Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamase-Producing Clinical Isolates of and in Two Kenyan Facilities: A National Referral and a Level Five Hospital

Overview

Journal Int J Microbiol

Publisher Wiley

Specialty Microbiology

Date 2024 Feb 22

PMID 38384586

Authors

Sylvia M Maveke

Gabriel O Aboge

Laetitia W Kanja

Alfred O Mainga

Naftaly Gachau

Beatrice W Muchira

Gervason A Moriasi

Affiliations

Soon will be listed here.

Abstract

Background: The emergence of antimicrobial resistance (AMR) and multidrug resistance (MDR) among and , especially through the production of extended spectrum -lactamases (ESBLs), limits therapeutic options and poses a significant public health threat.

Objective: The aim of this study was to assess the phenotypic and genetic determinants of antimicrobial resistance of ESBL-producing and isolates from patient samples in two Kenyan Hospitals.

Methods: We collected 138 and 127 isolates from various clinical specimens at the two health facilities from January 2020 to February 2021. The isolates' ESBL production and antibiotic susceptibility were phenotypically confirmed using a standard procedure. Molecular analysis was done through conventional polymerase chain reaction (PCR) with appropriate primers for A, B, , , , , , , and genes, sequencing and BLASTn analysis.

Results: Most (82.6%) and (92.9%) isolates were ESBL producers, with the highest resistance was against ceftriaxone (69.6% among and 91.3% among ) and amoxicillin/clavulanic acid (70.9% among ). The frequency of MDR was 39.9% among and 13.4% among isolates. The commonest MDR phenotypes among the isolates were CRO-FEP-AZM-LVX and CRO-AZM-LVX, while the FOX-CRO-AMC-MI-TGC-FM, FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI and CRO-AMC-TZP-AZM-MI were the most frequent among isolates. Notably, the FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI phenotype was observed in ESBL-positive and ESBL-negative isolates. The most frequent ESBL genes were (42%), (40.6%), and (36.2%) among , and (89%), (82.7%), (76.4%), and (72.5%) were most frequent ESBL genes among isolates. The and and genotypes were predominantly associated with FOX-CRO-FEP-MEM and CRO-FEP multidrug resistance (MDR) and CRO antimicrobial resistance (AMR) phenotypes, among isolates from Embu Level V (16.7%) and Kenyatta National Hospital (7.0%), respectively.

Conclusions: The high proportion of ESBL-producing and isolates increases the utilization of last-resort antibiotics, jeopardizing antimicrobial chemotherapy. Furthermore, the antimicrobial resistance patterns exhibited towards extended-spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, fluoroquinolones, and macrolides show the risk of co-resistance associated with ESBL-producing isolates responsible for MDR. Hence, there is a need for regular surveillance and implementation of infection prevention and control strategies and antimicrobial stewardship programs.

Citing Articles

Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamase-Producing Clinical Isolates of and in Two Kenyan Facilities: A National Referral and a Level Five Hospital.

Maveke S, Aboge G, Kanja L, Mainga A, Gachau N, Muchira B Int J Microbiol. 2024; 2024:7463899.

PMID: 38384586 PMC: 10881238. DOI: 10.1155/2024/7463899.

References

. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022; 400(10369):2221-2248. PMC: 9763654. DOI: 10.1016/S0140-6736(22)02185-7. View

Isgren C, Williams N, Fletcher O, Timofte D, Newton R, Maddox T . Antimicrobial resistance in clinical bacterial isolates from horses in the UK. Equine Vet J. 2021; 54(2):390-414. DOI: 10.1111/evj.13437. View

Jain P, Bepari A, Sen P, Rafe T, Imtiaz R, Hossain M . High prevalence of multiple antibiotic resistance in clinical E. coli isolates from Bangladesh and prediction of molecular resistance determinants using WGS of an XDR isolate. Sci Rep. 2021; 11(1):22859. PMC: 8613203. DOI: 10.1038/s41598-021-02251-w. View

Berhe D, Beyene G, Seyoum B, Gebre M, Haile K, Tsegaye M . Prevalence of antimicrobial resistance and its clinical implications in Ethiopia: a systematic review. Antimicrob Resist Infect Control. 2021; 10(1):168. PMC: 8642948. DOI: 10.1186/s13756-021-00965-0. View

Andrew B, Kagirita A, Bazira J . Prevalence of Extended-Spectrum Beta-Lactamases-Producing Microorganisms in Patients Admitted at KRRH, Southwestern Uganda. Int J Microbiol. 2017; 2017:3183076. PMC: 5320295. DOI: 10.1155/2017/3183076. View

Kettani Halabi M, Azzahra Lahlou F, Diawara I, El Adouzi Y, Marnaoui R, Benmessaoud R . Antibiotic Resistance Pattern of Extended Spectrum Beta Lactamase Producing Isolated From Patients With Urinary Tract Infection in Morocco. Front Cell Infect Microbiol. 2021; 11:720701. PMC: 8418096. DOI: 10.3389/fcimb.2021.720701. View

