Greener Journal of Medical Sciences

Excellence and Timeliness


Choose Language


Enyinnaya et al

Greener Journal of Medical Sciences

Vol. 11(2), pp. 181-186,  2021

ISSN: 2276-7797

Copyright ©2021, the copyright of this article is retained by the author(s)





Molecular Detection and Antibiotic Susceptibility Profile of ESBL-producing Klebsiella pneumoniae Isolates in a Central Nigerian Tertiary Hospital



Enyinnaya S.O1*, Iregbu K.C2, Uwaezuoke N.S3, Abdullahi N3, Lawson S.D1



1Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, Rivers State University, Port Harcourt, Rivers State, Nigeria.

2Department of Medical Microbiology and Parasitology, National Hospital, Abuja.

3 Department of Medical Microbiology and Parasitology, Federal Medical Centre, Abuja.






Article No.: 110521113

Type: Research

Full Text: HTML;EPUB


Background: Production of extended-spectrum β-lactamases (ESBLs) is the most common mechanism of resistance to third-generation cephalosporins among Enterobacteriaceae including Klebsiella pneumonia and this presents therapeutic challenges managing infections caused by these strains of bacteria.

Aim: To determine the prevalence, antibiotic susceptibility profile and major ESBL encoding genes among Klebsiella pneumoniae in clinical specimens.

Methods: Four hundred (400) consecutive and non-duplicate isolates of Klebsiella pneumoniae from clinical specimens were identified by standard laboratory methods at the National Hospital Abuja, subjected to antimicrobial susceptibility testing using the Kirby-Bauer disc diffusion method and identified ESBL phenotypes were confirmed using E-test. Multiplex PCR was used to detect ESBL genes.

Results: Out of the 400 Klebsiella pneumoniae isolates, 114 (28.5%) were ESBL producers, out of which 111 (97.4%)  were sensitive to meropenem, 101 (88.6%) to amikacin, 100 (87.7%) to fosfomycin, 96 (84.2%) to tigecycline, and 58 (50.9%) to nitofurantoin.  All the ESBL producers were resistant to cefotaxime while 107 (93.9%)  and 105 (92.1%) were resistant to amoxicillin-clavulanate, and ceftazidime respectively . There was a significantly higher distribution of multidrug resistance among ESBL producing isolates compared to non-ESBL producing isolates (chi-square =63.29, p-value = 0.0001). The distribution showed that 78 (70.3%) had the blaSHV gene, 99 (89.2%) had the blaCTX-M gene, 88 (79.3%) had the blaTEM gene and 3 (2.6%) had none of the major bla genes.

Conclusion: This study showed a relatively high prevalence of ESBL-producing Klebsiella pneumoniae isolates and a significant occurrence of multidrug-resistant Klebsiella pnuemoniae. Meropenem and amikacin are excellent therapeutic choices for empirical therapy of ESBL-producing Klebsiella pneumoniae infections and their use should be properly guarded through efficient infection control and antimicrobial stewardship..


Accepted:  05/11/2021

Published: 15/11/2021


*Corresponding Author

Enyinnaya, SO




Klebsiella pnuemoniae; ESBL; Multiplex-PCR; Antibiotic Resistance.




Return to Content       View  [Full Article - PDF]  

[Full Article - HTML]             [Full Article - EPUB]




1.       Keynan Y, Rubinstein E. The changing face of Klebsiella pneumoniae infections in the community. International Journal of Antimicrobial Agents. 2007;30(5):385-389. dol: 10.1016/j.ijantimicag. 2007.06.019

2.       Kiratisin P, Apisarnthanarak A, Laesripa C, Saifon P. Molecular characterization and epidemiology of extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates causing health care-associated infection in Thailand, where the CTX-M family is endemic. Antimicrob Agents Chemother. 2008;52(8):2818-24. doi: 10.1128/AAC.00171-08.

3.       Bush K, Jacoby GA. Updated Functional Classification of β-Lactamases . Antimicrob Agents Chemother . American Society for Microbiology (ASM); 2010;54(3):969–76. doi: 10.1128/AAC.01009-09

4.       Philippon A, Labia R, Jacoby G. Extended-spectrum beta-lactamases Antimicrob Agents Chemother. 1989 Aug; 33(8):1131-6

5.       Agrawal P, Ghosh AN, Kumar S, Basu B, Kapila K. Prevalence of extended-spectrum beta-lactamases among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital. Indian J Pathol Microbiol [Internet]. 2008;51(1):139–42. doi: 10.4103/0377-4929.40428

6.       Pitout JDD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis . Elsevier; 2008;8(3):159–66.doi: 10.1016/S1473-3099(08)70041-0

