Clonal Dissemination of Extended-Spectrum Beta-Lactamase (ESBL)- producing Klebsiella pneumoniae isolated from Medical devices and Hospital environments in the West region, Cameroon
Authors: Mbog Therese Espoir Ngo , Founou Raspail Carrel , Founou Luria Leslie , Koudoum Patrice Landry , Zemtsa Jessica Ravanola , Dimani Brice Davy , Mbossi Aurelia , Noubom Michel , Kenfack Bruno 
Published: October 2024

Abstract

Background
Hospital-acquired infections (HAIs) caused by antibiotic resistant Klebsiella pneumoniae are serious public health concern globally. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-K. pneumoniae) are major contributors to life-threatening HAIs especially in surgery and intensive care unit wards. Suboptimal hygiene measures and the non-existence of infection prevention control programs and policies contribute to the dissemination of ESBL-K. pneumoniae from the inanimate surfaces, medical devices, healthcare workers to hospitalized patients. This study aimed at determining the prevalence, genotypic characteristics and clonal relatedness of ESBL- K. pneumoniae isolated from surgical patients, medical devices and hospital environments at the Annex Regional Hospital of Dschang in the West region in Cameroon.
Methods
A cross-sectional study was conducted over a four-month period from February to May 2022. A total of 91 samples were collected from hospitalized patients (n = 46), medical equipments (n = 20) and hospital environments (n = 25). Samples were cultured on Eosin Methylene Blue agar. After culture and biochemical identification with API 20E, antibiotic susceptibility testing was carried out using disc diffusion method on Müller Hinton agar. ESBL phenotype was screening using ChromAgar™ ESBL (CHROMagar, Paris, France) coupled with double discs synergy test. In addition, the detection of resistance genes was done with Polymerase Chain Reaction (PCR) methods, while the clonal relatedness of isolates was performed using the Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR method.
Results
The prevalences of ESBL-K. pneumoniae isolated from surgical patients was 23.9% (11/46). Only two Klebsiella pneumoniae were isolated from medical equipment of which one isolate was ESBL producer with 5% (n = 01/20). The result of the hospital environment revealed 28% (07/25) were positive for ESBL-K. pneumoniae. High level of resistance (100%) to cefuroxime, amoxicillin-clavulanic acid, cefuroxime, ceftriaxone and cefotaxime were observed. In addition, the resistance rates to gentamicin and meropenem were (89.4%) and (42.1%) respectively. The leading β-lactam resistance gene detected was blaCTX−M (65.6%) followed by blaTEM (43.7%) and blaSHV (25%). The clonal relatedness revealed the likely circulation of ESBL-Klebsiella pneumoniae between wards and the hospital environment respectively.
Conclusion
Hospital environment remains a reservoir of ESBL-K. pneumoniae in this hospital setting and could be transmitted to the hospitalized patients. It is therefore imperative, even very urgent, to implement stringent infection prevention and control measures to curb the dissemination of ESBL-Klebsiella pneumoniae in hospital setting in West region.