Extended Spectrum Beta-lactamase and carbapenemase producing Enterobacteriaceae and associated factors among hospitalized patients at Ambo University Referral Hospital

Abstract

Background Extended-spectrum Beta-lactamase and Carbapenemase producing Enterobacteriaceae are spreading among both hospitals and communities, with varied levels of prevalence. They are considered as World Health Organization‘s most critical priority pathogens due to their high resistance to a large number of antibiotics. Objective: Therefore, this study is aimed to determine the prevalence and associated factors of Extended Spectrum Betalactamase and carbapenemase producing Enterobacteriacae in the study area. Methods: A hospital-based cross-sectional study design was implemented on 231 hospitalized patients using convenient sampling technique. Data collection was performed by using a structured questionnaire. The standard bacteriological techniques were used for the isolation and identification of bacterial species from stool, urine and sputum specimens collected from the hospitalized patients. The modified Kirby-Bauer disc diffusion method for screening, combination disk method and modified hodge test were used for confirming the production of Extended Spectrum Betalactamase and carbapenemase by Enterobacteriaceae. Data was entered by EPiData and analyzed using Statistical Package for Social Science version 26. Then, Statistical significance was determined by the P-value <0.05. Result: From 231 hospitalized patients, 72(31.2%) Enterobacteriaceae strains were isolated. The overall proportion of Enterobacteriaceae that were Extended-Spectrum Beta-lactamase producers, Carbapenemase-producers, and Multidrug-Resistant were 31.9%, 6.9%, and 72.2%, respectively. The most predominant Extended-Spectrum Beta-lactamase producer was E.coli 13(56.5%), followed by K.pneumoniae 9(39%) and Citrobacter species 1(4.3%). K.pneumoniae 3(60%), E.coli 1(20%) and Citrobacter species 1(20%) were carbapenemase producers. Factors associated with ESBL producing Enterobacteriaceae were previous hospitalization (P=0.04, AOR=4.326, 95% CI=1.059-17.677), other co-morbidity (P=0.04, AOR=4.918, 95% CI=1.051-23.016), admission to surgical ward (P=0.02, AOR=4.058, 95% CI=1.006-16.367), habit of handwashing (P=0.01, AOR=6.568, 95% CI=1.347-32.027) and family income (P=0.01, AOR=6.244, 95% CI=1.448-26.924) Conclusion: This study‘s overall proportion of Extended-Spectrum Beta-lactamase producing Enterobacteriaceae and Multidrug Resistant Enterobacteriaceae was high. Therefore, effective infection prevention and careful selection of empirical therapy were recommended to control their spread in the study area.