7.       Falagas ME, Karageorgopoulos DE. Extended-spectrum beta-lactamase-producing organisms. J Hosp Infect. 2009;73(4):345–54.doi: 10.1016/j.jhin.2009.02.021

8.       Rogers B.A., Sidjabat H.E., Paterson D.L. Escherichia coli O25b-ST131: A pandemic, multiresistant, community-associated strain. J. Antimicrob. Chemother. 2011;66:1–14. doi: 10.1093/jac/dkq415

9.       Ndir, A., Diop, A., Ka, R. et al. Infections caused by extended-spectrum beta-lactamases    producing Enterobacteriaceae: clinical and economic impact in patients hospitalized in 2 teaching hospitals in Dakar, Senegal. Antimicrob Resist Infect Control 5, 13 (2016). doi:10.1186/s13756-016-0114-7

10.    Elihani D, Bakir L, Aouni M, Passet V, Arlet G, Brisse S, Weill FX:Molecular epidemiology of extended–spectrum beta-lactamase-producing Klebsiella pneumoniae strains in a university hospital in Tunis, Tunisia, 1999–2005. Clin Microbiol Infect. 2010, 16 (2): 157-164. 10.1111/j.1469-0691.2009.03057.x.

11.     Shashwati N, Kiran T, Dhanvijay AG. Study of extended spectrum β-lactamase producing Enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital. J Nat Sci Biol Med. 2014;5(1):30-35. doi:10.4103/0976-9668.127280

12.    Biswas T, Das M, Mondal R, Raj HJ, Mondal S. Prevalence of ESBL producing Escherichia Coli and Klebsiella species with their co-resistance pattern to antimicrobials. Mymensingh Medical Journal : MMJ. 2013 ;22(2):377-384. PMID: 23715365

13.    Rudresh SM, Nagarathnamma T. Extended spectrum β-lactamase producing Enterobacteriaceae & antibiotic co-resistance. Indian J Med Res. 2011;133(1):116-118.

14.    Storberg V. ESBL-producing Enterobacteriaceae in Africa - a non-systematic literature review of research published 2008-2012. Infect Ecol Epidemiol. 2014;4(1). doi:10.3402/iee.v4.20342

15.    Workneh M, Katz MJ, Lamorde M, Cosgrove SE, Manabe YC. Antimicrobial Resistance of Sterile Site Infections in Sub-Saharan Africa: A Systematic Review. Open Forum Infect Dis. 2017;4(4). doi:10.1093/ofid/ofx209

16.    Abbot SL. Klebsiella, Enterobacter, Citrobacter, Serratia, Plesiomonas, and other Enterobacteriaceae. In: Murray PR, Baron EJ, Jorgensen, Pfaller MA, Yolken RH (eds). Manual of Clinical Microbiology 8th edition. Vol. I. ASM Press, Washington DC, USA; 2003: 685-700

17.    Winn W Jr, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P et al. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology, 6th edition, 2006:211-302

18.    Washington W.J, Stephen A, William J, Elmer K, Gary P PSG. Disc Diffusion Susceptibility Testing. In:  Koneman’s Color Atlas and Textbook of Diagnostic Microbiolog6th Ed Philadelphia: Lippincott Willam and Wilkins. 2006. p. 983–9.

19.    Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Sixteenth Informational Supplement M100, 30thed. (2020) Wayne, Pa, USA: CLSI. 2020. p. 32-41,104-106.

20.    Diagnostics L. MIC Test strip Technical sheet ESBL- MTS26 - Rev.2.1 / 07.11.2014

21.    Trung NT, Hien TTT, Huyen TTT, et al. Simple multiplex PCR assays to detect common pathogens and associated genes encoding for acquired extended spectrum betalactamases (ESBL) or carbapenemases from surgical site specimens in Vietnam. Ann Clin Microbiol Antimicrob. 2015;14(1). doi:10.1186/s12941-015-0079-z

22.    Mohammed Y, Gadzama GB, Zailani SB, Aboderin AO. Characterization of Extended-Spectrum Beta-lactamase from Escherichia coli and Klebsiella Species from North Eastern Nigeria. J Clin Diagn Res. 2016;10(2):DC07-DC10. doi:10.7860/JCDR/2016/16330.7254

23.    Raji MA,  Jamal W, Ojemeh O, Rotimi VO. Sequence analysis of genes mediating extended-spectrum beta-lactamase (ESBL) production in isolates of Enterobacteriaceae in a Lagos Teaching Hospital, Nigeria. BMC Infect Dis. 2015;15(259):doi:10.1186/s12879–015 – 1005 – x.

