https://doi.org/10.4081/mm.2025.12941
High prevalence of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae and Escherichia coli in clinical infections in a tertiary care hospital in southwestern Nigeria
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Published: 7 July 2025
Background: Extended-Spectrum Beta-Lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli infections significantly impact healthcare delivery and contribute to global antibiotic resistance. Thus, knowledge of their prevalence and risk factors is essential for quick and effective treatment, prevention, and management. In this study, we investigated the prevalence of ESBL production among clinical K. pneumoniae and E. coli isolates, determined their susceptibility profile, and identified risk factors associated with their infections in a tertiary care hospital.
Materials and Methods: two hundred ninety-one non-duplicate isolates from diverse clinical samples were collected and matched with patients' biographical information. The isolates were identified by standard microbiological methods and their antimicrobial susceptibility was determined by the disk diffusion method. All isolates were screened for ESBL production. Risk factors such as age, sex, hospitalization, and source of infection were assessed for their association with ESBL infections. Multivariate logistic regression analysis was used to identify associated risk factors.
Results: out of the 291 isolates collected, 152 (52.2%) were K. pneumoniae, while 139 (47.8%) were E. coli. Approximately 43.3% (n=126) of the isolates were ESBL producers, with 54% as K. pneumoniae and 46% as E. coli. The ESBL producers were predominantly isolated from blood samples (100%) and exhibited higher resistance rates to ampicillin (96.1%), streptomycin (95.4%), trimethoprim (93.8%), tetracycline (92.3%) and other antibiotics (>70%), except for cefoxitin (34.4%) and imipenem (12.4%), compared with the non-ESBL producers (p<0.05). Multivariate analysis indicated that patients with sepsis or hospitalized were more likely to acquire ESBL infections (p<0.05).
Conclusions: this study reports a higher prevalence of ESBL-producing E. coli and K. pneumoniae than previously reported in our hospital. Antimicrobial stewardship programs and effective infection control practices could help manage this growing concern.
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Abayneh M, Worku T. Prevalence of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli: a meta-analysis report in Ethiopia. Drug Target Insights 2020;14:16-25.
Abramson JH. WINPEPI Updated: computer programs for epidemiologists, and their teaching potential. Epidemiol Perspect Innov 2011;8:1.
Adeyemo AT, Adeyemo AT, Odetoyin BW, et al. Prevalence and molecular characteristics of extended-spectrum betalactamase-producing Gram-negative pathogens from patients in a tertiary care hospital in Nigeria. Journal of Medical Science and Clincial Research 2020;8:1-10.
Adeyemo AT, Adeyemo AT, Odetoyin BW, Onipede AO. Prevalence and risk factors for extended-spectrum β-lactamase-producing Gram-negative bacterial infections in hospitalized patients at a tertiary care hospital, southwest Nigeria. Af J Clin Exp Micro 2022;23:149-58.
Akanbi BO, Ojonuba BD, Njoku R. Detection of extended spectrum β-lactamase producing Klebsiella pneumoniae and Escherichia coli in two hospitals in the federal capital territory, Abuja, Nigeria. Open Journal of Medical Microbiology 2013;3:207-12.
Al-Kubaisy SH, Hussein RA, Al-Ouqaili MTS. Molecular screening of Ambler class C and extended-spectrum β-lactamases in multi-drug resistant Pseudomonas Aeruginosa and selected species of Enterobacteriaceae. Int J Pharm Res 2020;12:3.
Al-Ouqaili MTS, Al-Taei SA, Al-Najjar A. molecular detection of medically important Carbapenemases genes expressed by metallo-β-lactamase producer isolates of Pseudomonas aeruginosa and Klebsiella pneumoniae. Asian J Pharm 2018;12:3-S991.
Al-Ouqaili MTS, Jal’oot AS, Badawy AS. Identification of an OprD and Bla(IMP) gene-mediated carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa among Patients with Wound Infections in Iraq. Asian J Pharm 2019;12:2634.
Al-Ouqaili MTS, Khalaf EA, Al-Kubaisy SH. DNA sequence analysis of BlaVEB gene encoding multi-drug resistant and extended-spectrum ?-lactamases producer isolates of Enterobacteriaceae and Pseudomonas aeruginosa. Open Microbiol J 2020;14:40-7.
Castanheira M, Simner PJ, Bradford PA. Extended-spectrum β-lactamases: an update on their characteristics, epidemiology and detection. JAC - Antimicrobial Resistance 2021;3:dlab092.
Chukwu EE, Awoderu OB, Enwuru CA, et al. High prevalence of resistance to third-generation Cephalosporins detected among clinical isolates from sentinel healthcare facilities in Lagos, Nigeria. Antimicrobial Resistance & Infection Control 2022;11:134.
Clinical and Laboratory Standard Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 2020. Available from https://www.nih.org.pk/wp-content/uploads/2021/02/CLSI-2020.pdf
Codjoe FS, Donkor ES. Carbapenem resistance: a review. Medical Sciences (Basel, Switzerland) 2017;6:1.
Dhillon RH-P, Clark J. ESBLs: a clear and present danger? Crit Care Res Pract 2012;2012:625170.
