Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania.
Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania.
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DOI：
10.1186/1756-0500-3-348
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发表时间：
2010-12-24
影响因子：
1.8
通讯作者：
Maselle SY
中科院分区：
文献类型：
--
作者：
Moyo SJ;Aboud S;Kasubi M;Lyamuya EF;Maselle SY
已发表的关于本地尿路病原体中广谱β -内酰胺酶（ESBL）产生的存在和程度的数据有限。本研究的目的是确定某三级医院尿液样本中大肠埃希菌和克雷伯菌的抗微生物药物耐药性和ESBL产生的流行情况。这是在坦桑尼亚达累斯萨拉姆的Muhimbili国家医院进行的一项横断面研究。2010年1月至3月从儿童和成人中分离出的大肠杆菌和克雷伯氏杆菌尿路病原体共270例纳入研究。采用临床与实验室标准研究所的圆盘扩散法检测分离的大肠杆菌和克雷伯氏菌的抗菌药物敏感性。使用头孢噻肟和头孢他啶片进一步筛选这些分离株的ESBL表型。用ESBL e试纸条确认敏感性降低的分离株。270株分离物中，大肠杆菌138株（51.1%）、克雷伯氏菌132株（48.9%），检出ESBL 122株（45.2%）。产ESBL的大肠杆菌对复方新诺明（90.7%）、环丙沙星（46.3%）和萘啶酸（61.6%）的耐药性显著高于不产ESBL的菌株（p < 0.05）。产ESBL的克雷伯氏菌对复方新诺明（92.6%）、环丙沙星（25.0%）、钠地酸（66.2%）和庆大霉素（38.2%）的耐药性显著高于不产ESBL的克雷伯氏菌（P < 0.05）。产株多药耐药率（90.5%）显著高于非产株（68.9%）（P < 0.05）。住院分离株ESBL发生率明显高于门诊分离株[95株（50.5%）比27株（32.9%）]（p = 0.008）。儿童分离株中ESBL的发生率明显高于成人分离株[84例（54.9%）比38例（32.5%）]（p < 0.001）。产esbl的大肠杆菌和克雷伯氏菌菌株在住院患者和儿童中高发。大多数产生ESBL的分离株具有多重耐药性，使得可用的治疗选择有限。我们建议继续进行抗生素监测以及全面的多中心研究，以解决esbl相关感染的新问题，以保持大多数抗菌药物的持续有效性。进一步开展分子研究将有助于评估各种ESBL类型。
Published data on the existence and magnitude of extended spectrum beta-lactamase (ESBL) production in urinary pathogens in local setting is limited. The aim of the present study was to determine the prevalence of antimicrobial resistance and ESBL production among Escherichia coli and Klebsiella spp from urine samples in a tertiary hospital. This was a cross sectional study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 270 E.coli and Klebsiella spp urinary pathogens from children and adults isolated from January to March 2010 were included in the study. E. coli and Klebsiella spp isolates were tested for antimicrobial susceptibility by the Clinical and Laboratory Standard Institute's disc diffusion method. These isolates were further screened for ESBL phenotype using cefotaxime and ceftazidime discs. Isolates with reduced sensitivity were confirmed using ESBL E-test strips. Of 270 isolates, 138 (51.1%) were E. coli and 132 (48.9%) were Klebsiella spp. ESBL was detected in 122 (45.2%) of all the isolates. ESBL- producing E. coli strains were significantly more resistance to cotrimoxazole (90.7%), ciprofloxacin (46.3%) and nalidixic acid (61.6%) than strains that did not produce ESBL (p < 0.05). Similarly, ESBL- producing Klebsiella spp strains were significantly more resistance to cotrimoxazole (92.6%), ciprofloxacin (25.0%), nalidixic acid (66.2%), and gentamicin (38.2%) than strains that did not produce ESBL (P < 0.05). Multi-drug resistance was found to be significantly (P < 0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). The occurrence of ESBL was significantly higher among isolates from inpatients than outpatients [95 (50.5%) vs. 27(32.9%)] (p = 0.008). The occurrence of ESBL was significantly higher among isolates from children than in adults [84 (54.9%) vs. 38(32.5%)] (p < 0.001). High prevalence of ESBL-producing E. coli and Klebsiella spp strains was found among inpatients and children. Most of the ESBL- producing isolates were multi-drug resistant making available therapeutic choices limited. We recommend continued antibiotic surveillance as well comprehensive multi-center studies to address the emerging problem of ESBL-associated infections in order to preserve the continued usefulness of most antimicrobial drugs. Further more conducting molecular studies will help to evaluate the various ESBL types.