Prevalence and Molecular Characterization of Extended Spectrum β-Lactamase and Carbapenemase-Producing Enterobacteriaceae Isolates from Bloodstream Infection Suspected Patients in Addis Ababa, Ethiopia

Abstract

Background Production of Extended spectrum beta-lactamase (ESBL) and Carbapenemase is the most common strategy for drug resistance in clinical isolates of Enterobacteriaceae . This study was conducted to determine the magnitude of ESBL and Carbapenemase production (CPE) among clinical isolates of Enterobacteriaceae causing bloodstream infections (BSI) in Ethiopia. Methods A cross-sectional study was performed from September 2018 to January 2019 in Ethiopia. A total of 2397 BSI suspected patients were enrolled and blood culture was performed using a BacT/Alert instrument in combination with conventional methods for identification. After antimicrobial susceptibility test, phenotypic confirmation of ESBLs was done by combined disc-diffusion. Meanwhile carbapenemase production was done by modified carbapenem inactivation method. Multiplex PCR was conducted to detect the presence of bla CTX-M , bla SHV, bla TEM , bla KPC and bla NDM genes. Results A total of 104 (4.3%) Enterobacteriaceae were isolated from 2397 BSI suspected patients. Klebsiella pneumoniae (55/104, 52%) was the predominant isolate followed by E. coli , (19.2%, 20/104) and K.oxytoca (17.3%, 18/104). ESBL and carbapenemase production were observed from 70 (67.3%, 57.4 −76.2% at 95% CI) and 8 (7.7%, 3.4–14.6% at 95% CI) isolates respectively. The highest frequency of ESBL and carbapenemase production was observed in K. pneumoniae 78.2% (43/55) and 9.1% (5/55), respectively. All the 70 isolates confirmed as ESBL producers harbored at least one of the ESBL genes and the majority of them carried multiple beta-lactamase genes (84.3%), where bla CTX-M, type was the most predominant (67.3%). Similarly, the entire eight isolates positive for carbapenemase carried bla NDM but none of them carried bla KPC. Conclusion In our study, the rate of ESBL production among BSI-causing Enterobacteriaceae was alarming and most of the isolates carried multiple types of ESBL genes. A significant magnitude of CPE isolates causing BSI was recorded.

Molecular detection of ESBL- and carbapenemase-producing Klebsiella pneumoniae isolates in southwest Iran

“…On the other hand, Jamshidi et al in Iran showed that 90.4% of K. pneumoniae strains were ESBL producers, and bla TEM , bla SHV , and bla CTX−M genes were detected in 80.9%, 90.5%, and 76.2% of isolates, respectively, which was higher than our ndings [28]. The possible cause for this wide variation in the prevalence of ESBL could be attributable to differences in the geographical area of the research, overuse of broad-spectrum antibiotics, variation in antibiotic prescribing patterns, and a high rate of gastrointestinal tract colonization by ESBL-producing strains in the study site [6,29].…”

Molecular characterization of carbapenem-resistance in Gram-negative isolates obtained from clinical samples at Jimma Medical Center, Ethiopia

“…In previous studies conducted in Ethiopia, the rate of carbapenem resistance among Gram-negative rods was low ranging 1.7–15.1% ( Misha et al, 2021 ; Tekele et al, 2021 ; Seman et al, 2022 ; Tilahun et al, 2022 ; Alemayehu et al, 2023 ). However, our findings showed an increase in resistance to carbapenems (18.6%).…”

“…Back then, it could only be detected in some isolates of Acinetobacter baumannii , with no evidence of its presence in other isolates. However, NDM is no longer limited to Acinetobacter species and has been found in various GNB, such as K. pneumoniae , K. variicola , E. coli , P. aeruginosa , and P. mendocina ( Legese et al, 2022 ; Seman et al, 2022 ; Sewunet et al, 2022 ; Tufa et al, 2022 ). This enzyme is particularly concerning because it can rapidly spread between different bacterial species through horizontal gene transfer, leading to the emergence of extensively drug-resistant infections ( Da Silva and Domingues, 2016 ).…”

“…In total, 50 of the isolates carried multiple carbapenemase genes ( bla OXA-51, bla NDM, bla VIM, bla OXA-23, bla OXA-58, bla KPC42, bla OXA-48, and bla KPCu), which is consistent with other studies conducted in Ethiopia where multiple carbapenemase determinants have been reported ( Legese et al, 2022 ; Sewunet et al, 2022 ). In general, the prevalence of NDM in Acinetobacter and other GNB has been increasing globally in recent years ( Sands et al, 2021 ; Awoke et al, 2022 ; Seman et al, 2022 ).…”

Distribution of mcr-1 Harboring Hypervirulent Klebsiella pneumoniae in Clinical Specimens and Lytic Activity of Bacteriophage KpnM Against Isolates

“…It has chromosomal mediated gene bla SHV which is responsible for intrinsic resistance, whereas, in the case of acquired resistance, K. pneumoniae use to produce extended-spectrum -lactamase (ESBLs) and carbapenemases that are associated with the resistance to different generations of cephalosporins and carbapenems. 6 , 7 Moreover, K. pneumoniae displayed resistance against colistin due to the presence of plasmid-mediated mobilized colistin resistance ( mcr ) genes. 8 Due to the emergence of resistant variants and a dearth of new antibiotics, treatment options for MDR K. pneumoniae are limited.…”