Extended-Spectrum β-Lactamase and Carbapenemase Producing Gram-Negative Bacilli Infections Among Patients in Intensive Care Units of Felegehiwot Referral Hospital: A Prospective Cross-Sectional Study

Abstract

Background

Owing to the specific risk profile of its residents, intensive care units (ICUs) are the best place for selection pressure and the epicenter for resistance development and dissemination. Infections with β-lactamase releasing Gram-negative bacilli (GNB) at ICUs are an emerging global threat. This study dogged the magnitude of extended-spectrum β-lactamase (ESBL) and carbapenemase releasing Gram-negative bacilli infections and associated factors among patients in the ICUs of Felegehiwot Referral Hospital, Ethiopia.

Methods

A cross-sectional study was done through February to June 2020. Wound swabs, urine, blood and sputum samples were collected from patients in the ICUs symptomatic for infections while excluding those under coma and shock. Bacterial species were verified using standard microbiological methods. Carbapenemase and ESBL production were identified using modified carbapenem inactivation and combined disk diffusion methods, respectively. Multivariable analysis was calculated for factors associated with ESBL production. P-value < 0.05 was taken as cut-off for statistical significance.

Results

Out of 270 patients in the ICU, 67 (24.8%) and 14 (5.2%) had infections with ESBL and carbapenemase releasing GNB, respectively. The most frequent ESBL producing isolates were P. aeruginosa (100%), E. cloacae (100%), K. pneumoniae (82.8%) and E. coli (64%). The predominant carbapenemase producer isolates were K. pneumoniae (27.6%) and E. cloacae (33.3%). Overall, 77 (81.1%) of species were multi-drug resistant. All GNB species were 100% resistant to tetracycline and ampicillin. They are also resistant to cefuroxime, ceftazidime, sulfamethoxazole-trimethoprim and cefotaxime. Prior hospitalization (AOR = 5.5, CI = 2.63–11.46), support with medical care devices (AOR = 23.7, CI = 4.6–12) and arterial intravenous catheterization (AOR = 2.7, CI = 1.3–5.3) had significant association with β-lactamase producing GNB infection.

Conclusion

Infection with ESBL and carbapenemase producing Gram-negative bacilli linked with an alarming degree of multi-drug resistant isolates is a major healthcare threat among patients in ICUs. Hence, strict adherence to infection prevention practices and wise use of antibiotics are recommended to slow the spread of antimicrobial resistance.

Keywords:

• ICU
• GNB
• ESBL
• carbapenemase
• multi-drug resistance
• FHRH
• Ethiopia

Acknowledgments

This study was supported by Bahir Dar University. We are grateful to Ethiopian Public Health Institute for bringing bacterial reference strains. Our gratitude extends to Felegehiwot Referral Hospital for conducting this study in their facility. We are indebted to ICU healthcare workers for their role in identification of patients and support during sample collection. We acknowledge the study participants for their participation in the study.

Authors’ Information MA is Medical Microbiologist in the department of Clinical Laboratory Science, Chagni Hospital, Ethiopia.

FM is assistant professor of Medical Microbiology in the department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University. WM is Associate Professor of Medical Microbiology in the department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia.

Abbreviations

APHI, Amhara Public Health Institute; ATCC, American Type Culture Collection; AMR, antimicrobial resistance; BSI, blood stream infection; CLSI, Clinical and Laboratory Standards Institute; CP, carbapenemase; ESBL, extended-spectrum β-lactamase; GNB, Gram-negative bacilli; ICU, intensive care unit; LRTI, lower respiratory tract infection; MDR, multi-drug resistance; UTI, urinary tract infection.

Data Sharing Statement

Results of this study are generated from the data collected and analyzed based on stated materials and methods. All data concerning to this study are in the manuscript. All data are documented in the manuscript and there is no supplementary file.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; took part in drafting the article and revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.

Disclosure

The authors declared that they have no conflicts of interest for this work.