Department of Medical Microbiology, Aminu Kano Teaching Hospital, Kano; Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
Ann Afr Med. 2023 Oct-Dec;22(4):508-514. doi: 10.4103/aam.aam_155_22.
UTI is the most common nosocomial infection among hospitalized patients. Emerging increasing resistance has been observed among uropathogens of the family enterobacterales. Extended spectrum beta lactamase genes encode for multidrug resistance and unrestricted use of antibiotics in hospitals provides an environment for spread of infections with limited treatment options. This necessitates therapies based on culture and antimicrobial sensitivity to improve patients' outcomes We aimed to determine susceptibility pattern of ESBL uropathogens among hospitalized patients in Aminu Kano Teaching Hospital, Kano.
Three hundred and eighty-nine urine samples were obtained from in-patients with UTI between April 2020 and April 2021. Five samples were rejected and remaining analyzed. Susceptibility testing was done by modified Kirby Bauer technique. Clinical Laboratory Standards Institute guidelines 2019 (CLSI 2019) and the European Committee on Antimicrobial Susceptibility testing guidelines version 2 (EUCAST version 2) were used for screening and confirmation of ESBL production respectively.
Of the 384-urine processed, 105 (27.3%) were gram negatives and 81 were Enterobacterales, Isolation rates were E. coli-55.6%, K. pneumoniae-29.6%, Citrobacter spp.-12.3%, P. mirabilis-1.2% and Morganella spp.-1.2%. Among Enterobacterales, 32 (39.5%) were ESBL producers. Prevalence of ESBL were 62.5% for Escherichia coli, 28.1% for Klebsiella pneumoniae and 9.4% for Citrobacter species. Susceptibility showed that ESBL-producing Isolates were highly susceptible to amikacin (96.9%). Resistance to other antibiotics varied from 3.1% to 100%.
We recommend strengthening laboratory capacity, antibiotics stewardship and Infection control to prevent spread of resistant pathogens including ESBLs.
尿路感染是住院患者中最常见的医院获得性感染。肠杆菌科的尿路病原体的耐药性不断增强。扩展型β-内酰胺酶基因编码多药耐药性，医院中抗生素的无限制使用为感染的传播提供了环境，而治疗选择有限。这就需要基于培养和抗生素敏感性的治疗方法，以改善患者的预后。我们旨在确定 Aminu Kano 教学医院住院患者中产超广谱β-内酰胺酶的尿路病原体的敏感性模式。
2020 年 4 月至 2021 年 4 月期间，从尿路感染住院患者中获得了 389 份尿液样本。拒收了 5 份样本，其余的进行了分析。药敏试验采用改良 Kirby Bauer 技术进行。临床实验室标准化研究所 2019 年指南（CLSI 2019）和欧洲抗菌药物敏感性试验委员会指南 2.0 版（EUCAST 2.0 版）分别用于筛选和确认 ESBL 产生。
处理的 384 份尿液中，105 份（27.3%）为革兰氏阴性菌，81 份为肠杆菌科，分离率为大肠杆菌-55.6%，肺炎克雷伯菌-29.6%，柠檬酸杆菌属-12.3%，奇异变形杆菌-1.2%和摩氏摩根菌-1.2%。在肠杆菌科中，32 株（39.5%）为 ESBL 产酶菌。ESBL 的流行率为大肠埃希菌 62.5%，肺炎克雷伯菌 28.1%，柠檬酸杆菌属 9.4%。药敏试验显示，产 ESBL 的分离株对阿米卡星高度敏感（96.9%）。对其他抗生素的耐药性从 3.1%到 100%不等。
我们建议加强实验室能力、抗生素管理和感染控制，以防止包括 ESBL 在内的耐药病原体的传播。
