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

Figures & data

Table 1 Culture Confirmed Gram-Negative Bacilli Infections and Demographic Characteristics of Study Participants

Variables	Number of Study Participants	Culture Confirmed Gram-Negative Bacilli Infection
	N (%)	N (%)
Sex
Male	147 (54.4)	54 (36.7)
Female	123 (45.6)	41 (33.3)
Age (in years)
< 15	54 (20)	14 (25.9)
16–30	26 (9.6)	9 (34.6)
31–45	59 (21.9)	16 (27.1)
46–60	44 (16.3)	(36.4)
> 60	87 (32.2)	40 (46)
Marital status
Single	99 (36.7)	26 (26.3)
Married	136 (50.4)	50 (36.8)
Divorced	35 (13)	19 (54.3)
Residence
Urban	132 (48.9)	33 (25)
Rural	138 (51.1)	62 (44.9)
Educational level
Cannot read and write	91 (33.7)	38 (41.8)
Primary	87 (32.2)	32 (36.8)
Secondary	58 (21.5)	17 (29.3)
Diploma and above	34 (12.6)	8 (23.5)
Occupation
Employed	32 (11.9)	7 (21.9)
Merchant	31 (11.5)	17 (54.8)
Housewife	50 (18.5)	15 (30)
Daily laborer	32 (11.9)	9 (28.1)
Farmer	45 (16.7)	23 (51.1)
Others	80 (29.6)	24 (35.2)
Patient referral
Referred	170 (63)	72 (42.4)
Not referred	100 (37)	23 (23)
Site of infection
UTI	101 (37.4)	33 (32.7)
BSI	91 (33.7)	30 (33)
WI	44 (16.3)	16 (36.9)
LRTI	34 (12.6)	16 (47.1)
Total	270 (100)	95 (35.2)

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; WI, wound infection; LRTI, lower respiratory tract infection.

Figure 1 Prevalence of ESBL and carbapenemase producing Gram-negative bacilli infections.

Table 2 Isolation Rate of Bacterial Species Among Patients in the ICU

Clinical Samples	E. coli N (%)	K. pneumoniae N (%)	P. aeruginosa N (%)	Acinetobacter spp. N (%)	Citrobacter spp. N (%)	P. mirabilis N (%)	E. cloacae N (%)	Salmonella spp. N (%)	Serratia spp. N (%)	Providencia spp. N(%)
Wound (n = 16)	2 (12.5)	3 (18.8)	6 (37.5)	3 (18.8)	0	0	1 (6.3)	0	1 (6.3)	0
Urine (n = 33)	15 (45.5)	10 (30.3)	2 (6.1)	1 (3)	1 (3)	2 (6.1)	1 (3)	0	0	1 (3)
Blood (n = 30)	6 (20)	9 (30)	1 (3.3)	5 (16.7)	2 (6.7)	0	3 (10)	2 (6.7)	1 (3.3)	1 (3.3)
Sputum (n = 16)	2 (12.5)	7 (43.8)	2 (12.5)	4 (25)	0	0	1 (6.3)	0	0	0
Total (n = 95)	25 (26.3)	29 (30.5)	11 (11.6)	13 (13.7)	3 (3.2)	2 (2.1)	6 (6.3)	2 (2.1)	2 (2.1)	2 (2.1)

Table 3 Distribution of ESBL and CP Among Bacterial Isolates of Clinical Specimens at ICU

