Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia

Abstract

Objective: To estimate the prevalence and associated risk factors of extended-spectrum β-lactamase producing Enterobacte­riaceae (ESBL) in King Khaled General Hospital, Saudi Arabia. Methods: A twelve -month retrospective study for the presence of ESBL producing Enterobacteriaceae infection was per­formed by using the Microbiology and Infection Control Departments\' database. For all the collected specimens, microbiologi­cal identification and antimicrobial sensitivity testing were done using MicroScan WalkAway system and then confirmed by API 20E and E-test respectively. Results: The prevalence of ESBL producing Enterobacteriaceae infection among studied patients was 22%. The most common types of infections were urinary tract infections representing 59.2%. Previous use of antibiotics, urinary catheter, mechanical ventilation, previous hospitalization, previous intensive care unit admission and nosocomial origin of infection were significant risk factors for acquiring infection. Amikacin had the highest activity against ESBL producing isolates, whereas 20% of isolates were resistant to carbapenems Conclusions: The study revealed that prevalence of ESBL producing Enterobacteriaceae infection was relatively high. Our findings suggest that invasive devices, the use of antibiotics, prolonged hospitalization especially in the intensive care unit in­creases the risk of acquiring such infections. A strict antibiotic policy should be addressed especially with observed emergence of carbapenem resistance. Continuous review of need to invasive devices and strict compliance with basic infection control measures are mandatory to limit the spread of ESBL Enterobacteriaceae.

Keywords

• Enterobacteriaceae, extended-spectrum β-lactamase, prevalence, ESBL, resistant bacteria, risk factors

Prevalence and risk factors of extended-spectrum B-lactamases producing Enterobacteriaceae in a general hospital in Saudi Arabia

Öz

Amaç: Suudi Arabistan Kral Halid Hastanesi’nde genişlemiş spektrumlu β-laktamaz (GSBL) üreten Enterobacteriaceae prevalansı ve enfeksiyon gelişmesinde risk faktörlerinin belirlenmesi Yöntemler: Mikrobiyoloji ve Enfeksiyon Kontrol Birimleri’nin veri tabanı kullanılarak 12 aylık dönemde geriye yönelik olarak GSBL üreten Enterobacteriaceae ile enfeksiyon görülme oranı belirlendi. Bu sürede içerisinde elde edilen örneklerde mikrobiyolojik tanımlama ve antibiyogram testleri MicroScan WalkAway sistemi kullanılarak yapıldı. Sonuçlar API 20E ve E-test yöntemi ile doğrulandı. Bulgular: Çalışmaya alınan hastalarda GSBL üreten Enterobacteriaceae prevelansı % 22 olarak bulundu. En sık karşılaşılan enfeksiyon % 59,2 ile üriner sistem enfeksiyonu idi. Antibiyotik kullanımı, üriner kateterizasyon, mekanik ventilasyon, daha önce hastanede yatış, yoğun bakım ünitesinde tedavi görme ve enfeksiyonun hastane kaynaklı olması GSBL üreten Enterobacteriaceae ile enfeksiyon gelişmesi için risk faktörleri olarak bulundu. GSBL üreten bakterlere karşı en etkin antibiyotik amikasinken, izolatların % 20’sinde karbapenemlere karşı direnç saptandı. Sonuçlar: Bu çalışmanın sonuçları GSBL üreten Enterobacteriaceae oranının yüksek olduğunu göstermektedir. Bulgular; antibiyotik kullanımı, invaziv işlemler ve özellikle yoğun bakım ünitesine olmak üzere uzamış hastane yatışının GSBL üreten bakterilerle enfeksiyon gelişme riskini artırdığını göstermektedir. Gözlenen yüksek karbapenem direnç oranı antibiyotik kullanımıyla ilgili etkin politikalar oluşturulması gerektiğini ortaya koymaktadır. GSBL üreten Enterobacteriaceae yayılmasının engellenmesi için kullanılan invaziv cihazlara ihtiyacın sürekli olarak değerlendirilmesi ve temel enfeksiyon kontrol önlemlerine etkin şekilde uyulması gerekmektedir

Anahtar Kelimeler

• Enterobacteriaceae, genişlemiş spektrumlu β-laktamaz, prevalans. GSBL, dirençli bakteri, risk faktörleri

Kaynakça

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