Phenotypic Detection of Carbapenem-Resistant Gram-Negative Bacilli from a Clinical Specimen in Sidama, Ethiopia: A Cross-Sectional Study

Figures & data

Figure 1 Modified carbapenem inactivation method (mCIM) to determine carbapenem resistance of gram-negative bacteria from clinical specimens at tertiary care hospital, southern Ethiopia.

Table 1 Socio-Demographic and Clinical Characteristics of Patients for the Study of Carbapenem Resistance of Gram-Negative Bacteria from Clinical Specimens at Tertiary Care Hospital, Southern Ethiopia, February 13–June 7, 2020

Variables	Frequency (%)	Carbapenemases (%)		COR (95% CI)	p-value
		Yes	No
Age group (in years)
<5	62 (60.2)	6 (9.7)	56 (90.3)	0.500 (0.096–2.609)	0.411
>6	40 (38.8)	2 (5.0)	38 (95.0)	1
Sex
Male	54 (52.4)	3 (5.6)	51 (94.4)	1.93 (0.437–8.547)	0.385
Female	49 (47.6)	5 (10.2)	44 (898)	1
Residence
Urban	55 (53.4)	5 (9.1)	50 (90.9)	0.667 (0.151–2.949)	0.593
Rural	48 (46.6)	3 (6.3)	45 (93.8)	1
Wards
Paediatrics	38 (36.9)	3 (7.9)	35 (92.1)	1.167 (0.180–7.582)	0.872
Surgical	16 (15.5)	2 (12.5)	14 (87.5)	0.700 (0.088–5.578)	0.736
NICU	27 (26.2)	1 (3.7)	26 (96.3)	2.600 (0.220–30.745)	0.448
Others	22 (21.4)	2 (9.1)	20 (90.9)	1
Another Hospital stays
Yes	32 (31.1)	3 (9.4)	29 (90.6)	1	0.683
No	71 (68.9)	5 (7.0)	66 (93.0)	0.732 (0.164–3.271)
Length of hospital stay (days)
< 10	64 (62.1)	5 (7.8)	59 (92.2)	0.983 (0.222–4.364)	0.982
>11	39 (37.9)	3 (7.7)	36 (92.3)	1
Sites of infection
UTI	54 (52.4)	5 (9.5)	49 (90.7)	0.639 (0.144–2.827)	0.555
Others	49 (47.6)	3 (6.1)	46 (93.9)	1
External device used
Yes	85 (82.5)	7 (8.2)	78 (91.8)	0.655 (0.076–5.683)	0.701
No	18 (17.5)	1 (5.6)	17 (94.4)	1
Length of device indwelled (days)
<5	22 (21.4)	2 (9.1)	20 (90.9)	1	0.897
>6	61 (59.2)	5 (8.2)	56 (91.8)	0.893 (0.160–4.974)
Previous antibiotics usage
Yes	92 (89.3)	7 (7.6)	85 (92.4)	1.21 (0.135–10.908)	0.862
No	11 (10.7)	1 (9.1)	10 (90.9)	1
Class of antibiotics
Single	70 (76.1)	6 (8.6)	64 (91.4)	0.508 (0.058–4.465)	0.541
Combined	22 (23.9)	1 (4.5)	21 (95.5)	1
Underlined disease
Yes	36 (35.0)	4 (11.1)	32 (88.9)	0.508 (0.119–2.165)	0.360
No	67 (65.0)	4 (6.0)	63 (94.0)	1

Figure 2 Frequency of specimens included for the study of carbapenem resistance of gram-negative bacteria from clinical specimens at tertiary care hospital, southern Ethiopia February 13–June 7, 2020.

Figure 3 Frequency of bacteria isolated for the study of carbapenem resistance of gram-negative bacteria from clinical specimens at tertiary care hospital, southern Ethiopia February 13–June 7, 2020.

Table 2 Antibiotics Resistance Patterns of Isolates for the Study of Carbapenem Resistance of Gram-Negative Bacteria from Clinical Specimens at Tertiary Care Hospital, Southern Ethiopia, February 13–June 7, 2020

