College of Health Sciences, Arsi University, P.O. Box 04, Asella, Ethiopia.
Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia.
Antimicrob Resist Infect Control. 2020 Nov 4;9(1):175. doi: 10.1186/s13756-020-00836-0.
Local data from the Asella Teaching and Referral Hospital in the town of Asella, Ethiopia reveal a high prevalence of extended-spectrum β-lactamase- (ESBL) producing Gram-negative bacteria (GNB) in clinical isolates. To investigate a possible route of transmission, we determined the proportions ESBL-producing GNB in isolates from flies caught in the hospital and in the town of Asella.
Flies were collected in August 2019 from the neonatal intensive care unit (NICU), the orthopedic ward, the hospital's waste disposal area, and from a butchery situated 1.5 km from the hospital. After trapping, the flies were macerated and suspended in sterile normal saline. The suspensions were inoculated on MacConkey agar and incubated overnight. Species identification and antimicrobial susceptibility testing were performed using Vitek®-MS and VITEK® 2.
In total, 103 bacterial isolates were obtained from 85 flies (NICU: 11 isolates from 20 flies, orthopedic ward: 10 isolates from 12 flies, waste disposal area: 37 isolates from 26 flies, butchery: 45 isolates from 27 flies). The proportions of ESBL-producing bacteria among isolates obtained from flies collected in the hospital compound were significantly higher (82%, 90%, and 57% in NICU, orthopedic ward and waste disposal area, respectively) compared to flies collected outside of the hospital compound (2% (@1/45) in the butchery) (p ≤ 0.001). The proportion of ESBL was 67% (6/9) among Raoultella spp. 67% (4/6) among Kluyvera spp., 56% (5/9) among Enterobacter spp., 50% (5/10) among E. coli, and 44% (8/18) among Klebsiella spp.. Of the 40 ESBL-genes detected, 85% were CTX-M-like, 83% TEM-like, 23% SHV-like, and 2% CTX-M-2-like. ESBL-producing bacteria showed higher rates of resistance against ciprofloxacin (66% vs. 5%), gentamicin (68% vs. 3%), piperacillin-tazobactam (78% vs. 5%), and trimethoprim-sulfamethoxazole (88% vs. 16%), compared to non-ESBL-producing bacteria.
A high proportion of ESBL was identified in isolates from flies caught in the hospital compound compared with isolates of flies collected at a distance of 1.5 km from the hospital. Flies can be potential vectors for transmission of multidrug-resistant (MDR) bacteria within hospitals. Further studies are needed to determine the source of MDR colonization in flies and possible impact of MDR for nosocomial infections.
埃塞俄比亚阿塞拉教学和转诊医院的本地数据显示，临床分离的产超广谱β-内酰胺酶（ESBL）的革兰氏阴性菌（GNB）的流行率很高。为了调查可能的传播途径，我们确定了在医院和阿塞拉镇捕获的苍蝇中分离出的产 ESBL 的 GNB 的比例。
2019 年 8 月，从新生儿重症监护病房（NICU）、骨科病房、医院废物处理区以及距离医院 1.5 公里的一家肉铺收集苍蝇。捕获后，将苍蝇捣碎并悬浮在无菌生理盐水。将悬浮液接种到 MacConkey 琼脂上，并孵育过夜。使用 Vitek®-MS 和 VITEK® 2 进行物种鉴定和药敏试验。
总共从 85 只苍蝇中获得了 103 株细菌分离株（NICU：20 只苍蝇中有 11 株，骨科病房：12 只苍蝇中有 10 株，废物处理区：26 只苍蝇中有 37 株，肉铺：27 只苍蝇中有 45 株）。与医院大院外收集的苍蝇（27 只苍蝇中只有 1 只苍蝇有 2%（@1/45）的产 ESBL 菌）相比，从医院大院收集的苍蝇中分离的产 ESBL 细菌的比例明显更高（NICU：82%、90%和 57%；骨科病房：82%、90%和 57%；废物处理区）（p≤0.001）。产 ESBL 的细菌比例为 Raoultella spp. 67%（6/9），Kluyvera spp. 67%（4/6），Enterobacter spp. 56%（5/9），大肠埃希菌 50%（5/10），肺炎克雷伯菌 44%（8/18）。在检测到的 40 种 ESBL 基因中，85%为 CTX-M 样，83%为 TEM 样，23%为 SHV 样，2%为 CTX-M-2 样。与非产 ESBL 细菌相比，产 ESBL 细菌对环丙沙星（66% vs. 5%）、庆大霉素（68% vs. 3%）、哌拉西林-他唑巴坦（78% vs. 5%）和复方磺胺甲噁唑（88% vs. 16%）的耐药率更高。
与从距离医院 1.5 公里处收集的苍蝇分离株相比，从医院大院捕获的苍蝇中分离出的 ESBL 比例更高。苍蝇可能是医院内传播多重耐药（MDR）细菌的潜在媒介。需要进一步研究以确定苍蝇中 MDR 定植的来源以及 MDR 对医院感染的可能影响。
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