Distribution and Antibiotic Resistance Profile of Extended Spectrum Beta-Lactamase Producing Escherichia coli from Fish Farms within Abakaliki Metropolis
Jennifer Onyekachi Adibe-NwaforNwadaonwe Demian UdukuChidinma Stacy IrohaFrancis Amadi IbiamAdaora Lynda OnuoraKenneth Adibe NwaforIkemesit Udeme PeterIroha Ifeanyichukwu
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Abstract:
Background and Objectives: The emergence of antibiotic resistant determinant in fish farms and its spread is on the increase and has evolved into strains that are resistant to many classes of antibiotics. Thus, it is critical to identify the distribution and antibiotic resistance profile of Extended Spectrum Beta-lactamase (ESBL) producing Escherichia coli from fish farms within Abakaliki Metropolis.
Methodology: Aseptically, fifty (50) milliliters of fishpond water was collected from twenty locations in fifteen (15) fish farms and were analyze using standard microbiological culture and identification of Escherichia coli. Detection of phenotypic extended spectrum β-lactamases production was performed using Double-Disk Synergy Test (DDST). Antibiotic susceptibility studies of extended spectrum β-lactamases producing Escherichia coli was determined using the Kirby–Bauer disk diffusion method and the results were construed using the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints.
Results: Extended spectrum beta-lactamase producing Escherichia coli distribution from fishpond water revealed overall occurrence rate of 34(11.3 %). The proportion of ESBL producing Escherichia coli was 5(25.0 %) from fish farm L followed by Farm A, Farm E, Farm G, which both accounted for 20.0 % respectively while the least occurrence of 1(5.0 %) was recorded against Farm I. ESBL-producing E. coli were resistant to cephalosporin particularly Ceftriaxone (88.2%), Ceftazidime (91.2 %), Cefotaxime (94.1) and Cefepime (85.3 %). This was followed by Amoxicillin-Clavulanate (91. 2 %), Azetronam (97.1 %). In all, Ciprofloxacin (82.4 %), Imipenem (97.1 %), and Meropenem (100 %) were the most effective antibiotic against ESBL-producing E. coli isolate.
Conclusion: This study reveals the prevalence of the ESBL phenotype in fish farms. The increasing prevalence of resistance to routinely used antibiotics in medical and veterinary therapies among the study isolates from aquaculture products poses a significant challenge to the treatment of human and animal diseases. As a result, adequate antibiotic intervention is essential to ensure the continued efficacy of antibiotics for aquaculture and human health, as well as the industry's viability.Keywords:
Cefepime
Beta-lactamase
Objective: To evaluate the clinical effects of ceftazidime and cefotaxime on neoantal septicemia. Methods: Compared with a controll group of cefuroxime, a retrospective investigation was made to study the clinical effects and safety of ceftazidime and cefotaxime in treating the neonatal septicemia. Results: The incidence of positive value for treatment in the cefazidime and cefotaxime groups were 90.91% and 94. 12%, respectively. Compared with that of control group of cefuroxime (89. 12% ), the differences were not significant. The rate of ADR of two groups with different drugs was not different significantly, either ( P 0. 05) . But the periods of hospitalization of the patients of ceftazidime and cefotaxime groups were shorter than that of control group significantly ( P 0. 05). Conclusion: Ceftazidime and cefotaxime are of first choice for treating neonatal septicimia.
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Objective: To evaluate the cost effectiveness and safety of cefepime and ceftazidime in treatment of bacterial infections. Methods: 129 patients with bacterial infections were recruited and randomized into cefepime group and ceftazidime group. Dosage regimens were cefepime 2g bid and ceftazidime 2g q8h; while for urinary tract infections, the dosages were that cefepime 1g bid and ceftazidime 1g tid. The pharmaceutical economics strategy was employed to make the cost effectiveness analysis. Results:The cost effectiveness of cefepime was lower than that of ceftazidime (72.3% Vs 68.8% of cure rate and 92.3% Vs 90.6% of efficacy rate) in the treatment of four kinds of bacterial infections. Conclusion:Cefepime is better than ceftazidime in the treatment of bacterial infections in regard to their cost effectiveness.
