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High occurrence of blaCTX-M extended-spectrum-beta-lactamase genes in Gram-negative clinical isolates from a Tertiary Hospital, South-South Nigeria
Abstract
The extended-spectrum-beta-lactamase (ESBL) producing Gram-negative bacteria (GNB) has been implicated in the global spread of multi-drug resistance (MDR) genes leading to limited therapeutic options. This study aimed to determine the frequency of blaCTX-M and blaSHV ESBL genes in clinical isolates from patients with GNB infection in Akwa Ibom State, Nigeria. A cross-sectional study of patients having various infections was conducted at the University of Uyo Teaching Hospital, Uyo. Clinical samples were cultured by standard bacteriological methods and isolates identified using VITEK-2 protocols. Gram-negative bacteria identified were screened for antibiotics sensitivity, ESBL production and possession of ESBL genes using Kirby-Bauer disc diffusion, double disc synergy test and polymerase chain reaction, respectively. Out of 180 clinical samples of urine, blood and wound, 71 consecutive non-repetitive GNB were isolated of which 29% were ESBL producers. The GNB recovered from the samples were 35 (58.3%), 22 (36.7%) and 14 (23.3%), of which 12 (34.3%), 9 (40.9%) and 8 (57.1%), were ESBL producers, respectively. Escherichia coli was the most prevalent GNB and the highest ESBL producer (14.1%). Susceptibility test showed moderately high resistance of GNB to trimethoprim-sulfamethoxazole (59.1%), ceftazidime (56.3%) and cefotaxime (54.9%). Of the selected 25 ESBL-producers, 15 (60%) possessed the blaCTX-M genes while one (4%) harboured the blaSHV gene. The blaCTX-M detection rates in wound, blood and urine were 24%, 20% and 16%, respectively. Isolates with the blaCTX-M genes were E. coli, S. fonticola, K. pneumoniae, P. mirabilis, A. baumannii, K. oxytoca, B. cepacia, E. cloacae, and P. aeruginosa while Serratia fonticola carried the blaSHV gene. The implication of blaCTX-M genes in MDR could be associated with treatment failures in patients with GNB infections. Antimicrobial stewardship to guide appropriate and prudent use of antibiotics is advocated.
