Fecal Carriage of Extended-Spectrum β-Lactamase and Carbapenemase-Producing Enterobacteriaceae Among Oncology and Non-Oncology Patients at Jimma Medical Center in Ethiopia: A Comparative Cross-Sectional Study

Figures & data

Figure 1 Workflow on carriage isolation, identification, confirmation and antimicrobial susceptibility testing with oncology and non-oncology group from June 2021 to November 2021 at Jimma Medical Center, Jimma, Southwest Ethiopia.

Table 1 Sociodemographic Characteristics of Oncology and Non-Oncology Study Participants from June 2021 to November 2021 at Jimma Medical Center, Jimma, Southwest Ethiopia

Sociodemographic Characteristics		Study Participants		All (N= 214) N (%)
		Oncology Patients (N=107); n (%)	Non-Oncology Patients (N=107); n (%)
Sex	Male	50 (46.7)	64 (59.8)	114 (53.3)
	Female	57 (53.3)	43 (40.2)	100 (46.7)
Age	Mean – SD	28.01+17.23	20.40 + 17.65
	0–4	22 (20.6)	22 (20.6)	44 (20.6)
	5–14	39 (36.4)	27 (25.2)	66 (30.8)
	15–24	8 (7.5)	23 (21.5)	31 (14.5)
	25–34	3 (2.8)	12 (11.2)	15 (7.0)
	35–44	13 (12.1)	5 (4.7)	18 (8.4)
	45–54	7 (6.5)	8 (7.5)	15 (7.0)
	55–64	7 (6.5)	2 (1.8)	9 (4.2)
	65–74	5 (4.7)	3 (2.8)	8 (3.7)
	75–84	3 (2.8)	5 (4.7)	8 (3.7)
Age category	Pediatric	65(60.7)	61(57.0)	126(58.9)
	Adult	42(39.3)	46(43.0)	88(41.1)
Residence	Urban	42 (39.3)	49 (46.8)	91 (42.5)
	Rural	65 (60.7)	58 (54.2)	123 (57.5)

Table 2 Frequency of Clinical Profile of the Study Participants from June 2021 to November 2021 at Jimma Medical Center, Jimma, Southwest Ethiopia

Clinical Variables	Categories	Frequency	Percent (%)
Type of cancer	Carcinoma	49	45.8
	Leukemia	24	22.4
	Lymphoma	22	20.7
	Sarcoma	10	9.3
	Myeloma	1	0.9
	Rectal Adenosquamous carcinoma	1	0.9
Cases linked from other health care facility	Yes	69	64.5
	No	38	35.5
Hospitalized previously	Yes	21	20
	No	86	80
History of cancer chemotherapy	Yes	95	88.8
	No	12	11.2
Neutropenia	Yes	13	12.1
	No	94	87.9
Antimicrobial therapy use in the past 3 months duration	Yes	60	56.1
	No	47	43.9
Types of antimicrobials taken within the last 3 months (from patients cards)	SXT	11	18.3
	CRO	9	15.0
	AMP	1	1.7
	CRO, CN	6	10.0
	CRO, MET	4	6.7
	CAZ, V	3	5.0
	CRO, CIP	1	1.7
	SXT, CRO	1	1.7
	SXT, CRO, CN	14	23.3
	SXT, V, CAZ	2	3.3
	SXT, CIP, MET	1	1.7
	SXT, CRO, V, CN, CAZ	7	11.7

Abbreviations: AMP, ampicillin; CRO, ceftriaxone; SXT, trimethoprim and sulfamethoxazole; CAZ, ceftazidime; CN, gentamicin; CIP, ciprofloxacin; V, vancomycin; MET, metronidazole.

Table 3 Bacterial Profile of ESBL- and CPE Carriage Rate Among Oncologic and Non-Oncologic Cases from June 2021 to November 2021 at Jimma Medical Center, Jimma, Southwest Ethiopia

Enterobacteriaceae	Type of Organism	Number of Isolates (%)
		Oncology Isolates (138)*	Non-Oncology Isolates (79)*
ESBL-PE		128(92.8)	77(97.5)
	Escherichia coli	82 (64.0)	68 (88.3)
	Klebsiella oxytoca	15 (11.7)	6 (7.8)
	Klebsiella pneumonia	13 (10.2)	3 (3.9)
	Klebsiella ozaenae	5 (3.9)	–
	Enterobacter cloacae	5 (3.9)	–
	Citrobacter diversus	4 (3.1)	–
	Klebsiella rhinoscleromatis	2 (1.6)	–
	Citrobacter freundii	1 (0.8)	–
	Providencia spp.	1 (0.8)	–
Non ESBL-PE		10(6.3)	2(1.8)
	Escherichia coli	6(60.0)	2(100.0)
	Klebsiella oxytoca	2(20.0)	–
	Klebsiella pneumonia	1(10.0)	–
	Citrobacter diversus	1(10.0)	–

Note: (138) * or (79*) =ESBL-PE + Non-ESBL-PE.

