Multidrug-resistant profile and prevalence of extended spectrum β-lactamase and carbapenemase production in fermentative Gram-negative bacilli recovered from patients and specimens referred to National Reference Laboratory, Addis Ababa, Ethiopia

Abstract

BackgroundThe emergence of multidrug-resistance (MDR), production of extended-spectrum β-lactamases, and carbapenemase in members of fermentative gram-negative bacilli are a serious threat to public health.ObjectiveThe aim of this study was to determine the burden of multi-drug resistance, the production of extended-spectrum β-lactamases (ESBLs), and carbapenemase in fermentative Gram-negative bacilli in Ethiopian Public Health Institute.Materials and methodsA cross-sectional study was carried out from December 2017 to June 2018. Different clinical samples were collected, inoculated, and incubated according to standard protocols related to each sample. Bacterial identification was performed by using the VITEKR 2 compact system using the GNR card. Antimicrobial susceptibility testing was carried out by the Kirby-Bauer disc diffusion method. Production of ESBL and carbapenemase were confirmed by combination disc and modified Hodge Test method respectively.ResultsA total of 238 fermentative Gram-negative bacilli were recovered during the study period, among which E.coli were the predominant isolates followed by K. pneumoniae. The highest percentage of antibiotic resistance was noted against ampicillin (100%) followed by trimethoprim/sulfamethoxazole (81.9%). The isolates showed better sensitivity towards carbapenem drugs. Out of 238 isolates, 94.5% were MDR and of which 8.8% and 0.8% were extensively and pan drug resistant, respectively. Nearly 67% and 2% of isolates were producers of ESBL and carbapenemase, respectively. The isolation rates of MDR, ESBL, and carbapenemase producing stains of the isolates were ≥70% in intensive care unit while the isolation rates in other wards were ≤25%.ConclusionsThe findings of this study revealed that the burden of MDR and ESBL was high and carbapenemase producing isolates were also identified which is concerning. This situation warrants a consistent surveillance of antimicrobial resistance of fermentative Gram-negative bacilli and implementation of an efficient infection control program.

Prevalence of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli: A meta-analysis report in Ethiopia

“…The pooled proportional estimate of resistance against third-generation cephalosporins (cefotaxime and ceftazidime), amoxicillin-clavulanic acid, gentamicin, ciprofloxacin, SXT and TET ranges from 43.8% to 79.0%. Almost similar findings were reported in Ethiopia and Chile, in which 45.4% to >88% isolates exhibit resistance against beta-lactams and non-lactam drugs ( 33 , 48 ). This high resistance rate might be associated with an interesting feature of ESBL-producing isolates as resistance mechanisms, which may be either chromosomally or plasmid-encoded, especially CTX-M that often showed feature of coresistance to various classes of antibiotics such as fluoroquinolones, aminoglycosides, and co-trimoxazole.…”

“…III ). This finding is higher than a finding of previous meta-analysis in Ethiopia, in which the pooled proportional estimates of MDR isolates were 59.7% ( 47 ); however, it was lower than a single study finding in Ethiopia ( 33 ) and Chile ( 48 ), in which 94.5% and 100% isolates exhibited MDR profiles. Lower study finding was also reported in Ethiopia, in which the overall prevalence of MDR was 69.9%, of which 81.5% was in the hospital environment, while 54.2% was in non-hospital environment samples ( 49 ).…”

“…Some studies reviewed estimated ESBL proportions using purely phenotypic methods, while others used both phenotypic and molecular-based methods. For instance, in this study, most of the reviewed articles used CDT ( 17 , 18 , 19 , 20 , 23 , 28 , 32 , 33 ) and DDST ( 22 , 27 , 29 , 30 , 31 ) methods alone for the detection of ESBL-producing isolates, and only one study used molecular technique for investigations and characterizations of the gene encoding ESBL ( 24 ).…”

<p>Prevalence and Molecular Typing of Colistin-Resistant <em>Pseudomonas aeruginosa</em> (CRPA) Among β-Lactamase-Producing Isolates: A Study Based on High-Resolution Melting Curve Analysis Method</p>

“…Some researchers reported that the same result and stated that the frequency of β-lactamases in XDR strains is higher than MDR ones. 1,3,30,31 However, to increase the predictive value of this association, precise and sensitive molecular methods should be used in epidemiological studies. 32 In this study, we developed an HRMA assay for the detection of ESBL producing, KPC-producing, and CRPA strains by melting curve analysis technology.…”

Antimicrobial Resistance Profiles for Different Isolates in Aden, Yemen: A Cross-Sectional Study in a Resource-Poor Setting

“…The low bacterial resistance to ertapenem might be due to its relatively new administration and low rate of prescription for infectious illness. Studies in Ethiopia and Colombia also reported low resistance to ertapenem [40,41].…”