title: Epidemiology of Carbapenem Resistance among Multi-drug Resistant Enterobacteriaceae in Uganda.
abstract: BACKGROUND
  Multi-drug resistant (MDR) Enterobacteriaceae are on the increase worldwide and their spread has become a global challenge. Escalating the challenge is the possibility that many of these are Carbapenemase-producing Enterobacteriaceae (CPE). This further complicates patient management. The magnitude of MDR-CPE in many developed settings has been reported, however, there is paucity of data from resource limited settings. We evaluated the epidemiology of MDR-CPE of clinical origin in South Western Uganda.
  
  
  METHODS
  From September 2013 to June 2014, all Enterobacteriaceae isolated from diverse specimens obtained from patients attending Mbarara Regional Referral Hospital, South-western Uganda, were screened for MDR in a laboratory-based cross sectional study. Isolates found to be MDR were screened for carbapenem susceptibility/resistance phenotypically by Kirby Bauer disc diffusion method following CLSI guidelines and genetically using the multiplex real-time Polymerase Chain Reaction (RT-PCR).
  
  
  RESULTS
  Of the 658 strains isolated, 183 (27.8%) were MDR and 68 (37.15%) of those MDR exhibited at least one form of carbapenem resistance with 23 (12.57%) and 56 (30.60%) isolates expressing phenotypic and genetic resistance, respectively. Eleven MDR-CPE (6.01%) isolates exhibited both phenotypic and genotypic resistance to carbapenems. OnlyblaVIMandblaOXA-48genes were detected among the genetically resistant isolates.
  
  
  CONCLUSIONS
  The high prevalence of MDR-CPE calls for aggressive infection control and prevention strategies, including reinforcement of hand hygiene, using contact precautions and early detection of CPE through use of targeted surveillance and molecular techniques in resource limited settings.
authors.affiliation: Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Ampaire
authors.affiliation: Department of Laboratory, Epicentre Mbarara Research Centre, Mbarara, Uganda ; Department of Microbiology and Immunology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Victoria
authors.initials: V
authors.lastname: Katawera
authors.affiliation: Department of Microbiology and Immunology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Dan
authors.initials: D
authors.lastname: Nyehangane
authors.affiliation: Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda ; Department of Laboratory, Epicentre Mbarara Research Centre, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: Department of Microbiology and Immunology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Joel
authors.initials: J
authors.lastname: Bazira
keywords: CPE; ESBL; Enterobacteriaceae; carbapenemase; multi-drug resistant