Epidemiology of extended-spectrum β-lactamase producing Escherichia coli from hospital settings in Yemen

Abstract

Introduction: Infection with Extended spectrum β-lactamases (ESBLs) producing bacteria is considered as serious health problem worldwide. The aim of this cross-sectional study was to investigate the prevalence of ESBL producing Escherichia coli in hospitalized patients and the risk factors contributed for its nosocomial infections in addition to the antibiotics susceptibility patterns of isolates from 130 inpatients collected in Al Thawra General Hospital and Al-Kuwait University Hospital in Sana'a city.

Methodology: Antibiotic susceptibility testing and confirmation of ESBL production were performed according to the Clinical and Laboratory Standards Institute guidelines.

Results: Out of 130 E. coli isolates, 44 (33.8%) were ESBLs producers, the majority of ESBLs producers were in wound exudates samples (52.2%). The highest significant rates were among the elderly, patients with previous hospitalization, patients who have stayed in hospital more than 22 days, patients who have taken third generation cephalosporins as treatment and diabetic patients. All ESBL-producing isolates were resistant to amoxicillin, trimethoprim-sulfamethoxazole and the third generation cephalosporins (100%). Resistance to other antimicrobial agents among these isolates was: amoxicillin-clavulanic acid (90.9%), nalidixic acid (95.5%), ciprofloxacin (90.9%), ofloxacin (88.6%) and tetracycline (54.5%). The most effective antibiotics in vitro for both types of isolates (ESBL producing and non ESBL producing E. coli) were Imipenem (100%), Amikacin (75%) and (93.0%), respectively, and Pipracillin-tazobactam (68.2%) and (88.4%), respectively.

Conclusion: ESBLs detection tests must be performed as routine work in all hospitals and laboratories. Furthermore, a strict adherence of infection control policies and procedures with continuous antibiotics resistance surveillance are important to prevent nosocomial infections.

Keywords: Escherichia coli; Yemen; extended spectrum β-lactamases.