Abstract

Ivan Muhwezi43644*, Joel Bazira43645, Henry Zamarano43647, Frederick Byarugaba43648, Wilber Sabiiti43649, Mathew Holden43650 and Benon B Asiimwe43651

Background: Bacterial infections are the commonest in both community and healthcare settings. Emergency of Extended Spectrum Beta-Lactamase producing Enterobacteriaceae has contributed to poor clinical outcomes. More efforts regarding antibiotic resistance have been dedicated to clinical settings and we do not know the extent of the catastrophe in community settings. We aimed at determining the burden, antimicrobial susceptibility patterns and molecular characteristics of Extended Spectrum Beta-Lactamase producing Enterobacteriaceae in agro-pastoral communities of Mbarara district, South Western Uganda.

Methods: A laboratory based descriptive cross-sectional study was carried out among Enterobacteriaceae isolated from outpatients presenting with signs and symptoms of Urinary Tract Infections. Urine samples were delivered to Microbiology Laboratory of Mbarara University of Science and Technology for culture, identification, testing for ESBL production and Antibiotic Susceptibility Testing. Molecular characterization of ESBL producing Enterobacteriaceae was carried out at Medical and Molecular Laboratories Limited of Makerere University.

Results: A total of 88 Enterobacteriaceae fulfilling the inclusion criteria were considered into the study. Escherichia coli 70.45% and Klebsiella pneumoniae 13.64% were the most isolated followed by Klebsiella oxytoca, Proteus mirabilis and Enterobacter aerogenes at 10.23%, 3.41% and 2.27% respectively. The production of ESBL was observed at 23.86%. Generally, high resistance rates were observed against Ampicillin 100%, Cefepime 100%, Aztreonam 95.24%, Nalidixic acid 90.48%, Ciprofloxacin 85.71% and Amoxicillin/clavulanate 80.95%. High rates of sensitivity were observed to Meropenem 95.24%, Imipenem 95.24%, Amikacin 95.24%, Gentamycin 90.48%, Cefoxitin 76.19% Piperacillin/tazobactam 80.95% and Nitrofurantoin 66. 67%. Multi-Drug Resistance (MDR) was observed at 85.71%. The most prevalent genes in ESBL producing Enterobacteriaceae were CTX-MU (Cefotaxime-Munich) 46.7%, TEM 30.00% and SHV (Sulfhydryl Reagent Variable) 23.3%.

Conclusion: We demonstrated high prevalence, antibiotic resistance rates among Extended Spectrum Beta-Lactamase producing Enterobacteriaceae in the community. We recommend more community ESBL related studies and a One Health Approach to guide public health interventions.