Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae clinical isolates in a Senegalese teaching hospital: A cross sectional study

Abstract

Extended spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) have been increasingly reported worldwide. The objective of this study is to determine the prevalence of these multidrug-resistant strains in a major university teaching hospital in Dakar, Senegal. A total of 1205 Enterobacteriaceae stains were tested for ESBL and carbapenemase production. Antibiotics susceptibility test was performed with disk diffusion method. ESBL was detected using a double-disk synergy method. Carbapenemase production was detected with ertapenem 10 µg disk charge. The overall prevalence of ESBL-and carbapenemase-producing Enterobacteriaceae was 26.2 (316/1205) and 5.1% (62/1205), respectively. Interestingly, 3.8% of these pathogens were both ESBL-carbapenemase producers. Among the Enterobacteriaceae ESBL positive, Escherichia coli (45.2%, 143/316), Klebsiella pneumoniae (26.3%, 83/316), Enterobacter cloacae (12.7%, 40/316), and Proteus vulgaris (9.2%, 29/316) were the most prevalent. These strains were mainly isolated from urine (56.6%) and pus (22.7%) specimen. The most prevalent CPEs were E. coli (45.2%, 28/62), K. pneumoniae (27.4%, 17/62), and E. cloacae (16.1%, 10/62), particularly isolated from urine (58%) and pus (19.3%). The majority of these MDR strains were isolated from patients hospitalized in urology (32.4%), surgery (27.7%), internal medicine (18.5%), and intensive care units (10%). ESBL-producing Enterobacteriaceae remain highly susceptible to fosfomycin (94.1%), amikacin (92.5%) and ertapenem (88.6%), while carbapenemase producers were fully susceptible to amikacin (100%), and to a lesser extent, fosfomycin (66.7%) and colistin (60%). This study revealed increasing prevalence of ESBL-and carbapenemase-producing Enterobacteriaceae with limited therapeutic options, suggesting a need for continuous multi-drug resistant (MDR) surveillance patterns particularly in hospital settings.

Genetic Study of Extended Spectrum Beta-Lactamase and Carbapenemase Producing Escherichia Coli Causing Sepsis among Egyptian Children

“…High resistance was detected to cefotaxime, cefoxitin also (79.6% and 81.6% among ESBL producers respectively and 36.7% and 33.3% among carbapenemase producers; respectively). A study in Senegal showed that all strains were resistant to ceftriaxone or cefotaxime (99.9%) [27]. In the present study low rates of resistance to amikacin was detected, which is consistent with findings from Korea [45], Taiwan [31], Japan [46] and Senegal [27].…”

“…A study in Senegal showed that all strains were resistant to ceftriaxone or cefotaxime (99.9%) [27]. In the present study low rates of resistance to amikacin was detected, which is consistent with findings from Korea [45], Taiwan [31], Japan [46] and Senegal [27].…”

“…Higher rates were even reported in other studies from India (>80%), China (>60%) [24]. While in other researches, all the tested E. coli were ESBL-positive; in Saudi Arabia [25], Ethiopia [26] and Senegal [27]. In this study, carbapenemase production among isolated E. coli was higher than those previously studied from clinical isolates in New Zealand (15%) [21].…”

“…In this study, carbapenemase production among isolated E. coli was higher than those previously studied from clinical isolates in New Zealand (15%) [21]. Meanwhile, in another study, carbapenemase production among E. coli was higher (45.2%) [27]. These high rates of ESBL producing E. coli and CPE in Egypt are probably related to the overuse of antibiotics, improper administration of antimicrobial agents in trial therapies for the management of any febrile illness or due to lack of proper infection control practices (that can lead to an emergence of resistant organisms).…”

“…Meanwhile, all Carbapenemase producers in our study were resistant to Imipenem and Meropenem. Whereas, relatively high sensitivity of ESBL E. coli producers to sulfamethoxazole/trimethoprim complex (78.4%), and ciprofloxacin (75%) were observed in contrast to other authors that showed high resistance rates with sulfamethoxazole/trimethoprim complex (85.7%) and ciprofloxacin (72%) [27]. Colistin, amikacin, fosfomycin, and temocillin are the only few remaining antibiotics used to treat infections caused by carbapenemase-producing Gram-negative bacilli.…”