Investigation of Extended-Spectrum β-Lactamase and Carbapenemase Producing Gram-Negative Bacilli in Rectal Swabs Collected from Neonates and Their Associated Factors in Neonatal Intensive Care Units of Southern Ethiopia

Figures & data

Table 1 Socio-Demographic Characteristic of Study Participant in the NICU

Variables	Category	ESβL-PGNB Carrier		Total N = 212 (%)
		-ve N (%)	+ve N (%)
Sex	Male	87(67.4)	42(32.6)	129(60.8)
	Female	53(63.9)	30(36.1)	83(39.2)
Gestational age group (weeks)	<32	6(35.3)	11(64.7)	17(8.0)
	32–36	28 (58.3)	20(41.7)	48(22.6)
	>36	106(72.1)	41(27.9)	147(69.3)
Birth weight (g)	<2500	47(56)	37(44)	84(39.6)
	>2500	93(72.7)	35(27.3)	128(60.4)
Age at admission (days)	0–2	98(64.5)	54(35.5)	152(71.7)
	3–28	42(69.1)	18(30.5)	60(28.3)
Birth place	Hospital	99(63.5)	57(36.5)	156(73.6)
	Health center	41(73.2)	15(26.8)	56(26.4)
Type of delivery	NVD	101(64.3)	56(35.7)	157(74.0)
	CSD	39(70.9)	16(29.1)	55(26)
Types of feeding at admission	Breast feeding	72(70.6)	30(29.4)	102(48.1)
	Formula milk	25(74.1)	10(28.6)	35(16.5)
	No feeding	43(57.3)	32(42.7)	75(35.4)

Abbreviations: NVD, normal vaginal delivery; CSD, cesarean section delivery; -ve, negative; +ve, positive; ESβL-PGNB, extended spectrum β-lactamase producing gram negative bacilli; NICU, neonatal intensive care unit.

Table 2 Clinical Characteristics of Neonates Hospitalized in the NICU

Variables and Category			ESβL-PGNB Carrier		Total N = 212(%)
			-ve: N (%)	+ve: N (%)
Reason for hospitalization	Prematurity	Yes	30(48.4)	32(51.6)	62(29.2)
		No	110(73.3	40(26.7)	150(70.8)
	Respiratory distress	Ye	65(62.5)	39(37.5)	104(49.1)
		No	75(69.4)	33(30.6)	108(50.9)
	Neonatal infections	Ye	130(66.3)	66(33.7)	196(92.5)
		No	10(62.5)	6(37.5)	16(7.5)
	Surgical pathology	Ye	4(44.4)	5(55.6)	9(4.2)
		No	136(67.0)	67(33.0)	203(95.8)
	Birth defect	Yes	7(50)	7(50)	14(6.6)
		No	133(67.2)	65(32.8)	198(93.4)
	Hypothermia	Yes	26(49.1)	27(50.9)	53(25)
		No	114(71.7)	45(28.3)	159(75)
Exposure to invasive device	Parenteral nutrition	Yes	63(54.8)	52(44.3)	115(54.2)
		No	77(79.4)	20(20.6)	97(45.8)
	Venous catheter	Yes	135(66.2)	69(33.8)	204(96.2)
		No	5(62.5)	3(37.5)	8(3.8)
	CPAP	Yes	79(62.7)	47(37.3)	126(59.4)
		No	61(70.9)	25(29.1)	86(40.6)
	Endotracheal intubation	Yes	27(42.9)	36(57.1	63(32)
		No	113(75.8)	36(24.5)	149(70.3)
Antibiotic treatment status after admitted	Treated with antibiotics	Yes	136(66.0)	70(34.0)	206(97.2)
		No	4(66.7)	2(33.3)	6(2.8)
	Ampicillin +Gentamycin	Yes	74(56.5)	57(43.5)	131(61.8)
		No	66(81.5)	15(18.5)	81(38.2)
	3rd-G Cephalosporin + Gentamycin	Yes	16(66.7)	8(33.3)	24(11.3)
		No	124 (66)	64(34)	188(88.7)
Length of NICU stay and duration of antibiotic use	Duration of antibiotic use (days) during hospitalization	0	4(66.7)	2(33.3)	6(2.8)
		1–5	29(76.3)	9(23.7)	38(18)
		6–10	70(71.4)	28(28.6)	98(46.2)
		>10	37(52.9)	33(47.1)	70(33)
	Length of stay in NICU	1–10	85(77.3)	25(22.7)	110(51.9)
		11–20	48(56.5)	37(43.5)	85(40.1)
		>20	7(41.2)	10(58.8)	17(8)