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The efficacy, safety, and cost-effectiveness of ceftazidime and cefepime were evaluated in a prospective, noninterventional, investigator-blinded study involving 100 patients with hospital-acquired pneumonia. There were 50 patients in each group. Clinical success rates were 60% and 78% for patients treated with ceftazidime and cefepime, respectively (P=.05). Microbiologic eradication rates were 55% for ceftazidime and 77% for cefepime (P=.04). In those patients in whom Pseudomonas aeruginosa was isolated, the organism was eradicated in 14 (70%) of 20 cefepime patients and in seven (50%) of 14 ceftazidime patients. The frequency of concomitant antibiotic use was less in the cefepime group (ceftazidime, 37 [74%] of 50 patients; cefepime, 22 [44%] of 50 patients; P=.004), particularly with vancomycin (ceftazidime, 11 [22%] of 50 patients; cefepime, one [2%] of 50 patients). Cefepime was more cost-effective than ceftazidime (ceftazidime, $395.93 ± $355.22; cefepime, $266.59 ± $200.1 7; P=.05). Sensitivity analysis of efficacy rates demonstrated that ceftazidime would have to be 51 % more effective than cefepime to change the economic outcome. In conclusion, these data support cefepime as a cost-effective alternative to ceftazidime in the therapy for hospital-acquired pneumonia.
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One hundred and seventy-two ampicillin-resistant E. coli strains isolated from commercial chickens in Enugu State, Nigeria, were screened for beta-lactamase production using the broth method with nitrocefin® as the chromogenic cephalosporin to detect enzyme production. Beta-lactamase producing strains were further examined for extended-spectrum beta-lactamase (ESBL) production using the Oxoid combination discs method. One hundred and seventy (98.8%) of the 172 ampicillin-resistant E. coli strains produced beta-lactamase enzyme. Sixteen (9.4%) beta-lactamase producers were phenotypically confirmed to produce ESBLs. Six of the ESBL producing strains were only detected with ceftazidime versus ceftazidime/clavulanate combination while ten of the ESBL producers were detected with cefotaxime versus cefotaxime/clavulanate combination. Chicken may serve as a reservoir of ESBL-producing E. coli strains which could be transferred to man and other animals.
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In this randomized multicentre study, we compared the safety and efficacy of cefepime, 2.0 g bd iv. with that of ceftazidime, 2.0 g tid iv, as initial treatment of adult patients with serious infections of bacterial aetiology. Three hundred and forty-eight patients were entered into the study, 173 received cefepime and 175 ceftazidime. The treatment groups were comparable with respect to demographic characteristics, including the types of infection (cefepime/ceftazidime: urinary tract. 55/72; lower respiratory tract, 83/74; skin and soft tissue, 23/14; septicaemia, 81/81; and others, 15/5). Gram-positive bacteria were identified as pathogens on 86 occasions (cefepime/ceftazidime: 48/41), including 20 Staphylococcus aureus isolates (13/7) and 27 Streptococcus pneumoniae isolates (14/13). Gram-negative bacilli were isolated on 261 occasions (126/135), and included 219 Enterobacteriaceae (cefepime/ceftazidime: 108/111) and 34 strains of Pseudomonas aeruginosa (14/20). An intention-to-treat analysis revealed satisfactory clinical response rates of 80% and 79% for the cefepime and ceftazidime groups, respectively, and bacteriological eradication rates of 85% and 88% for the cefepime and ceftazidime groups, respectively. Of patients with microbiologically documented infections, 86% (84 of 98) treated with cefepime and 87% (94 of 108) treated with ceftazidime responded satisfactorily. Thirty-two patients (19%) treated with cefepime and 26 (15%) treated with ceftazidime died. Thirty-six patients in the cefepime group and 23 in the ceftazidime group experienced adverse events; therapy was discontinued prematurely in four and two patients in the cefepime and ceftazidime groups, respectively. Of the patients experiencing adverse events, 22 (13%) treated with cefepime developed intolerance at the injection site, compared with 11 (6%) treated with ceftazidime (P = 0.045). In conclusion, twice-daily cefepime (2 g bd) is at least as effective as ceftazidime (2 g tid), as initial empirical therapy for serious bacterial infections in non-neutropenic patients.
