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RefWorks
Reference Manager
BibTeX
Zotero
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-
1.
Richelsen R , Smit J , Schonheyder HC , Laxsen Anru P , Gutierrez-Gutierrez B , Rodriguez-Bano J , Nielsen H , 2020. Outcome of community-onset ESBL-producing Escherichia coli and Klebsiella pneumoniae bacteraemia and urinary tract infection: A population-based cohort study in Denmark. J Antimicrob Chemother 75: 3656–3664.
-
2.
MacVane SH , Tuttle LO , Nicolau DP , 2014. Impact of extended-spectrum beta-lactamase-producing organisms on clinical and economic outcomes in patients with urinary tract infection. J Hosp Med 9: 232–238.
-
3.
Leoncio JM , Almeida VF , Ferrari RAP , Capobiango JD , Kerbauy G , Tacla M , 2019. Impact of healthcare-associated infections on the hospitalization costs of children. Rev Esc Enferm USP 53: e03486.
-
4.
Li JQ , Tang CQ , Wang H , Ji SZ , Lu KY , Xiao SC , Deng AM , Huang Y , Xia ZF , 2016. Impact of extended-spectrum beta-lactamase on clinical outcome and medical cost in patients with bloodstream infection due to Klebsiella pneumoniae [in Chinese]. Zhonghua Yi Xue Za Zhi 96: 1903–1906.
-
5.
Kariuki S , Dougan G , 2014. Antibacterial resistance in sub-Saharan Africa: An underestimated emergency. Ann N Y Acad Sci 1323: 43–55.
-
6.
Kim MH , Lee HJ , Park KS , Suh JT , 2010. Molecular characteristics of extended spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae and the prevalence of qnr in Extended spectrum beta-lactamase isolates in a tertiary care hospital in Korea. Yonsei Med J 51: 768–774.
-
7.
Nasser M , Palwe S , Bhargava RN , Feuilloley MGJ , Kharat AS , 2020. Retrospective analysis on antimicrobial resistance trends and prevalence of beta-lactamases in Escherichia coli and ESKAPE pathogens isolated from Arabian patients during 2000–2020. Microorganisms 8: 1626.
-
8.
Denisuik AJ , Karlowsky JA , Adam HJ , Baxter MR , Lagace-Wiens PRS , Mulvey MR , Hoban DJ , Zhanel GG , Canadian Antimicrobial Resistance Alliance (CARA) and CANWARD , 2019. Dramatic rise in the proportion of ESBL-producing Escherichia coli and Klebsiella pneumoniae among clinical isolates identified in Canadian hospital laboratories from 2007 to 2016. J Antimicrob Chemother 74: iv64–iv71.
-
9.
Onduru OG , Mkakosya RS , Aboud S , Rumisha SF , 2021. Genetic determinants of resistance among ESBL-producing Enterobacteriaceae in community and hospital settings in east, central, and southern Africa: A systematic review and meta-analysis of prevalence. Can J Infect Dis Med Microbiol 2021: 5153237.
-
10.
Bezabih YM , Sabiiti W , Alamneh E , Bezabih A , Peterson GM , Bezabhe WM , Roujeinikova A , 2021. The global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli in the community. J Antimicrob Chemother 76: 22–29.
-
11.
Muvunyi CM , Masaisa F , Bayingana C , Mutesa L , Musemakweri A , Muhirwa G , Claeys GW , 2011. Decreased susceptibility to commonly used antimicrobial agents in bacterial pathogens isolated from urinary tract infections in Rwanda: Need for new antimicrobial guidelines. Am J Trop Med Hyg 84: 923–928.
-
12.
Ntirenganya C , Manzi O , Muvunyi CM , Ogbuagu O , 2015. High prevalence of antimicrobial resistance among common bacterial isolates in a tertiary healthcare facility in Rwanda. Am J Trop Med Hyg 92: 865–870.
-
13.
Bush K , Bradford PA , 2016. Beta-lactams and beta-lactamase inhibitors: An overview. Cold Spring Harb Perspect Med 6: a025247.
-
14.
Hoashi K , Hayama B , Suzuki M , Sakurai A , Takehana K , Enokida T , Takeda K , Ohkushi D , Doi Y , Harada S , 2022. Comparison of the treatment outcome of piperacillin-tazobactam versus carbapenems for patients with bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli in areas with low frequency of coproduction of OXA-1: A preliminary analysis. Microbiol Spectr 10: e0220622.
