Prevalence and Antibiogram Profile of Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae among Patients with Urinary Tract Infection in Abakaliki, Nigeria

Abstract

Background and Objectives: Carbapenem antibiotic are drug of last-resort from the treatment of bacterial infection, as a result of the prevalence and rapidly evolving enzymes from Carbapenem resistant bacteria such Escherichia coli and Klebsiella pneumoniae make urinary tract infection difficult, and in some cases impossible to treat in health care settings. With limited progress of new antibacterial drugs, the best approach is monitoring the prevalence and antibiogram profile of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae among patients with UTI in Abakaliki, Nigeria.
 Methodology: A non-repetitive, clean catch mid-stream urine was collected from five hundred (500) diagnosed UTI inpatient and outpatient. The samples were evaluated using routine microbiological protocol for isolation and identification of Escherichia coli and Klebsiella pneumoniae. Phenotypic screening of Carbapenem-resistant strains was performed using Modified Hodge Testing. Antibiogram studies of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae was performed using the Kirby–Bauer disk diffusion method and the results were interpreted using the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints. Multiple antibiotic resistance index (MARI) was determined for MDR strain.
 Result: The prevalence of Escherichia coli and Klebsiella pneumoniae isolate accounted for 148(29.6 %) consisting of 95(54.3 %) and 53(16.3 %) from in-patients and out-patients. Escherichia coli accounted overall isolation rate of 112(22.4 %) comprising of high proportion among in-patient 82(46.9 %) over out-patient 30(9.2 %). The proportion of K. pneumoniae accounted for 36(7.2 %) with 13(7.4 %) and 23(7.1 %) recorded among in-patients and out-patients. Association between presence of Escherichia coli and Klebsiella pneumoniae isolates in clinical samples was statistically significant with patient’s population with p value <0.05. Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae accounted for 37(7.4 %) comprising of 24(13.7) and 13(4.0 %) among in-patients and out-patients respectively while carbapenem-susceptible Escherichia coli and Klebsiella pneumoniae accounted for overall detection rate of 111(22.2 %) consisting of 71(40.6 %) and 40(12.3 %) among in-patients and out-patients respectively. The isolates resistance rate to cephalosporins were relatively high i.e., Cefotaxime, Cefoxtin Ceftazidime, Ceftriaxone resistance was observed at 60-100% while amoxicillin/clavulanate, azetronam, tetracycline nitrofurantoin and Ticarcillin-clavulanic acid recorded 100 % with MDR index ranged from 0.5-0.8, but were 100 % and 85.0 % sensitive to ciprofloxacin and ofloxacin.
 Conclusion: These results strongly hypothesize that MDR bacteria, including Carbapenem-resistant isolate, have become common residents in various hospital environments, however with substantial evidence in this study, ciprofloxacin and ofloxacin as drugs of choice could be used for treatment of UTI. Therefore, its importance that good antibiogram evaluation of other drug classes beside fluoroquinoles reported in this study need to be establishes as baseline for empirical diagnosis, epidemiological surveillance, drug prescriptions and infection management.

Urinary Tract Infection Caused by Carbapenemase-Producing K. pneumoniae and E. coli at the Institute of Kidney Disease Peshawar, Pakistan

“…The KPC enzyme was first discovered in a K. pneumoniae sample from North Carolina, USA. Isolates that make KPC have spread to 38 states in the US since 2001 ( Nomeh et al, 2022). Even though K. pneumoniae Cproducers are being found at an alarming rate in Europe, mostly through clonal propagation, we don't know of any reports of blaK, pneumoniae C-positive isolates from this area of study ( kidney hospital (IKD), Peshawar, Pakistan).OXA-1 has been found most often in E. coli and K. pneumoniae, despite its global prevalence ( Aminu et al, 2021).…”

“…The World Health Organization categorized Carbapenemase-producing E. coli and K. pneumoniae as "critical" and "high priority" pathogens in 2017. As a result of the rapid development and spread of Carbapenemase-generating genotypes, the prevalence of carbapenem-resistant strains of E. coli and K. pneumoniae has increased worldwide ( Nomeh et al, 2022). Sumyya H. Hariri 1 and Suleman Khan 2 .…”

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Aims: Carbapenemase-producing bacteria make infections of the urinary tract (UTIs) challenging to cure with last-resort treatment like carbapenem. Carbapenemase-producing E. coli and K. pneumoniae implicated in UTI must be detected molecularly since their ability to spread broadly among patients is rising ( Nomeh et al, 2022). Methodology: Ten non-repeated clinical isolates of Escherichia coli (Ecoli1, Ecoli2, Ecoli3, Ecoli4, and Ecoli5) and Klebsiella pneumoniae (Kp6, Kp7, Kp8, Kp9, Kp10) were selected from urinary tract infection patients at Institute of Kidney Disease Peshawar, Pakistan, based on their in vitro phenotypic carbapenem antibiotic resistance.

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Detection of Carbapenemase-Producing Escherichia coli and Klebsiella pneumoniae Implicated in Urinary Tract Infection

“…A carbapenemase-producing Escherichia coli or Klebsiella pneumoniae is a bacterium that is resistant to carbapenem antibioitics in susceptibility testing or has a carbapenemase gene [1]. In 2017, the World Health Organization designated carbapenemase-producing E. coli and Klebsiella pneumoniae as 'critical' and 'high priority pathogens' [1,2].…”

“…A carbapenemase-producing Escherichia coli or Klebsiella pneumoniae is a bacterium that is resistant to carbapenem antibioitics in susceptibility testing or has a carbapenemase gene [1]. In 2017, the World Health Organization designated carbapenemase-producing E. coli and Klebsiella pneumoniae as 'critical' and 'high priority pathogens' [1,2]. Since then, carbapenem resistant Escherichia coli and Klebsiella pneumoniae is a growing concern worldwide [3,4] due to rapid evolution and spread of carbapenemase producing genotype e.g., New Delhi metallo-β-lactamase (bla NDM ), Imipenemases (bla IMP ), Verona integron Metallo-beta-lactamase (bla VIM ), Oxacillinase (bla OXA ) and Klebsiella pneumoniae carbapenemase (bla KPC ) which are increasingly being reported among health care associated complicated UTIs owing to their ability to truncates the action of carbapenem and other beta-lactam antibiotics [4,5,6].…”