PREVALENCE OF EXTENDED SPECTRUM BETA-LACTAMASES (ESBLS) PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE AMONG HOSPITALIZED PATIENTS FROM NIGERIA

  • Olivia Sochi Egbule
  • Bernard O. Ejechi
Keywords: antibiotics, Multidrug-Resistance (MDR), ESBL production, Klebsiella pneumoniae, Escherichia coli.

Abstract

The aim of this study was to determine the resistance patterns and ESBLs production among clinical isolates of Escherichia coli and Klebsiella pneumoniae in two government hospitals of Delta State, Nigeria. Urine, blood and wound samples were aseptically collected from hospitalized patients, bacteriologically processed and isolates identified using standard protocols. Antimicrobial susceptibility testing was determined by disc diffusion method. The plasmid DNA of Multidrug resistance (MDR) isolates were extracted by alkaline lysis method. Phenotypic ESBL production of the MDR isolates was done by Double Disc Synergy Test (DDST) while PCR was used to detect blaCTX-M, blaSHV and blaTEM among isolates. A total of 217 isolates were obtained, of which 161(74.2%) and 56(25.8%) were Escherichia coli and Klebsiella pneumoniae respectively. The antimicrobial resistance varied from one location to another. All isolates obtained from blood of general hospital Warri (GHW) were 100% resistant to amoxicillin clavulanic acid and the cephalosporins (ceftazidime, cefotaxime, and cefuroxime). Isolates from General hospital Agbor (GHA) showed high resistance of 75.0% to cefotaxime, 93.8% to each of ceftazidime and cefuroxime. Overall low resistance to nitrofurantoin was observed in E. coli isolates obtained from urine of GHW (27.5%) and GHA (20.8%). Out of 217 isolates, 75.1% (163/217) were MDR, of which 36.8% and 39.3% produced ESBL by DDST and PCR respectively. The most common ESBL gene was blaCTX-M expressed by 28(17.2%) of the isolates. The high prevalence of MDR and ESBL underscores the need for a continuous local monitoring of antibiotic resistance.

 

 

References

Agyekum, A., Fajardo-Lubián, A., Ansong, D., Partridge, S.R., Agbenyega, T. and Iredell, J.R. (2016). blaCTX-M -15 carried by IncF-type plasmids is the dominant ESBL gene in Escherichia coli and Klebsiella pneumoniae at a hospital in Ghana. Diagnostic Microbiology and Infectious Disease, 84: 328.

Akanbi, B., Ojonuba, B. and Njoku, R. (2013). Detection of Extended Spectrum β-lactamase Producing Klebsiella pneumonia and Escherichia coli in Two Hospitals in the Federal Capital Territory, Abuja, Nigeria. Journal of Medical Microbiology, 3(4): 207-212.

Aly, N.Y., Al-Mousa, H.H. and Al Asar, E.S.M. (2008). Nosocomial infections in a medical-surgical intensive care unit. Medical Principles and Practice, 17: 373-377.

Azekhueme, I., Moses, A.E. and Abbey, S.D. (2015). Extended Spectrum Beta-Lactamases in Clinical Isolates of Escherichia coli and Klebsiella pneumoniae from University of Uyo Teaching Hospital, Uyo-Nigeria. Journal of Advances in Medical and Pharmaceutical Sciences, 2(3): 117-125.

Barrios, H., Garza-Ramos, U., Mejia-Miranda, I., Reyna-Flores, F., Sánchez-Pérez, A., Mosqueda-García, D. and Silva-Sanchez, J. (2017). ESBL-producing Escherichia coli and Klebsiella pneumoniae: The most prevalent clinical isolates obtained between 2005 and 2012 in Mexico. Journal of Global Antimicrobial Resistance, 10: 243–246.

Barrow, G.H. and Feltham, R.K.A. (1993). Cowan and Steel’s Manual for Identification of Medical Bacteria. 3rd Edition, Cambridge University Press, Cambridge, pp-331.

Betteridge, T., Merlino, J., Natoli, J., Cheong, E.Y., Gottlieb, T., Stokes, H.W. (2013). Plasmids and bacterial strains mediating multi-drug resistant hospital acquired infections are coresidents of the hospital environment. Microbial Drug Resistance, 19: 104-109.

