Fecal Carriage of Extended-Spectrum Β-Lactamase And Carbapenemase Producing Enter obacteriaceae among Oncology and Non-Oncology Patients at Jimma Medical Center in Ethiopia

Abstract

Introduction: Extended-spectrum β-lactamase (ESBL) and Carbapenemase-producing (CP) Enterobacteriaceae are major global health concerns because of their encoded protection against key antibiotics. The group is a cause of increased mortality and hospital expenditures. Objective: To determine the fecal carriage rate and phenotypic resistance patterns of ESBL as well as CP Enterobacteriaceae species among oncology and non-oncology patients and to assess associated risk factors attending Jimma Medical Center (JMC). Methodology: A comparative cross-sectional study design was conducted among oncology and non-oncology (outpatient department) patients. A total of 214 oncology and non-oncology clients were included using a consecutive sampling technique. Stool or rectal swabs were collected from oncology and non-oncology participants from June 2021 to November 2021. Samples were screened for ESBLs and CP enteric organisms using ChromID ESBL media, and confirmed using the combination disc test and modified carbapenem inactivation method, respectively. The disk dif usion method was used to determine the susceptibility of the isolates to antimicrobials. Data was entered to Epi data manager version 4.6.0.6 and analyzed by using SPSS version 23 software. Descriptive statistics were presented using tables and figures. Bivariable and multivariable logistic regression analysis was done to assess the association between dependent and independent variables. A Chi-square test was employed to compare the carriage rate of oncology and non-oncology patients. P-Values of <0.05 were considered statistically significant. Results: The fecal carriage rate of ESBL-PE was found to be 90(84.1%) among oncology and 77(71.9%) among non-oncology patients (P-value 0.652). The most common ESBL-PE was Escherichia coli (82(62.5%) and 68(88.3%) in oncology patients and non-oncology, respectively), followed by Klebsiella oxytoca (15(11.5%) and 6(7.8%)). Out of total ESBL-PE isolates from oncology and non-oncology patients, the maximum level of resistance was seen towards cefepime 166(96.0%), trimethoprim and sulfamethoxazole 144(80.2%), aztreonam 154(89.0%) and ceftazidime 142(85%), whereas better susceptibility was seen to tigecycline 163(97%), meropenem 131(75.7%), ertapenem 127(66.4%) and piperacillin-tazobactam 104(60.5%). ESBL-PE showed the highest sensitivity to tigecycline in both groups (121(96.0%) III and 42(100%), respectively), followed by meropenem (93(71%) and 38(90.5%)) and ertapenem (62(58.5%) and 37(88.1%)). Ciprofloxacin exhibited a high level of resistance among both groups (105(80.2%) and 39(92.8%)). Carbapenemase-producing isolates from oncology patients were13(12.1%), whereas from non-oncology patients 4(3.7%) (P-value 0.611). The result of this study showed that less than 6 months of duration of cancer was a significant association with ESBL-PE fecal carriage in oncology patients. Bacterial isolates from oncology in this study showed a trend of multiple drug resistance 115(87.8 %). Conclusions and recommendation: the result revealed an alarmingly high carriage rate of ESBL-PE and CPE species from the study participants. Moreover, the isolates showed high resistance to alternative drugs and may become a major problem in the management of oncology and non-oncology patients in Jimma. The majority of the ESBL-PE isolates had multiple antibiotic-resistant patterns. Hence, it is strongly required to emphasize strict adherence to hand hygiene protocols to reduce the transmission of such bacteria from patient to patient among oncologic and non-oncologic patients. It also needs further study on the impact of colonization on such patients who may develop an infection due to ESBL-PE & CPE.