title: Multidrug resistant and carbapenemase producing Enterobacteriaceae among patients with urinary tract infection at referral Hospital, Northwest Ethiopia.
abstract: BACKGROUND
  Updates on the epidemiology of antibiotic resistance bacterial pathogens is important. This is because the spread of multidrug resistant enterobacteriaceae (MDRE) and recently carbapenemase producing enterobacteriaceae (CPE) have emerged as a major public health concern in patients with urinary tract infections (UTIs). This study is therefore, aimed to assess the prevalence and associated risk factors of MDR and CPE among patients with UTIs.
  
  
  METHODS
  A cross sectional study was conducted among 442 symptomatic UTI suspected patients. Data on socio-demographic characteristics, clinical information and possible risk factors were collected using structured questionnaire. Early morning mid-stream urine samples were collected and processed to characterize bacterial isolates. Disk diffusion method was used to determine the antibiotic susceptibility patterns of isolates. Carbapenemase producing strains were detected using CHROMagar KPC medium. Data were entered and analyzed using SPSS version 20. P-value <0.05 was considered as statistical significant.
  
  
  RESULTS
  Among 442 patients enrolled a total of 183 Enterobacteriaceae were recovered. Of these isolates; 160 (87.4%) were MDRE; the most common isolates were K. pneumoniae and E.coli. Five (2.73%) of the isolates were found to be carbapenemase producers and all of CPE strains were 100% ESBL producers. Significant drug resistances were observed among CPE compared to other MDRE, low resistance rates were noted to ciprofloxacin (20%). Being female (OR 4.46; P = 0.018), age (OR 1.08; P = 0.001), hospitalization (OR 5.23; P = 0.006), and prior antibiotic use (OR 3.98; P = 0.04) were associated risk factors for MDRE.
  
  
  CONCLUSIONS
  High rates of MDR (87.4%) were observed among enterobacteriaceae uropathogens; K. pneumoniae and E.coli were the principal MDR isolates. Overall prevalence of CPE was 2.73% and all of these strains were 100% ESBL producer. Attributing risk factors for MDR UTIs were found to be sex (female), age, hospitalization, and history of antibiotic therapy. Therefore, efforts should be made to reduce patient hospital stay and maximize rational use of drugs. Additional and vigorous investigation especially on CPE should be encouraged.
authors.affiliation: Department of Medicine, Debre Markos University, Debre Markos, Ethiopia.
authors.forename: Setegn
authors.initials: S
authors.lastname: Eshetie
authors.affiliation: Department of Microbiology, University of Gondar, Gondar, Ethiopia.
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Unakal
authors.affiliation: Department of Microbiology, University of Gondar, Gondar, Ethiopia.
authors.forename: Aschalew
authors.initials: A
authors.lastname: Gelaw
authors.affiliation: University of Gondar Hospital, Gondar, Ethiopia.
authors.forename: Birhanu
authors.initials: B
authors.lastname: Ayelign
authors.affiliation: Department of Microbiology, University of Gondar, Gondar, Ethiopia.
authors.forename: Mengistu
authors.initials: M
authors.lastname: Endris
authors.affiliation: Department of Microbiology, University of Gondar, Gondar, Ethiopia.
authors.forename: Feleke
authors.initials: F
authors.lastname: Moges
keywords: Carbapenemase; Enterobacteriaceae; Multidrug resistant; Urinary tract infection