Abstract
Abstract Introduction: Extended-spectrum β-lactamases (ESBLs), AmpC type, carbapenem resistant Enterobacteriaceae (CRE), are important mechanisms of resistance among Enterobacteriaceae. The aim of this study was to investigate the prevalence of ESBL, AmpC and CRE among Enterobacteriaceae isolates recovered from pediatric patients in Tripoli, Libya. Methods: This cross-sectional study was carried out in Tripoli Children Hospital (TCH), a total of 915 Gram negative bacteria isolates were evaluated for susceptibility to a panel of antimicrobials and were analyzed phenotypically for the ESBL, AmpC type and CRE using chromagen media, E-test and combination disc test. Results: The predominant organisms were Escherichia coli (56.8%) and Klebsiella spp. (21.4%). The overall prevalence of ESBL producing Enterobacteriaceae was 24.5% (224/915). Out of 224, Enterobacteriaceae proved ESBL producer, Klebsiella spp. (54%) and E. coli (34.4%) were the leading ESBL producers. ESBL-producers were more often resistant to major classes of antibiotics compared with non-ESBL producers, significantly high resistance rates (P < 0.001) were observed for ceftriaxone, cefepime, and ceftazidime (87.5 - 95.9%) among ESBL producers compared to non-ESBL producers (7.2 - 13.5%). MDR was documented for 50/224 (22.3%) of ESBL producers and was significantly higher (P < 0.0001) among ESBLs compared with non-ESBL producer isolates. Phenotypic detection of AmpC revealed 60/915 (6.6%) isolates as potential AmpC β-lactamase producers, E. coli exhibited a lower level of AmpC (8.3%) compared with Klebsiella spp. (56.6%). The overall prevalence of CRE was 9% (83/915). Carbapenemase-producing organisms in this study were as follows: Klebsiella spp. (44.6%); Acinetobacter spp. (24%); Pseudomonas spp. (9.6%). Conclusion: This study revealed that the prevalence of ESBL, AmpC, CRE and MDR Enterobacteriaceae isolates in Children hospital was within acceptable frequency. arabic 11 English 91