Antibiotic Resistance of Common Pathogenic Bacterial Isolates in Yemen: An Epidemiological and Molecular study

Abstract

Antibiotics-resistant is becoming one of the major health problem all over the world. The emergence of antimicrobial resistance is not a new phenomenon and has become as a snowballed given rise to several serious health problems concern with economic, social and political implications. The study was designed to determine antibiotic resistance among common pathogenic bacteria in Yemen as well as genes responsible for Extended Spectrum β- Lactamase (ESBL) in these bacteria. A total of 950 clinical specimens were collected from three major Cities in Yemen. Viz: 1. Sana'a, 2. Aden, 3. Taiz . These specimens were cultivated on bacteriological media for primary isolation. The isolates were identified according to standard methods. Antimicrobial susceptibility tests were assessed according to the Kirby– Bauer method. ESBL-producers were determined by using double disc synergy test and confirmed by cephalosporin/clavulanate combination disks. The ESBL genes were identified by Polymerase Chain Reaction. Among investigated specimens, Escherichia coli was the most common pathogens 117 (30.8%), followed by Klebsiella pneumoniae 107 (28.2%), Staphylococcus aureus 95 (25.0%), Pseudomonas aeruginosa 40 (10.5%), and Proteus spp. 21(5.5%). Study on antibiotic sensitivity revealed that, 62.3%, 35.8% and 1.9% of the isolates were sensitive, resistant and moderate sensitive to all antibiotics used in this study respectively. On the other hand, it was found that the antibiotic resistance was statistically significant(p < 0.0001) among isolates of intensive care units and surgical ward. The prevalence of ESBL producers was 35.4%. The difference between ESBL and non- ESBL producing pathogens was statistically significant (p < 0. 007). Klebsiella pneumoniae was the most common organisms producing ESBL 51(47.9%), followed by Escherichia coli 45 (38.5%), Proteus species 2 (9.5%) and Pseudomonas aeruginosa 3(7.5%). The prevalence of ESBL production in Sana'a, Aden and Taiz was 43.9%, 24.6% and 27.9% respectively. Antibiotic resistance was seen significantly among ESBL producing isolates (P <0.0001). Moreover, antibiotic resistance of all ESBL- producing isolates were statistically significant to all tested antibiotic ( p < 0.0001) except impenem. The most frequent identified genes among (ESBL) isolates were CTX-M 73 (75.3%), followed by TEM 49 (50.5%) and SHV 15 (15.5%). It was concluded that Escherichia coli were the most frequent pathogen in Yemen and the major causative agents of female urinary tract infections. Staphylococcus aureus was the most prevalence pathogen among outpatients with low resistance to antibiotics. Klebsiella pneumoniae was the predominant pathogens among inpatients with high resistance to antibiotics. The major source of ESBL-producers was intensive care units and surgical words. All isolates were susceptible to impenem (100%). This study is considered as the first document on the prevalence of ESBLs and their epidemiological distribution in Yemen. More studies are needed to confirm and enrich the data obtained during this research.