Abbreviations: CPAP, continuous positive airway pressure; CSD, cesarean section delivery; -ve, negative; +ve, positive; ESβL-PGNB, extended spectrum β-lactamase producing gram negative bacilli; NICU, neonatal intensive care unit.

Figure 1 Frequency of ESβL-producing gram negative bacilli (K. pneumonia is the leading ESβL producing gram-negative bacteria).

Table 3 Types of Gram-Negative Bacilli Isolated from Hospitalized Neonates

S. No	Types of Isolated Bacteria	Frequency	Percentage
1	Klebsiella pneumonia	74	30.8
2	Escherichia coli	66	27.5
3	Klebsiella oxytoca	46	19.2
4	Morganella morganii	15	6.3
5	Pseudomonas aeruginosa	6	2.5
6	Citrobacter species	17	7.1
7	Enterobacter species	10	4.1
8	Proteus species	6	2.5
	Total	240	100

Table 4 Prevalence and Association of ESβL-Producing Gram-Negative Bacilli Carriage Rate with Demographic and Clinical Factors Among Hospitalized Neonates

Variables and Category	ESβL + N(%)	Bivariate		Multivariate
		OR (95%, CI)	P-value	AOR (95%, CI)	P-value
Gestational age (weeks)
<32	11(64.7)	4.7(1.6–13.7)	0.004	0.8(0.9–6.5)	0.805
32–36	20(41.7)	1.8(0.938–3.6)	0.076	0.6(0.9–4.2)	0.621
>36	41(27.9)	1		1
Birth weight (g)
<2500	37(44)	2.1(1.2–3.7)	0.013	1.8(0.66.0)	0.308
>2500	35(27.3)	1		1
Birth place
Hospital	57(36.5)	1.6(0.8–3.1)	0.188	0.8(0.35–1.9)	0.686
Health center	15(26.8)	1		1
Types of feeding
Breast feeding	30(29.4)	0.6(0.3–1.0)	0.069	2(0.7–5.6)	0.173
Formula milk	10(28.6)	0.5(0.23–1.3)	0.159	1.7(0.5–5.9)	0.399
No feeding	32(42.7)	1		1
Prematurity
Yes	32(51.6)	2.9(1.6–5.4)	0.000	1(0.2–5.9)	0.933
No	40(26.7)	1		1
Surgical intervention
Yes	5(55.6)	2.5(0.7–9.7)	0.175	4(0.7–33.2)	0.101
No	67(33.0)	1		1
Birth defect
Yes	7(50)	2(0.7–6.0)	0.197	0.8(0.2–4.6)	0.887
No	65(32.8)	1		1
Hypothermia
Yes	27(50.9)	2.6(1.4–5.0)	0.003	1.5(0.6–3.7)	0.293
No	45(28.3)	1		1
Parenteral nutrition
Yes	52(44.3)	3.2(1.7–5.9)	0.000	2(0.8–5.5)	0.138
No	20(20.6)	1		1
CPAP
Yes	47(37.3)	1.5(0.8–2.6)	0.215	0.6(0.3–1.4)	0.283
No	25(29.1)	1		1
Endotracheal intubation
Yes	36(57.1	4.2(2.2–7.8)	0.000	4.2(1.8–9.5)	0.001
No	36(24.5)	1
Treated with AMP+GENT
Yes	57(43.5)	3.4(1.6–6.5)	0.000	3.3(1.5–7.6)	0.004
No	15(18.5)	1
Length of stay in NICU
1–10	25(22.7)	1		1
11–20	37(43.5)	2.6(1.4–4.8)	0.002	2(1.0–4.5)	0.042
>20	10(58.8)	4.9(1.7–14.0)	0. 004	1.9(0.5–6.8)	0.350

