Antibiotics Susceptibility Profile of Extended Spectrum Beta Lactamase Producing Gram Negative Bacteria from Widal Positive Patients in Ekiti State University Teaching Hospital

Abstract

Aims: To investigate the age occurrence of typhoid fever, antibiotics susceptibility profile of Extended Spectrum Beta-lactamase producing gram negative bacteria recovered from the blood culture of widal positive patients attending Ekiti State University Teaching Hospital. Place and Duration of Study: Microbiology Laboratory, Ekiti State University Teaching Hospital from August- November, 2011. Methodology: Widal status of patients was detected using Widal Agglutination test kits. Demographic data descriptively analysed using tables and statistical software (SPSS 17 version). Isolates were identified using standard methods, subjected to antimicrobial susceptibility by disc diffusion method and extended spectrum beta-lactamase production (ESBL) detection done by Double Disc Synergy Test. Results: A total of 99 samples were examined, 86 subjected to widal test before blood culture and 13 cultured directly. Widal result showed that 42 (48.8%) had a titer of 1:160 and above. The disease has the highest rate of occurrence among the females, 18 (18.2%) females were positive as against 8 (8.1%) males and  age group 20-29 years with 12 (13.95%) patients. Overall typhoid prevalence was found to be 26 (30.23%). Out of which, age group 20-29years 12 (13.95%) and adult age group 6 (7%) recorded the highest prevalence respectively. Nine different bacteria genera were isolated from the blood culture, 13 (36.1%) strains of Klebsiella specie was found to be predominant among the gram negative bacteria isolated. The recovered isolates all showed (100%) resistance to ceftazidime (30 µg), augmentin (30 µg) and ampicillin (10 µg), cefuroxime (30 µg) (94.4%), gentamycin (10 µg) (47.2%), ciprofloxacin (5 µg) (25%) and Ofloxacin (5 µg) (25%).  Fourteen (38.9%) of the recovered isolates showed ESBLs patterns. Cefuroxime showed synergism with amoxcillin-clavulanic acid in 8 (57.1%) of the bacteria isolates. Conclusion: The recovery of gram negative ESBLs bacteria 14 (38.9%) from the blood culture of widal presumptively diagnosed typhoid patients suggests that a laboratory culture proven result is advisable to be the most definitive diagnosis of typhoid fever. We suggest that antibiotic therapy should not be initiated regardless of the widal antibody titre until the blood culture result has proven to be positive for typhoid fever.