Bacterial Species	Blood (n = 30)		Urine (n = 33)		Wound (n = 16)		Sputum (n = 16)		Total ESBL N (%)	Total CP N (%)
	ESBL N (%)	CP N (%)	ESBL N (%)	CP N (%)	ESBL N (%)	CP N (%)	ESBL N (%)	CP N (%)
E. coli (n = 25)	3 (30)	0	11 (33.3)	1 (3)	1 (6.3)	0	1 (6.3)	1 (6.3)	16 (64)	2 (8)
K. pneumoniae (n = 29)	7 (70)	3 (30)	8 (24.2)	3 (9.1)	3 (18.8)	1(6.3)	6(37.5)	1 (6.3)	24 (82.8)	8 (27.6)
P. aeruginosa (n = 11)	1 (10)	0	2 (6.1)	1 (3)	6 (37.5)	1(6.3)	2(12.5)	0	11 (100)	2 (18.2)
Acinetobacter spp. (n = 13)	2 (20)	0	0	0	2(12.5)	0	2(12.5)	0	6 (46.2)	0
Citrobacter (n =3)	1 (10)	0	1 (3)	0	0	0	0	0	2 (66.7)	0
P. mirabilis (n=2)	0	0	0	0	0	0	0	0	0	0
E. cloacae (n=6)	2 (20)	1(10)	1 (3)	0	1 (6.3)	1 (6.3)	1 (6.3)	0	6 (100)	2 (33.3)
Salmonella spp. (n=2)	1 (10)	1(10)	0	0	0	0	0	0	1 (50)	0
Serratia spp. (n=2)	0	0	0	0	0	0	0	0	0	0
Providencia spp. (n=2)	0	0	1 (3)	0	0	0	0	0	1 (50)	0
Total (n = 95)	17 (56.6)	4 (40)	24 (72.7)	5 (15.2)	13 (81.3)	3 (18.8)	12 (75)	2 (12.5)	67 (70.5)	14 (14.7)

Abbreviations: ICU, intensive care unit; ESBL, extended-spectrum beta-lactamase; CP, carbapenemase.

Table 4 Antimicrobial Resistance Profiles of Bacterial Species Among Patients at the ICU

GNB Isolates (n)	Antibiotics Tested
	AMP	PIP	CRX	CAZ	CTX	CRO	CEP	CN	CIP	F	SXT	TET	AMC	MRO	IMP
	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)	R (%)
K. pneumoniae (n = 29)	29 (100)	29 (100)	27(93.1)	27 (93.1)	26(89.7)	26 (86.2)	21 (72.4)	26 (62.1)	20(68.9)	26(89.7)	26 (89.6)	29(100)	26(89.7)	8(27.6)	7 (24.1)
E. coli (n = 25)	25 (100)	25 (100)	19 (76)	17 (68)	15 (60)	16 (60)	13 (52%)	18 (72)	10 (40)	15 (60)	15 (60)	25(100)	15(60)	4(12)	2 (8)
P. aeruginosa (n = 11)	11 (100)	11 (100)	11 (100)	11 (100)	11 (100)	11 (100)	10 (90.9)	11 (100)	5 (45.5)	10(90.9)	11 (100)	11(100)	11(100)	2(18.2)	3 (27.3)
Acinetobacter spp. (n = 13)	13 (100)	13 (100)	13 (100)	10 (76.9)	11 (100)	8 (61.6)	5 (38.5%)	8 (61.5)	11(84.7)	12(92.4)	12(92.3)	13(100)	9(69.2)	4(30.8)	2 (15.4)
Citrobacter spp.(n = 3)	3	3	2	2	2	2	2	2	0	2	3	3	3	0	0
E. cloacae (n = 6)	6 (100)	5 (83.3)	6 (100)	6 (100)	6 (100)	5 (83.3)	3 (50)	5 (83.3)	2 (33.3)	5 (83.3)	5 (100)	6 (100)	6 (100)	2 (33.3)	2 (33.3)
P. mirabilis (n = 2)	2	0	0	0	0	0	0	0	0	0	0	2	0	0	0
Salmonella spp. (n =2)	2	2	0	0	0	0	0	2	0	0	1	2	0	0	0
Serratia spp.(n = 2)	2	1	0	0	0	0	0	0	0	0	0	2	0	0	0
Providencia spp.(n =2)	2	1	1	1	1	1	1	1	1	1	1	2	1	0	0
Total (n = 95)	95 (100)	90 (94.7)	79 (83.2)	74 (77.9)	72 (75.8)	69 (72.6)	55 (57.9)	73 (76.8)	49 (51.6)	71 (74.7)	74 (77.9)	95 (100)	71 (74.7)	20 (21.1)	16 (16.8)

Abbreviations: AMC, amoxicillin-clavulanic acid; Amp, ampicillin; CAZ, ceftazidime; CEP, cefepime; CRO, ceftriaxone; CRX, cefuroxime; CTX, cefotaxime; F, nitrofurantoin; CN, gentamicin; IMP, imipenem; MER, meropenem; PIP, piperacillin; SXT, trimethoprim-sulfamethoxazole; TET, tetracycline; CIP, ciprofloxacin; GNB, Gram-negative bacilli; n, total number; R%, percent of bacterial isolates resistant to antimicrobial agents.