Bharat, P.M., Janak, K., Rajan, D.K., Shyam, M.K., Prem, K.K. and Tuladhar, N.R. (2006). Multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing Salmonella enterica (serotypes Typhi and Paratyphi A) from blood isolates in Nepal: Surveillance of resistance and a search for newer alternatives. International Journal of Infectious Diseases, 10: 434-438.

Birnboim, H.C. and Doly, J.A. (1979). Rapid alkaline extraction procedure for screening recombinant plasmid DNA. Nucleic Acids Research, 7(6):1513–1523.

Bouchillon, S., Johnson, B., Hoban, D., Johnson, J., Dowzicky, M. and Wu, D. (2004). Determining incidence of extended spectrum β-latamase producing Enterobacteriaceae, vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus in 38 centres from 17 countries: the PEARLS study 2001-2002. International Journal of Antimicrobial Agents, 24(2): 119-124.

Bryce, A., Hay, A.D., Lane, I.F., Thornton, H.V., Wootton, M. and Costelloe, C. (2016). Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. British Medical Journal, 15: 939-945.

Bush, K. (1989). Characterization of β-lactamases. Antimicrobial Agents and Chemotherapy, 33: 259-276.

Cao, V., Lambert, T. and Courvalin, P. (2002). COLEC1-Like Plasmid PIP843 of Klebsiella pneumonia encoding extending spectrum beta lactamase (TXM-17). Antimicrobial Agents and Chemotherapy, 46: 1212-1217.

Carroll, M., Rangaiahagari, A., Musabeyezu, E., Singer, D. and Ogbuagu, O. (2016). Five-year antimicrobial susceptibility trends among bacterial isolates from a tertiary health-care facility in Kigali, Rwanda. American Journal of Tropical Medicine and Hygiene, 95: 1277-1283.

Clinical and Laboratory Standards Institute (CLSI) (2012). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement. CLSI Document M100-S22, Wayne, 32(1).

Essack, S.Y., Desta, A.T., Abotsi, R.E. and Agoba, E.E. (2017). Antimicrobial resistance in the WHO African region: current status and roadmap for action. Journal of Public Health, 39(1): 8-13.

Fang, H., Ataker, F., Hedin, G. and Dornbusch, K. (2008). Molecular epidemiology of extended-spectrum β-lactamases among Escherichia coli isolates collected in a Swedish hospital and its associated health care facilities from 2001-2006. Journal of Clinical Microbiology, 46(2): 707-712.

Fernando, M., Luke, W., Miththinda, J., Wickramasinghe, R., Sebastiampillai, B. and Gunathilake, M. (2017). Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern- a hospital base cross sectional study. BMC Infectious Diseases, 17(1): 138.

Fridkin, S., Baggs, J., Fagan, R., Magill, S., Pollack, L.A. and Malpiedi, P. (2014). Vital signs: Improving antibiotic use among hospitalized patients. Morbidity and Mortality Weekly Report, 63(9): 194-200.

Gargiullo, L., Chierico, F.D., D’Argenio, P. and Putigiani, L. (2019). Gut microbiota modulation for multidrug resistant organism decolonization: Present and future perspectives. Frontiers in Microbiology, 10: 1704.

Ghafourian, S., Sadeghifard, N., Sohelli, S. and Sekawi, Z. (2015). Extended spectrum Beta-lactamases: definition, classification and epidemiology. Current Issues in Molecular Biology, 17: 11-21.

Gupta, K., Hooton, T.M., Naber, K.G., Wullt, B., Coigan, R., Miller, L.G., Morgan, G.J., Nicolle, L.E., Raz, R., Schaeffer, A.J. and Soper, D.E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Disease Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5): e103-e120.

Iroha, I.R., Adikwu, M.U., Esimone, C.O., Aibinu, I. and Amadi, E.S. (2009). Extended spectrum beta-lactamase (ESBL) in E. coli isolated from a tertiary hospital in Enugu state, Nigeria. Pakistan Journal of Medical Sciences, 25(2): 279-282.

