Prevalence of Esbl-Producing Enterobacteriaceae Strains Isolated to the University Hospital Center of N djamena and their Sensitivity to Antibiotics

Research Article

J Bacteriol Mycol. 2023; 10(2): 1208.

Prevalence of Esbl-Producing Enterobacteriaceae Strains Isolated to the University Hospital Center of N’djamena and their Sensitivity to Antibiotics

Hamadou A1-4*; Ban-bo BA2; Traore AK3; Kadidja G4; Nikiema EM3; Mahamat SM1; Ouoba BJ3; Evariste Bako3; Bouda SC3; Nadlou B4,5; Barro N3

1Faculty of Health Sciences, Adam Barka University of Abeche, Chad

2Biology Laboratory of the Faculty of Exact and Applied Sciences, University of N’Djamena, Chad

3Laboratory of Molecular Biology, Epidemiology and Surveillance of Bacteria and Viruses Transmissible by Water and Food, Joseph Ki-ZERBO University, 03 BP 7021, Ouagadougou 03, Burkina Faso, Chad

4National Reference University Hospital Center of N’Djamena, Chad

5Faculty of Human Health Sciences of N’Djamena, Chad

*Corresponding author: Hamadou A Department of Basic Biomedical and Pharmaceutical Sciences, Adam Barka University of Abeche, Chad. Tél: 00235 66785932 Email: hamadouabba@gmail.com

Received: July 05, 2023 Accepted: August 08, 2023 Published: August 15, 2023

Abstract

Introduction: The resistance of Enterobacteriaceae to antibiotics is experiencing a worrying worldwide evolution with a growing impact in the community and medical sector. The difficulties encountered in hospitals in treating certain infections resulting from multi-resistant bacteria are a source of great concern in human health. The aim of this study was to determine the prevalence, diversity and antibiotic resistance of Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae in the hospital setting.

Materials and Methods: A total of 830 specimens from hospitalized and outpatients including 341 stools, 257 urine and 232 pus were collected between August 2017 and February 2019. Enterobacteriaceae were identified using the Api 20E gallery and the VITEK® 2TM 15 compact automaton. E. coli and Salmonella serotyping were performed by serum agglutination using the Latex Test Kil and the Kauffmann-White Kit, respectively. Sensitivity tests according to the Antibiogram Committee of the French Society of Microbiology and double disc synergy to detect ESBLs have been carried out.

Results: Out of the 830 specimens, 181 (21%) strains were isolated at the N’Djamena National Reference University Hospital between August 2017 and February 2019. 56 strains produced ESBLs, i.e. a prevalence of 30.9% (56/181). Escherichia coli was more common (74%), followed by Klebsiella pneumoniae (6.6%), Proteus spp (14.9%), Salmonella (2.8%) and Shigella (1.7%) (p<0,05). These germs were isolated from urine at 47%, pus at 38% and stool at 15%. Resistance with E. coli was respectively 60.8% and 50% for imipenem and amoxicillin + clavulanic acid. Regarding Klebsiella pneumoniae, these rates were 70% and 55% respectively. Salmonella showed resistance to ciprofloxacin (80%), gentamicin (80%) and ceftriaxone (60%). E. coli, Klebsiella pneumoniae have been the most implicated with strong resistance to the majority of antibiotics.

Conclusion: This study highlighted the diversity of enterobacteria causing diarrhea and the emergence of multi-resistant bacteria. It helps to update knowledge for better patient care.

Keywords: Enterobacteriaceae; Multiresistant; ESBLs; Hospitol; Tchad

Introduction

The resistance of Enterobacteriaceae to antibiotics is experiencing a worrying worldwide evolution with a growing impact in the community and medical sector. The number of Enterobacteriaceae producing Extended-Spectrum Beta-Lactamases (ESBL) has recently increased worldwide [1]. The resistance of Enterobacteriaceae to antibiotics is observed all over the world, but to varying degrees depending on the country and the services, depending on prescription habits and hygiene practices. It is experiencing a worrying global evolution with a growing impact in the community environment [2,3].

