Carbapenem-Resistant Enterobacteriaceae among In-Patients of Tertiary Hospitals in Southwest, Nigeria

Ibikunle I. ANIBIJUWON; Ifeoluwa Deborah GBALA; Olusoji O. ADEBISI

doi:10.15835/nsb10310300

Authors

Ibikunle I. ANIBIJUWON University of Ilorin, Faculty of Life Sciences, Department of Microbiology, Ilorin (NG)
Ifeoluwa Deborah GBALA University of Ilorin, Faculty of Life Sciences, Department of Microbiology, Ilorin (NG)
Olusoji O. ADEBISI University of Ilorin, Faculty of Life Sciences, Department of Microbiology, Ilorin (NG)

DOI:

https://doi.org/10.15835/nsb10310300

Keywords:

carbapenem; carbapenem-resistant; enterobacteriaceae; in-patients; multi-drug resistance

Abstract

The study assessed the incidence and risk factor associated with the occurrence of carbapenem-resistant Enterobacteriaceae (CRE) among hospitalized patients at three tertiary hospitals in Southwest, Nigeria. A cross-sectional study was performed over a six-month surveillance period in the locations with a total of 300 blood and urine samples. A structured close-ended questionnaire was also administered to all subjects for review of demographics and potential risk factors. Fifty-nine isolates belonging to genera Escherichia (52.5%), Enterobacter (23.8%), Klebsiella (10.2%) and Proteus (13.6%) were isolated. All the isolates were multi-drug resistant with a notable resistance (100%) to cephalosporins and significant sensitivity to nitrofurantoin. A total of 23 isolates including Escherichia coli (n = 8), Enterobacter aerogenes (n = 9), Klebsiella pneumoniae (n = 1) and Proteus mirabilis (n = 5) exhibited resistance to one or both of imipenem and meropenem. The overall incidence of CRE in the three locations at the time of study was 7.7%. Age (p = 0.01) and exposure to invasive devices were significant risk factors for CRE colonization. Although at low incidence, the occurrence of CRE among this group calls for active monitoring because of its implication fatality of infections as well as the propensity to spread.

Metrics

Metrics Loading ...

References

Albiger B, Glasner C, Struelens M, Grundmann H, Monnet D (2015). The European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE) working group-carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries. Euro Surveillance 20(45):2-8.

Bauer AW, Kirby WMM, Sherris JC, Turk M (1966). Antibiotic susceptibility testing by a standardized single disk method. American Journal Clinical Pathology 45:493-496.

Cai Y, Venkatachalam I, Tee N, Tan T, Kurup A, Wong S, et al., Marimuthu K (2017). Prevalence of healthcare-associated infections and antimicrobial use among adult inpatients in Singapore acute-care hospitals: Results from the first national point prevalence survey. Clinical Infectious Diseases 64:S61-S67.

Castelo-Branco C, Soveral I (2013). The immune system and aging: a review. Gynecological Endocrinology 30(1):16-22.

Clinical and Laboratory Standards Institute (CLSI) (2012). CLSI Document M07-A9.

Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically: approved standard. 19th Edition, CLSI, Wayne.

Clinical and Laboratory Standards Institute (CLSI) (2016). Performance standards for antimicrobial susceptibility testing; Twenty-sixth informational supplement. CLSI document M100-S26. Wayne, PA: Clinical and Laboratory Standards Institute.

Cunha C, Kassakian S, Chan R, Tenover F, Ziakas P, Chapin K, Mermel L (2016). Screening of nursing home residents for colonization with carbapenem-resistant Enterobacteriaceae admitted to acute care hospitals: Incidence and risk factors. American Journal of Infection Control 44(2):126-130.

Demiraslan H, Cevahir F, Berk E, Metan G, Cetin M, Alp E (2017). Is surveillance for colonization of carbapenem-resistant gram negative bacteria important in adult bone marrow transplantation units? American Journal of Infection Control 45(7):735-739.

Ejikeugwu C, Ugwu M, Iroha I, Eze P, Gugu T, Esimone C (2014). Phenotypic detection of Metallo-β-Lactamase (MBL) enzyme in Enugu, Southeast Nigeria. American Journal of Biological, Chemical and Pharmaceutical Sciences 2(2):1-6.

European Centre for Disease and Control (ECDC) (2013). Carbapenemase-producing Enterobacteriaceae in Europe: Interim results from the European survey on carbapenemase-producing Enterobacteriaceae (EUSCAPE) project 2013. Technical Report pp 6-13.

Guh AY, Bulens SN, Mu Y, Jacob JT, Reno J, Scott J, et al., Kallen AJ (2015). Epidemiology of carbapenem-resistant Enterobacteriaceae in 7 US communities, 2012-2013. JAMA 314(14):1479-1487.

Huang S, Liu M, Lin C, Shi Z (2014). Molecular surveillance and clinical outcomes of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae infections. Journal of Microbiology, Immunology and Infection 47(3):187-196.

Jeong HJ, Jund HL, Jae JL, Kwang SP, Asad MK, Chnag-Ro L, Byeong CJ, Sang HL (2015). Structural basis for carbapenem-hydrolyzing mechanisms of carbepenemase conferring antibiotic resistance. International Journal of Molecular Science 16(5):9654-9692.

Lixandru B, Cotar A, Straut M, Usein C, Cristea D, Ciontea S, ... Damian M (2015). Carbapenemase-producing Klebsiella pneumoniae in Romania: A six-month survey. PLoS ONE 10(11):e0143214.

Mohammed Y, Dabo NT, Umar MK (2015). Laboratory evaluation of clinical bacterial isolates for detection of carbapenemase-producing Enterobacteriaceae in Kano, Northwest, Nigeria. International Journal of Tropical Disease and Health 12(3):1-5.

Montecino-Rodriguez E, Berent-Maoz B, Dorshkind K (2013). Causes, consequences, and reversal of immune system aging. The Journal of Clinical Investigation 123(3):958-965.

Motayo PO, Akinduti PA, Adeyakinu FA, Okerentugba PO, Nwanze JC, Onoh CC, Innocent-Adiele HC, Okonko IO (2013). Antibiogram and plasmid profiling of carbapenemase and extended spectrum Beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in Abeokuta, South western, Nigeria. African Health Sciences 13(4):1091-1097.

Oduyebo O, Falayi O, Oshun P, Ettu A (2015). Phenotypic determination of carbapenemase producing enterobacteriaceae isolates from clinical specimens at a tertiary hospital in Lagos, Nigeria. Nigerian Postgraduate Medical Journal 22(4):223-227.

Simon A, Hollander G, McMichael A (2015). Evolution of the immune system in humans from infancy to old age. Proceedings of the Royal Society B: Biological Sciences 282(1821):20143085.

Yusuf I, Magashi AM, Firdausi FS Sharif AA, Getso MI, Bala JA, Aliyu IA (2012). Phenotypic detection of Carbapenemases in members of Enterobacteriaceae in Kano, Nigeria. International Journal of Science and Technology 2(11):802-804.