Short Communication: Laboratory survey of extended spectrum beta-lactamase producing enterobacteriaceae in clinical infections among hospitalised patients at LAUTECH Teaching Hospital, Ogbomoso, Nigeria

Abstract

Background: The extended-spectrum beta-lactamase (ESBL) producing enterobacteriaceae are a major public health threat globally, causing both community and healthcare associated infections (HAIs). Due to multi-resistant nature of these strains, infections caused by them are associated with treatment failure, high mortality, and increased healthcare costs. This laboratory survey determined the prevalence of infections caused by ESBLproducing enterobacteriaceae in LAUTECH Teaching Hospital, Ogbomoso

Methodology: Over three years (January 2016 to December 2018), non-duplicate clinical samples (sputum, blood, urine, and wound swabs) collected from hospitalised patients with suspected clinical infections were routinely processed at microbiology laboratory of our hospital for aerobic culture and isolation of enterobacteriaceae. Antibiotic susceptibility of each isolate to routinely used antibiotics was determined by the disk diffusion method and ‘double disk’ synergy test was used to routinely confirm ESBL production. Demographic and clinical data were extracted from the requisition form.

Results: Of the total 4,198 hospitalised patients over the three year period, 1,222 (29.1%) had clinical infections, out of which 689 (16.4%) were laboratory confirmed. Enterobacteriaceae were isolated from 343 patients (prevalence rate, 8.2%) while ESBL producers were isolated from 46 (prevalence rate, 1.1%). The most frequent enterobacteriaceae were Klebsiella spp (54.5%) and Escherichia coli (35.9%) recovered mainly from urinary tract infection (UTI, 45.2%), skin and soft tissue infection (SSTI, 27.9%) and lower respiratory tract infection (LRTI, 17.5%) but ESBL producers were frequently associated with osteomyelitis (50%), LRTI (18.3%) and SSTI (14.6%). The ESBL producers were all resistant to ampicillin, cefotaxime, ceftazidime, cefepime, gentamicin, and ciprofloxacin but susceptible to imipenem. The non-ESBL producers were comparatively less resistant with 43.8%, 34.3%, 29%, 35%, 43%, 37%, and 4% resistant to ampicillin, cefotaxime, ceftazidime, cefepime, gentamicin, ciprofloxacin and imipenem respectively.

Conclusion: The prevalence of clinical infections among hospitalised patients in our facility is high but the rate of ESBL-producing enterobacteriaceae is relatively low. In spite of this, there is need for continuous surveillance of ESBL and other antibiotic resistant pathogens as part of the infection prevention and control (IPC) programme, with implementation of measures that will reduce the incidence of these infections in our hospital.

Keywords: Laboratory survey; hospitalised patients; ESBL; multidrug resistance