Abstract

Extended spectrum β-lactamases (ESBLs) have emerged as a major threat worldwide with limited treatment options. The prevalence of ESBL producing Escherichia coli and Klebsiella pneumoniae strains largely remain unknown in Ethiopia. The study was aimed at determining the occurrence of extended spectrum β-lactamase-producing E. coli and K. pneumoniae among inpatient and outpatient settings, their antimicrobial resistance profile and associated risk factors in Jimma University Specialized Hospital (JUSH). A total of 471 consecutive, non repetitive clinical specimens were collected among inpatients (n=314) and outpatients (n=157). Among these, 112 isolates of K. pneumoniae (n=27) and E. coli (n=85) were recovered. Overall prevalence of extended spectrum beta lactamase (ESBL) producers was 38.4% (n=43) of total isolates. Extended spectrum beta lactamases were found in 28.2% (n=24) of E. coli and 70.4% (n=19) of K. pneumoniae. Extended spectrum beta lactamase producers mediated very high resistance to both beta-lactams and non-betalactams, and they were significantly higher among in-patients (46.4%) than out-patients (14.3%). On Multivariate analysis, treatment with third generation cephalosporin was identified as a sole risk factor for acquisition of ESBL enzyme. Our findings confirmed that infection due to extended spectrum beta lactamase-producing E. coli and K. pneumonia is prevalent in JUSH and that exposure to third generation cephalosporin was associated with these infections. The magnitude of E. coli and K. pneumoniae infection was more in inpatients with higher levels of extended spectrum beta lactamase production than outpatients.

Key words: Escherichia coli, Klebsiella pneumoniae, extended spectrum β-lactamases, inpatients, outpatients.

Abbreviation

BSI, Blood stream infection; CLSI, Clinical and Laboratory Standards Institute; CTX-M, Cefotaximase-Munich; DDST, double disk synergy test; ESBL, extended spectrum β-lactamase; ESBL-EK, ESBL-producing Escherichia coli and K. pneumoniae; ESBL-EC, ESBL-producing E. coli; ESBL-Kp, ESBL-producing K. pneumoniae; MDR, multi drug resistant; PBP, penicillin-binding protein; SHV, sulphydryl variable; TEM, for Temoniera-name of a patient; TMP, trimethoprim; SMX, sulfamethoxazole; WHO, World Health Organization