Investigation Of Extended-Spectrum Beta-Lactamase And Carbapenemase Producing Gram-Negative Bacilli In Rectal Swabs Collected From Neonates And Their Associated Factors In Neonatal Intensive Care Units Of Southern Ethiopia

Background: Currently extended-spectrum beta-lactamase (ES beta L) and carbapenemase producing gram-negative bacteria are the greatest concern among the neonatal population with very limited therapeutic options. The aim of this study was to assess the prevalence of ES beta L and carbapenemase producing gram-negative bacilli, associated factors and antimicrobial resistance patterns among neonates in intensive care units.Methods: An institutional-based cross-sectional study was conducted from February to June 2021 on 212 neonates in intensive care units. Risk factors data were collected by using a well-designed questionnaire. A rectal swab sample was collected using a sterile cotton swab and inoculated on MacConkey agar. Bacterial isolates were identified using various biochemical tests. ES beta L and carbapenemase were first screened by indicator cephalosporins (cefotaxime (30 mu g) and ceftazidine (30 mu g)) and carbapenem (meropenem and ertapenem), respectively. ES beta L and carbapenemase were confirmed by a double-disk synergy test and modified carbapenem inactivation methods, respectively. SPSS version 21.0 was used for data analysis. A P-value <= 0.05 was considered as statistically significant.Results: The overall prevalence of ES beta L-producing gram-negative bacilli was 72/212 (34%). The predominant ES beta L-producing isolate was Klebsiella pneumoniae 23/72 (31.9%) followed by Escherichia coli 17/72 (23.6%). Five (2.4%) carbapenemase-producing gram-negative bacilli were isolated. ES beta L-producing isolates showed a high resistance against ampicillin 72/72 (100%), augmentin 69/72 (95.8%) and gentamycin 57/72 (79.2%). The majority 63/72 (87.5%) of isolated ES beta L-producing gram-negative bacilli were multi-drug resistant (MDR). Rectal carriage of ES beta L by neonates showed a statistically significant association with endotracheal intubation (p = 0.001; AOR = 4.2; 96% CI = (1.8-9.5)), treatment with ampicillin+gentamycin (p = 0.004; AOR = 3.3; 95% CI = (1.5-7.6)) and staying in a neonatal intensive care unit (NICU) between 11 and 20 days (p = 0.042; AOR = 2; 95% CI = (1.0-4.5)).Conclusion: A high prevalence of ES beta L-producing bacterial isolates was observed for commonly used antibiotics which needs further attention. Therefore, continuous and regular follow-ups of drug resistance patterns is important for the proper treatment and management of ES beta L and carbapenemase producing gram-negative bacilli.