Abbreviations: CPAP, continuous positive airway pressure; AMP, ampicillin; GENT, gentamicin; OR, odds ratio; AOR, adjusted odds ratio; NICU, neonatal intensive care unit.

Table 5 Antimicrobial Resistance Patterns of ESβL-Producing Gram-Negative Bacilli Among Hospitalized Neonates

Bacteria	No. (%) of Resistant Isolates Respective to Each Antibiotics
	AMC	AUG	GEN	AMK	TE	NAL	CIP	SXT	CRN	MER
K. pneumoniae (n=23)	23(100)	23(100)	23(100)	0 (0)	20(87)	6(26.1)	15(65.2)	19(82.6)	14(60.6)	2(8.7%)
E. coli (n=17)	17(100)	16(94)	11(64.7)	2(11.8)	11(64.7)	2(11.8)	7(41.2)	7(41.2)	8(47.1)	2(11.8)
K. oxytoca (n=14)	14(100)	12(85.7)	13(93)	0 (0)	13(93)	3(21.4)	8(57.1)	8(57.1)	10(71.4)	2(14.3)
Enterobacter spps (n=6)	6(100)	4(100)	4(66.7)	1(16.7)	4(66.7)	3(50)	2(33.3)	5(83.3)	2(33.3)	0(0)
Citrobacter spps (n=4)	4(100)	4(100)	1(25)	1(25)	1(25)	1(25)	2 (50)	1(25)	2 (50)	1(25)
M. morganii (n=3)	3(100)	3(100)	2(66.7)	0 (0)	1(33.3)	1(33.3)	2(66.7)	2(66.7)	1(33.3)	1(33.3)
Proteus spps (n=3)	3(100)	3(100)	1(33.3)	0 (0)	2(66.7)	0 (0)	0 (0)	1(33.3)	2(66.7)	0(0)
P. aeruginosa (n=2)	2(100)	2(100)	2(100)	1(50)	1(50)	0 (0)	1(50)	2(100)	2(100)	0(0)
Total (n=72)	72(100)	69(95.8)	57(79.2)	5(6.9)	53(73.6)	16(22)	37(51.4)	45(62.5)	41(56.9)	8(11)

Abbreviations: AMC, ampicillin; AUG, augmentin; GEN, gentamycin; AMK, amikacin; TE, tetracycline; NAL, nalidixic acid; CIP, ciprofloxacin; SXT, trimethoprim- sulfamethoxazole; CR, chloramphenicol; MER, meropenem.

Table 6 Multidrug Resistance Patterns of ESβL Producing Gram-Negative Bacilli Among Hospitalized Neonates

Bacteria	Multiple Antibiotics Resistance						Total
	R0	R1	R2	R3	R4	R5 and Above
K. pneumonia	0	0	1	2	1	19	23
E. coli	0	1	0	3	3	10	17
K. oxytoca	0	1	2	1	1	9	14
M. morganii	0	0	0	1	0	2	3
P. aeruginosa	0	0	0	0	0	2	2
Citrobacter spp	0	2	2	0	0	3	6
Enterobacter spp	0	0	1	0	2	1	4
Proteus spps	0	0	0	1	0	2	3
Total	0	3	6	8	7	48	72

Notes: R0, bacterial isolates sensitive to all antibiotics; R1, resistant against one class of antibiotics; R2, resistant against two classes; R3, resistant against three classes; R4, resistant against four classes and R5; resistant against five classes and above of antibiotics.