Prevalence of Extended Spectrum Beta lactamase Producing Enterobacteriaceae and Associated Risk Factors Among Diabetes Mellitus Patients with Urinary Tract Infection at Shanan Gibe General Hospital, Jimma Town, South West Ethiopia

Abstract

Background:The worldwide emergence and spread of extended-spectrum beta-lactamases producing Enterobacteriaceae has become a threat to deal with an infections. This problem is more critical in low & middle income countries. Enterobacteriaceae family bacterial organisms are among bacterial isolates most frequentely encountered from different clinical samples. They are the most frequent causative agents of urinary tract infection among diabetic patients. Objective:Todetermine prevalence of Extended Spectrum Betalactamase producing Entrobacteriaceae (ESBL-PE)& associated risk factors among Diabetes mellitus patients with urinary tract infection. Methods: A hospital based cross-sectional study was conducted from July to October 2021.A total of272consecutive DM patients were included and their socio-demographic and risk factor-related data were collected using structured questionnaire. Mid-stream urine specimens were collected from study participants & analyzed using standard bacteriological methods.Antimicrobial Susceptiblity Testing (AST) & ESBLs production testing were doneby Disk diffusion & Double Disk Synergy Test methods respectively. Data were entered into Epidata version 3.1 & analyzed using SPSS ver. 26. Results: The overall prevalence of urinary tract infection bacteria due to Enterobacteriaceae was 10.6% &most frequent isolates were E.coli 42.8%&K. pneumoniae 34.5%.The majority (98.3%)of isolated organisms were resistant to third generation cephalosporin (3GC)& Ampicillin & 96.3% were resistant to Cotrimoxazole.The prevalence of ESBL-PE isolates was 34.5% with E.coli & K. pneumonia being the dominant species contributing for 40% & 30% of the ESBL-PE prevalence respectively. Magnitude of multi-drug resistance level was 27/29(93.1%). Having history of previous antibiotic exposure & current UTI symptoms(PV=0.041) among study participants were found to be independent risk factors for acquiring UTI by ESBL-PE. Conclusion& recommendation: Isolates of all analyzed species showed considerably high levels of resistance to commonly priscribed antibiotics as well as high frequency of multi drug resistant (MDR) and ESBL phenotypes among diabetic patients as compared with previous similar studies conducted at nearby health facility. Early detection of isolates and rational use of drugs as wel as culture and AST result are necessary before initiating antibiotics.