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Title: Prevalence and multidrug resistance of Escherichia coli from community acquired infections in Lagos, Nigeria

Author
item ADENIPEKUN, EYITAYO - Olabisi Onabanjo University
item Jackson, Charlene
item RAMADAN, HAZEM - Mansoura University
item IWALOKUN, BAMIDELE A - Olabisi Onabanjo University
item OYEDEJI, KOLAWOLE S - University Of Lagos
item Frye, Jonathan
item Barrett, John
item Hiott, Lari
item Woodley, Tiffanie
item OLUWADUN, AFOLABI - Olabisi Onabanjo University

Submitted to: Journal of Infection
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/10/2016
Publication Date: 9/30/2016
Citation: Adenipekun, E., Jackson, C.R., Ramadan, H., Iwalokun, B., Oyedeji, K., Frye, J.G., Barrett, J.B., Hiott, L.M., Woodley, T.A., Oluwadun, A. 2016. Prevalence and multidrug resistance of Escherichia coli from community acquired infections in Lagos, Nigeria. Journal of Infection. 10(9):920-931.

Interpretive Summary: Escherichia coli, a normal inhabitant of the intestinal tract of mammals, is a common cause of intestinal infections, urinary tract infections, and bacteremia in humans of all ages. Infections caused by E. coli can become more complicated to treat if the bacteria are also resistant to antimicrobials. In this study, prevalence, antimicrobial resistance, and genetic characteristics of multi-drug resistant (MDR) community isolates of E. coli from Lagos, Nigeria were determined. Samples of urine and stool were obtained from out-patients attending Lagos State hospitals and animal handlers in abattoirs, poultry facilities, and open markets from December, 2012 to July, 2013. Approximately 50% of urine samples and 88% of stool samples were positive for E. coli. A subset of those isolates was chosen for further study. E. coli exhibited the highest levels of resistance to tetracycline, trimethoprim/sulfamethoxazole, and ampicillin. Approximately 19% of the isolates were pan-susceptible and none of the isolates were resistant to amikacin or piperacillin/tazobactam. MDR was observed in 69.6% of the isolates with resistance to as few as two and as many as 16 different antimicrobials and up to five different antimicrobial classes. Forty-eight E. coli resistant to at least five antimicrobials were selected for further analysis using Pulsed-field Gel Electrophoresis (PFGE) and Multilocus Sequence Typing. Seven distinct PFGE clusters and 30 different sequence types were detected. Four phylogenetic groups were also identified among those isolates including potentially pathogenic ones belonging to group B2 and D. Results of this study demonstrate the presence of circulating MDR E. coli in the Nigerian community and indicate that monitoring of antimicrobial resistance in developing countries is necessary to optimize empiric treatment and the prudent use of antimicrobials. This information is useful for policy makers and scientists as they develop prevention and control strategies for combatting antimicrobial resistance.

Technical Abstract: Escherichia coli is one of the most frequent causes of bacterial infections among humans. The emergence of multi-drug resistance (MDR; resistance to >2 more antimicrobials) in E. coli is of great concern due to the complications encountered in its treatment in a resource constrained economy. In this study, prevalence, antimicrobial resistance, and genetic characteristics of MDR community isolates of E. coli from Lagos, Nigeria were determined. Samples of urine (n=394) and stool (n=136) were obtained from out-patients attending Lagos State hospitals and animal handlers in abattoirs, poultries, and open markets from December, 2012 to July, 2013. Approximately 50% of urine samples (200/394) and 88% of stool samples (120/136) were positive for E. coli. Based upon '-lactamase production, a subset of those isolates (n=247) were selected for further study. Of the 22 antimicrobials tested using broth microdilution, E. coli exhibited resistance to all antimicrobials except amikacin and piperacillin/tazobactam. The highest levels of resistance were to tetracycline (182/247; 73.7%), trimethoprim/sulfamethoxazole (152/247; 61.5%) and ampicillin (147/247; 59.1%); 19% (47/247) of the isolates were pan-susceptible. MDR was observed in 69.6% (172/247) of the isolates with resistance to as few as two and as many as 16 different antimicrobials and up to five different antimicrobial classes. Forty-eight E. coli resistant to at least five antimicrobials were selected for further analysis using Pulsed-field Gel Electrophoresis; seven distinct clusters were observed among the diverse patterns. Of the 48 MDR E. coli, 30 different sequence types were detected using Multilocus Sequence Typing. Four phylogenetic groups were also identified among those isolates including potentially pathogenic ones belonging to group B2 and D. Results of this study demonstrate the presence of circulating MDR E. coli in the Nigerian community and indicate that monitoring of antimicrobial resistance in developing countries is necessary to optimize empiric treatment and the prudent use of antimicrobials.