High prevalence of ESBL-producing Klebsiella pneumoniae in clinical samples from central Cote d'Ivoire

Objectives: Infections caused by multidrug-resistant Enterobacterales pose a significant challenge to clinical patient care, particularly in resource-constrained settings where epidemiological data on antimicrobial resistance are scarce. The aim of this study was to determine the prevalence of extended spectrum beta-lactamase-(ESBL)-producing Klebsiella pneumoniae among clinical samples from a teaching hospital in Bouake, central Cote d'Ivoire. Methods: Clinical specimens were collected from sterile and non-sterile body sites and were subjected to microbiological diagnostics (April 2016-June 2017). The antimicrobial susceptibility patterns of K. pneumoniae were analysed using automated resistance testing and double-disk diffusion to test for ESBL production. Multiplex PCR was carried out to determine the presence of the resistance-conferring genes bla(CTX-M), bla(SHV) and bla(TEM). Results: A total of 107 isolates were included, most of which were obtained from bloodstream (39%; n = 42) and urinary tract infections (39%; n = 42). Among all K. pneumoniae isolates, 84% (n = 90) were ESBL producers, many of which were also not susceptible to sulfonamides (99%), quinolones (81%) and aminoglycosides (79%). The majority of ESBL-producing strains harboured all three investigated bla genes. Conclusion: The high prevalence of ESBL-producing K. pneumoniae in clinical isolates from Cote d'Ivoire calls for revised empirical treatment regimens in critically ill patients with suspected Gram-negative infections, and the establishment of antimicrobial resistance surveillance systems. (c) 2019 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.