Phenotypic Detection of Extended Spectrum Beta-lactamase Resistance of Escherichia coli from Patients Attending Selected Healthcare Facilities in Nasarawa State, Nigeria

Abstract

Aims: This study investigated the phenotypic detection of extended spectrum beta-lactamase resistance of diarrheagenic E. coli isolated from diarrheic patients attending some major health facilities in Nasarawa State, Nigeria. Place and Duration of Study: Department of Microbiology, Nasarawa State University, P.M.B 1022, Keffi, Nasarawa State, Nigeria; between December, 2017 to March, 2019. Methodology: A total of 207 confirmed E. coli isolates from loose stool samples of patients with suspected cases of diarrhea (69 from Federal Medical Centre Keffi [MCK] 69 from General Hospital Akwanga [GHA] and 69 from Dalhatu Araf Specialist Hospital Lafia [DASHL]) were included in this study. Results: E. coli was isolated and identified using standard microbiological methods. The antibiotic susceptibility testing for the isolates was carried out and interpreted in accordance with Clinical and Laboratory Standards Institute protocol. Phenotypic detection of ESBL production in isolates resistant to ciprofloxacin, cefotaxime and ceftazidime) was carried out using double disc synergy test. The occurrence of E. coli was 100% in all the hospitals. Age groups 0-5 and 6-10 years have the highest occurrence than age group 35 – >45 years. Isolates from DASHL were more resistant to amoxicillin/clavulanic acid (86.9%), Streptomycin (75.0%) and sulphamethoxazole/trimethoprim (68.1%), isolates from FMCK were more resistant to amoxicillin/clavulanic acid (84.1%), sulphamethoxazole/trimethoprim (69.6%), isolates from GHA were more resistant to amoxicillin/clavulanic acid (85.5%) and sulphamethoxazole/trimethoprim (73.0%). Multiple antibiotic resistance (MAR) was observed with the order of occurrence: FMCK (98.6%) > DASHL (92.8%) > GHA (89.9%). The most common MAR index of 0.2 in DASHL was 0.4 (20.3%); FMCK was 0.4 (15.9%) and GHA was 0.3 (17.4%). The order of occurrence of classes of antibiotic resistance in E. coli isolates in DASHL was MDR (84.0%) ˃ XDR(7.2%) > PDR and NMDR (4.3%); in FMCK was MDR (91.3%) ˃ XDR(4.3%) ˃ NMDR (2.9%) and PDR(1.4%); and in GHA was MDR (88.8%) ˃ NMDR(5.8%) > XDR and PDR(2.9%). Detection rate of ESBL was 53.6% (30/207), distributed in relation to the location as DASHL (60.0%), FMCK (50.0%) and GHA (52.6%). Conclusion: Most of the isolates from the study locations were antibiotic resistance. Further studies on molecular detection of ESBL, diversity and characterization of the E. coli into pathotypes are ongoing.