Molecular Epidemiology of Extended-Spectrum Beta-Lactamase and AmpC Producing Enterobacteriaceae among Sepsis Patients in Ethiopia: A Prospective Multicenter Study

Abstract

Extended-spectrum beta-lactamases (ESBLs) and AmpC producing <i>Enterobacteriaceae</i> are public health threats. This study aims to characterize ESBL and AmpC producing <i>Enterobacteriaceae</i> isolated from sepsis patients. A multicenter study was conducted at four hospitals located in central (Tikur Anbessa and Yekatit 12), southern (Hawassa) and northern (Dessie) parts of Ethiopia. Blood culture was performed among 1416 sepsis patients. <i>Enterobacteriaceae</i> (<i>n</i> = 301) were confirmed using MALDI-TOF and subjected for whole genome sequencing using the Illumina (HiSeq 2500) system. The overall genotypic frequencies of ESBL and AmpC producing <i>Enterobacteriaceae</i> were 75.5% and 14%, respectively. The detection of ESBL producing <i>Enterobacteriaceae</i> at Hawassa, Yekatit 12, Tikur Anbessa and Dessie was 95%, 90%, 82% and 55.8%, respectively. The detection frequency of <i>bla</i>_CTX-M, <i>bla</i>_TEM and <i>bla</i>_SHV genes was 73%, 63% and 33%, respectively. The most frequently detected ESBL gene was <i>bla</i>_CTX-M-15 (70.4%). The common AmpC genes were <i>bla</i>_ACT (<i>n</i> = 22) and <i>bla</i>_CMY (<i>n</i> = 13). Of <i>Enterobacteriaceae</i> that harbored AmpC (<i>n</i> = 42), 71% were ESBL co-producers. Both <i>bla</i>_TEM-1B (61.5%) and <i>bla</i>_SHV-187 (27.6%) were the most frequently detected variants of <i>bla</i>_TEM and <i>bla</i>_SHV, respectively. The molecular epidemiology of ESBL producing <i>Enterobacteriaceae</i> showed high frequencies and several variants of ESBL and AmpC genes. Good antimicrobial stewardship and standard bacteriological laboratory services are necessary for the effective treatment of ESBL producing <i>Enterobacteriaceae</i>.