Beta-lactamase Producing Bacteria in Community and Hospital Setting in Riyadh: Occurrence, and Susceptibility to Antibiotics

Najwa Al-Mously¹, Lamiaa Z. Abu Zaid^{2, 3,} and Shazia Mukaddam⁴

¹Microbiology Department, Faculty of Medicine, King Fahad Medical City, Riyadh 11525, Saudi Arabia

²Community Medicine Department, Faculty of Medicine, King Fahad Medical City, Riyadh 11525, Saudi Arabia

³Department of Public Health, Community & Occupational Medicine and Environmental Heath, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

⁴Trinitas Hospital Group LCC, Medical Centre, Elizabeth, NJ, USA

Cite this paper:
Najwa Al-Mously, Lamiaa Z. Abu Zaid and Shazia Mukaddam. Beta-lactamase Producing Bacteria in Community and Hospital Setting in Riyadh: Occurrence, and Susceptibility to Antibiotics. American Journal of Epidemiology and Infectious Disease. 2017; 5(1):14-20. doi: 10.12691/ajeid-5-1-3

Abstract

Background: Extended-spectrum β-lactamase producing bacteria (ESBL) poses an increasing challenge to both public health and hospital infection control services. Objective: To determine the prevalence of ESBL producing bacteria, types of infection they cause and their susceptibility patterns to antibiotics in hospital and community settings. Settings and Design: This is a cross-sectional study that was conducted at a Medical City in Riyadh. Methods: All clinical specimens with positive culture for Gram-negative bacteria were collected from the microbiology laboratory for the year 2013. When bacteria are identified as ESBL strain, the antimicrobial susceptibility is analyzed. Demographic data were collected from patients’ records. Results: Overall, 763/6993 (10.9%) were ESBL producing strains from all gram negative bacteria. The highest detection of ESBL bacteria were from specimens of patients over sixty years (34.2%), and 23.7% were from 0-<15 year old. The most frequently detected bacteria was E.coli (76.5%) (Significantly higher among outpatients 54.5%) with highest detection from urine, skin swab, blood, wound and ulcer specimens, followed by K .pneumonia (23.1%) (Significantly higher among inpatients 69.3%) with highest detection from respiratory specimens including sputum. The resistance pattern to antimicrobials was (75.5%, 81.3%) to trimethoprim/sulfamethoxazole, (69.7%, 42.6%) to ciprofloxacin, (38.9%, 58.5%) to gentamicin and (8.7%, 30.7) to piperacillin/tazobactam (E.coli, K. pneumonia respectively). However, very high sensitivity to imipenem and meropenem was reported for both bacteria. Generally, ESBL bacteria isolated from outpatients showed significantly higher resistance to ciprofloxacin than the isolates from inpatients (p=0.02), conversely is detected with piperacillin/tazobactam (p<0.0001). Conclusion: Currently, carbapenems and amikacin are the first line antibiotics that can be used for the treatment of ESBL bacterial infections in both settings. Since ESBL bacterial resistance pattern is increasing, periodical monitoring of antimicrobial susceptibility of isolated ESBL bacteria, and rotating the use of the effective antimicrobial drugs according to guidelines of antimicrobial stewardship programs should always be considered.

Keywords:
ESBL bacterial infections hospital setting community setting antimicrobial susceptibility

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