Hailemariam M, Alemayehu T, Tadesse B, Nigussie N, Agegnehu A, Habtemariam T . Major bacterial isolate and antibiotic resistance from routine clinical samples in Southern Ethiopia. Sci Rep. 2021; 11(1):19710. PMC: 8492677. DOI: 10.1038/s41598-021-99272-2. View

Onduru O, Mkakosya R, Aboud S, Rumisha S . Genetic Determinants of Resistance among ESBL-Producing in Community and Hospital Settings in East, Central, and Southern Africa: A Systematic Review and Meta-Analysis of Prevalence. Can J Infect Dis Med Microbiol. 2021; 2021:5153237. PMC: 8192179. DOI: 10.1155/2021/5153237. View

Dela H, Egyir B, Majekodunmi A, Behene E, Yeboah C, Ackah D . Diarrhoeagenic E. coli occurrence and antimicrobial resistance of Extended Spectrum Beta-Lactamases isolated from diarrhoea patients attending health facilities in Accra, Ghana. PLoS One. 2022; 17(5):e0268991. PMC: 9135277. DOI: 10.1371/journal.pone.0268991. View

10.

Rodriguez-Bano J, Gutierrez-Gutierrez B, Machuca I, Pascual A . Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae. Clin Microbiol Rev. 2018; 31(2). PMC: 5967687. DOI: 10.1128/CMR.00079-17. View

11.

Apondi O, Oduor O, Gye B, Kipkoech M . HIGH PREVALENCE OF MULTI-DRUG RESISTANT IN A TERTIARY TEACHING HOSPITAL IN WESTERN KENYA. Afr J Infect Dis. 2017; 10(2):89-95. PMC: 5411993. DOI: 10.21010/ajid.v10i2.3. View

12.

Karlowsky J, Walkty A, Golden A, Baxter M, Denisuik A, McCracken M . ESBL-positive Escherichia coli and Klebsiella pneumoniae isolates from across Canada: CANWARD surveillance study, 2007-18. J Antimicrob Chemother. 2021; 76(11):2815-2824. DOI: 10.1093/jac/dkab269. View

13.

Dallenne C, da Costa A, Decre D, Favier C, Arlet G . Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae. J Antimicrob Chemother. 2010; 65(3):490-5. DOI: 10.1093/jac/dkp498. View

14.

Lord J, Gikonyo A, Miwa A, Odoi A . Antimicrobial resistance among , , and spp. isolates from clinical specimens from a hospital in Nairobi, Kenya. PeerJ. 2021; 9:e11958. PMC: 8418212. DOI: 10.7717/peerj.11958. View

15.

Pereira J, Volcao L, Baracy Klafke G, Vieira R, Goncalves C, Ramis I . Antimicrobial Resistance and Molecular Characterization of Extended-Spectrum β-Lactamases of Escherichia coli and Klebsiella spp. Isolates from Urinary Tract Infections in Southern Brazil. Microb Drug Resist. 2018; 25(2):173-181. PMC: 6441284. DOI: 10.1089/mdr.2018.0046. View

16.

Khalifa S, El-Aziz A, Hassan R, Abdelmegeed E . β-lactam resistance associated with β-lactamase production and porin alteration in clinical isolates of E. coli and K. pneumoniae. PLoS One. 2021; 16(5):e0251594. PMC: 8136739. DOI: 10.1371/journal.pone.0251594. View

17.

Sonda T, Kumburu H, van Zwetselaar M, Alifrangis M, Mmbaga B, Lund O . Molecular epidemiology of virulence and antimicrobial resistance determinants in Klebsiella pneumoniae from hospitalised patients in Kilimanjaro, Tanzania. Eur J Clin Microbiol Infect Dis. 2018; 37(10):1901-1914. DOI: 10.1007/s10096-018-3324-5. View

18.

Sharahi J, Hashemi A, Ardebili A, Davoudabadi S . Molecular characteristics of antibiotic-resistant Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran. Ann Clin Microbiol Antimicrob. 2021; 20(1):32. PMC: 8077724. DOI: 10.1186/s12941-021-00437-8. View

19.

Elton L, Thomason M, Tembo J, Velavan T, Pallerla S, Arruda L . Antimicrobial resistance preparedness in sub-Saharan African countries. Antimicrob Resist Infect Control. 2020; 9(1):145. PMC: 7456056. DOI: 10.1186/s13756-020-00800-y. View

20.

Holmes D, Quigley M . A rapid boiling method for the preparation of bacterial plasmids. Anal Biochem. 1981; 114(1):193-7. DOI: 10.1016/0003-2697(81)90473-5. View