Detection of Extended Spectrum β-Lactamase Producing Escherichia coli in Neonatal Unit of a Tertiary Health Institution, South-South Nigeria

Abstract

Aims: To determine the prevalence of multidrug resistant (MDR) and Extended Spectrum β-lactamase producing (ESBL) E. coli in neonates, their mothers and healthcare workers (HCWs) in the neonatal wards of the University of Uyo Teaching Hospital (UUTH), Uyo-Nigeria. Study Design: It is a cross sectional hospital-based study involving neonates, their mothers and healthcare workers in the respective neonatal units of the hospital. Place and Duration of Study: This study was conducted at the University Uyo Teaching Hospital, Uyo between May and November, 2012. Methodology: The study involved 310 neonates admitted in Sick Babies’ Unit, Special Care Babies’ Unit and Neonatal ward; their mothers (168) and Healthcare Workers (35). Body sites of neonates, palms of consented mothers and healthcare workers (HCWs) in these units were swabbed. Stool samples were also collected from the neonates and their mothers. Isolation and identification of E. coli were carried out using standard microbiological procedures. Antimicrobial susceptibility testing was done using the modified Kirby-Bauer disc diffusion method. Extended spectrum β-lactamase test was conducted using the disc diffusion synergy method following CLSI 2011 guidelines. Results: Neonatal and maternal E. coli isolates were 38(12.3%) and 82(48.8%) respectively, and HCWs, 3(48.8%). Among the neonatal and mother isolates, resistance to Amoxycillin/Clavulanic acid ranged from 1.2% - 2.6%; Ceftriaxone and Ceftazidime resistance, 29.3% - 39.5% and resistance to Cefepime, 21.1% - 25.6%. Isolates from palms of HCWs were highly resistant to all antibiotics. Fourteen neonatal strains exhibiting multidrug resistance (MDR) had 100% homologous drug combinations with 18 maternal isolates. Neonatal isolates that are ESBL producers were 15(39.5%); mothers, 26(31.7%), and HCWs, 3(100%). Conclusion: The importance of maintaining good hand hygiene by HCWs in neonatal units is highlighted in this study. There were high rates of MDR and ESBL-producing E. coli among neonates, mothers and HCWs in UUTH, Uyo. Similarities in drug combinations observed among the MDR strains obtained from subjects indicate possible transmission of E. coli from mothers and HCWs to neonates necessitating epidemiological concern. The practice of proper hygiene by mothers and HCWs should not be made optional. The high resistance strains observed may limit therapeutic options for serious neonatal infections with fatal consequences. Increased ESBL surveillance in neonatal units of hospitals is advocated.