Gharavi MJ, Zarei J, Roshani-Asl P, et al. Comprehensive study of antimicrobial susceptibility pattern and extended spectrum beta-lactamase (ESBL) prevalence in bacteria isolated from urine samples. Sci Rep 2021;11:578.
Husna A, Rahman MdM, Badruzzaman ATM, et al. Extended-spectrum β-lactamases (ESBL): challenges and opportunities. Biomedicines 2023;11:2937.
Hussein RA, Al-Kubaisy SH, Al-Ouqaili MTS. The influence of efflux pump, outer membrane permeability and β-lactamase production on the resistance profile of multi, extensively and pandrug resistant Klebsiella pneumoniae. J Infect Public Health 2024;17:11.
Ibrahim DR, Cer D, Stekel DJ, et al. Multidrug-resistant ESBL-producing E. coli in clinical samples from the UK. Antibiotics 2023;12:169.
Kim B, Kim SG, Lee SS, et al. Extended-spectrum beta-lactamase and multidrug resistance in urinary sepsis patients admitted to the intensive care unit. ACC 2014;29:257-65.
Mahamat O, Lounnas M, Hide M, et al. high prevalence and characterization of extended-spectrum ß-lactamase producing enterobacteriaceae in Chadian hospitals. BMC Infectious Diseases 2019;19:205.
Maveke SM, Aboge GO, Kanja LW, et al. Phenotypic and genotypic characterization of extended spectrum beta-lactamase-producing clinical isolates of Escherichia coli and Klebsiella pneumoniae in two Kenyan facilities: a national referral and a level five hospital. International Journal of Microbiology 2024;2024:1-18.
Menkem EZ, Labo Nanfah A, Takang T, et al. Attitudes and practices of the use of third-generation cephalosporins among medical doctors practicing in Cameroon. Int J Clin Pract 2023;2023:1-7.
Musa BM, Imam H, Lendel A, et al. The burden of extended-spectrum β-lactamase-producing enterobacteriaceae in Nigeria: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2020;114:241-8.
Nepal K, Pant ND, Neupane B, et al. Extended-spectrum beta-lactamase and metallo beta-lactamase production among Escherichia coli and Klebsiella pneumoniae isolated from different clinical samples in a tertiary care hospital in Kathmandu, Nepal. Ann Clin Microbiol Antimicrob 2017;16:62.
Nwobodo CD, Ugwu MC, Oliseloke Anie C, et al. Antibiotic resistance: the challenges and some emerging strategies for tackling a global menace. Clinical Laboratory Analysis 2022;36:e24655.
Odetoyin B, Adewole O. Prevalence of extended-spectrum β-lactamase-production among clinical Gram-negative bacilli isolates in a tertiary hospital, southwest Nigeria. Eur J Med Health Sci 2021;3:9-13.
Owaid HA, Mts A-O. Molecular and bacteriological investigations for the co-existence crispr/cas system and β-lactamases of types extended-spectrum and carbapenemases in multidrug, extensive drug and pandrug-resistant Klebsiella pneumoniae. Saudi J Biol Sci 2024;31:104022.
Pratiwi AD, Rusli M, Utomo B. Correlation between ESBL-producing bacteria infection with sepsis severity of patient in medical ward of internal medicine department Dr. Soetomo General Hospital in 2016. Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga 2019;10:83-6.
Ramatla T, Mafokwane T, Lekota K, et al. “One Health” perspective on prevalence of co-existing extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae: a comprehensive systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2023;22:88.
Rawat D, Nair D. Extended-spectrum ß-lactamases in Gram-negative bacteria. J Global Infect Dis 2010;2:263.
Sekoni KF, Oreagba IA, Oladoja FA. Antibiotic utilization study in a teaching hospital in Nigeria. JAC Antimicrob Resist 2022;4:1-8.
Shaikh S, Fatima J, Shakil S, et al. Antibiotic resistance and extended spectrum beta-lactamases: types, epidemiology and treatment. Saudi J Biol Sci 2015;22:90-101.
Siriphap A, Kitti T, Khuekankaew A, et al. High prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates: a 5-year retrospective study at a tertiary hospital in northern Thailand. Frontiers in Cellular and Infection Microbiology 2022;12:1-8.
Tanko N, Bolaji RO, Olayinka AT, Olayinka BO. A systematic review on the prevalence of extended-spectrum beta lactamase-producing Gram-negative bacteria in Nigeria. Journal of Global Antimicrobial Resistance 2020;22:488-96.
Teklu DS, Negeri AA, Legese MH, et al. Extended-spectrum beta-lactamase production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control 2019;8:39.
Tetteh FKM, Ablordey A, Obeng-Nkrumah N, et al. Extended-spectrum betalactamases in clinical isolates of Escherichia coli and Klebsiella pneumoniae recovered from patients at the Tamale Teaching Hospital, Ghana. PLOS One 2024;19:e0300596.
World Health Organization (WHO). WHO updates list of drug-resistant bacteria most threatening to human health. 2024. Available from: https://www.who.int/news/item/17-05-2024-who-updates-list-of-drug-resistant-bacteria-most-threatening-to-human-health.
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