PREVALENCE AND MOLECULAR IDENTIFICATION OF THIRD GENERATION CEPHALOSPORIN-RESISTANT KLEBSIELLA PNEUMONIAE ISOLATED FROM WOUNDS OF PATIENTS ATTENDING SELECTED HOSPITALS IN MINNA, NIGERIA

Abstract

In recent years, the emergence and circulation of third generation cephalosporin-resistant Klebsiella pneumoniae due to the production of extended spectrum beta- lactamases in both hospital and community settings is increasing worldwide resulting in high morbidity and mortality. This study determined the prevalence and molecular identity of third generation cephalosporin-resistant K. pneumoniae isolated from wounds of patients attending selected Hospitals in Minna, Nigeria. A total of 500 wound samples were collected in General Hospital and Ibrahim Badamasi Babangida Specialist Hospital Minna, between the period of June and December 2019. Wound samples were cultured on MacConkey Agar and Nutrient Agar. Klebsiella. Pneumoniae isolates were identified based on colonial morphology, motility, Gram’s staining, detailed biochemical tests and molecular techniques. The prevalence of K. pneumoniae was 57 (11.40 %). The distribution of K. pneumoniae on the basis of age showed 24.5 %, 56.2 %, and 19.3 % for age groups 0-30, 31-60 and 61-90 years respectively. The prevalence of K. pneumoniae wound infection based on gender indicated 77.2 % and 22.8 % for male and female gender respectively. Antibiotic susceptibility profile of 57 K. pneumoniae isolates was evaluated by Kirby-Bauer modified disc Agar diffusion technique. The antibiogram showed that all the 57 (100 %) K. pneumoniae isolates demonstrated different and high levels of resistance to third generation cephalosporin (cefotaxime 66.7 %, ceftazidime 45.6 %, ceftriaxone 38.6 %, cefixime 43.9 %, cefpodoxime 47.4 % and cefdinir 98.2 %). Most 50 (87.7 %) of the isolates also showed high level of co-resistance to other antibacterial agent like penicillin (ampicillin 80.7 %), aminoglycoside (gentamycin 47.4 %) and fluoroquinolone (ciprofloxacin 28.1 %), while the least resistance was shown against carbapenem (imipenem 3.5 %). Multidrug resistance was observed in 27 (47.4 %) of the isolates while the multiple antibiotic resistance index analysis for each of the isolates ranged from 0.1-1.0. All the 3GC-R K. pneumoniae isolates were phenotypically screened for the presence of Extended Spectrum Beta- Lactamases (ESBLs) using Double Disc Synergy Test (DDST). The prevalence of ESBL producing 3GC-R K. pneumoniae isolates was 23/57 (40.4 %). Molecular analysis showed that five representatives of ESBL producing 3GC-R K. pneumoniae isolates were identified as K. pneumoniae strains MBT51, RBT40, MO1, J42 and NPK3-1-39. Five isolates carried CTX-M and TEM genes while only two of the isolates harboured SHV gene. The rate of wound colonization by ESBL producing 3GC-R K. pneumoniae was found to be high underscoring the need for public health measures to prevent wound infection. Hence there is need for regular screening and monitoring of 3GC-R and ESBL producing K. pneumoniae isolates in General Hospital and IBB Specialist Hospital Minna.