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Gashaw M, Gudina EK, Tadesse W, Froeschl G, Ali S, Seeholzer T, Kroidl A, Wieser A. Hospital Wastes as Potential Sources for Multi-Drug-Resistant ESBL-Producing Bacteria at a Tertiary Hospital in Ethiopia. Antibiotics (Basel) 2024; 13:374. [PMID: 38667050 PMCID: PMC11047370 DOI: 10.3390/antibiotics13040374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
The hospital environment is increasingly becoming an important reservoir for multi-drug-resistant (MDR) Gram-negative bacteria, posing serious challenges to efforts to combat antimicrobial resistance (AMR). This study aimed to investigate the role of hospital waste as a potential source of MDR ESBL-producing bacteria. Samples were collected from multiple sources within a hospital and its vicinity, including surface swabs, houseflies, and sewage samples. The samples were subsequently processed in a microbiology laboratory to identify potential pathogenic bacteria and confirmed using MALDI-TOF MS. Bacteria were isolated from 87% of samples, with the predominant isolates being E. coli (30.5%), Klebsiella spp. (12.4%), Providencia spp. (12.4%), and Proteus spp. (11.9%). According to the double disc synergy test (DDST) analysis, nearly half (49.2%) of the bacteria were identified as ESBL producers. However, despite exhibiting complete resistance to beta-lactam antibiotics, 11.8% of them did not test positive for ESBL production. The characterization of E. coli revealed that 30.6% and 5.6% of them carried blaCTX-M group 1 type-15 and blaNDM genes, respectively. This finding emphasizes the importance of proper hospital sanitation and waste management practices to mitigate the spread of AMR within the healthcare setting and safeguard the health of both patients and the wider community.
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Affiliation(s)
- Mulatu Gashaw
- School of Medical Laboratory Sciences, Jimma University, Jimma P.O Box 378, Ethiopia
- CIHLMU Center for International Health, University Hospital, LMU Munich, Leopoldstrasse 5, 80802 Munich, Germany
| | | | - Wondwossen Tadesse
- School of Medical Laboratory Sciences, Jimma University, Jimma P.O Box 378, Ethiopia
- Department of Medical Microbiology, Wachemo University, Hosaina P.O Box 667, Ethiopia
| | - Guenter Froeschl
- CIHLMU Center for International Health, University Hospital, LMU Munich, Leopoldstrasse 5, 80802 Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU), 80802 Munich, Germany
| | - Solomon Ali
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa P.O Box 1271, Ethiopia
| | - Thomas Seeholzer
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology, Infection and Pandemic Research, Türkenstraße 87, 80799 Munich, Germany
| | - Arne Kroidl
- CIHLMU Center for International Health, University Hospital, LMU Munich, Leopoldstrasse 5, 80802 Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU), 80802 Munich, Germany
- German Center for Infection Research (DZIF), 80802 Munich, Germany
| | - Andreas Wieser
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU), 80802 Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology, Infection and Pandemic Research, Türkenstraße 87, 80799 Munich, Germany
- German Center for Infection Research (DZIF), 80802 Munich, Germany
- Max von Pettenkofer-Institute (Medical Microbiology), Ludwig Maximilian University of Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
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Wolde D, Eguale T, Alemayehu H, Medhin G, Haile AF, Pirs M, Strašek Smrdel K, Avberšek J, Kušar D, Cerar Kišek T, Janko T, Steyer A, Starčič Erjavec M. Antimicrobial Susceptibility and Characterization of Extended-Spectrum β-Lactamase-Producing Escherichia coli Isolated from Stools of Primary Healthcare Patients in Ethiopia. Antibiotics (Basel) 2024; 13:93. [PMID: 38247652 PMCID: PMC10812509 DOI: 10.3390/antibiotics13010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Antimicrobial resistance of Escherichia coli is a growing problem in both developed and developing countries. This study aimed to investigate the phenotypic antimicrobial resistance of E. coli isolates (n = 260) isolated from the stool specimen of patients attending public health facilities in Addis Ababa and Hossana. This study also aimed to characterize phenotypically confirmed extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates (n = 22) using whole-genome sequencing. Resistance to 18 different antimicrobials was assessed using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The highest resistance rate among the E. coli isolates was found for ampicillin (52.7%), followed by trimethoprim-sulfamethoxazole (29.6%). Of all isolates, 50 (19.2%) were multidrug-resistant and 22 (8.5%) were ESBL producers. ESBL genes were detected in 94.7% of the sequenced E. coli isolates, and multiple β-lactamase genes were detected in 57.9% of the isolates. The predominant ESBL gene identified was blaCTX-M-15 (78.9%). The blaTEM-1B gene was detected in combination with other ESBL genes in 57.9% of the isolates, while only one of the sequenced isolates contained the blaTEM-1B gene alone. The blaCTX-M-3 gene was detected in three isolates. The genes blaCTX-M-15 and blaTEM-1B as well as blaCTX-M-15 and blaTEM-169 were confirmed to coexist in 52.6% and 10.5% of the sequenced E. coli isolates, respectively. In addition, blaOXA-1 was identified together with blaCTX-M-15 and blaTEM-1B in one isolate, and in one isolate, blaTEM-169 together with blaCTX-M-15 and blaTEM-1B was found. The results obtained show that measures need to be taken to reduce the spread of drug resistance and ensure the long-term use of available antimicrobials.