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AIM: To compare the efficacy and cost of cefepime vs ceftazidime in treating moderate severe pneumonia. METHODS: Fifty six patients were randomly divided into 2 groups. Twenty eight patients (M 26, F 2; age 79 a± s 6 a) were treated with cefepime 1.0 g iv, gtt, bid, for 7-10 d. Another twenty eight patients (M 25,F 3;age 78 a±4 a) were treated with ceftazidime 1.0 g iv, gtt, tid, for 7-10 d. RESULTS: The clinical effective rates of cefepime and ceftazidime were similar, 96% vs 93% respectively ( P 0.05), but the cost for ceftazidime was higher than that for cefepime 6924 Yuan±702 Yuan vs 5504 Yuan±615 Yuan, ( P 0.05). CONCLUSION: The ceftazidime has similar effect to cefepime, but its cost is higher.
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One hundred clinical isolates resistant to ceftazidime and/or cefotaxime were examined for susceptibility to cefepime. The most frequently encountered ceftazidime-cefotaxime-resistant strains belonged to the genera Enterobacter, Pseudomonas, and Citrobacter. Among these strains, 92% were resistant to cefoperazone, 91% were resistant to cefotaxime, 84% were resistant to ceftazidime, and 6% were resistant to cefepime. Of the members of the family Enterobacteriaceae, 57% were resistant to ceftriaxone. The six strains resistant to cefepime were all Pseudomonas aeruginosa and were resistant to both cefotaxime and ceftazidime. Cefepime-resistant P. aeruginosa strains had exceptionally high levels of beta-lactamase activity, higher than the levels found in strains resistant to ceftazidime but susceptible to cefepime. The beta-lactamases from the cefepime-resistant strains were type I (Richmond-Sykes), were constitutively produced, and did not have increased affinity or hydrolytic activity for cefepime. Thus, cefepime was active against most gram-negative bacteria which have developed resistance to the broad-spectrum cephalosporins, and resistance to cefepime in P. aeruginosa appears to be associated with higher beta-lactamase levels than in cefepime-susceptible strains.
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The selection frequencies of cefepime (BMY 28142), ceftazidime, and cefotaxime resistance among Pseudomonas aeruginosa strains were determined. Cefepime-resistant mutants were not selected by cefepime (frequency, less than 10(-11)). Ceftazidime- and cefotaxime-resistant mutants were isolated at frequencies of 10(-5) to 10(-10) and were often cross-resistant. However, cefepime resistance among ceftazidime- and cefotaxime-resistant mutants was rare. Selected mutants resistant to cefepime constitutively produced 40- to 450-fold more beta-lactamase than did the parent strain.
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Step-wise resistance to cefepime, ceftazidime, cefotaxime, and cefpirome were determined for 16 Pseudomonas aeruginosa strains by daily transfer for 7 days to fresh media containing two-fold serial dilution of antibiotic. By the third transfer 4 of 16 strains (25%) were resistant (MIC > or = 32 mg/L) to ceftazidime compared with none, five (31%) and ten (60%) strains becoming resistant to cefepime, cefpirome and cefotaxime (MIC > or = 64 mg/L), respectively. At the end of the 7 day serial transfer, only four (25%) of the 16 strains were resistant to cefepime, in contrast to nine (56%) cefpirome resistant, 12 (75%) ceftazidime resistant and 13 (81%) cefotaxime resistant. These results are consistent with the infrequent, single-step development of resistance to cefepime, and this may also explain the frequent cefepime susceptibility of cefotaxime/ceftazidime-resistant clinical isolates of P. aeruginosa.
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