AUTHOR=Odoko Desta , Kumalo Abera , Alemu Getachew , Demisse Tigistu , Mulugeta Teshale , Temesgen Muluneh 

TITLE=Extended-spectrum β-lactamase and carbapenemase producing Enterobacteriaceae among patients suspected with surgical site infection at Hospitals in Southern Ethiopia

JOURNAL=Frontiers in Microbiology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2024.1417425

DOI=10.3389/fmicb.2024.1417425

ISSN=1664-302X

ABSTRACT=<sec><title>Background</title><p>Extended-spectrum β-lactamase and carbapenemase-producing <italic>Enterobacteriaceae</italic> are an increasing problem for patients today. Data on clinical samples for ESBL and carbapenemase-producing <italic>Enterobacteriaceae</italic> for surgical site infection patients in developing countries are limited, including Ethiopia, mainly due to resource constraints. Hence, this study aimed to determine the prevalence of extended-spectrum beta-lactamase- and carbapenemase-producing <italic>Enterobacteriaceae</italic> among patients suspected to have surgical site infection at Hospital in Southern Ethiopia.</p></sec><sec><title>Materials and methods</title><p>A hospital-based cross-sectional study was conducted on 422 suspected surgical site infections from June 1, 2022 to August 30, 2022 at Hospitals in Southern Ethiopia. Sociodemographic and clinical data were obtained by using a structured questionnaire. Clinical samples (pus, pus aspirates, and wound swabs) were collected aseptically and processed within 30 min by placing the swabs in sterile test tubes containing sterile normal saline (0.5 mL). Samples were cultured on blood and MacConkey agar plates. All positive cultures were characterized by colony morphology, Gram staining, and standard biochemical tests. Antimicrobial sensitivity tests were performed using Kirby Baur disk diffusion on Mueller–Hinton agar. ESBL production was confirmed using a double-disc synergy test (DDST) method. Carbapenemase production was assessed using the modified Hodge test. Logistic regression analysis was used to determine associated factors. A <italic>P</italic>-value &lt; 0.05 were considered statistically significant.</p></sec><sec><title>Result</title><p>Bacteria belonging to the order <italic>Enterobacterales</italic> were cultured in 23.7% out of 422 patients with suspected surgical wound infection. Of all the isolates, <italic>Enterobacteriaceae</italic> (69 isolates) were the most frequent, with <italic>E. coli</italic> (29/69) followed by <italic>K. pneumoniae</italic> (14/69). Of 69 <italic>Enterobacteriaceae</italic> isolates, 66.6 % (46/69) were positive for ESBL production, and 21.7 (15/69) were positive for carbapenemase-producing <italic>Enterobacteriaceae</italic>. The majority of <italic>Enterobacteriaceae</italic> isolates showed sensitivity to meropenem (72.1%); however revealed 63.9% and 70.5% were resistant to gentamicin and ciprofloxacin, respectively. Similarly, a higher resistance rate to cefepime (91.8%), amoxicillin-clavulanic acid (98.4%), ceftriaxone (95.1%), and ceftazidime (91.8%). MDR rate of <italic>Enterobacteriaceae</italic> isolates was 25/61 (41%) among patients suspected for surgical site infection. The Multivariable analysis revealed that length of hospital stay in hospital [AOR = 3.81 (95% CI 2.08–6.95)] remained statistically significant factor associated with surgical site infection due to ESBL producing <italic>Enterobacteriaceae</italic>.</p></sec><sec><title>Conclusion</title><p>Study results showed the severity of ESBL-producing <italic>Enterobacteriaceae</italic> is critical and CPE is alarming. Meropenem is the most effective antibiotic against the ESBL-producing <italic>Enterobacteriaceae</italic>. MDR rate of <italic>Enterobacteriaceae</italic> isolates was 61 (61%) among patients suspected for surgical site infection. Therefore, antibiotic selection should be based on the results of the culture and sensitivity tests.</p></sec>