Isolates Tested	Antibiotics Tested
	Cot (67)	CAZ (48)	MER (111)	GEN (108)	CAF (53)	AMP (96)	CIP (61)	CTX (106)	CXR (57)	AMK (106)	NIT (50)	PIT (84)
	R	R	R	R	R	R	R	R	R	R	R	R
K. pneumoniae	14 (100)	11 (91.7)	3 (9.7)	26 (86.7)	11 (64.7)	28 (100)	10 (66.7)	29 (96.7)	21 (100)	4 (12.9)	11 (100)	11 (52.4)
E. coli	23 (88.5)	16 (84.2)	3 (8.8)	18 (52.9)	0 (0.0)	25 (100)	22 (84.6)	26 (83.9)	16 (84.2)	2 (6.2)	11 (47.8)	15 (50)
P. aeruginosa	4 (100)	1 (100)	3 (37.5)	2 (28.6)	4 (100)	7 (100)	2 (100)	7 (87.5)	2 (100)	2 (25.0)	4 (100)	2 (33.3)
Acinetobacter spp.	4 (66.7)	1 (33.3)	3 (27.3)	7 (63.6)	6 (85.7)	10 (90.9)	2 (50.0)	9 (81.8)	2 (50)	1 (9.1)	3 (100)	5 (62.5)
K. ozaenae	3 (100)	3 (100)	0 (0.0)	5 (83.3)	3 (75.0)	6 (100)	3 (100)	6 (100)	3 (100)	0 (0.0)	1 (50)	2 (40)
K. oxytoca	5 (71.4)	4 (100)	1 (11.1)	7 (77.8)	0 (0.0)	7 (100)	5 (100)	9 (100)	4 (100)	0 (0.0)	2 (66.7)	3 (42.9)
K. rhinoscolaris	2 (100)	1 (100)	0 (0.0)	1 (100)	0 (0.0)	2 (100)	0 (0.0)	1 (100)	NT	0 (0.0)	1 (100)	1 (100)
C. diversus	1 (100)	1 (100)	0 (0.0)	1 (50.0)	0 (0.0)	2 (100)	1 (100)	2 (100)	2 (100)	0 (0.0)	1 (100)	NT
M. morganii	3 (100	2 (100)	0 (0.0)	4 (80.0)	0 (0.0)	5 (100)	2 (100)	5 (100)	2 (100)	0 (0.0)	1 (50)	2 (66.7)
P. mirabilis	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (50)	0 (0.0)	0 (0.0)	NT	0 (0.0)	NT	0 (0.0)
E. agglomerus	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (100)	0 (0.0)	0 (0.0)	NT	0 (0.0)	NT	0 (0.0)
Total	58 (88.1)	40 (83.3)	13 (11.7)	71 (65.7)	25 (47.2)	94 (97.9)	47 (77.1)	94 (88.7)	52 (91.2)	9 (8.5)	35 (70.0)	41 (48.8)

Abbreviations: R, resistance; NT, not tested; COT, cotrimoxazole; CAZ, ceftazidime, MER, meropenem; GEN, gentamycin; CAF, chloramphenicol; AMP, ampicillin; CIP, ciprofloxacin; CTX, cefotaxime; CXR, cefuroxime; AMK, amikacin; NIT, nitrofurantoin; PIT, piperacillin-tazobactam.

Table 3 Multidrug Resistance Isolates from the Study of Carbapenem Resistance of Gram-Negative Bacteria from Clinical Specimens at Tertiary Care Hospital, Southern Ethiopia from February 13 to June 7, 2020

Bacteria	Class of Antibiotics									MDR ≥ R3
	R1(6)	R2	R3	R4	R5	R6	R7	R8	R9
K. pneumoniae (31)	0 (0.0)	1 (3.2)	7 (22.6)	9 (29.0)	1 (3.2)	8 (25.8)	4 (12.9)	1 (3.2)	0 (0.0)	30 (96.8)
E. coli (34)	1 (2.9)	5 (14.7)	5 (14.7)	9 (26.5)	3 (8.8)	5 (14.7)	5 (14.7)	1 (2.9)	0 (0.0)	28 (82.4)
P. aeruginosa (8)	0 (0.0)	0 (0.0)	3 (37.5)	2 (25.0)	0 (0.0)	2 (25.0)	0 (0.0)	1 (12.5)	0 (0.0)	8 (100)
Acinetobacter spp. (11)	2 (18.2)	0 (0.0)	2 (18.2)	1 (9.1)	1 (9.1)	4 (36.4)	0 (0.0)	0 (0.0)	1 (9.1)	9 (81.8)
K. ozaenae (6)	0 (0.0)	0 (0.0)	0 (0.0)	3 (50.0)	1 (16.7)	1 (16.7)	1 (16.7)	0 (0.0)	0 (0.0)	6 (100)
K. oxytoca (9)	0 (0.0)	0 (0.0)	3 (33.3)	1 (11.1)	3 (33.3)	1 (11.1)	0 (0.0)	1 (11.1)	0 (0.0)	9 (100)
K. rhinoscolaris (2)	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (50)
C. diversus (2)	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (50)
M. morganii (5)	0 (0.0)	1 (20.0)	1 (20.0)	1 (20.0)	1 (20.0)	1 (20.0)	0 (0.0)	0 (0.0)	0 (0.0)	4 (80)
P. mirabilis (2)	2 (100)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
E. agglomerus (1)	1 (100)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Total	6 (5.4)	9 (8.1)	21 (18.9)	26 (23.4)	10 (9.0)	24 (21.6)	10 (9.0)	4 (3.6)	1 (0.9)	96 (86.5)

Notes: R1–9 – resistance to 1-classes, 2-classes, 3- classes … 9-classes.

Abbreviation: MDR, multidrug resistances.

Figure 4 Rates of MDR, XDR and PDR bacteria from clinical specimens at tertiary care hospital, southern Ethiopia from February 13 to June 7, 2020.

Figure 5 Magnitude of carbapenem resistance of gram-negative bacteria from clinical specimens at tertiary care hospital, southern Ethiopia from February 13 to June 7, 2020.