Kome, O., Osogho, V.O. and Nwankwo, C.P. (2019). Escherichia coli as possible agents of spread of multidrug resistance in Port Harcourt, Rivers State. Annals of Science and Technology, 4(1): 16-21.

Kumburu, H.H., Sonda, T., Mmbaga, B.T., Alifrangis, M., Lund, O., Kibiki, G. and Aarestrup, F.M. (2017). Patterns of infections, etiological agents, and antimicrobial resistance at a tertiary care hospital in northern Tanzania. Tropical Medicine and International Health, 22: 454-464.

Lal, P., Kapil, A., Das, B.K. and Sood, S. (2007). Occurrence of TEM & SHV gene in extended spectrum β-lactamases (ESBLs) producing Klebsiella sp. isolated from a tertiary care hospital. Indian Journal of Medical Research, 125:173-178.

Lensing, J., Vilankar, K., Hyojung, K., Donald, B., Amy, M. and Laura, B (2017). Environmental reservoirs of nosocomial infection: Imputation method for linking clinical and environmental microbiological data to understand infection transmission. AMIA Annual Symposium Proceedings, 1120-1129.

Liu, W., Chen, L., Li, H., Duan, H. and Zhang, Y. (2009). Novel CTX-M beta-lactamase genotype distribution and spread into multiple species of Enterobacteriaceae in Changsha, Southern China. Journal of Antimicrobial Chemotherapy, 63: 895–90.

Mahamat, O.O., Lounnas, M., Hide, M., Dumon,t Y., Tidjani, A., Kamougam, K., Abderrahmane, M., Benavides, J., Solassol, J., Bañuls, A., Jean-Pierre, H., Carrière, C. and Godreuil, S. (2019). High prevalence and characterization of extended-spectrum β-lactamase producing Enterobacteriaceae in Chadian hospitals. BioMed Central, 19(1): 205.

Mbanga, J., Dube, S. and Munyanduki, H. (2010). Prevalence and drug resistance in bacteria of the urinary tract infections in Bulawayo province, Zimbabwe. East African Journal of Public Health, 7: 229-232.

Muhammad, M.H. and Swedan, S. (2015). Molecular and phenotypic characterization of carbapenem resistance and extended spectrum beta-lactamase among urinary Escherichia coli isolates. International Journal of Science and Technology, 5(9): 1-9.

Muluye, D., Wondimeneh, Y., Ferede, G., Nega, T., Adane, K., Biadgo, B., Tesfa, H. and Moges, F. (2014). Bacterial isolates and their antibiotic susceptibility patterns and patients with pus and/or wound discharge at Gondar University hospital. BMC Research Notes, 7: 619-624.

Nedjai, S., Barguigua, A., Djahmi, N., Jamali, L., Zerouali, K., Dekhil, M. and Timinouni, M. (2013). Prevalence and characterization of extended spectrum beta-lactamase- producing Enterobacter cloacae strains in Algeria. Journal of Infection in Developing Countries, 7(11):804-811.

Nordmann, P., Dortet, L. and Poirel, L. (2002). Carbapenem resistance in Enterobacteriaceae: Here is the storm! Trends in molecular medicine, 18(5): 263-272.

O’Neill J. (2015). Review on Antimicrobial Resistance. Tackling a crisis for the Health and Wealth of Nations. Review on Antimicrobial Resistance, United Kingdom, pp. 1-16.

Ogefere, H.O., Aigbiremwen, P.A. and Omoregie, R. (2015). Extended Spectrum Beta-Lactamase (ESBLs) producing Gram-negative isolates from urine and wound specimens in a tertiary health facility in southern Nigeria. Tropical Journal of Pharmaceutical Research, 14(6): 1089-1094.

Okesola, A.O. and Adeniji, T.W. (2010). Pattern of extended-spectrum beta-lactamase production among clinical isolates of Proteus species in Western Nigeria. World Journal of Medical Science, 5: 94–97.

Oluduro, A.O., Aregbesola, O.A. and Fashina, C.D. (2014). Extended Spectrum Beta-lactamase Producing Uropathogenic Escherichia coli in Pregnant Women Diagnosed with Urinary Tract Infection in South-Western Nigeria. Journal of Molecular Biology Research, 4(1): 34-41.

