Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Ann Clin Microbiol Antimicrob. 2021 Mar 11;20(1):16. doi: 10.1186/s12941-021-00422-1.
Multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Gram-negative bacteria (GNB) has become a public health threat worldwide. This threat is worse in developing countries where there is high infectious disease burden and spread of antimicrobial resistance co-exist. The aim of the present study was, therefore, to assess MDR, ESBL and carbapenemase producing GNB from patients attending three selected referral hospitals in Amhara region.
A cross-sectional study was conducted from December 2017- April 2018 at the University of Gondar Comprehensive Specialized Hospital, Dessie Referral Hospital and Debre Markos Referral Hospital of Amhara national regional state. A total of 833 study subjects were recruited using a convenient sampling technique. Clinical samples such as blood, urine, stool, wound, abscess, ear discharge, nasal discharge, cervical discharge and body fluid specimens were aseptically collected. Culturing for identification of bacteria and determination of drug susceptibility testing were done following standard microbiological techniques. Selected MDR isolates were phenotypically assessed for ESBL and carbapenemase production.
Of the 833 clinical samples cultured for bacterial growth, 141 (16.9%) were positive for GNB. The most common GNB identified were E. coli 46 (32.6%), Klebsiella spp. 38 (26.5%) and Proteus spp. 13 (9.2%). The overall MDR prevalence was 121 (85.8%). Among the total isolates, 137 (97.2%) were resistant to ampicillin followed by cotrimoxazole 115 (81.6%), amoxicillin-clavulanic acid 109 (77.3%), cefixime 99 (70.2%), cefepime 93 (66.0%) and tetracycline 91 (64.5%). The extended-spectrum beta-lactamase producing GNB were 69/124 (55.6%). Of which Klebsiella spp. 19 (15.3%) and E. coli 17 (13.7%) were common ESBL producers. Carbapenemase-producing isolates were 8/51(15.7%). Of which Enterobacter, Klebsiella and E. coli were common carbapenemase producers.
Multi-drug resistance and ESBL producing isolates in the present study were high. E. coli and Klebsiella spp. were the most common ESBL producing GNB. Klebsiella spp., Enterobacter spp., E. coli and Citrobacter spp. were typical carbapenemase-producing isolates. Continuous monitoring, antibiotic stewardship and molecular detection of the gene responsible for drug resistance are important means to reduce the spread of drug-resistant pathogens.
多药耐药（MDR）、产超广谱β-内酰胺酶（ESBL）和碳青霉烯酶的革兰氏阴性菌（GNB）已成为全球公共卫生威胁。在发展中国家，这种威胁更为严重，那里的传染病负担高，抗菌药物耐药性的传播并存。因此，本研究的目的是评估来自阿姆哈拉地区三个选定转诊医院的患者的 MDR、ESBL 和产碳青霉烯酶的 GNB。
2017 年 12 月至 2018 年 4 月在贡德尔大学综合专科医院、德西雷转诊医院和德布雷马克罗斯转诊医院进行了一项横断面研究。采用便利抽样技术共招募了 833 名研究对象。无菌采集血液、尿液、粪便、伤口、脓肿、耳分泌物、鼻分泌物、宫颈分泌物和体液标本进行培养以鉴定细菌并进行药敏试验。对选定的 MDR 分离株进行表型评估以检测 ESBL 和碳青霉烯酶的产生。
在培养细菌生长的 833 个临床样本中，有 141 个（16.9%）呈 GNB 阳性。最常见的 GNB 鉴定为大肠埃希菌 46 株（32.6%）、肺炎克雷伯菌 38 株（26.5%）和变形杆菌 13 株（9.2%）。总体 MDR 患病率为 121 例（85.8%）。在总分离株中，137 株（97.2%）对氨苄西林耐药，其次是复方磺胺甲噁唑 115 株（81.6%）、阿莫西林克拉维酸 109 株（77.3%）、头孢克肟 99 株（70.2%）、头孢吡肟 93 株（66.0%）和四环素 91 株（64.5%）。产超广谱β-内酰胺酶的 GNB 有 69/124 株（55.6%）。其中肺炎克雷伯菌 19 株（15.3%）和大肠埃希菌 17 株（13.7%）为常见 ESBL 产生菌。产碳青霉烯酶的分离株有 8 株（51 株）（15.7%）。其中肠杆菌、肺炎克雷伯菌和大肠埃希菌为常见产碳青霉烯酶菌。
本研究中多药耐药和产 ESBL 的分离株很高。大肠埃希菌和肺炎克雷伯菌是最常见的产 ESBL 的 GNB。肺炎克雷伯菌、肠杆菌属、大肠埃希菌和柠檬酸杆菌属是典型的产碳青霉烯酶分离株。持续监测、抗生素管理和耐药基因的分子检测是减少耐药病原体传播的重要手段。
Zotero 插件