Occurrence and Anti-Microbial Susceptibility Pattern of Extended Spectrum Beta‑Lactamase Producing Enterobacteriaceae in Governmental Hospitals Wastewater in Addis Ababa, Ethiopia

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Abstract Background Worldwide, come out and dissemination of Extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae had been warning the efficacy of antibiotics to treat an infection. Hospital Wastewater might be a reservoir of such kind of resistant bacteria. The aim of this study was to get information about the occurrence of ESBLs producing and antibiotic susceptibility pattern of Enterobacteriaceae in hospital wastewater release from five governmental hospitals in Addis Ababa, Ethiopia. Methods A cross-sectional study was carried out from April 1 to May 31, 2020. Using a “Grab sampling technique” a total of 100 discrete wastewater samples were collected from each ward/unit wastewater collecting manholes of five governmental hospitals. For isolation and characterization of Enterobacteriaceae a loopful of a well-mixed sample was streaked on to MacConkey agar. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on Muller Hinton agar (MHA). All Enterobacteriaceae isolates were screened using cefotaxime and ceftazidime for ESBLs production as per CLSI guideline. The ESBLs suspicious were confirmed by a combination disk test (CDT). Data were entered and analyzed by using SPSS version-20. Result Of all Enterobacteriaceae the potential and confirmed ESBLs producer were 55.1% (81/147) and 48.3 % (71/147) respectively. The highest ratio of ESBLs- producer Enterobacteriaceae within sampling unit was observed in adult ward (66.7%) and laundry unit effluent (58.8%); in addition, the highest ESBL production was detected from E. coli (21.8%), K. pneumoniae (4.8%) and Citobacter spp. (4.8%). The most elevated resistance level of ESBL producer was observed to cefotaxime (95.8%) and amoxacilline/clavunalate (93%). Furthermore, ESBL producing Enterobacteriaceae showed higher co-resistance rates to ciprofloxacine (74.6%) and cotrimoxazole (73.2%). The overall magnitude of MDR isolates were observed in 64% (94/147) of tested Enterobacteriaceae. Conclusion In our study MDR and ESBLs producing Enterobacteriaceae was higher in hospital effluents. This indicates a potential risk of disseminating these resistance bacteria and resistant genes to the community if the hospital wastewater discharged without getting appropriate treatment.

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