Molecular characterization of carbapenem-resistance in Gram-negative isolates obtained from clinical samples at Jimma Medical Center, Ethiopia

Mulatu Gashaw; Esayas Kebede Gudina; Solomon Ali; Liegl Gabriele; Thomas Seeholzer; Bikila Alemu; Guenter Froeschl; Arne Kroidl; Andreas Wieser

doi:10.3389/fmicb.2024.1336387

Molecular characterization of carbapenem-resistance in Gram-negative isolates obtained from clinical samples at Jimma Medical Center, Ethiopia

Front Microbiol. 2024 Jan 24:15:1336387. doi: 10.3389/fmicb.2024.1336387. eCollection 2024.

Authors

Mulatu Gashaw^{1

2}, Esayas Kebede Gudina³, Solomon Ali⁴, Liegl Gabriele⁵, Thomas Seeholzer⁶, Bikila Alemu¹, Guenter Froeschl^{2

7}, Arne Kroidl^{2

7

8}, Andreas Wieser^{5

6

7

8}

Affiliations

¹ School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia.
² CIHLMU Center for International Health, Ludwig Maximilians Universität München, Munich, Germany.
³ Department of Internal Medicine, Jimma University, Jimma, Ethiopia.
⁴ Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
⁵ Max von Pettenkofer-Institute (Medical Microbiology), Ludwig Maximilian University of Munich, Munich, Germany.
⁶ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany.
⁷ Division of Infectious Disease and Tropical Medicine, University Hospital (LMU), Munich, Germany.
⁸ German Center for Infection Research (DZIF), Munich, Germany.

Abstract

Background: In resource-constrained settings, limited antibiotic options make treating carbapenem-resistant bacterial infections difficult for healthcare providers. This study aimed to assess carbapenemase expression in Gram-negative bacteria isolated from clinical samples in Jimma, Ethiopia.

Methods: A cross-sectional study was conducted to assess carbapenemase expression in Gram-negative bacteria isolated from patients attending Jimma Medical Center. Totally, 846 Gram-negative bacteria were isolated and identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Phenotypic antibiotic resistance patterns were determined using the Kirby-Bauer disk diffusion method and Etest strips. Extended-spectrum β-lactamase phenotype was determined using MAST disks, and carbapenemases were characterized using multiplex polymerase chain reactions (PCR).

Results: Among the isolates, 19% (157/846) showed phenotypic resistance to carbapenem antibiotics. PCR analysis revealed that at least one carbapenemase gene was detected in 69% (107/155) of these strains. The most frequently detected acquired genes were blaNDM in 35% (37/107), blaVIM in 24% (26/107), and blaKPC42 in 13% (14/107) of the isolates. Coexistence of two or more acquired genes was observed in 31% (33/107) of the isolates. The most common coexisting acquired genes were blaNDM + blaOXA-23, detected in 24% (8/33) of these isolates. No carbapenemase-encoding genes could be detected in 31% (48/155) of carbapenem-resistant isolates, with P. aeruginosa accounting for 85% (41/48) thereof.

Conclusion: This study revealed high and incremental rates of carbapenem-resistant bacteria in clinical samples with various carbapenemase-encoding genes. This imposes a severe challenge to effective patient care in the context of already limited treatment options against Gram-negative bacterial infections in resource-constrained settings.

Keywords: ESBL; Jimma; blaNDM; blaOXA; carbapenem-resistant; carbapenemases.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was funded by the German Academic Exchange Service (DAAD) through its Exceed program and by the University & Hospital Partnerships in Africa initiative of the German Gesellschaft für International Zusammenarbeit (GIZ) (grant number 81248133) in cooperation with the German Ministry of Economic Cooperation and Development (BMZ). The funder did not have any role in the design of the study and collection, analysis, and interpretation of data or in the development of the manuscript.