Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among Ethiopian children

Infection and Drug Resistance, Jan 2017

Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among Ethiopian children Melese Hailu Legese,1 Gebru Mulugeta Weldearegay,1 Daniel Asrat,2 1Department of Clinical Laboratory Sciences, School of Allied Health Sciences, 2Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Background: Infections by extended-spectrum beta-lactamase- (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in children nowadays. Hence, the aim of this study was to determine the prevalence of ESBL- and carbapenemase-producing Enterobacteriaceae among children suspected of septicemia and urinary tract infections (UTIs). Methods: A cross-sectional study was conducted from January to March 2014. A total of 322 study participants suspected of septicemia and UTIs were recruited. All blood and urine samples were cultured on blood and MacConkey agar. All positive cultures were characterized by colony morphology, Gram stain, and standard biochemical tests. Antimicrobial susceptibility test was performed on Muller-Hinton agar using disk diffusion. ESBL was detected using combination disk and double-disk synergy methods, and the results were compared. Carbapenemase was detected by modified Hodge method using meropenem. Data were analyzed using SPSS version 20. Results: The overall prevalence of ESBL- and carbapenemase-producing Enterobacteriaceae was 78.57% (n=22/28) and 12.12%, respectively. Among the Enterobacteriaceae tested, Klebsiella pneumoniae (84.2%, n=16/19), Escherichia coli (100%, n=5/5), and Klebsiella oxytoca (100%, n=1/1) were positive for ESBL. Double-disk synergy method showed 90.9% sensitivity, 66.7% specificity, 95.2% positive predictive value, and 50% negative predictive value. Carbapenemase-producing Enterobacteriaceae were K. pneumoniae (9.09%, n=3/33) and Morganella morganii (3.03%, n=1/33). Conclusion: Screening Enterobacteriaceae for ESBL production is essential for better antibiotics selection and preventing its further emergence and spread. In resource-limited settings, double-disk synergy method can be implemented for screening and confirming ESBL production. Moreover, occurrence of CRE in countries where no carbapenems are sold is worrying microbiologists as well as clinicians. Hence, identifying factors that induce carbapenemase production in the absence of carbapenems prescription is essential for control of CRE dissemination within the community. Keywords: ESBL, carbapenem resistance, Enterobacteriaceae, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

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Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among Ethiopian children

Infection and Drug Resistance extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among ethiopian children Melese hailu legese 1 gebru Mulugeta Weldearegay 1 Daniel asrat 0 0 Department of Microbiology, Immunology and Parasitology, school of Medicine, college of health sciences, addis ababa University , addis ababa, ethiopia 1 Department of clinical laboratory sciences, school of allied health sciences PowerdbyTCPDF(ww.tcpdf.org) Background: Infections by extended-spectrum beta-lactamase- (ESBL) and carbapenemresistant Enterobacteriaceae (CRE) are an emerging problem in children nowadays. Hence, the aim of this study was to determine the prevalence of ESBL- and carbapenemase-producing Enterobacteriaceae among children suspected of septicemia and urinary tract infections (UTIs). Methods: A cross-sectional study was conducted from January to March 2014. A total of 322 study participants suspected of septicemia and UTIs were recruited. All blood and urine samples were cultured on blood and MacConkey agar. All positive cultures were characterized by colony morphology, Gram stain, and standard biochemical tests. Antimicrobial susceptibility test was performed on Muller-Hinton agar using disk diffusion. ESBL was detected using combination disk and double-disk synergy methods, and the results were compared. Carbapenemase was detected by modified Hodge method using meropenem. Data were analyzed using SPSS version 20. Results: The overall prevalence of ESBL- and carbapenemase-producing Enterobacteriaceae was 78.57% (n=22/28) and 12.12%, respectively. Among the Enterobacteriaceae tested, Klebsiella pneumoniae (84.2%, n=16/19), Escherichia coli (100%, n=5/5), and Klebsiella oxytoca (100%, n=1/1) were positive for ESBL. Double-disk synergy method showed 90.9% sensitivity, 66.7% specificity, 95.2% positive predictive value, and 50% negative predictive value. Carbapenemase-producing Enterobacteriaceae were K. pneumoniae (9.09%, n=3/33) and Morganella morganii (3.03%, n=1/33). Conclusion: Screening Enterobacteriaceae for ESBL production is essential for better antibiotics selection and preventing its further emergence and spread. In resource-limited settings, double-disk synergy method can be implemented for screening and confirming ESBL production. Moreover, occurrence of CRE in countries where no carbapenems are sold is worrying microbiologists as well as clinicians. Hence, identifying factors that induce carbapenemase production in the absence of carbapenems prescription is essential for control of CRE dissemination within the community. - 8 1 0 2 l u J 3 1 n o 2 7 1 . 3 6 1 . 7 3 . 4 5 y b / m o c . s s e tance to nearly all beta-lactam antibiotics such as ceftazidime, cefotaxime, ceftriaxone, monobactam – aztreonam, and related oxyimino beta-lactams.2,3 If Enterobacteriaceae are resistant to one of the extended-spectrum cephalosporins, it means they are therapeutically resistant to all the cephalosporins even though antimicrobial sensitivity is indicated in the laboratory test results.4 Moreover, many ESBL-producing Enterobacteriaceae are also resistant to other antimicrobial agents such as aminoglycosides, trimethoprim, and the quinolones which poses a serious antibiotic management problem as the genes for ESBL production are easily transferred through plasmids.5,6 ESBL-producing Enterobacteriaceae have worldwide distributions with varying degree of prevalence in community as well as hospitals.4–7 Nowadays, infections due to ESBL-producing Enterobacteriaceae are concerning for many reasons including increased hospital costs, length of stay, and mortality rates.4,6,7 For the pediatric population, blood stream infections and urinary tract infections (UTIs) .rvdoepw l.syeon dpruoebtloemEn.1tTerhoibsaacleterrtsiacclienaiecarlesmisitcarnotbtioolEoSgiBstLs atoreidaennetmifyertghiensge /ww lua ESBL-producing organisms parallel to antimicrobial suscep/: n s o tthp rspe tibility testing even in resource-limited settings by applying from roF simple screening and confirmatory methods. Data obtained de from such methods are so valuable to develop appropriate loda institutional-based drug therapy guideline.7,8 Though various now phenotypic ESBL detection methods have been described, ced implementation of highly sensitive and specific methods in itssaenR resoIunrfceec-tliimonitsedcaauresaesdisbcyhaEllSeBngLin-goyrept.8lasmid-mediated rug AmpC-producing Enterobacteriaceae are often treated by dD carbapenems (e.g., ertapenem, imipenem, meropenem, and nan doripenem) which are antimicrobials of last resort and crucial itcoe for the management of life-threatening health care-associated fIn infections.9 However, due to recent emergence and spread of imipenem/meropenem-resistant Enterobacteriaceae throughout the world, clinical utility of this group of antibiotics is under threat.10 Production of carbapenemases that are capable of hydrolyzing the carbapenems and loss of outer membrane proteins are major (...truncated)


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Melese Hailu Legese, Gebru Mulugeta Weldearegay, Daniel Asrat. Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among Ethiopian children, Infection and Drug Resistance, 2017, pp. 27-34, DOI: 10.2147/IDR.S127177