Co–resistance between Flouroquinolones, Trimethoprim/Sulfamethoxazole (SXT), and aminoglycosides with extended spectrum B–lactameses (ESBLS) in Eschericia coli isolated from blood, pus and urine specimens at Makerere University Clinical Microbiology Laboratory

Abstract

Background The global emergence and spread of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae have been threatening the ability to treat an infection. Hence, this study aimed to determine co – resistance between fluoroquinolones, trimethoprim/sulfamethoxazole (SXT), and aminoglycosides with extended spectrum b-lactamases (ESBLS) in Escherichia coli isolated from blood, pus and urine specimens at Makerere University Clinical Microbiology Laboratory, Kampala - Uganda. Methods A retrospective cross-sectional study was conducted from May 16, 2023 using bivariate quantitative methods. Data was collected from laboratory bench books manually on a master sheet, entered into excel sheet later analyzed using STATA version 14. A total of 99 samples of E.coli isolates were identified from clinical specimens of blood, urine and pus. Out of 99 samples, only 68 samples were ESBL positive, and that is the number the study mostly relied on. The isolates were collected from MUCML. Antimicrobial susceptibility testing was performed using Muller Hinton agar (MHA). Results. The median (IQR) age of the participants was 30(9, 52) years. Majority of the participants were female, n=48(56.5%). More than three quarters were resistant to SXT, n=54(85.7%). About one third were sensitive to CIP, n=26(32.9%) while three quarters were resistant to CTX, n=55(76.4). The prevalence of ESBLs E. coli among the blood samples was 54.5% (95% CI: 33.4-74.1), among the pus samples was 77.5% (95% CI: 61.6-88.1) and that of urine samples 87.5 (95% CI: 66.6-96.1). The overall prevalence of ESBLs E. coli was 74.4 (95% CI: 63.9-82.7). The prevalence of ESBLs E. coli among the blood samples was 71.4% (95% CI: 42.3-89.5), among the pus samples was 66.7% (95% CI: 49.4-80.4) and that of urine samples 66.7(95% CI: 41.7-84.8). The overall prevalence of ESBLs E. coli was 67.6 (95% CI: 55.4-77.9). At bivariate analysis, no factor was significant to be considered for further multivariate analysis therefore analysis was stopped at bivariate. Conclusion. Findings revealed high prevalence of ESBL among females than males with the mean age of 30. There was co- resistance between Ciprofloxacin with SXT contrary to Gentamycin that showed higher sensitivity rate to isolated E. coli. The ESBL prevalence was high in urine next in pus than blood that pulled lowest prevalence percentage with an overall percentage of 74.4. This explains why there is a high E. coli prevalence among females than males. Due to limited factors from laboratory bench books, Objective three was quiet tricky to analyze. Recommendations. Missing data in the laboratory bench books- Clinicians should make sure all laboratory patient request forms are properly filled with all the indicated particulars and fill them properly. Laboratory staff should make sure they complete laboratory tests a point in case were various ESBL tests were not done, some drugs not set during susceptibility tests. Laboratory staff should bounce back all those forms that are not properly filled. The MoH should regulate use of antibiotics within the population.