Onanuga, A., Mahindroo, J., Singh, S. and Taneja, N. (2019). Phenotypic and molecular characterization of antimicrobial resistant Escherichia coli from urinary tract infections in Port-Harcourt, Nigeria. Pan African Medical Journal, 34: 144.

Pai, H., Choi, E.H., Lee, H.J., Hong, J.Y. and Jacoby, G.A. (2001). Identification of CTX-M-14 extended-spectrum beta lactamase in clinical isolates of Shigella sonnei, Escherichia coli and Klebsiella pneumonia in Korea. Journal of clinical microbiology, 39: 3747-3749.

Pitout, J.D. and Laupland, K.B. (2008). Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infectious Diseases, 8(3): 159-166.

Raji, M.A., Jamal, W., Ojemeh, O. and Rotimi, V.O. (2015). Sequence analysis of genes mediating extended-spectrum beta-lactamase (ESBL) production in isolates of Enterobacteriaceae in Lagos teaching hospital, Nigeria. BMC Infectious Disease, 15: 259.

Reta, A., Kifilie, A.B. and Mengist, A. (2019). Bacterial infections and their antibiotic resistance pattern in Ethiopia: A systematic review. Advances in Preventive Medicine, 2019: 1-10.

Shaikh, S., Fatima, J., Shakil, S., Mohd, R. and Kamal, M.A. (2015). Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment. Saudi Journal of Biological Sciences, 22(1): 90-101.

Song, W., Lee, K.M., Kang, H.J., Shin, D.H. and Kim, D.K. (2001). Micrologic aspects of predominant bacteria isolated from the burn patients in Korea. Burns, 27: 136-139.

Stadler, T., Meinel, D. and Aguilar-Bulet, L. (2018). Transmission of ESBL-producing Enterobacteriaceae and their mobile genetic elements. Identification of sources by whole genome sequencing: Study protocol for an observational study in Switzerland. BMJ Open, 8: e021823.

Teklu, D.S., Negei, A.A., Legese, M.H., Badada, T.L., Woldermariam, H.K. and Tellu, D.K. (2019). Extended-spectrum beta-lactamase production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia. Antimicrobial Resistance and Infection control, 8(1): 39.

Vaidya, V.K. (2011). Horizonal Transfer of Antimicrobial Resistance by Extended Spectrum β Lactamase-Producing Enterobacteriaceae. Journal of Laboratory Physicians, 3(1): 37-42.

Warren, J.W., Abrulyn, E., Habel, J.R., Johnson, J.R., Schaeffer, A.J. and Stamm, W.E. (1999). Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clinical Infectious Disease, 29: 745-759.

Woerther, P.L., Burdet, C., Chachaty, E. and Andremont, A. (2013). Trends in Human Faecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M. Clinical Microbiology Reviews, 26: 744–758.

World Health Organization (2014). Antimicrobial resistance: global report on surveillance.

World Health Organization (2017). Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics.

Yusuf, I., Haruna, M. and Yahaya, H. (2013). Prevalence and antibiotic susceptibility of ampc and ESBL producing clinical isolates at a tertiary health care centre in Kano, Northwest Nigeria. African Journal of Clinical and Experimental Microbiology, 14(2): 109-119.

Zaman, M.A., Pasha, M.H. and Akhter, M.Z. (2010). Plasmid curing of Escherichia coli cells with etidium bromide, sodium dodecyl sulfate and acridine orange. British Medical Journal 27: 28-31.

Zykov, I.N., Sundsfjord, A., Smabrekke, L. and Samuelsen, O. (2016). The antimicrobial activity of mecillinam, nitrofurantoin, temocillin and Fosfomycin and comparative analysis of resistance patterns in a nationwide collection of ESBL-producing Escherichia coli in Norway 2010-2011. Infectious Diseases, 48(2): 99-107
Published
2021-07-26
How to Cite
Egbule, O. S., & Ejechi, B. O. (2021). PREVALENCE OF EXTENDED SPECTRUM BETA-LACTAMASES (ESBLS) PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE AMONG HOSPITALIZED PATIENTS FROM NIGERIA. FUDMA JOURNAL OF SCIENCES, 5(2), 584 - 595. https://doi.org/10.33003/fjs-2021-0502-676