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High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia.
PLoS One. 2016; 11(8):e0161685.Plos

Abstract

We investigated the gastrointestinal colonization rate and antibiotic resistance patterns of Extended-Spectrum Beta-Lactamase (ESBL)- producing Escherichia coli and Klebsiella pneumoniae in hospitalized patients admitted at Ethiopia's largest tertiary hospital. Fecal samples/swabs from 267 patients were cultured on chrome agar. ESBL. Bacterial species identification, verification of ESBL production and antibiotic susceptibility testing were done using Vitek 2 system (bioMérieux, France). Phenotype characterization of ESBL-E.coli and ESBL- K.pneumoniae was done using Neo-Sensitabs™. ESBL positivity rate was much higher in K. pneumoniae (76%) than E. coli (45%). The overall gastrointestinal colonization rate of ESBL producing Enterobacteriaceae (ESBL-E) in hospitalized patients was 52% (95%CI; 46%-58%) of which, ESBL-E. coli and K.pneumoniae accounted for 68% and 32% respectively. Fecal ESBL-E carriage rate in neonates, children and adults was 74%, 59% and 46% respectively. Gastrointestinal colonization rate of ESBL-E.coli in neonates, children and adults was 11%, 42% and 42% respectively. Of all E. coli strains isolated from adults, children and neonates, 44%, 49% and 22% were ESBL positive (p = 0.28). The prevalence of ESBL-K.pneumoniae carriage in neonates, children and adults was 68%, 22% and 7% respectively. All K. pneumoniae isolated from neonates (100%) and 88% of K. pneumoniae isolated from children were ESBL positive, but only 50% of K.pneumoniae isolated from adults were ESBL positive (p = 0.001). Thirteen patients (5%) were carriers of both ESBL-E.coli and ESBL-KP. The overall carrier rate of ESBL producing isolates resistant to carbapenem was 2% (5/267), all detected in children; three with E.coli HL cephalosporinase (AmpC), resistant to ertapenem and two with K. pneumoniae Carbapenemase (KPC) resistant to meropenem, ertapenem and impenem. We report a high gastrointestinal colonization rate with ESBL-E and the emergence of carbapenems-resistant K. pneumoniae in Ethiopia. Urgent implementation of infection control measures, and surveillance are urgently needed to limit the spread within healthcare facilities and further to the community.

Authors+Show Affiliations

Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of Gynecology & Obstetrics, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of pediatrics, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of Orthopedics School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.School of Public Health College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.The Public Health Agency of Sweden, Stockholm, Sweden.The Public Health Agency of Sweden, Stockholm, Sweden.The Public Health Agency of Sweden, Stockholm, Sweden.Division of clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, SE 141 86, Stockholm, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27574974

Citation

Desta, Kassu, et al. "High Gastrointestinal Colonization Rate With Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. Pneumoniae in Ethiopia." PloS One, vol. 11, no. 8, 2016, pp. e0161685.
Desta K, Woldeamanuel Y, Azazh A, et al. High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia. PLoS ONE. 2016;11(8):e0161685.
Desta, K., Woldeamanuel, Y., Azazh, A., Mohammod, H., Desalegn, D., Shimelis, D., Gulilat, D., Lamisso, B., Makonnen, E., Worku, A., Mannerqvist, K., Struwe, J., Aspevall, O., & Aklillu, E. (2016). High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia. PloS One, 11(8), e0161685. https://doi.org/10.1371/journal.pone.0161685
Desta K, et al. High Gastrointestinal Colonization Rate With Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. Pneumoniae in Ethiopia. PLoS ONE. 2016;11(8):e0161685. PubMed PMID: 27574974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia. AU - Desta,Kassu, AU - Woldeamanuel,Yimtubezinash, AU - Azazh,Aklilu, AU - Mohammod,Halima, AU - Desalegn,Dawit, AU - Shimelis,Damte, AU - Gulilat,Dereje, AU - Lamisso,Biruk, AU - Makonnen,Eyasu, AU - Worku,Alemayehu, AU - Mannerqvist,Kerstin, AU - Struwe,Johan, AU - Aspevall,Olov, AU - Aklillu,Eleni, Y1 - 2016/08/30/ PY - 2016/02/03/received PY - 2016/08/10/accepted PY - 2016/8/31/entrez PY - 2016/8/31/pubmed PY - 2017/8/22/medline SP - e0161685 EP - e0161685 JF - PloS one JO - PLoS ONE VL - 11 IS - 8 N2 - We investigated the gastrointestinal colonization rate and antibiotic resistance patterns of Extended-Spectrum Beta-Lactamase (ESBL)- producing Escherichia coli and Klebsiella pneumoniae in hospitalized patients admitted at Ethiopia's largest tertiary hospital. Fecal samples/swabs from 267 patients were cultured on chrome agar. ESBL. Bacterial species identification, verification of ESBL production and antibiotic susceptibility testing were done using Vitek 2 system (bioMérieux, France). Phenotype characterization of ESBL-E.coli and ESBL- K.pneumoniae was done using Neo-Sensitabs™. ESBL positivity rate was much higher in K. pneumoniae (76%) than E. coli (45%). The overall gastrointestinal colonization rate of ESBL producing Enterobacteriaceae (ESBL-E) in hospitalized patients was 52% (95%CI; 46%-58%) of which, ESBL-E. coli and K.pneumoniae accounted for 68% and 32% respectively. Fecal ESBL-E carriage rate in neonates, children and adults was 74%, 59% and 46% respectively. Gastrointestinal colonization rate of ESBL-E.coli in neonates, children and adults was 11%, 42% and 42% respectively. Of all E. coli strains isolated from adults, children and neonates, 44%, 49% and 22% were ESBL positive (p = 0.28). The prevalence of ESBL-K.pneumoniae carriage in neonates, children and adults was 68%, 22% and 7% respectively. All K. pneumoniae isolated from neonates (100%) and 88% of K. pneumoniae isolated from children were ESBL positive, but only 50% of K.pneumoniae isolated from adults were ESBL positive (p = 0.001). Thirteen patients (5%) were carriers of both ESBL-E.coli and ESBL-KP. The overall carrier rate of ESBL producing isolates resistant to carbapenem was 2% (5/267), all detected in children; three with E.coli HL cephalosporinase (AmpC), resistant to ertapenem and two with K. pneumoniae Carbapenemase (KPC) resistant to meropenem, ertapenem and impenem. We report a high gastrointestinal colonization rate with ESBL-E and the emergence of carbapenems-resistant K. pneumoniae in Ethiopia. Urgent implementation of infection control measures, and surveillance are urgently needed to limit the spread within healthcare facilities and further to the community. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27574974/High_Gastrointestinal_Colonization_Rate_with_Extended_Spectrum_β_Lactamase_Producing_Enterobacteriaceae_in_Hospitalized_Patients:_Emergence_of_Carbapenemase_Producing_K__pneumoniae_in_Ethiopia_ L2 - http://dx.plos.org/10.1371/journal.pone.0161685 DB - PRIME DP - Unbound Medicine ER -