-
15.
Rawat D , Nair D , 2010. Extended-spectrum beta-lactamases in Gram negative bacteria. J Glob Infect Dis 2: 263–274.
-
16.
Tamma PD , Aitken SL , Bonomo RA , Mathers AJ , van Duin D , Clancy CJ , 2022. Infectious Diseases Society of America 2022 Guidance on the Treatment of Extended-Spectrum beta-lactamase Producing Enterobacteriaceaes (ESBL-E), Carbapenem-Resistant Enterobacteriaceaes (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). Clin Infect Dis 75: 187–212.
-
17.
Bezabih YM et al., 2022. Comparison of the global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli between healthcare and community settings: A systematic review and meta-analysis. JAC Antimicrob Resist 4: dlac048.
-
18.
Cunha CB , Opal SM , 2018. Antibiotic stewardship: Strategies to minimize antibiotic resistance while maximizing antibiotic effectiveness. Med Clin North Am 102: 831–843.
-
19.
Bosch FJ , van Vuuren C , Joubert G , 2011. Antimicrobial resistance patterns in outpatient urinary tract infections—The constant need to revise prescribing habits. S Afr Med J 101: 328–331.
-
20.
Munyemana JB , Gatare B , Kabanyana P , Ivang A , Mbarushimana D , Itangishaka I , Niringiyumukiza JD , Musoni E , 2022. Antimicrobial resistance profile of bacteria causing pediatric infections at the University Teaching Hospital in Rwanda. Am J Trop Med Hyg 107: 1308–1314.
-
21.
Teklu DS , Negeri AA , Legese MH , Bedada TL , Woldemariam HK , Tullu KD , 2019. Extended-spectrum beta-lactamase production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control 8: 39.
-
22.
Kibwana UO , Majigo M , Kamori D , Manyahi J , 2020. High fecal carriage of extended Beta Lactamase producing Enterobacteriaceae among adult patients admitted in referral hospitals in Dar es Salaam, Tanzania. BMC Infect Dis 20: 557.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 742 | 742 | 259 |
| Full Text Views | 42 | 42 | 7 |
| PDF Downloads | 49 | 49 | 10 |
Prevalence of Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae and Associated Clinical Implications at the University Teaching Hospital of Kigali in Rwanda
Muhirwa Patrick Kayinamura
Muhirwa Patrick Kayinamura
University Teaching Hospital of Kigali, Kigali, Rwanda;
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Alphonse Muhirwa
Alphonse Muhirwa
University Teaching Hospital of Kigali, Kigali, Rwanda;
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Aimee Claudine Kamaliza
Aimee Claudine Kamaliza
University Teaching Hospital of Kigali, Kigali, Rwanda;
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Yves Bigirimana
Yves Bigirimana
University Teaching Hospital of Kigali, Kigali, Rwanda;
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Samuel Rutare
Samuel Rutare
University Teaching Hospital of Kigali, Kigali, Rwanda;
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Innocent Hahirwa
Innocent Hahirwa
University Teaching Hospital of Kigali, Kigali, Rwanda;
School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Théoneste Nkubana
Théoneste Nkubana
University Teaching Hospital of Kigali, Kigali, Rwanda;
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Angelique Dusabe
Angelique Dusabe
University Teaching Hospital of Kigali, Kigali, Rwanda;
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Jean Bosco Munyemana
Jean Bosco Munyemana
University Teaching Hospital of Kigali, Kigali, Rwanda;
School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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ABSTRACT.
Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae poses a global problem and complicates therapeutic choices. The paucity of data in resource-poor countries undermines the understanding of the problem’s extent, and cases of antimicrobial treatment failure continue to accumulate. This study aimed to determine the prevalence and clinical implications of ESBL-producers at the University Teaching Hospital of Kigali in Rwanda. A 1-year cross-sectional retrospective study was conducted on Escherichia coli and Klebsiella pneumoniae isolated in blood and urine from January 1 to December 31, 2022. In total, 1,283 isolates were recorded. The results showed an overall prevalence of ESBL phenotypes at 300/1,283 (23.4%). Extended spectrum beta-lactamase–positive E. coli was more frequently detected than K. pneumoniae in both urine (20.6% versus 10.1%) and blood (8.8% versus 6.2%). These isolates were 100% resistant to amoxicillin-clavulanic acid, third-generation cephalosporins, piperacillin, sulbactam ampicillin, ampicillin, cefuroxime, and cefoxitin. The least resistance was observed to amikacin (18%), meropenem (10%), and polymyxin B (3%). Hospital stays ranging from 8 to 21 days were the most frequent, and the mortality rate was 10.3% in patients with ESBL cases, which was more than double the general hospital mortality rate in the same period. In conclusion, our findings indicate a high prevalence of ESBL phenotypes, high antibiotic resistance rates, prolonged hospital stays, and an increased mortality rate. These findings suggest the need for continued surveillance, planning appropriate interventions, and caution during empirical therapy.
- Supplemental Materials (PDF 328.97 KB)
Author Notes
Disclosure: Research ethical approval was obtained from the institutional review board of the University of Rwanda, College of Medicine, and Health Sciences (CMHS/IRB/151/2023) and the ethics committee of the University Teaching Hospital of Kigali (EC/CHUK/041/2023).
Current contact information: Muhirwa Patrick Kayinamura, Alphonse Muhirwa, Aimee Claudine Kamaliza, and Yves Bigirimana, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, E-mails: kmpatrick09@gmail.com, muhirwalf@gmail.com, aimekam4@gmail.com, and ybigirimana7@gmail.com. Samuel Rutare, Theoneste Nkubana, and Angelique Dusabe, University Teaching Hospital of Kigali, Kigali, Rwanda, E-mails: rutaresamuel@gmail.com, nkubanatheo@gmail.com, and angedouce014@gmail.com. Innocent Hahirwa and Jean Bosco Munyemana, University Teaching Hospital of Kigali, Kigali, Rwanda, and School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, E-mails: innocenthahirwa@gmail.com and j.b.munyemana@ur.ac.rw or munyebos1@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Richelsen R , Smit J , Schonheyder HC , Laxsen Anru P , Gutierrez-Gutierrez B , Rodriguez-Bano J , Nielsen H , 2020. Outcome of community-onset ESBL-producing Escherichia coli and Klebsiella pneumoniae bacteraemia and urinary tract infection: A population-based cohort study in Denmark. J Antimicrob Chemother 75: 3656–3664.
-
2.
MacVane SH , Tuttle LO , Nicolau DP , 2014. Impact of extended-spectrum beta-lactamase-producing organisms on clinical and economic outcomes in patients with urinary tract infection. J Hosp Med 9: 232–238.
-
3.
Leoncio JM , Almeida VF , Ferrari RAP , Capobiango JD , Kerbauy G , Tacla M , 2019. Impact of healthcare-associated infections on the hospitalization costs of children. Rev Esc Enferm USP 53: e03486.
-
4.
Li JQ , Tang CQ , Wang H , Ji SZ , Lu KY , Xiao SC , Deng AM , Huang Y , Xia ZF , 2016. Impact of extended-spectrum beta-lactamase on clinical outcome and medical cost in patients with bloodstream infection due to Klebsiella pneumoniae [in Chinese]. Zhonghua Yi Xue Za Zhi 96: 1903–1906.
-
5.
Kariuki S , Dougan G , 2014. Antibacterial resistance in sub-Saharan Africa: An underestimated emergency. Ann N Y Acad Sci 1323: 43–55.
-
6.
Kim MH , Lee HJ , Park KS , Suh JT , 2010. Molecular characteristics of extended spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae and the prevalence of qnr in Extended spectrum beta-lactamase isolates in a tertiary care hospital in Korea. Yonsei Med J 51: 768–774.
-
7.
Nasser M , Palwe S , Bhargava RN , Feuilloley MGJ , Kharat AS , 2020. Retrospective analysis on antimicrobial resistance trends and prevalence of beta-lactamases in Escherichia coli and ESKAPE pathogens isolated from Arabian patients during 2000–2020. Microorganisms 8: 1626.
-
8.
