Emerging trends and resistance patterns of extended-spectrum beta-lactamases producing Enterobacteriaceae: an epidemiological insight from Ibn Tofail hospital in Marrakesh, Morocco

Abstract

Introduction: The epidemiology of ESBL infection varies widely from one region to another and rapidly evolves across hospital and community boundaries. Therefore, obtaining an updated local picture of the epidemiology of ESBL-producing microorganisms and analyzing trends in their dissemination is essential. The main aim of this study was to assess the prevalence and the antibiotic resistance profiles of ESBL-producing Enterobacteriaceae (ESBL-E) at Ibn Tofail Hospital in Marrakesh.

Methodology: To our knowledge, the present study is the first to conduct a descriptive analysis from January 1, 2010, to December 31, 2022, including all ESBL-E strains isolated in the microbiology laboratory. Antimicrobial susceptibility testing was determined using the standardized Kirby-Bauer disk diffusion method on Mueller-Hinton agar. The double-disc synergy test confirmed the presence of ESBL.

Results: Among 3672 Enterobacteriaceae strains isolated, 20% were ESBL producers. Klebsiella pneumoniae accounted for 45.9% of ESBL-E, followed by Escherichia coli (25.3%) and Enterobacter cloacae (12.8%). The surgical and intensive care units were most affected. Urine samples were the most common source (42.4%). ESBL-E strains exhibited high resistance to tobramycin (80.3%), gentamicin (72.9%), and ciprofloxacin (73.7%), but maintained sensitivity to imipenem (15.6% resistance) and amikacin (21.9%). Significant differences were detected between non-ESBL and ESBL regarding all tested antibiotics. Male patients were significantly more affected by ESBL-E than females.

Conclusions: The increasing incidence of ESBL-E has become a significant concern. Monitoring their epidemiological and resistance profiles is crucial for guiding antibiotic therapy and preventing the development of further resistant strains.