The emergence of these resistant germs has upset not only the epidemiological profile of infections but also the resulting treatment regimens [4]. This situation gives rise to a great deal of reflection which should lead to preventive measures in order to control the repercussions on public health. The characterization of multi-resistant germs in the hospital is one of the quality indicators for healthcare establishments. The aim of this study was to determine the prevalence, diversity and antibiotic resistance of extended-spectrum beta-lactamase -producing (ESBLs) Enterobacteriaceae in hospitals in Chad.

Materials and Methods

Sample Collection

A total of 830 clinical samples (urine, pus and stool) were collected in sterile universal vials taken from patients sent to the Bacteriology laboratory of the national reference of N'djamena university hospital center. All samples were immediately transported to the laboratory for processing.

Isolation and Identification of Enterobacteriaceae Strains

The bacterial strains were isolated at the national reference of N'djamena university hospital center following the methods in force in the center. After the Gram staining of the suspicious colonies, a subculture on Muller Hinton (MH) was carried out and the identification of the strains is carried out by the API 20E gallery (Bio Mérieux, France) and the VITEK® 2TM 15 compact automatons.

The study of the sensitivity to antibiotics of the strains of enterobacteria isolated was carried out on antibiogram by the method of diffusion of the discs in agar medium. The interpretation of the strain profiles was made according to the recommendations of the antibiogram committee of the French society of microbiology. The search for extended spectrum Β-lactamase (ESBL) class A secretion was carried out by the double disc synergy test (synergy between an Amoxicillin + Clavulanic acid (AMC) disc and the 3rd grade Cephalosporin discs (C3G). Serotyping of E. coli, Shigella and Salmonella spp strains was performed by serum agglutination using the Latex Test Kil, Research Shigella sera, BIO-RAD and the Kauffmann-White Kit respectively for serogroups.

The isolated strains were stored at -20°C in brain heart broth (BCC) (BIO-RAD) with 20% glycerol following the guidelines of the National Committee on Characterizations of Clinical Laboratory Standards and Centers for Disease Control for future research.

Data Management and Analysis

Data analysis was performed using Microsoft Excel 2016 and Statistical Software for the Social Sciences (SPSS™) version 20.0 (IBM, Armonk, NY, USA) and presented as percentage of baseline distribution. Data with a p-value less than 0.05 (95% CI) were considered significant.

Results and Discussion

During the study period, 830 samples were taken and cultured in the laboratory bacteriology unit of the national reference of N'djamena university hospital center, including 257 (31%) urine, 232 (28%) various pus and 341 (41%) stools.

Prevalence of Isolated Enterobacteriaceae

The analysis of the cases shows out of the 830 samples taken, 181 strains of Enterobacteriaceae were isolated and identified, i.e. a prevalence of 21.8%.

Table 1 shows the distribution of Enterobacteriaceae strains isolated according to the type of sample. The species Escherichia coli dominated the etiology of the infections with a rate of 74% (n=134) of all the Enterobacteriaceae isolated, followed by Proteus spp (14.9%), Klebsiella (6.6%), Salmonella (2.8%) and Shigilla (1.7%). These respective prevalence rates vary significantly (p<0.05) depending on the origin of the samples. In addition, Escherichia coli was observed in the urine, various pus and stool samples respectively with a proportion of 38.7%, 24.9% and 10.5%. Proteus spp and Shigella dysenteriae were only observed in urine (6.6%) and stool (2.2%) samples. While Salmonella spp was observed in urine (0.6%) and stool (1.7%) samples respectively [5] (WHO, 2018). In addition, these enterobacteriaceae were isolated from urine, various pus and stool with a proportion of 47%, 38% and 15% respectively. Similar Enterobacteriaceae prevalence levels in hospital settings were also observed by Nadlou et al. [6,7], respectively in the refugee camps and the National General Hospital of N'Djamena in Chad. However, our results are lower than those observed in Chad (62.9%) by ouchar. et al. (2019) [8]. This difference could be explained by the period and the number of study sites. Indeed ouchar et al. [8] had worked in three hospitals in the city of N’Djamena.