Molecular Epidemiology of Extended Spectrum Beta-lactamases Producing Escherichia coli and Klebsiella Species in Catheterized Patients

Irrational antibiotics use has added to the escalation of antibiotics resistance, especially among hospitalized patients on prolonged urethral catheterization, a significant risk factor for urinary tract infection and urosepsis. Extended-spectrum β-lactamases are transferable plasmid-mediated resistance mechanism orchestrated majorly by Enterobacteriaceae, which confer resistance to β- lactam antibiotics and other classes of antibiotics. This work was aimed at determining the molecular characteristics of uropathogenic Escherichia coli and Klebsiella spp involved in urinary tract infections among patients on prolonged urethral catheterization in two major tertiary hospitals in Lagos. One hundred and one samples were collected from participants in Lagos University Teaching Hospital and 68 Army Reference Hospital Yaba, between November 2015 and May 2016. The mean age of the participants was 49.04± 8.8years. Single, non -repeat aseptically aspirated urine specimens from the catheter ports were obtained from consenting participants and processed immediately. Bacterial species were isolated and characterized by conventional methods. Antibiotics susceptibility testing was done using a modified Kirby Bauer method. Further analysis was done by Polymerase Chain Reaction amplification aimed to detect bla SHV, bla TEM, and bla CTX-M resistance genes. Isolates were considered significant if there were up to 104 CFU/ml in symptomatic participants and ≥105 CFU/ml in asymptomatic participants with analyzed. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 16.0 (Inc., Chicago 111). Forty (39.6 %) males and 61 (60.4 %) female participants’ catheter urines were sampled, with male to female ratio of 1:1.5. Fifty-nine (58.4%) out of 101 samples had significant growth, while 32 (54.2%) of these were lactose fermenters. Of the 32 lactose fermenters, 26 were identified as E. coli and Klebsiella spp, while 23 (88.5%) of these 26 (identified as E. coli and Klebsiella spp) were ESBL producers carrying ESBL gene(s) and revealed various degrees of antibiotics resistance. We conclude by discussing the epidemiological importance of improving the infection control practices and antibiotics stewardship program as central dogma to controlling antibiotics resistance in hospitals.