Background: Currently extended-spectrum β-lactamase (ESβL) and carbapenemase producing gram-negative bacteria are the greatest concern among the neonatal population with very limited therapeutic options. The aim of this study was to assess the prevalence of ESβL and carbapenemase producing gram-negative bacilli, associated factors and antimicrobial resistance patterns among neonates in intensive care units.
Methods: An institutional-based cross-sectional study was conducted from February to June 2021 on 212 neonates in intensive care units. Risk factors data were collected by using a well-designed questionnaire. A rectal swab sample was collected using a sterile cotton swab and inoculated on MacConkey agar. Bacterial isolates were identified using various biochemical tests. ESβL and carbapenemase were first screened by indicator cephalosporins (cefotaxime (30μg) and ceftazidine (30μg)) and carbapenem (meropenem and ertapenem), respectively. ESβL and carbapenemase were confirmed by a double-disk synergy test and modified carbapenem inactivation methods, respectively. SPSS version 21.0 was used for data analysis. A P-value ≤ 0.05 was considered as statistically significant.
Results: The overall prevalence of ESβL-producing gram-negative bacilli was 72/212 (34%). The predominant ESβL-producing isolate was Klebsiella pneumoniae 23/72 (31.9%) followed by Escherichia coli 17/72 (23.6%). Five (2.4%) carbapenemase-producing gram-negative bacilli were isolated. ESβL-producing isolates showed a high resistance against ampicillin 72/72 (100%), augmentin 69/72 (95.8%) and gentamycin 57/72 (79.2%). The majority 63/72 (87.5%) of isolated ESβL-producing gram-negative bacilli were multi-drug resistant (MDR). Rectal carriage of ESβL by neonates showed a statistically significant association with endotracheal intubation (p = 0.001; AOR = 4.2; 96% CI = (1.8– 9.5)), treatment with ampicillin+gentamycin (p = 0.004; AOR = 3.3; 95% CI = (1.5– 7.6)) and staying in a neonatal intensive care unit (NICU) between 11 and 20 days (p = 0.042; AOR = 2; 95% CI = (1.0– 4.5)).
Conclusion: A high prevalence of ESβL-producing bacterial isolates was observed for commonly used antibiotics which needs further attention. Therefore, continuous and regular follow-ups of drug resistance patterns is important for the proper treatment and management of ESβL and carbapenemase producing gram-negative bacilli.



中文翻译：

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埃塞俄比亚南部新生儿重症监护病房新生儿直肠拭子中产超广谱β-内酰胺酶和碳青霉烯酶革兰阴性杆菌的调查及其相关因素

背景：目前广谱 β-内酰胺酶 (ESβL) 和产碳青霉烯酶的革兰氏阴性菌是新生儿人群最关心的问题，治疗选择非常有限。本研究的目的是评估重症监护病房新生儿中 ESβL 和产生碳青霉烯酶的革兰氏阴性杆菌的流行率、相关因素和抗菌素耐药性模式。
方法：2021 年 2 月至 2021 年 6 月，对重症监护病房的 212 名新生儿进行了一项基于机构的横断面研究。通过使用精心设计的问卷收集风险因素数据。使用无菌棉签收集直肠拭子样本并接种在麦康凯琼脂上。使用各种生化测试鉴定细菌分离物。ESβL和碳青霉烯酶首先分别通过指示剂头孢菌素（头孢噻肟（30μg）和头孢他嗪（30μg））和碳青霉烯（美罗培南和厄他培南）进行筛选。ESβL和碳青霉烯酶分别通过双盘协同试验和改良的碳青霉烯灭活方法得到证实。SPSS 21.0版用于数据分析。P 值≤0.05 被认为具有统计学意义。
结果：产 ESβL 革兰氏阴性杆菌的总体流行率为 72/212 (34%)。产生 ESβL 的主要分离物是肺炎克雷伯菌23/72 (31.9%)，其次是大肠杆菌17/72 (23.6%)。分离出五个（2.4%）产碳青霉烯酶的革兰氏阴性杆菌。产生 ESβL 的分离株对氨苄青霉素 72/72 (100%)、增强素 69/72 (95.8%) 和庆大霉素 57/72 (79.2%) 表现出高耐药性。大部分 63/72 (87.5%) 分离的产生 ESβL 的革兰氏阴性杆菌具有多重耐药性 (MDR)。新生儿直肠携带 ESβL 与气管插管（p = 0.001；AOR = 4.2；96% CI = (1.8–9.5)）、氨苄青霉素+庆大霉素治疗（p = 0.004；AOR = 3.3；95% CI = (1.5–7.6)) 并在新生儿重症监护室 (NICU) 停留 11 至 20 天 (p = 0.042; AOR = 2; 95% CI = (1.0–4.5))。
结论：对于需要进一步关注的常用抗生素，观察到产生 ESβL 的细菌分离物的高流行率。因此，持续和定期跟踪耐药模式对于正确治疗和管理 ESβL 和产生碳青霉烯酶的革兰氏阴性杆菌很重要。