Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania

BMC Research Notes, Dec 2010

Background Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among Escherichia coli and Klebsiella spp from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Findings A total of 270 E.coli and Klebsiella spp urinary pathogens from children and adults isolated from January to March 2010 were included in the study. E. coli and Klebsiella spp isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were E. coli and 132 (48.9%) were Klebsiella spp. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing E. coli strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing Klebsiella spp strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (P < 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001). Conclusions High prevalence of ESBL-producing E. coli and Klebsiella spp strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.

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Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania

BMC Research Notes Antimicrobial resistance among producers and non-producers of extended spectrum beta- lactamases in urinary isolates at a tertiary Hospital in Tanzania Sabrina J Moyo 0 Said Aboud 0 Mabula Kasubi 1 Eligius F Lyamuya 0 Samuel Y Maselle 0 0 Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania 1 Department of Laboratory Services-Central Pathology Laboratory, Muhimbili National Hospital , Dar es Salaam , Tanzania Background: Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among Escherichia coli and Klebsiella spp from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Findings: A total of 270 E.coli and Klebsiella spp urinary pathogens from children and adults isolated from January to March 2010 were included in the study. E. coli and Klebsiella spp isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were E. coli and 132 (48.9%) were Klebsiella spp. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing E. coli strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing Klebsiella spp strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (P < 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001). Conclusions: High prevalence of ESBL-producing E. coli and Klebsiella spp strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types. Background Urinary tract infection (UTI) is the second most common infectious presentation in community practice. Worldwide, about 150 million people are diagnosed with UTI each year, costing the global economy in excess of 6 billion US dollars [ 1 ]. There have been significant changes in the antimicrobial resistance patterns of uropathogens over the years including resistance due to extended spectrum beta lactamase (ESBL)-producing pathogens [ 2-6 ]. The increasing prevalence of infections caused by antibiotic-resistant bacteria makes empirical treatment of these infections difficult [ 7 ]. Antibiotic resistance varies according to geographic locations and is directly proportional to the use and misuse of antibiotics. Understanding the impacts of drug resistance is crucial as the changing rate of antibiotic resistance has a large impact on the treatment of UTI [ 3,4 ]. Production of ESBL is the most common amongst the mechanisms of resistance to third generation cephalosporins in Gram-negative bacilli [ 8 ]. While there are many published reports on ESBL-producing microorganisms in developed and developing countries [ 5,6,9 ], two previous studies which were done in 2005 confirmed the presence of ESBL-producing organisms in nosocomial and blood stream infections in a tertiary referral hospital in Dar es Salaam [ 10,11 ]. The current study aimed to determine the prevalence of antimicrobial resistance and ESBL production among E. coli and Klebsiella spp isolated from patients with UTI in a tertiary hospital. Materials and methods Study design and setting This was a cross-sectional study conducted at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Urinary isolates collected from January to March 2010 were included in the study. Bacterial isolates Urine samples received in the Central Pathology Laboratory (CPL) were plated on cysteine lactose electrolytes deficient (CLED) agar incubated at 37°C for 24 hours. A growth of >105 colony forming units per mL of one type of organism wa (...truncated)


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Sabrina J Moyo, Said Aboud, Mabula Kasubi, Eligius F Lyamuya, Samuel Y Maselle. Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania, BMC Research Notes, 2010, pp. 348, Volume 3, Issue 1, DOI: 10.1186/1756-0500-3-348