24.    Ibukun Aibinu, Tolu Odugbemi BJM. Extended-Spectrum ß-Lactamases in isolates of Klebsiella spp and Escherichia coli from Lagos, Nigeria. Nig J Heal Biomed Sci. 2003;2(2):53–60.

25.    Emmanuel O.N,Nasiru S.M, Jamila T. Antibiotic susceptibility pattern of extended spectrum betalactamase (ESBL) producers and other bacterial pathogens in Kano, Nigeria. Tropical Journal of Pharmaceutical Research. 2015;14(7) 1273–8. Available from:

26.    Makanjuola O.B, Fayemiwo S.A, Okesola A.O, Gbaja A, Ogunleye V.A,Kehinde A.O, Bakare R.A. Pattern of multidrug resistant bacteria associated with intensive care unit infections  in Ibadan Nigeria. Annals of Ibadan postgraduate Medicine.2018;16(2)162-169.

27.    Iregbu KC, Anwaal U. Extended spectrum Beta-Lactamase-producing Klebsiella pneumoniae septicaemia outbreak in the Neonatal Intensive Care Unit of a tertiary hospital in Nigeria. Afr J Med Med Sci. 2007;36(3):225–8.

28.    Siddiqi  a, Khan D a, Khan F a, Razzaq  a. Therapeutic drug monitoring of amikacin in preterm and term infants. Singapore Med J. 2009;50(5):486-489.

29.    Doan TL, Fung HB, Mehta D, Riska PF. Tigecycline: A glycylcycline antimicrobial agent. Clin Ther. 2006;28(8):1079-1106. doi:10.1016/j.clinthera.2006.08.011

30.    Boyd D a., Tyler S, Christianson S, et al. Complete nucleotide sequence of a 92-kilobase plasmid harboring the CTX-M-15 extended-spectrum beta-lactamase involved in an outbreak in long-term-care facilities in Toronto, Canada. Antimicrob Agents Chemother. 2004;48(10):3758-3764. doi:10.1128/AAC.48.10.3758-3764.2004

31.    Livermore DM, Canton R, Gniadkowski M, et al. CTX-M: Changing the face of ESBLs in Europe. J Antimicrob Chemother. 2007;59(2):165-174. doi:10.1093/jac/dkl48

32.    Al Hashem G, Al Sweih N, Jamal W, Rotimi VO. Sequence analysis of bla(CTX-M) genes carried by clinically significant Escherichia coli isolates in Kuwait hospitals. Med Princ Pr. 2011;20(3):213-219. doi:10.1159/000321242

33.    Hawkey PM. Prevalence and clonality of extended-spectrum ??-lactamases in Asia. Clin Microbiol Infect. 2008;14(SUPPL. 1):159-165. doi:10.1111/j.1469-0691.2007.01855.x

34.    Mshana SE, Hain T, Domann E, Lyamuya EF, Chakraborty T, Imirzalioglu C. Predominance of Klebsiella pneumoniae ST14 carrying CTX-M-15 causing neonatal sepsis in Tanzania. BMC Infect Dis. 2013;13:466. doi:10.1186/1471-2334-13-466

35.    Iroha IR, Esimone CO, Neumann S, et al. First description of Escherichia coli producing CTX-M-15- extended spectrum beta lactamase (ESBL) in out-patients from south eastern Nigeria. Ann Clin Microbiol Antimicrob. 2012;11:19. doi:10.1186/1476-0711-11-19

36.    Aibinu I, Odugbemi T, Koenig W, Ghebremedhin B. Sequence Type ST131 and ST10 Complex (ST617) predominant among CTX-M-15-producing Escherichia coli isolates from Nigeria. Clin Microbiol Infect. 2012;18(3):E49-E51. doi:10.1111/j.1469-0691.2011.03730.x

37.    Rawat D, Nair D. Extended-spectrum β-lactamases in Gram Negative Bacteria. J Glob Infect Dis. 2010;2(3):263-274. doi:10.4103/0974-777X.68531




Cite this Article: Enyinnaya SO; Iregbu KC; Uwaezuoke, NS; Abdullahi, N; Lawson, SD (2021). Molecular Detection and Antibiotic Susceptibility Profile of ESBL-producing Klebsiella pneumoniae Isolates in a Central Nigerian Tertiary Hospital. Greener Journal of Medical Sciences, 11(2): 181-186.



Call for Papers

Call for Scholarly Articles

Authors from around the world are invited to send scholary articles that suits the scope of this journal. The journal is currently open to submissions and will process and publish articles monthly in two yearly issues.

The journal is centered on quality and goes about its processes in a very timely fashion. Seasoned editors/reviewers will be consulted to review each article(s), profer quality evaluations and polish the articles with expertise before publication.

Simply send your article(s) as an e-mail attachment to or



Login Form

Other Journals