DETECTION OF COMMUNITY-ACQUIRED AND EXTENDED SPECTRUM BETA LACTAMASE-PRODUCING UROPATHOGENS IN A SUB-URBAN COMMUNITY IN RIVERS STATE, NIGERIA.

Easter Godwin Nwokah* and Smart Enoch Amala

ABSTRACT

Extended-spectrum β-lactamase-producing (ESBLs) organisms are a major challenge today in hospital and community-acquired infections. These plasmid-mediated enzymes hydrolyze extended spectrum Cephalosporins like Ceftazidime, Cefotaxime which are used in the treatment of urinary tract infections (UTI) and rendering them ineffective. This study was undertaken to determine the prevalence of extended spectrum beta lactamase-producing uropathogens in a sub-urban setting. 250 mid-stream clean catch urine samples were collected randomly from consenting subjects at Nchia, Eleme, Rivers State. Samples were analysed microbiologically for significant bacteriuria. Significant asymptomatic bacteriuria was detected in 92 (36.8%) of the total study population of 250 subjects. Distribution of the isolates showed Escherichia coli as the highest occurring isolate (40.2%), followed by Klebsiella pneumoniae (26.1%). The least isolated is Pseudomonas spp (1.1%). Study also showed 26 (28.3%) of the isolates as ESBL producers with Escherichia coli and Klebsiella pneumoniae accounting for 57.7% and 26.9% respectively. Furthermore, based on species, 15 (40.5%) of 37 Escherichia coli and 7 (29.2%) of 24 Klebsiella pneumoniae were ESBL producers. On antibiotic susceptibility testing, isolates showed highest susceptibility to the Carbapenems- Meropenem (100%) and Imipenem (96.7%). All the ESBL isolates were susceptible to the carbapenems emphasizing their high therapeutic value. Susceptibility to Ciprofloxacin was 82.6% while the Cephalosporins- Ceftazidime, Cefotaxime and Ceftriaxone – showed 66.3%, 65.2% and 63.0% susceptibilities respectively. Highest level of resistant was observed in ampicillin (6.5%). Most of the ESBL producing isolates were multidrug resistant. Besides antimicrobial susceptibility testing, it has become very necessary, in our setting, to include routine screening for ESBL to guide therapy for UTI.

Keywords: Urinary tract infection, Antimicrobial Resistance, Extended spectrum ?-lactamases.