Denisuik AJ , Karlowsky JA , Adam HJ , Baxter MR , Lagace-Wiens PRS , Mulvey MR , Hoban DJ , Zhanel GG , Canadian Antimicrobial Resistance Alliance (CARA) and CANWARD , 2019. Dramatic rise in the proportion of ESBL-producing Escherichia coli and Klebsiella pneumoniae among clinical isolates identified in Canadian hospital laboratories from 2007 to 2016. J Antimicrob Chemother 74: iv64–iv71.
-
9.
Onduru OG , Mkakosya RS , Aboud S , Rumisha SF , 2021. Genetic determinants of resistance among ESBL-producing Enterobacteriaceae in community and hospital settings in east, central, and southern Africa: A systematic review and meta-analysis of prevalence. Can J Infect Dis Med Microbiol 2021: 5153237.
-
10.
Bezabih YM , Sabiiti W , Alamneh E , Bezabih A , Peterson GM , Bezabhe WM , Roujeinikova A , 2021. The global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli in the community. J Antimicrob Chemother 76: 22–29.
-
11.
Muvunyi CM , Masaisa F , Bayingana C , Mutesa L , Musemakweri A , Muhirwa G , Claeys GW , 2011. Decreased susceptibility to commonly used antimicrobial agents in bacterial pathogens isolated from urinary tract infections in Rwanda: Need for new antimicrobial guidelines. Am J Trop Med Hyg 84: 923–928.
-
12.
Ntirenganya C , Manzi O , Muvunyi CM , Ogbuagu O , 2015. High prevalence of antimicrobial resistance among common bacterial isolates in a tertiary healthcare facility in Rwanda. Am J Trop Med Hyg 92: 865–870.
-
13.
Bush K , Bradford PA , 2016. Beta-lactams and beta-lactamase inhibitors: An overview. Cold Spring Harb Perspect Med 6: a025247.
-
14.
Hoashi K , Hayama B , Suzuki M , Sakurai A , Takehana K , Enokida T , Takeda K , Ohkushi D , Doi Y , Harada S , 2022. Comparison of the treatment outcome of piperacillin-tazobactam versus carbapenems for patients with bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli in areas with low frequency of coproduction of OXA-1: A preliminary analysis. Microbiol Spectr 10: e0220622.
-
15.
Rawat D , Nair D , 2010. Extended-spectrum beta-lactamases in Gram negative bacteria. J Glob Infect Dis 2: 263–274.
-
16.
Tamma PD , Aitken SL , Bonomo RA , Mathers AJ , van Duin D , Clancy CJ , 2022. Infectious Diseases Society of America 2022 Guidance on the Treatment of Extended-Spectrum beta-lactamase Producing Enterobacteriaceaes (ESBL-E), Carbapenem-Resistant Enterobacteriaceaes (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). Clin Infect Dis 75: 187–212.
-
17.
Bezabih YM et al., 2022. Comparison of the global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli between healthcare and community settings: A systematic review and meta-analysis. JAC Antimicrob Resist 4: dlac048.
-
18.
Cunha CB , Opal SM , 2018. Antibiotic stewardship: Strategies to minimize antibiotic resistance while maximizing antibiotic effectiveness. Med Clin North Am 102: 831–843.
-
19.
Bosch FJ , van Vuuren C , Joubert G , 2011. Antimicrobial resistance patterns in outpatient urinary tract infections—The constant need to revise prescribing habits. S Afr Med J 101: 328–331.
-
20.
Munyemana JB , Gatare B , Kabanyana P , Ivang A , Mbarushimana D , Itangishaka I , Niringiyumukiza JD , Musoni E , 2022. Antimicrobial resistance profile of bacteria causing pediatric infections at the University Teaching Hospital in Rwanda. Am J Trop Med Hyg 107: 1308–1314.
-
21.
Teklu DS , Negeri AA , Legese MH , Bedada TL , Woldemariam HK , Tullu KD , 2019. Extended-spectrum beta-lactamase production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control 8: 39.
-
22.
Kibwana UO , Majigo M , Kamori D , Manyahi J , 2020. High fecal carriage of extended Beta Lactamase producing Enterobacteriaceae among adult patients admitted in referral hospitals in Dar es Salaam, Tanzania. BMC Infect Dis 20: 557.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 742 | 742 | 259 |
| Full Text Views | 42 | 42 | 7 |
| PDF Downloads | 49 | 49 | 10 |