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Affiliation(s)
- Deneke Wolde
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wachemo University, Hossana P.O. Box 667, Ethiopia;
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (T.E.); (H.A.); (G.M.); (A.F.H.)
- Department of Microbiology, Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tadesse Eguale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (T.E.); (H.A.); (G.M.); (A.F.H.)
| | - Haile Alemayehu
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (T.E.); (H.A.); (G.M.); (A.F.H.)
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (T.E.); (H.A.); (G.M.); (A.F.H.)
| | - Aklilu Feleke Haile
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (T.E.); (H.A.); (G.M.); (A.F.H.)
| | - Mateja Pirs
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (K.S.S.)
| | - Katja Strašek Smrdel
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (K.S.S.)
| | - Jana Avberšek
- Institute of Microbiology and Parasitology, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.A.); (D.K.)
| | - Darja Kušar
- Institute of Microbiology and Parasitology, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.A.); (D.K.)
| | - Tjaša Cerar Kišek
- National Laboratory of Health, Environment and Food, 2000 Maribor, Slovenia; (T.C.K.); (T.J.); (A.S.)
| | - Tea Janko
- National Laboratory of Health, Environment and Food, 2000 Maribor, Slovenia; (T.C.K.); (T.J.); (A.S.)
| | - Andrej Steyer
- National Laboratory of Health, Environment and Food, 2000 Maribor, Slovenia; (T.C.K.); (T.J.); (A.S.)
| | - Marjanca Starčič Erjavec
- Department of Microbiology, Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
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Karambwe S, Traoré AN, Potgieter N. Epidemiology of Cefotaxime-Hydrolysing β-Lactamase-Producing Escherichia coli in Children with Diarrhoea Reported Globally between 2012 and 2022. Microorganisms 2024; 12:171. [PMID: 38257997 PMCID: PMC10820611 DOI: 10.3390/microorganisms12010171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
The global spread of cefotaxime-hydrolysing β-lactamase (CTX-M)-producing Escherichia coli (E. coli) and its associated impact on paediatric diarrhoeal treatment and management has become a public health concern. This review assessed surveillance studies on CTX-M-producing E. coli associated with diarrhoea in children published between 2012 and 2022 globally. A total of thirty-eight studies were included for data analysis, categorised into continental regions, and tabulated. The majority (68%) of studies were conducted in Asian countries while few studies were conducted in Europe (11%) and Africa (18%), respectively. On the African continent, the majority (11%) of studies were conducted in Northern Africa while no studies were reported in East Africa. On the American continent, 3% of the studies were reported from South America. The studies included were classified into diarrheagenic E. coli (74%; 28/38) and faecal carriage (26%; 10/38). Of all the E. coli pathotypes associated with CTX-M production, EPEC was frequently reported. The prevalence of CTX-M-producing E. coli including the CTX-M-15-producing variants ranged between 1% and 94%. About 37% of the studies generalised the report as blaCTX-M-positive E. coli. The use of sequencing in characterising the CTX-M-producing E. coli was reported in only 32% of all the studies. This review provides information on the epidemiology of CTX-M-15-producing E. coli in paediatric diarrhoea and the extent to which surveillance is being performed. This is relevant in informing clinical practice for the management of diarrhoea as well as the design of future surveillance studies.
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Affiliation(s)
| | | | - Natasha Potgieter
- Department of Biochemistry and Microbiology, University of Venda, Private Bag X5050, Thohoyandou 0950, South Africa; (S.K.); (A.N.T.)
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