Table 4 Prevalence of ESBL and C-P Enterobacteriaceae Isolated from Oncology and Non-Oncology Patients from June 2021 to November 2021 at Jimma Medical Center, Southwest Ethiopia

Enterobacteriaceae Isolates	Oncology Patients, N (%)	Non-Oncology Patients, N (%)	Chi- Square (x^2)	P value
ESBL-PE
Yes	90 (84.1)	77 (71.9)	4.61	0.032
No	17 (15.9)	30 (28.1)
C-PE
Yes	12 (11.2)	4 (3.7)	3.31	0.069
No	95 (88.8)	103 (96.3)
Total patients	107	107	214

Figure 2 Isolation of ESBL-PE against age of patients with oncology and non-oncology group from June 2021 to November 2021 at Jimma Medical Center, Jimma, Southwest Ethiopia.

Table 5 Antimicrobial Resistance Patterns of ESBL-E Isolates from Oncologic and Non-Oncologic Cases from June 2021 to November 2021 at Jimma Medical Center, Jimma, Southwest Ethiopia

Types of Antibiotics Tested	Oncology Isolates (N= 128)	Non-Oncology Isolates (N=77)	Total Number of Isolates (N=205)
	No. of Isolate (% of R^#)	No. of Isolate (% of R)	No. of Isolate (% of R)
Trimethoprim -Sulfamethoxazole	103 (80.5)	NA* NA	103 (80.2)
Tigecycline	5 (3.9)	0 (0.0)	5 (2.4)
Tetracycline	97 (75.8)	NA (NA)	97 (75.8)
Piperacillin and tazobactam	55 (43.0)	20 (26.0)	75 (36.6)
Meropenem	36 (28.1)	7 (9.1)	43 (21.0)
Gentamicin	54 (42.2)	33 (42.9)	87,111(42.4)
Ertapenem	51 (39.8)	9 (11.7)	60 (29.3)
Ciprofloxacin	105 (82.0)	72 (93.5)	177 (86.3)
Cefoxitin	62 (47.3)	15 (19.5)	77 (37.6)

Notes: NA*, not done; ^#R, Resistance.

Table 6 Multidrug Resistance Patterns of ESBL-Producing Enterobacteriaceae Isolates Among Oncology Patients from June 2021 to November 2021 at Jimma Medical Center, Jimma, Southwest Ethiopia

Antibiotic Resistance Level [n (%)]*
Isolates(Number)	R1	R2	R3	R4	R5	R6	≥R7	Total MDR Isolates (R≥3)
E. coli (n=82)	0(0.0)	10(12.2)	13(15.9)	20(24.4)	15(18.3)	10(12.2)	14(17.1)	72(87.8)
K. oxytoca (n=15)	1(6.7)	1(6.7)	2(13.3)	1(6.7)	3(20.0)	2(13.3)	5(33.3)	13(86.7)
K. pneumoniae (n=13)	1(7.7)	1(7.7)	0(0.0)	1(7.7)	4(30.7)	5(38.5)	1(7.7)	11(84.6)
E. cloacae (n=5)	0(0.0)	1(20.0)	1(20.0)	2(40.0)	1(20.0)	0(0.0)	0(0.0)	4(80.0)
K. ozaenae (n=5)	0(0.0)	0(0.0)	3(60.0)	0(0.0)	0(0.0)	1(20.0)	1(20.0)	5(100.0)
Citrobacter spp. (n=5)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	2(40.0)	2(40.0)	1(20.0)	5(100.0)
K. rhinoscleromatis (n=2)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(50.0)	0(0.0)	1(50.0)	2(100.0)
Providencia spp. (n=1)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(100.0)	0(0.0)	1(100.0)
Total (n=128)	2(1.6)	13(10.1)	19(14.8)	24(18.8)	26(20.3)	23(18.0)	24(18.8)	113(88.3)

Notes: R1-7: resistance to 1, 2, 3, 4, 5, 6, and 7 antibiotics; ≥R3: resistance to 3 or more antibiotics from different classes, MDR-multidrug resistance. *Different class-β-lactam combination agents (piperacillin-tazobactam) (cefepime, cefotaxime, ceftazidime), monobactams (aztreonam), carbapenems (ertapenem, meropenem), aminoglycosides (gentamicin), glycylcyclines (tigecycline), tetracyclines (tetracycline), quinolones (ciprofloxacin), folate pathway antagonists (trimethoprim/sulfamethoxazole).