title: High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia.
abstract: We investigated the gastrointestinal colonization rate and antibiotic resistance patterns of Extended-Spectrum Beta-Lactamase (ESBL)- producing Escherichia coli and Klebsiella pneumoniae in hospitalized patients admitted at Ethiopia's largest tertiary hospital. Fecal samples/swabs from 267 patients were cultured on chrome agar. ESBL. Bacterial species identification, verification of ESBL production and antibiotic susceptibility testing were done using Vitek 2 system (bioMérieux, France). Phenotype characterization of ESBL-E.coli and ESBL- K.pneumoniae was done using Neo-Sensitabs™. ESBL positivity rate was much higher in K. pneumoniae (76%) than E. coli (45%). The overall gastrointestinal colonization rate of ESBL producing Enterobacteriaceae (ESBL-E) in hospitalized patients was 52% (95%CI; 46%-58%) of which, ESBL-E. coli and K.pneumoniae accounted for 68% and 32% respectively. Fecal ESBL-E carriage rate in neonates, children and adults was 74%, 59% and 46% respectively. Gastrointestinal colonization rate of ESBL-E.coli in neonates, children and adults was 11%, 42% and 42% respectively. Of all E. coli strains isolated from adults, children and neonates, 44%, 49% and 22% were ESBL positive (p = 0.28). The prevalence of ESBL-K.pneumoniae carriage in neonates, children and adults was 68%, 22% and 7% respectively. All K. pneumoniae isolated from neonates (100%) and 88% of K. pneumoniae isolated from children were ESBL positive, but only 50% of K.pneumoniae isolated from adults were ESBL positive (p = 0.001). Thirteen patients (5%) were carriers of both ESBL-E.coli and ESBL-KP. The overall carrier rate of ESBL producing isolates resistant to carbapenem was 2% (5/267), all detected in children; three with E.coli HL cephalosporinase (AmpC), resistant to ertapenem and two with K. pneumoniae Carbapenemase (KPC) resistant to meropenem, ertapenem and impenem. We report a high gastrointestinal colonization rate with ESBL-E and the emergence of carbapenems-resistant K. pneumoniae in Ethiopia. Urgent implementation of infection control measures, and surveillance are urgently needed to limit the spread within healthcare facilities and further to the community.
authors: Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Kassu
authors: K
authors: Desta
authors: Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Yimtubezinash
authors: Y
authors: Woldeamanuel
authors: Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Aklilu
authors: A
authors: Azazh
authors: Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Halima
authors: H
authors: Mohammod
authors: Department of Gynecology & Obstetrics, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Dawit
authors: D
authors: Desalegn
authors: Department of pediatrics, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Damte
authors: D
authors: Shimelis
authors: Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Dereje
authors: D
authors: Gulilat
authors: Department of Orthopedics School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Biruk
authors: B
authors: Lamisso
authors: Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Eyasu
authors: E
authors: Makonnen
authors: School of Public Health College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Alemayehu
authors: A
authors: Worku
authors: The Public Health Agency of Sweden, Stockholm, Sweden.
authors: Kerstin
authors: K
authors: Mannerqvist
authors: The Public Health Agency of Sweden, Stockholm, Sweden.
authors: Johan
authors: J
authors: Struwe
authors: The Public Health Agency of Sweden, Stockholm, Sweden.
authors: Olov
authors: O
authors: Aspevall
authors: Division of clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, SE 141 86, Stockholm, Sweden.
authors: Eleni
authors: E
authors: Aklillu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000201:enzymology / Q000302:isolation & purification; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase