ArticleBMC infectious diseases2025
Molecular characterization of extended spectrum beta-lactamase-producing Enterobacterales from urinary tract infections in Burundi.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe production of β-lactamases by the Enterobacterales family is currently the leading cause of antibiotic resistance. Urinary tract infections (UTIs) account for 25% of all infections, and UTIs caused by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) constitute a serious public health concern in children and adult patients. The aim of this study was to describe the antimicrobial susceptibility profiles and molecular characteristics of ESBL-PE isolates from UTIs in Burundi.
methodsA laboratory-based cross-sectional study involving 247 isolates of Enterobacterales was carried out at six selected hospital sites in Burundi. The bacterial isolates, which were collected over a nine-month period, were randomly selected from the biobank of isolated and identified enteric gram-negative bacteria from urine samples from UTI patients. The clinical and demographic characteristics of the UTI patients were extracted from the OpenClinic GA Information System via a structured data collection sheet. The ESBL-PEs were confirmed via a double-disk synergy test and PCR methods. The chi-square test was used to determine the relationship between epidemiological and microbiological variables; as well as the presence of ESBL-PE isolates.
resultsAmong the 247 Enterobacterales isolates, Escherichia coli (72.4%) and Klebsiella pneumoniae (14.5%) predominated. Among the isolates, 28.74% were phenotypically positive for ESBL production. The high percentage of resistant isolates to antibiotics were observed for tetracycline (91.5%), amoxycillin-clavulanic acid (72.6%) and cotrimoxazole (65.6%). There was no resistance to either meropenem or imipenem. The most effective antibiotics were nitrofurantoin (91.1%) and amikacin (71.7%). The majority of the blaCTX-M genes (80.28%) were found in ESBL-PE isolates from UTI patients. The percentages of blaTEM and blaSHV genes were 53.52% and 25.35%, respectively. The blaCTX-M and blaTEM genes were the most prevalent coexisting resistance genes (26.8%), followed by the group of blaCTX-M, blaTEM, and blaSHV genes (18.3%). The blaTEM and blaSHV genes did not coexist in this study.
conclusionThe blaCTX-M gene is predominant in UTIs, which are caused primarily by the ESBL-PE strains acquired in hospital and community settings. Amikacin, nitrofurantoin, imipenem and meropenem could be the drugs of choice for treating ESBL-PE in Burundi. On the basis of these findings, we suggest the development of infection prevention and control interventions, antibiotic stewardship policies and the establishment of routine surveillance of ESBL-PE in Burundi. The transmission dynamics of TEM- and CTX-M-type ESBL-PE need to be further understood in Burundian hospital and community settings.
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