Purpose: Extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) are among the major threats to global health because of their encoded protection against key antibiotics.
Methods: A comparative cross-sectional study was conducted among oncology and non-oncology patient groups (1:1; n = 214) on a consecutive sampling approach. Stool or rectal swab was collected from June 2021 to November 2021 and screened for ESBL-PE and CPE using ChromID-ESBL media. Confirmation for the enzymes was made by using combination disc and modified carbapenem inactivation methods, respectively. Disk diffusion method was used to determine antimicrobial susceptibility testing following the recommendations of CLSI 2022. SPSS software version 23 was used for data analysis.
Results: Fecal carriage prevalence of ESBL-PE was found in 90 (84.1%) of oncology participants and in 77 (71.9%) of non-oncology patients (p = 0.032). Escherichia coli was the most common ESBL-PE isolate in 82 (62.5%) and 68 (88.3%) of oncology and non-oncology patients, followed by Klebsiella oxytoca [15 (11.5%) versus 6 (7.8%)], respectively. Out of the total ESBL-PE isolates from both oncology and non-oncology patient groups, the maximum level of resistance was observed against ciprofloxacin 177 (86.3%), trimethoprim-sulfamethoxazole 103 (80.3%), tetracycline 97 (75.8%), whereas enhanced susceptibility was appreciated to tigecycline 200 (97.6%), meropenem 162 (79.0%), and ertapenem 145 (70.7%) with no significant difference between oncology and non-oncology group. Carbapenemase-producing isolates from oncology patients were 12 (11.2%), whereas it was 4 (3.7%) (p = 0.611) from non-oncology group. Bacterial isolates from oncology in this study showed a trend of multiple drug resistance of 113 (88.3%).
Conclusion: The results revealed alarmingly high carriage rates of ESBL and CPE among all study participants. Moreover, the isolates showed increased resistance rates to alternative drugs and had multiple antibiotic-resistant patterns. Hence, it is important to emphasize strict adherence to antimicrobial stewardship program as well as infection prevention and control practices.

Keywords: carriage rate, oncology, extended-spectrum beta-lactamase, carbapenemase, Enterobacteriaceae, Ethiopia


中文翻译：

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埃塞俄比亚 Jimma 医疗中心肿瘤患者和非肿瘤患者粪便中携带超广谱 β-内酰胺酶和碳青霉烯酶肠杆菌科细菌：一项比较横断面研究

目的：超广谱 β-内酰胺酶 (ESBL) 和产碳青霉烯酶肠杆菌科 (CPE) 因其编码的针对关键抗生素的保护作用而成为全球健康的主要威胁。
方法：采用连续抽样方法在肿瘤和非肿瘤患者组（1:1；n = 214）中进行比较横断面研究。2021 年 6 月至 2021 年 11 月收集粪便或直肠拭子，并使用 ChromID-ESBL 培养基筛查 ESBL-PE 和 CPE。分别使用组合圆盘和改良碳青霉烯灭活方法对酶进行了确认。按照CLSI 2022的建议，采用纸片扩散法测定抗菌药物敏感性试验。使用SPSS软件23版进行数据分析。
结果：在 90 名（84.1%）肿瘤参与者和 77 名（71.9%）非肿瘤患者中发现粪便携带 ESBL-PE 流行率（p = 0.032）。在 82 例 (62.5%) 和 68 例 (88.3%) 肿瘤患者和非肿瘤患者中，大肠杆菌是最常见的 ESBL-PE 分离株，其次是产酸克雷伯菌 [分别为 15 例 (11.5%) 和 6 例 (7.8%)]。在来自肿瘤和非肿瘤患者组的总 ESBL-PE 分离株中，观察到对环丙沙星 177 (86.3%)、甲氧苄啶-磺胺甲恶唑 103 (80.3%)、四环素 97 (75.8%) 的最大耐药水平，而对替加环素 200 (97.6%)、美罗培南 162 (79.0%) 和厄他培南 145 (70.7%) 的敏感性增强，肿瘤组和非肿瘤组之间没有显着差异。来自肿瘤患者的产生碳青霉烯酶的分离株为 12 株 (11.2%)，而非肿瘤组的产碳青霉烯酶菌株为 4 株 (3.7%) (p = 0.611)。本研究中从肿瘤学分离的细菌显示出 113 种（88.3%）多重耐药的趋势。
结论：结果显示所有研究参与者中 ESBL 和 CPE 的携带率高得惊人。此外，分离株对替代药物的耐药率增加，并且具有多种抗生素耐药模式。因此，必须强调严格遵守抗菌药物管理计划以及感染预防和控制实践。

关键词：携带率、肿瘤学、超广谱 β-内酰胺酶、碳青霉烯酶、肠杆菌科、埃塞俄比亚