Detection of High Prevalence of TEM/SHV/CTX-M Genes in ESBL Producingand Multidrug Resistant Klebsiella Pneumoniae and Klebsiella Oxytoca

Background: Klebsiella spp. are Enterobacteriaceae frequently isolated from pathological specimens during urinary tract infections, bloodstream infection, and pus. They are becoming more and more resistant to antibiotics and challenging treatment options. β-lactamases are a great variety of enzymes capable of inducing resistance to β- lactams. The objective of this study was to identify extended-spectrum-β-lactamase (ESBL) genes in Klebsiella spp. strains isolated from various specimens in Lome, Togo. Methods: Sixty-four strains of Klebsiella spp. were isolated from different pathological specimens. They were then further characterized and tested against 3rd generation cephalosporin (ceftazidime, ceftriaxone, cefotaxime) and aztreonam. The detection of blaTEM, blaSHV and blaCTX-M was performed on these strains using simplex and multiplex PCR techniques. Results: Fifty five (85.94%) Klebsiella pneumoniae and 9 (14.06%) Klebsiella oxytoca were isolated. These strains derived from urine (n=33; 51.56%), vaginal swabs (n=21; 32.81%), pus (n=8; 12.5%) and sperm samples (n=2; 3.13%). All strains were resistant to cefepime. The resistance rate to other β-lactams was 29.69% (19/64) for piperacillin-tazobactam, 23.08% (12/52) for cefoxitin and 1.56% (1/64) for imipenem. Other inactive antibiotics were trimethoprim-sulfamethoxazole 96.72% (59/61), doxycycline 92.06% (58/63), ciprofloxacin 90.63% (58/64), nalidixic acid 80.95% (51/63), chloramphenicol 77.42% (48/62) and gentamicin 76.69% (51/64). Amikacin and fosfomycin remained the most active antibiotics with 1.56% (1/64) and 4.69% (3/64) resistance rates respectively. ESBL genes were detected in 63/64 (98.44%) strains. TEM/SHV/CTX-M was predominant 61.90% (39/63) followed by TEM/SHV 20.63% (13/63), SHV/CTX-M 11.11% (7/63), TEM/SHV 4.76% (3/63) and TEM 1.59% (1/63). Conclusion: ESBL genes occur more by combination 96.88% (62/64) than singularly 1.59% (1/63). These strains were also very resistant to quinolones and trimethoprim-sulfamethoxazole. These findings are of high importance in a medical and scientific perspective and may motivate decision makers towards a better monitoring and control of antimicrobial resistance in Togo.