title: Extended-Spectrum beta (β)-Lactamases and Antibiogram in Enterobacteriaceae from Clinical and Drinking Water Sources from Bahir Dar City, Ethiopia.
abstract: BACKGROUND
  The spread of Extended-Spectrum beta (β)-Lactamases (ESBL)-producing Enterobacteriaceae has become a serious global problem. ESBL-producing Enterobacteriaceae vary based on differences in antibiotic use, nature of patients and hospital settings. This study was aimed at determining ESBL and antibiogram in Enterobacteriaceae isolates from clinical and drinking water sources in Bahir Dar City, Northwest Ethiopia.
  
  
  METHODS
  Enterobacteriaceae species were isolated from clinical materials and tap water using standard culturing procedures from September 2013 to March 2015. ESBL-producing-Enterobacteriaceae were detected using double-disk method by E-test Cefotaxim/cefotaxim+ clavulanic acid and Ceftazidime/ceftazidime+ clavulanic acid (BioMerieux SA, France) on Mueller Hinton agar (Oxoid, UK).
  
  
  RESULTS
  Overall, 274 Enterobacteriaceae were isolated. Of these, 210 (44%) were from patients and 64 (17.1%) were from drinking water. The median age of the patients was 28 years. Urinary tract infection and blood stream infection accounted for 60% and 21.9% of Enterobacteriaceae isolates, respectively. Klebsiella pneumoniae was isolated from 9 (75%) of neonatal sepsis. The overall prevalence of ESBL-producing Enterobacteriaceae in clinical and drinking water samples were 57.6% and 9.4%, respectively. The predominant ESBL-producers were K. pneumoniae 34 (69.4%) and Escherichia coli 71 (58.2%). Statistically significant associations were noted between ESBL-producing and non- producing Enterobacteriaceae with regard to age of patients, infected body sites and patient settings (P = 0.001). ESBL-producing Enterobacteriaceae showed higher levels of resistance against chloramphenicol, ciprofloxacin and cotrimoxazole than non-ESBL producers (P = 0.001).
  
  
  CONCLUSIONS
  ESBL-producing Enterobacteriaceae coupled with high levels of other antimicrobials become a major concern for treatment of patients with invasive infections such as blood stream infections, neonatal sepsis and urinary tract infections. ESBL-producing Enterobacteriaceae were also detected in drinking water sources.
authors.affiliation: Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
authors.forename: Bayeh
authors.initials: B
authors.lastname: Abera
authors.affiliation: Department of Biology, Science College, Bahir Dar University, Bahir Dar, Ethiopia.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Kibret
authors.affiliation: Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
authors.forename: Wondemagegn
authors.initials: W
authors.lastname: Mulu
mesh_terms: D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects / Q000201:enzymology / Q000235:genetics*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015870:Gene Expression; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D000071074:Neonatal Sepsis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D060766:Drinking Water; D002939:Ciprofloxacin; D002701:Chloramphenicol; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D001618:beta-Lactamases