Figure 2 MDR profile among bacterial isolates from intensive care units.

Abbreviation: MDR, multi-drug resistance.

Table 5 Bivariable and Multivariable Analysis of Factors Associated with β-Lactamase Producing GNB Infection Among Patients in the Intensive Care Units

Variables	ESBL Producing GNB Infection		COR (95% CI)	P-value	AOR (95% CI)	P. value
	Positive	Negative
Sex
Male	34	113	1
Female	33	90	0.821(0.47–1.43)	0.484	NA	NA
Age (years)
≤ 15	10	44	2.316 (1.02 −5.24)	0.044	0.3 (0.002–0.48)	0.13
16–30	7	19	1		0.21 (0.3 −1.58)	0.13
31–45	11	48	1.429 (0.54–3.77)	0.47	0.29 (0.056 −1.52)	0.15
46–60	9	35	2.297 (1.04–5.06)	0.04	0.58 (0.18 −1.87)	0.36
> 60	30	57	2.049 (0.87–4.816)	0.10	0.81(0.25–2.55)	0.72
Marital status
Single	18	81	4.76 (−2.06)	< 0.001	1.6 (0.5–5.18)	0.49
Married	31	105	1		1
Divorced	18	17	3.58 (1.65–7.78)	0.001	2.9 (1.1–7.64)	0.02
Residence
Urban	22	110	1
Rural	45	93	0.41 (0.23–0.74)	0.003	0.55 (0.26–1.18)	0.12
History of admission for the last 12 months
Yes	37	33	0.15 (0.09–0.89)	< 0.001	5.5 (2.63–11.46)	< 0.001
No	30	170	1
History of antibiotic use
Yes	42	72	3.18 (1.78–5.67)	< 0.001	0.51 (0.6–4.32)	0.538
No	24	131	1
Hospital visit for the last 3 months
Yes	43	71	3.3(1.8–5.9)	< 0.001	1.7 (0.58–4.96)	0.329
No	24	132	1
Patients on antibiotic treatment
Yes	66	191	4.14 (0.52–32.5)	0.17	5.2 (0.31–85)	0.247
No	1	12
History of antibiotic interruption
Yes	48	90	0.31 (0.17–0.57)	< 0.001	0.92 (0.28–2.9)	0.892
No	19	113	1
Patients’ ICU ward
Medical ICU	8	24	0.29 (0.07–1.2)	0.09
Surgical ICU	56	148	0.25 (0.08–0.87)	0.03	6.69 (1.20–36.5)	0.03
Neonatal ICU	3	31		1
Patient has diarrhea
Yes	28	39	3.02(1.6–5.4)	< 0.01	1.89 (0.79–4.37)	0.14
No	39	164	1
Patient was referred
Yes	50	120	0.5 (0.26–0.9)	0.024	0.9 (0.37–2.36)	0.897
No	17	83	1
ICU room cleanliness
Yes	48	168	1.9 (0.9–3.6)	0.05	0.79 (0.32–1.93)	0.79
No	19	35	1
ICU room with ventilation
Yes	38	124	1.2 (0.68–2.09)	0.52	NA	NA
No	29	79
Hand hygiene practices
Yes	61	196	2.7 (0.89–8.5)	0.07	0.43 (0.08–2.09)	0.29
No	6	7
Patient with supportive medical care devices
Yes	53	201	26.5 (5.85–120.43)	< 0.001	23.7 (4.6–12)	< 0.001
No	14	2
Patient was under mechanical ventilation
Yes	9	33	1.2 (0.56–2.77)	0.58	NA	NA
No	58	170
Patient has supra pubic catheter
Yes	43	156	1.8 (1.02–3.36)	0.04	0.44 (0.17–1.14)	0.09
No	24	47
Patient has urethral catheter
Yes	59	190	1.98 (0.78–5.01)	0.149	0.7(0.17–2.7)	0.614
No	8	13
Patient has intravenous catheter
Yes	52	161	1.19 (0.60–2.33)	0.61	NA	NA
No	15	39
Patient has arterial IV catheter
Yes	28	118	2 (1.1–3.5)	0.015	2.7 (1.3–5.3)	0.002
No	39	82

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio; ESBL, extended-spectrum beta-lactamase; GNB, Gram-negative bacilli, ICU, intensive care unit; IV, intravenous; NA, not applicable; 1, reference category.