Prevalence of Multidrug resistance amongst archived Enterobacteriaceae from patients in Mulago National Referral Hospital maternity ward.

Abstract

Background: Multi drug resistance in enterobacteriaceae is a common cause of hospital and community acquired infections. Enterobacteriaceae are gram negative bacteria like E.coli, Klebsiella Pneumoniae are pathogenic organisms causing many infections like pyelonephritis in pregnant women, neonatal sepsis in babies, blood stream infections which are usually acquired in hospitals. These bacteria can be treated with antibiotics like fluoroquinolones, aminoglycosides, beta lactams, and macrolides. However, bacteria developed resistance to these drugs. For years Carbapenems have been used successfully to treat infections due to resistant Enterobacteriaceae including those producing Extended Spectrum Beta lactamases (ESBLs). Misuse of Carbapenems has led to the emergence of resistance in gram negative bacteria. Objective: The general objective was to determine the prevalence of multidrug resistance (ESBL (CTX-M U) and Carbapenemase (NDM and OXA-48) among archived enterobacteriaceae from patients in Mulago National Referral hospital Maternity ward. Methodology: This was a cross sectional laboratory-based prospective study. The DNA of the archived samples used was extracted using boiling lysis method and the samples selected by random sampling method. Conventional PCR was used during amplification and agarose gel electrophoresis carried out to visualize the bands of the different genes. Results: Out of 44 archived samples, 0% prevalence was detected for NDM and OXA-48 genes with n=0 for E.coli, n=0 for Klebsiella pneumoniae and n=0 for Enterobacter species. However out of the 44 samples, 64% prevalence (P) for CTX-M U was obtained where Klebsiella Pneumoniae with 71%(P=17/24) prevalence was the most predominant for CTX-M U gene followed by Enterobacter species with 64%(P=7/11) prevalence and the E.coli with 44% prevalence for CTX-M U gene(P=4/9). Conclusion: This study showed 64% prevalence of ESBL gene (CTX-M U) a great threat to public health and 0% of Carbapenemase encoding genes (NDM and OXA-48). Implying infection control measures particularly compliance with hand hygiene guidelines, as well as appropriate antibiotic policies in order to prevent the ever-increasing problem of emergence of MDR ESBL and Carbapenemase producing gram negative organisms.