Extended-spectrum beta-lactamase- and carbapenemase-producingEnterobacteriaceaeamong Ethiopian children.
BACKGROUND
Infections by extended-spectrum beta-lactamase- (ESBL) and carbapenem-resistantEnterobacteriaceae(CRE) are an emerging problem in children nowadays. Hence, the aim of this study was to determine the prevalence of ESBL- and carbapenemase-producingEnterobacteriaceaeamong children suspected of septicemia and urinary tract infections (UTIs).


METHODS
A cross-sectional study was conducted from January to March 2014. A total of 322 study participants suspected of septicemia and UTIs were recruited. All blood and urine samples were cultured on blood and MacConkey agar. All positive cultures were characterized by colony morphology, Gram stain, and standard biochemical tests. Antimicrobial susceptibility test was performed on Muller-Hinton agar using disk diffusion. ESBL was detected using combination disk and double-disk synergy methods, and the results were compared. Carbapenemase was detected by modified Hodge method using meropenem. Data were analyzed using SPSS version 20.


RESULTS
The overall prevalence of ESBL- and carbapenemase-producingEnterobacteriaceaewas 78.57% (n=22/28) and 12.12%, respectively. Among theEnterobacteriaceaetested,Klebsiella pneumoniae(84.2%, n=16/19),Escherichia coli(100%, n=5/5), andKlebsiella oxytoca(100%, n=1/1) were positive for ESBL. Double-disk synergy method showed 90.9% sensitivity, 66.7% specificity, 95.2% positive predictive value, and 50% negative predictive value. Carbapenemase-producingEnterobacteriaceaewereK. pneumoniae(9.09%, n=3/33) andMorganella morganii(3.03%, n=1/33).


CONCLUSIONS
ScreeningEnterobacteriaceaefor ESBL production is essential for better antibiotics selection and preventing its further emergence and spread. In resource-limited settings, double-disk synergy method can be implemented for screening and confirming ESBL production. Moreover, occurrence of CRE in countries where no carbapenems are sold is worrying microbiologists as well as clinicians. Hence, identifying factors that induce carbapenemase production in the absence of carbapenems prescription is essential for control of CRE dissemination within the community.
Department of Clinical Laboratory Sciences, School of Allied Health Sciences.
Melese Hailu
MH
Legese
Department of Clinical Laboratory Sciences, School of Allied Health Sciences.
Gebru Mulugeta
GM
Weldearegay
Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Daniel
D
Asrat
Addis Ababa; ESBL; Enterobacteriaceae; Ethiopia; Tikur Anbessa Specialized Hospital; carbapenem resistance