nigeria. Swabs were collected from the rectum (n = 29) and bed linens (n = 27) of patients within the surgical wards of the hospital between March and August, 2018 and processed using Centers for Disease Control and Prevention (CDC) broth enrichment method for isolation of carbapenem resistant Gram-negative bacteria (CR-GNB). In addition, 110 bacteria isolated from clinical specimens submitted to microbiology laboratory of the hospital were collected and tested for susceptibility to antibiotics using the disc diffusion method. The carbapenem resistant isolates were further evaluated for MBL-production using the combined disc method. Overall, 31(28.2%) of the Gram-negative bacterial isolates were carbapenem resistant. The most predominant isolated bacterium in this study was E. coli (18; 36%). The isolates were highly resistant to cephalosporins (74%) and fluoroquinolones (52.7%) while remaining moderately susceptible to gentamicin (38.8%) and amoxicillin-clavulanate (45.7 %). Majority of the CR-GNB were extensively drug resistant (19; 38%) and pan drug resistant (10; 20%). The MBL-production test revealed that 19 (38.0%) of the CR-GNB were MBL-positive. The study revealed a high prevalence of MBL-producing CR-GNB in a hospital with no history of its use. This report documents for the first time the independent emergence of such resistance in our hospital. Implementation of adequate antibiotic stewardship program is therefore imperative so as to contain this emerging threat.

Phenotypic and genotypic characterization of clinical carbapenem-resistant Enterobacteriaceae isolates from Sokoto, northwest Nigeria

“…Previous reports across the country have established varying rates. For example, 28% carbapenem resistance was reported in the preceding year in one of the hospitals among carbapenem-naive patients [ 18 ]. Also, in a neighbouring West Africa country, Ghana, a rate of 66% carbapenem-resistant Gram-negative bacteria has been reported [ 31 ].…”

“…Interest in research on carbapenem resistance began recently. Most studies on CPE have been limited to phenotypic testing [ 17 , 18 ]. However, a few studies have used genotypic methods to establish the occurrence of carbapenemase genes among clinical and non-clinical bacterial isolates in Nigeria [ 19 , 20 ].…”

Concurrent Resistance to Carbapenem and Colistin Among Enterobacteriaceae Recovered From Human and Animal Sources in Nigeria Is Associated With Multiple Genetic Mechanisms

“…We recently reported the occurrence of mcr-mediated colistin resistance among 99 colistin resistant isolates; Escherichia coli (67/99), Klebsiella pneumoniae (30/99), Citrobacter werkmanii (1/99), and Alcaligenes faecalis (1/99) from humans and animals in Nigeria (Ngbede et al, 2020). Studies have also reported a high prevalence, up to 52%, of carbapenem resistance mediated by carbapenemase producing genes in samples from humans in Nigeria (Ogbolu and Webber, 2014;Jesumirhewe et al, 2017;Olowo-okere et al, 2019;Otokunefor et al, 2019;Ogbolu et al, 2020;Olalekan et al, 2020;Olowo-Okere et al, 2020;Shettima et al, 2020). These findings suggest that resistance to the last resort drugs carbapenem and colistin is a significant problem in Nigeria.…”

High prevalence of multidrug-resistant Gram-negative bacterial infections in Northwest Nigeria

“…11 Despite the untenable rate of antibiotic resistant bacterial infections reported in most Nigerian cities, there is substantial gap in the surveillance of these infections in several Nigerian cities especially in northwest Nigeria where limited research has been done on the prevalence of difficult to treat infections. 12,13 In the few studies conducted, a limited number of antimicrobial classes have been tested. This study therefore aimed to comprehensively investigate the prevalence of multidrug resistant (MDR) Gram-negative bacterial infections among patients attending two major hospitals in northwest Nigeria.…”